August 2, 2012

Occupations That Can Assist People with Diabetes

For this blog, I will start with the people that may have the least training. This is not to say that many do not have college degrees or have not learned from experience or the college of hard knocks. Some will do excellent work and be able to translate information into understandable meaning for people new to diabetes or people still learning about diabetes. Most will not be afraid to tell patients that now is the time to learn when they hear someone say, “It could not have been important as my doctor did not mention this,” or “I did not hear anything about this.”

Yes, many doctors do not cover everything because of time constraints. This is where peer-to-peer workers and peer mentors will become a valuable asset in working with other diabetes patients. They can use experiences to excellent advantage and gently challenge other patients to learn.

Peer-to-peer workers will generally be working on a one on one basis and will report to a doctor at some point. Some patients will do better in a peer-to-peer setting and this should be taken full advantage of, as education is so important. The informal setting is often more relaxing and makes the giving and receiving of information easier. If the person giving the information is given proper training, she/he can become a powerful tool in getting information to other patients.

Peer mentors may or may not work with groups of people. They can work in either an informal setting or a formal setting. When working in a group setting, they need to be open to taking the discussion in a direction that will teach the most people. Having just had my first session as a volunteer peer mentor by video conferencing (telemedicine if you will permit), there are many areas to be concerned about. With no formal training or certification to point to, a peer mentor must not make medical recommendations about medications or when to take medications. This is the function of doctors and other medically qualified individuals. This does not mean that you are prohibited from talking about different medications as long as you make comparisons and discuss all sides of any issues. There are areas where you have experiences that you may share, and many subjects that may be presented for discussion.

If you are working with patients of a particular doctor(s) like I am, you must set the ground rules before hand to not conflict with a doctor's instructions. I am fortunate that wife of this husband-wife team earned a degree in nutrition before her medical degree, so I don't need to answer most nutrition questions. I have been given permission to discuss pros and cons of different diets, suggesting what works best for one individual may not be the best for another, and then passing them to her for further discussion. Since I am a blogger, the two doctors knew my position on many issues and only asked me to tone down my position on a few issues. Because they have no certified diabetes educators that will work with them, they were looking for other means to cover many areas. We had discussed many issues in the weeks leading up to the shared medical appointment (SMA) and they had one SMA before this where they discussed doing this, but this still did not prevent a couple of the questions.

They knew areas where I could be aggressive in nature and that I normally would not tell readers to use a particular medication. We had a long discussion about the many times I would suggest to patients that they may need to consider finding another doctor. They explained their position on many of these issues and were surprised when I stated that their position was what I was looking for and expressed agreement. The wife did ask that I not get too expressive about some areas of nutrition, but that I was welcome to encourage people to find their own level for carbohydrates, protein, and fat. She felt this could be an area of concern for many patients as they only had one person on a low carb diet. She as a dietitian was not concerned about fat levels other than avoiding anything over 60%. She would prefer people stayed under 50%, but would allow people to experiment. She also stated she would prefer working with people at their dietary preference and if needed encourage them to eat certain foods the help balance their nutrients. This did not come up in the first session, but they will be doing more testing to determine certain deficiencies and suggesting supplements for those who cannot or will not eat certain foods. They both said my blogs had alerted them to the vitamin B12 deficiency for patients who had been on metformin for extended periods and they had one patient with a deficiency.

Nutritionists need to step forward and be recognized. I am talking about those that have a four-year degree or an advanced degree in nutrition. The field of diabetes is in need of people that are more concerned with the nutritional value of food consumed by people with diabetes that how many carbohydrates are in each meal. Nutrition for people with diabetes is not a one-size-fits-all proposition and we need guidance on an individual basis. We have had enough of the mandates, mantras, and dogma. This may work for some, but not the many.

One group that I have also had conflicts with is people that call themselves diabetes coaches. These people seldom have diabetes and come from a variety of professional pursuits. Of the four I have dealt with, all have come from the nursing profession. I know a few that have a dietitian background, and another that was a certified diabetes educator. I am not saying that there are not possibly good diabetes coaches, but I personally disagree with many of their positions and visions of how people with diabetes must eat, live, and sleep. I have only seen one that recognized the value of exercise. Most diabetes coaches promote the same mantras, mandates, and dogma as certified diabetes educators and dietitians that are members of the Academy of Nutrition and Dietetics (AND). This means whole grains and low fat and no compromises. Disagree with them or question them, and they will not keep you as a customer or client. Unfortunately, my experience has been – it is their way, or the highway. Considering the following paragraph, I may have had experiences with the bad apples in diabetes coaching.

On July 30, 2012, Allison B has an excellent blog on the Diabetes Coaches. This presented in a different light than I have encountered. Apparently, this category has some people that know what they are doing and can be an excellent addition to your healthcare team. They have an international  professional organization and do work across many chronic illnesses and diseases. Some of these coaches do have diabetes and speaks well for what they are accomplishing. Take time to read the blog as this may help you decide that this is a group you need. Many use the telemedicine type of communication, which means that can be successful to wide geographical locations.

Until the lawsuit is settled and there will be more, I will attempt to leave the registered dietitians and AND out of discussions. If there is more news that surfaces about them, yes, I will write about it.

Like any profession, the certified diabetes educators (CDEs) have their bad apples. Their numbers are not keeping pace with the need and increase of people diagnosed with diabetes. It would be interesting to know what the actual numbers of CDEs are and whether they are in practice as CDEs, whether they work full-time or only part-time, or whether they are writing books and doing speaking tours, and not actually serving patients.

If these people would do the education that their title says, we might not have the epidemic we are facing today. Lack of diabetes education is just that, little is actually being taught.

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