What Does "Diabetic Friendly" Really Look Like?

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Wellness businesses have a great opportunity to capitalize on the growing market of people with diabetes — IF they understand what customers with diabetes want. It’s not just education, low carb diet plans, and weight loss tips.

I’m a Type 1 diabetic and I’m also training for a half Ironman. My coach for the open-water swim was a guy named Bryan who’s training to swim the English Channel later this year.

Bryan’s coaching business doesn’t specialize in diabetic triathletes  — yet it’s definitely diabetic-friendly. Here’s how every wellness business can ensure it’s diabetic-friendly:

1. Understand it’s not a lifestyle choice

Sure, a lot of folks with diabetes are overweight. So is most of America, but they’re not all diabetic.

Clearly something’s missing. It’s beyond question that what we eat affects our health, and more specifically, our weight. But being overweight, while it’s a risk factor for Type 2 diabetes doesn’t make them diabetic, any more than working for the highway department makes you road kill. And weight isn’t even a risk factor for Type 1 diabetes — that’s an autoimmune disorder.

The American Diabetes Association’s Tour de Cure annually attracts thousands of “Red Rider” diabetic cyclists who cover distances up to 100 miles a day. These are folks with both types of diabetes who train all year, fuel like serious athletes, in some cases can top 40 mph on a bicycle on a flat stretch of road, and maintain speeds upwards of 20 mph literally for as much as five to six hours.

What works: don’t assume your diabetic clients are lazy, undisciplined, or inactive. Ask them what they’re doing and how it’s working. Then respond accordingly.

2. Understand the role of carbs in diabetes

OK, so this one doesn’t have anything to do with my swim coach. But it’s absolutely essential if you’re in the business of diet, nutrition, sports conditioning or personal training and work with folks with diabetes.

There’s a myth going around that “diabetic friendly” foods are those extremely low in carbs and higher in dietary fats and protein. Avoiding carbs is actually dangerous for seriously active type 1 diabetics. Without them, exercise can cause dangerous drops in blood sugar. And Type 2s can also be at risk, depending on the specifics of their Type 2 diagnosis and their medication.

Folks with diabetes have to plan for every carb they take in. That means they have to count every carb they take in. This challenge is a constant struggle for folks with diabetes who are active or want to be. And fairly common co-morbidities like gastroparesis, and various bariatric surgical interventions, can complicate the carb/exercise picture even more.

Clients see you as an expert, and many will blindly try to follow your advice — say, “avoid all white foods, especially sugar” — even when it’s actually bad advice for them under some conditions.

So remember: when you dole out diet, exercise, and nutrition advice, many clients with diabetes are literally trusting you with their lives. The stakes are high.

3. Tailor the help to the client

One patient might want to get his A1C below 9, no matter what it takes. Another may want help losing weight safely without experiencing low blood sugars. Someone else may want to know what to eat every day to keep his blood sugars level. And yet another may want help with fueling tips for diabetic marathoners.

The advice for these clients will seldom be the same in every case.

One thing I really liked about my swim coach Bryan was that we talked about diabetes up front, and after that he quickly started checking in between swim drills to make sure I was doing OK sugar-wise. That simple.

4. Check your “ick factor” at the door

Nobody likes to see blood or syringes. That includes folks who have to test their blood sugar and get shots. But saying “Euw, I could never do that” or asking folks to test or inject themselves in the bathroom is a bit like asking them to sit in the back of the bus.

Good news: you’re not obliged to look. Or as a friend of mine says, “I’ll get my shot in the bathroom if you’ll eat by the dumpster.” A little empathy goes a long way.

5. Ask all the questions you want…

UNLESS of course that person has a low blood sugar, is testing their blood sugar, or taking meds or drawing insulin. Those are simply bad times to be distracted.

In general, folks with diabetes actually appreciate curiosity; it’s the first stage of acceptance, and one of the reasons I recommended Bryan to my friends. I’ve literally made over a dozen referrals to him, just because he was curious.

