Diabetes coaching company, Fit4D, helps inspire both existing athletes and everyday people with diabetes (PWD) through personalized nutrition, fitness, and wellness programming.  
 
By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net
 
David Weingard (pictured, lower right) was just a few weeks away from participating in a survival race which consisted of running, cycling, and swimming when one day he woke up and was extremely exhausted and could not shake the feeling. He decided to go see his doctor and struggled to walk the three blocks to his physician’s office. This was highly unusual for an endurance athlete who was used to training for numerous hours a day. At his doctor’s, Weingard was told he had type 1 diabetes.
 
Weingard, like most people when told the news, was in disbelief, and he quickly wanted to know how this would affect his exercise routines and the athletic events he wanted to compete in.

Anyone diagnosed with diabetes quickly understands that performing physical exertion creates a lot of complexities, including figuring out how to account for blood sugars, food intake, and timing of routines to coordinate insulin dosing.

While he could not participate in the survival race he had been training for, Weingard chose not to let his diagnosis keep him down, so he decided to do what came to him naturally—he entered a triathlon.
 
For the uninitiated, a triathlon typically consists of swimming, biking, and running long distances. During his triathlon training, Weingard sought out advice from medical professionals and exercise experts to help him deal with his diabetes while exercising. It was during this time Weingard got the idea of coaching other athletes with the disease and helping them navigate the maze of training with the chronic condition. This set the stage for what was to become his current company, Fit4D

Fit4D counsels both premier athletes and everyday PWD so they can realize their training and overall fitness goals. Weingard points out that many of Fit4D’s clients are people with type 2 diabetes who have not exercised for years and now want to integrate it back into their lives. In these cases, it is often the encouragement people need the most and that Fit4D’s coaches can provide.

Fit4D employs diabetes coaches whose professional backgrounds include dietitians, nurses, exercise physiologists, pharmacists, social workers and personal trainers. Many of the coaches are also certified diabetes educators. Fit4D not only looks at peoples’ long-term goals, but provides their patients with extremely valuable everyday strategies as well as tips to help them be prepared during their exercise routines, just in case, their diabetes becomes a factor.

One of the ways Fit4D has differentiated itself is through its responsiveness to communicating to their clients through contemporary means. For example, Fit4D’s Facebook page is staffed by CDEs, and visitors to the site have the ability to ask questions and get responses back from an educator. They also run virtual webinars and support groups. They use a blog, which includes the latest in diabetes research and trends and speaks from the perspective of the medical provider.

Weingard did complete that initial triathlon and then graduated to the grandfather of triathlons: the Ironman. And he raced it while fundraising for the Juvenile Diabetes Research Foundation.The Ironman consists of 2.4 miles of swimming,112 miles of biking, and 26.2 miles of running. 
 
Through his example of steely resolve in training for major endurance sporting events, Weingard looks to inspire other people with diabetes as he understands their daily challenges that arise during training.

Fit4D has also developed partnerships with pharmaceutical companies and healthcare insurers, as they have been at the forefront of the preventative medicine movement and looking for proactive, lifestyle approaches to dealing with chronic conditions like diabetes so as to prevent further complications down the road.

Diabetescare.net talked to Weingard about how coaching differs from traditional diabetes education, how his company is partnering with healthcare companies, and how technology has changed the way PWD communicate with their medical professionals.

DiabetesCare.net: You founded Fit4D after your own challenges with training as an endurance athlete. What are some of the events you have competed in thus far, and the most important considerations during the actual sporting event you must account for?
 
Weingard: I ran my first marathon when I was 17, but I wasn’t diagnosed until I was 36 and was training for a survival race. I had to rebuild my training regimen. Since then, I have done two Ironmans, the Escape from Alcatraz triathlon, and numerous other such events.

As much as I practice, it remains a challenge to balance food, exercise, and insulin. Also there are variables you can’t account for that you have to adapt to during training and events. For example, this past month I did a triathlon in Missouri, and it was pouring rain during the run portion of it. I ran for two hours in the rain, and I was worrying about my insulin pump working. The whole time I’m trying to cover my pump with my race number. It’s things just like that, other people don’t have to worry about. I have multiple injection sites on my body, in case a pump comes off.

I keep a lot of logs and records and learn from each race. I also do a lot of simulations of when the race is going to start, and do food and insulin routines. There are some days that are easier than others.

