Learning how to BOLUS for pizza with an expert? Priceless

by Elizabeth Snouffer on 12/01/2011

Who can resist?

Gary Scheiner, Diabetes Coach, Certified Diabetes Educator (CDE) and Exercise Physiologist has a special tutorial designed so people can learn how to manage diabetes while eating any type of pizza.  Pizza?  I tuned in very quickly.  In his 10 minute video, Gary explains why pizza is such a difficult food to eat with diabetes, why spikes occur hours and even the next day after the meal and what people on insulin can do about it.  He offers his free tutorial on a website called Type 1 University which features a series of online courses designed to provide “higher education” to people using intensive insulin therapy (pumps or multiple daily injections).  Classes include topics ranging from how to better manage hypoglycemia to the “weight gain side-effects of high blood sugar.”

Coaching patients to learn how to better manage their diabetes through intensive insulin therapy sounded like something even I could use – but during our interview he so had me at the word PIZZA that I decided he really did understand what it was like living with the disease.  When I read about Gary Scheiner’s coaching practice in the LA Times earlier this month, I was intrigued.  Today, I wanted to know more.  Why so much insight? Clearly he was no ordinary diabetes coach.

Gary in New York

I soon understood. Gary was diagnosed with type 1 diabetes 25 years ago.  He understands exactly what a blood sugar of 49 mg/dl or 300 mg/dl feels like, and this makes him approach diabetes patient care in a totally different way.  There was something else too.  Gary has been working on intensive insulin therapy for many years.   His best-selling book, “How to Think Like a Pancreas” was one I read voraciously seven years ago.  Now an updated version is coming out in two weeks.  It’s easy to see that Gary gets at the heart of diabetes.  What’s more, he’s funny.

“If I am presenting at a conference, I always start by telling the audience I was diagnosed at the age of 18 in a place called Sugarland, Texas.  That tends to grab everyone’s attention pretty quickly.”

The name of Gary’s practice is Integrated Diabetes Worldwide, and this is where he and three other CDE’s, all of whom have a direct personal link to diabetes, work with thousands of patients all over the world.  While most of his patients are residents of the U.S., “We get pockets of people who join our practice internationally and that’s based on where I have been on my professional travels.”  Gary works with patients who live in Japan, the United Kingdom and Australia – places far from his office on the East coast of the United States in Pennsylvania.

Approximately 80% of Gary’s patients are utilizing insulin pump therapy.  One third of Gary’s patients are children, while the other two-thirds are mostly type 1 adults and a small percentage of type 2 patients.  There is a reason for this.  Interestingly Gary points out that today more than half of all people diagnosed with type 1 diabetes are over the age of 18.  After the initial consultation, Gary does most all of his coaching online by reviewing weekly data, then discussing trends or obstacles directly.

“It’s amazing what can be achieved today with digital technology. We have Skype, texting and email, but more than that is how easy it is to download all relevant patient data from pumps or meters.”  The Continuous Glucose Monitor has also played a huge role in making better sense of a patient’s blood sugar levels and maximizing intricate details surrounding dosing and eating behaviors.  Of course, the telephone is used too, but most significantly is helping people realize how to get the most out of all the new technology, something he finds pretty atypical.

“In the world of diabetes today, we have patients who might be wearing a $6000 machine, but are unaware of all the functions or benefits that device offers.”  Gary tries to fix that, and usually he finds the difficulties are in the details.

The reasons why a patient might contact the practice?   While delaying or keeping complications at bay exist as overarching rationales for better care, patient reasons tend to be related more to ‘quality of life’ issues.  Top five motivators are:

1.  Weight Control

2. Sports performance

3.  Academic or career performance

4. Avoiding chronic colds or infections

5.  Improving social skills and overall moods.

Gary points out how there is one pervasive over-riding factor that leads patients to his practice: diabetes burn-out.  “Patients usually come to us and need to do something new or different that will help them achieve more.”  While some patients are self-motivated to do better, Gary’s team works hard to give additional encouragement by offering new strategies for better results.  One caveat exists in getting someone unstuck in a diabetes rut.

The updated version

“We like set appropriate expectations and go slowly.  We like to see ourselves as collaborators.  If someone comes to me with sugars averaging around 200, we won’t tell them we want them to get to 120 mg/dl immediately.  Instead we ask them to take smaller steps that will get them to success faster, for example, we might say, ‘Let’s try and get 70% of all your pre-meal blood sugars between 160-180 mg/dl, and then we build on that. “

Lack of quality healthcare is the number one reason Gary’s practice fills a void.  Gary believes that if people feel that their doctor is not working with them or they don’t feel they are getting the best care – it is usually a signal that change is needed.  “Doctors aren’t teaching patients how to use the devices or understanding how to fine-tune their doses.  Most medical professionals aren’t inspiring patients to do better so how can they expect a patient to improve or change?”

Gary will correspond with doctors if requested by a patient, but he finds that most patients don’t ask.  “Often patients are worried they might upset their doctor.  Usually I am in the position of referring patients unhappy with their current healthcare professional to someone with a better track record.”

For more information:

Integrated Diabetes Services
333 E. Lancaster Ave.
Wynnewood, PA 19096
Email: info@integrateddiabetes.com
Toll-free number (877-735-3648).
General e-mail box:  info@integrateddiabetes.com, or to ask Gary something specifically, you can send him an email:  gary@integrateddiabetes.com

Type 1 University

Live and pre-recorded class options.

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