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From patient to dietitian

Dietetics

A blog post with a twist!! Sally Marchini has lived with both type 1 diabetes and coeliac disease for many years. She was inspired to change careers and become qualified as an Accredited Practising Dietitian and set up her own business – Marchini Nutrition. She offers personalised consultations that aim to enhance her client’s quality of life through empowerment, their confidence through understanding and their knowledge through her personal experience: www.marchininutrition.com

“My name is Sally Marchini. I am 47 years old, married with one son. I have a wonderful supportive family, and have lived an incredible life so far – in fact, it’s quite amazing that I’ve lasted this long!

When I was 12 years old (35 years ago) I was diagnosed with type 1 diabetes (my first close call) and started on insulin injections.  Ten years ago I was just going about life trying to lose the weight I had gained in my recent pregnancy (another close call), when my diabetes specialist (endocrinologist) noticed in a routine blood test that my iron levels were a little low.

He asked me about my diet, which included plenty of iron sources, and asked me if I had been feeling bloated or suffering any gastrointestinal ‘issues’. I had none.  He said just in case he’d like to order a coeliac serology, which he did and it came back positive.  We re-did the blood test, just to be sure, but it was still positive for the antibodies that can indicate coeliac disease, so I was sent for the gold standard gastroscopic biopsy which also came back positive.

This was a positive diagnosis of coeliac disease, meaning I’d got the ‘double whammy’ of type 1 diabetes and coeliac disease.  My endocrinologist explained that although I felt no symptoms (about 30% of type 1s with coeliac disease are asymptomatic) it was very important that I become compliant with a strict gluten free diet or I would put myself at risk of lymphoma cancer, malnutrition issues and poor diabetes control. It was a huge shock, and a massive learning curve!

I then had a number of incidents that built up to me making a life-changing decision.

Firstly I was referred to see a dietitian to find out what a gluten free diet was all about.  This was my first ever visit to see a dietitian and all I remember of the visit was her telling me what I could no longer eat and giving me lots of photocopied recipes of foods I didn’t eat normally anyway.  It was a depressing visit.

I then proceeded to put on 6 kilos in weight, testing out all the gluten free foods on the market. It’s normal to gain some weight when newly diagnosed with coeliac disease, but I was already overweight in recovery of the pregnancy, so was not impressed.  It was my husband who saved me by saying “Just because you can eat it, doesn’t mean you should!”.

At the same time, I felt my diabetes control wasn’t that great. It was certainly very hard work, but my endocrinologist couldn’t offer any suggestions and said I had nothing to worry about as my HbA1c was normal at 7%.  I knew there must be a more scientific approach to it, but strangely he didn’t suggest that I speak to a dietitian!

Fortunately I received a flyer in the post from Diabetes Australia (now called Australian Diabetes Council) for a talk by an endocrinologist and dietitian about type 1 diabetes and coeliac disease which I attended and found absolutely fascinating! The dietitian who spoke was Carmel Smart who is a highly qualified and experienced paediatric dietitian from the John Hunter Hospital, Newcastle. Her talk just blew me away and led me on a greater quest to learn more.  I believe it was this talk by Carmel that was the key to inspiring me to undertake the challenge of what would be six years of university – four of those years in full-time study.

It was a huge decision to make, especially with a young child but my husband and family were very supportive.

One of my most memorable diabetes learning experiences actually happened on one of my university placements in 2nd year at University at the Diabetes Service at John Hunter Hospital. We were fortunate to be sent out in groups of two to spend time with a dietitian to see ‘how’s it’s done’. How lucky was I? I was sent to Melba Mensche who is one of the most experienced diabetes educators and dietitians in Australia, and luckily for me on that day there were no patients to see, so I volunteered to be the patient.

Little did I know just how little I knew!! And Melba led by example – not having diabetes herself, she still weighs all the carbs she eats and counts everything as though she does have it.  I was so impressed.  So Melba taught me a whole lot in my ‘appointment’ and suggested that I needed further training.

This is important to understand, because I had decided to become a dietitian so I could know as much as possible for my own health, but also help others better than the dietitian I’d seen for my coeliac disease.  So at that placement with Melba Mensche I discovered that there was a more scientific approach to managing my diabetes control that I had been struggling with for years.  I wondered, ‘how many others must also struggle?’. At the same time she addressed general healthy eating issues that I now know is imperative to ‘throw-in’ to all dietetic appointments regardless of the reason for the patient’s visit.

So, I worked hard and finally graduated with a Bachelor of Nutrition & Dietetics from the University of Newcastle in 2011, aged 46 years old! I’m now so excited to be helping people every day to improve their health and quality of life, knowing what it’s like to be on the other side as a patient.”

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