As a CDCES (Certified Diabetes Care and Education Specialist) aka Diabetes Educator, I want to know - directly from those with t1d - how we can be better educators!
Wow, that question is an attention getter! Off the top of my head:
- When looking at a CGM/Pump report and seeing something you want to address start with “Can you tell me what was going on here?” Assumptions are the second number one cause of not listening to a healthcare provider. Also, I was probably at Disneyland that day.
- Language and language supports are very important and the whole office team. Try reading a research paper that’s using mmol/L, that’s what it is like for someone who doesn’t know diabetes vocabulary. Scaffolding the Academic Success of Adolescent English Language Learners: A Pedagogy of Promise Don’t take “ELL” and “Adolescent” in the title literally, whats in here can help you help even a native english speaker like me learn.
- If device settings changes are necessary have the patient make the changes and include the before and after values in the paperwork the patient walks away from the appointment with. This makes sure that the patient understands the changes, agrees to the changes and understands how to use the dohicky that is keeping them alive.
hi @Shannybanany18 welcome to Breakthrough T1d. You know.. I’ll tell a little bit of my story: I had had diabetes for 20+ years before I started taking care of myself (that is another story) The kind doctor I went to see was a friend of a friend of my brother. The success of that meeting was because I felt comfortable with this person and they did not address or want an explanation of what led up to the appointment. He seemed glad I was there that day . He started me on a new set of instructions for MDI, and asked if I wanted to see a “Diabetes Educator”. At that moment in time, I was determined to make all of the positive changes I could in my life and so I agreed. The meeting with the doctor was absolutely great, but as I left there I was shaking and it took me a full day to recover from the panic attacks I had during the appointment and afterwards.
So the day of my educator appointment came and I went to the office. I recalled how 20+ years ago a person explained that “this is how we eat and it is very important to do the same things every day at the same times”. I also has an idea of “carbohydrate exchanges” and was given a 1 protein, 2 carb, 1 vegetable meal exchange plan complete with 2x 1 carb snacks. I figured out carb counting and insulin ratios by myself. I abandoned counting proteins alltogether. That initial meeting left me sacred and having to make big changes to my life to fit diabetes.
The educator was a super friendly person who listened to me. I told her this was not the beginning of my diabetes journey and what I had been doing. She was not judgmental at all. She showed me some pump stuff but I was not ready (pumps, by the way were awful then) so she moved on. We talked about the basics and then I asked - “look, I work hard, play hard, and I occasionally drink beer and eat salami, I am not interested in bending my life around diabetes, tell me how to do a plan that works for my life”… and she did. It grew my trust as well as improved my overnight blood sugars. It was the beginning of going from not knowing my a1c to controlling it to the low 6’s for decades.
I dont have a list or a formula. I suppose there will be patients that want you to do it for them, and those that want to do it by themselves. There will be those confounded by “there’s sugar in bread?” and there will be others who have an understanding. There will be confident and courageous people, and there will be panic stricken people who are in shock and may still not have come to terms with the trauma of their diagnosis, or even believe that THIS is happening. All I can tell you is that for me, my educator matched their style to my state of mind and it was great. Good luck to you! 
1 Like
I just got done with a diabetes educator appointment and since I’m kinda starting over on a pump since all my Omnipods were recalled there wasn’t any good data to look at so we had some extra time. I told her about your question and asked if she had tips to pass along. The look on her face said she could talk all day about things not in the materials. She said (paraphrased) people are complicated and messy and you have to get to know them in order to know how to provide information that will help them.
I agree.
This experience was not with a Diabetes Nurse Educator (as I’ve been accustomed to calling them) but maybe it will transfer: I had an appointment with a cardiologist the other day but they messed up the schedule so they said I could see their PA instead. Heart check was just fine and as she was going through my records she saw my last a1c was 6.5 and proclaimed it a little high. I told her it was an improvement (0.7 points​
) over the previous one, which is where my numbers typically land.
Lately I’ve been reading about lots of people whose a1c is under 6 - that may be desirable and fine for some but even with a closed loop, aiming for <6 can be challenging, burdensome and maybe even dangerous for others. Taking time to learn about lifestyle, “pump style” and other factors before making a judgment as to quality and goals could inform those recommendations - a person who lives alone and is at risk of falling may want to keep their numbers and a1c a little higher than an active person who lives in community, for instance.