I continue to train and do these events and I’m proud of that. I have tried to pass along what I have learned to other people.

DiabetesCare.net: Has micromanaging your condition in your training made you a better athlete?

Weingard: It did enhance my understanding of nutrition and the complexity of how it works. I was a pretty detail-oriented person before, but this adds on a whole layer of being organized.

In the Missouri race I did a few weeks ago—which was a half Ironman distance consisting of a 1.2 mile swim, 56 mile bike, and 13.1 mile run—it typically takes me between 6 and 6 and ½ hours to complete while trying to balance my nutrition and insulin. There are so many variables to consider. You are up at 3:30 in the morning eating, and in the water swimming by 7am. It definitely has been a trial and error approach and has helped me to understand what works. I know exactly in a half Ironman what I am going to drink, when I wake up how much insulin I need, what I’ll eat on the bike, and I know where I’ll run low in the run. 

Still there is about a 25% unknown variable in every race. It could be a hot day and dehydration has an impact. They could delay the start of a triathlon for 20 minutes and that changes everything. You can have a plan that gets you most of the way there, then you have to think on your feet towards the end.

DiabetesCare.net: One of the important components Fit4D and diabetes coaching does is incorporate exercise as part of the continuum of care for both athletes and regular PWDs. Can you talk about the people who are your clients?

Weingard: We help all people with diabetes and especially those who want to follow an exercise regimen, have an athletic goal, as well as those who haven’t exercised in 20 years.
 
We have exercise physiologists on staff, but for the person who needs motivation and support to begin exercise, we may involve a social worker on the team or a nurse who gives a person emotional support and reinforcement around everyday activity. Just getting that feedback from our staff in-between visits with their primary care provider is helpful. We have heard from physicians that these patients are engaged and are on their way to improvement.
 
On the other end of the spectrum, we have also coached the JDRF’s Ride to Cure bicyclists. These include highly motivated people who are riding across the U.S. We have also had several people who have done triathlons and marathons. We have had two graduates of our program who have done the Ironman. 
 
DiabetesCare.net: Is diabetes coaching also for regular people with smaller exercise-related goals?

Weingard: We do help people that come to our site who ask for coaching directly, and those are the self pay folks. Many of the people we are helping are type 2s, and they are not athletes. They are people struggling every day. They may be in denial about their conditions. They might not see the doctor for 6 months. They may have gone on medications and stopped it. They need emotional support, a coach. We are someone on the Internet with diabetes expertise and credentials who gets to know them. These people need individualized attention.

DiabetesCare.net: Can you describe how diabetes coaches` approaches differ from the traditional diabetes education paradigm?
 
Weingard: For the last 20 years, primary care physicians and healthcare payers have been periodically trying to reduce costs and improve care at the same time—a difficult balancing act. One method has been to have registered nurses who are not diabetes educators responsible for answering the phone lines in these practices.

This phone model is expensive and it is not how the world has evolved. People like to use e-mail, text messaging, and connect through Facebook. It doesn’t matter to us how we communicate, but that we are connecting with our people on a personal basis where they trust us and they want us to help them with their diabetes management.

The real trick is to find a way to engage people with diabetes. It is one thing to connect with them, but to really improve their health, you have to gain their trust to improve their primary care. We focus on leveraging a multi-disciplinary team of diabetes experts, and engage patients on what they want to focus their energies on and moving them along with a continuum of care.

DiabetesCare.net: Insurers and healthcare companies have been looking for proactive, innovative ways to protect against chronic conditions like diabetes. Is this why Fit4D has partnered with such companies?

Weingard: We work with the companies that develop a relationship with the patients, especially the pharmaceutical companies who want to keep adherence to their brands or with companies who want their employees to participate in a diabetes program.

We are a market innovator. I was in a key e-business role at Microsoft, and I left there because of my personal commitment to improve the lives of the diabetes population. Fit4D optimizes the mix of technology and the human contact and expertise of the certified diabetes educator.

For companies that are looking for innovation, whether they be a pharmaceutical company or an insurance company, they don’t want to just give their customers over to anyone, and they understand what we do.

DiabetesCare.net: You said you are blending technology and diabetes education, is it also about the way we are communicating and how we treat diabetes today?

Weingard: Absolutely. There is a lot of information on the net, but we are about being credible and personalizing the information. We are an extension of the physician’s office. We can be there for behavioral and lifestyle support in-between visits—that is key.