6. …unless you don’t want to hear the answers

For people with diabetes, the disease is horrendous and life-altering. They worry about the fact that it’s a 24/7 thing, that they could pass out and even die from a low, that they could end up in the hospital with high sugars, that they’ll be judged as lazy or unmotivated, that they’ll lose their eyesight or develop other complications over the long haul. For many it feels like a biochemical and psychological tornado with no escape.

They’ve got a lot on their mind, and it’s nice that someone wants to know. Just remember, you asked.

7. Hold your unasked-for advice

This doesn’t mean you should just shut up. But it does mean you should listen before you talk.

Bryan was very good at listening. Sometimes we talked about swimming and diabetes more than I actually swam.

Even if you’ve got clinical credentials it doesn’t mean that you understand what it’s like to live with a chronic disease. You probably have no idea just how hard someone is trying to follow instructions. You probably don’t know how many times they’ve heard advice like yours — and you probably don’t actually understand why that advice didn’t work. You just think you do.

The fact is, until and unless you get to know your specific client or patient, you don’t know a thing about her.

Once you’ve listened thoroughly to their story and heard their questions, then the conversation with patients can begin on your end. Otherwise you’re just talking at them.

8. Provide a physically supportive environment

Sharps containers are a nice touch so clients can dispose of used lancets, test strips, syringes and other biohazards. Privacy for weigh-ins and other biometric measurements. It’s especially nice if you have them, and it’s a sign that you’re looking out for your special-needs members.

A ready supply of fast-acting sugar to treat low blood sugars is also great. One thing, though, that’s important to understand is that people experiencing a low blood sugar episode have impaired thinking (the brain is being starved of glucose), so don’t expect them to pay for the food until their blood sugar has returned to normal. Get to know them, and if you see that Diabetic Dan is going straight for the orange juice, opening the bottle and drinking it, don’t call the cops on him for shoplifting. I actually ran into exactly such as situation with a diabetic man at a convenience store. I offered to test his blood sugar with my own glucose meter and he was indeed dangerously low. I paid for his food and asked everyone to just calm down and let his blood sugar return to normal.

Since it was a convenience store, I cut them some slack.

But if you’re my regular gym, how about relaxing that policy of outside food being brought in? Then we don’t have to “go there” about whether I’m shoplifting orange juice from the health bar.

The truth is, federal law may require you to relax it anyway. I recently learned of a friend’s none-year-old type 1 daughter being told by a local gym that she couldn’t use a juice box to treat a low blood sugar. They dug in their heels on the food policy rather than changing it. Consider that not providing reasonable accommodation for a disability (yes, type 1 diabetes is a disability) is a violation of the Americans with Disabilities Act, which makes it a federal crime with a minimum first-time fine of $75,000 and fines for subsequent violations that start at $150,000. You may be personally responsible, too. Are you really willing to literally bet your house on your “no outside food “policy?

We have other concerns, too, like safety for insulin pumps and security for diabetic supplies. I’ve met people whose gyms managed to somehow “lose” an important piece of lifesaving medical equipment. I understand your lockers are not guaranteed to be secure, but be creative. That starts with focusing on the special needs of certain customers and making sure you’re helping them feel safe and welcome. Take their concerns seriously and ask how you can help.

One of the things Bryan, my swim coach, noticed was that I always wanted to keep my (non-waterproof) insulin pump and testing equipment in sight, even at the pool.  We talked about different kinds of watertight containers, just in case they got splashed on or dumped into the pool. Which of course did eventually happen.

Be like Bryan, not like my friend’s local gym.

9. …and a shoulder to lean on

High and low blood sugars can make it impossible to think, impossible to do anything comfortably or sensibly. Sometimes that means having someone around who recognizes the signs of low blood sugar and offering the person with diabetes something with sugar in it. Sometimes it’s recognizing the signs of a high blood sugar. Train your team accordingly, and coach them on effective ways to support clients in these situations.

And sometimes it’s just watching out for your customers because you care about them….something that most folks in health and wellness already know how to do!