After Ron Archer had oral surgery last fall, he wasn’t able to eat solid food for a few days, so he decided it would be a good time to start a diet. Living mostly on soup and crackers, he lost 40 pounds in four weeks.

“That wasn’t normal, and I knew it,” he said.

When he went to his doctor for the “annual” physical he had skipped for a couple of years, a lab test showed that his blood glucose level was about four times higher than normal. He was severely diabetic.

Archer’s doctor prescribed medication and referred him to FirstHealth’s Diabetes Self-Management Program. There he learned all about diabetes and what he should do to keep his blood sugars under control. He attended group classes and received individual counseling on proper nutrition, exercise and how to monitor his blood glucose level.

The Diabetes Self-Management Program serves patients in Moore, Montgomery, Richmond, Hoke and Lee counties, and is staffed by registered nurses and dietitians who are specially trained in diabetes care. Several are certified diabetes educators. “We help patients understand that diabetes is a progressive disease and that they are the most important person when it comes to managing it,” says Phyllis Simmons, R.N., a nurse educator with the Diabetes Self- Management Program in Moore County.

As a nurse educator with the FirstHealth Diabetes Self-Management Program, Phyllis Simmons, R.N., helps patients understand their disease and how they can manage it.

“Many years ago, diabetes care was focused more on treating complications. Now we emphasize preventing complications through simple lifestyle changes such as regular exercise and meal planning. We educate patients to start making these changes as early as a diagnosis of pre-diabetes, because complications can begin to develop even before blood sugars are high enough to be diagnosed as diabetes. Since heart disease is the leading serious complication of diabetes, exercise and heart-healthy eating help bring about improvement with both disease states.”

Debra Deschamps, R.D., a registered dietitian, teaches patients about the effects of different foods on their blood sugars. She teaches them about foods that are high in carbohydrates, which the body converts into sugar for energy, and helps them balance all their foods into healthy meal plans. They also learn about hearthealthy eating; different forms of fat, cholesterol and fiber; and limiting high-sodium foods.

“We talk about how to use their meal plans and how to read food labels so they can regulate the amount of things like carbohydrates, sodium, fat and cholesterol in their diet.” Deschamps says. “Study after study has shown that watching what you eat and exercising are key to helping manage diabetes.”

Patients in the Diabetes Self-Management Program learn about the different meters that are available for checking blood sugars. They decide which ones work best for them, and the Diabetes Self-Management staff shows them how to correctly check their blood sugars. These meters can help patients keep their blood sugars in a healthy range, says Betsy Robbins, R.N., the Diabetes Self-Management Program nurse educator for Montgomery, Richmond and Hoke counties.

“Blood sugar monitoring is a good behavior modification tool,” she says. “If you’re not checking your blood sugars, then you’re less likely to be thinking about them. But if you are checking them regularly and seeing what those numbers are, you start to realize what influences your blood sugars and what behaviors you can change to bring them down. It’s rewarding to see them come down and be under control.”

Learning about food
For Archer, learning about food and how different foods affect his type 2 diabetes was the most valuable part of the Diabetes Self-Management Program.

“I had basically always eaten what I liked, and I guess that is part of what got me into trouble,” he says. “I had to learn what carbohydrates are, which foods have carbohydrates and the size of portions I could eat.”

Archer, who is 48, completely changed his diet. Green beans, which he dresses up in various ways, became a staple for lunch and dinner. Along with beans and other vegetables, he eats small portions of meat and even smaller portions of rice, bread or other high-carbohydrate foods.

“The first three or four weeks were horrible, because I was always hungry,” he says. “It was difficult to get used to proper portion sizes, but I kept telling myself my stomach would shrink and I would get used to it, and I did.”

By using a glucose meter to check his blood sugar several times a day, Archer quickly learned which foods were most likely to cause problems.

“I discovered that potatoes, cornbread and pizza—all the stuff I like—shoots my sugar through the roof,” he says.

By January, just three months after his diabetes was diagnosed, Archer’s blood glucose levels were consistently in the normal range.

“My doctor essentially told me that if I keep this up for the rest of my life, I should have no complications whatsoever from being diabetic,” he says.

Type 2 diabetes, which is often triggered by obesity, is much more common than type 1. Most people with type 2 diabetes are at least somewhat overweight, and many of them get little or no regular exercise. Starting an exercise program can help bring down blood sugar levels, and continuing to exercise can help keep them down.

Kay Maria Green, a registered clinical physiologist, teaches the exercise lecture in the Diabetes Self-Management Program for patients in the Pinehurst area. She encourages patients to exercise daily, pointing out that even individuals with serious physical limitations can exercise in some form. Some may need to exercise in a pool while others may need to spread their exercise routine over the course of a day, however.

“We try not to let limitations be an excuse not to exercise, even if it’s just chair exercises,” says Deschamps. “There is always something they can do.”

As an incentive to get serious about exercising, every patient who completes the Diabetes Self-Management Program is offered a free trial membership pass to the FirstHealth Centers for Health & Fitness.

Most health insurance plans cover participation in the Diabetes Self-Management Program for patients who are referred by a physician.

Simmons and Deschamps conduct classes and counsel patients at the Diabetes Self-Management Program office between Pinehurst and West End. Robbins and registered dietitian Julie Nance, R.D., do the same at the program’s facilities in Rockingham, Troy and Raeford. Marilyn Novosel, R.N., and registered dietitian Melissa Herman, R.D., serve Lee County patients at a location in Sanford.

Herman is manager of the Diabetes Self-Management Program.

Never too old to change
At 73, Vivian Owens-Trott was older than most people when they are diagnosed with diabetes. When she went to her doctor for a routine check-up last fall, a blood test showed that her glucose level was high. It wasn’t very far outside the normal range, but high enough to mean that she had type 2 diabetes.

Her fondness for Kit-Kat bars may have had something to do with it. Still, she was surprised to learn she was diabetic because, although she had gained a few pounds, she wasn’t terribly overweight and she felt fine.

Her doctor said she needed to change her eating habits, and he referred her to the Diabetes Self-Management Program. By the time she had finished the six weekly classes, she had lost 17 pounds and her blood sugar levels were within the normal range.

“I didn’t have to make any drastic changes,” she says. “Debra (Deschamps) said I could keep eating most of the same foods, but just eat smaller portions and cut down on sweets. When you fall into the habit of eating this and eating that, it can be a little hard to change, but I did it. Instead of eating candy, now I might have a piece of fruit for a snack.”

Owens-Trott, who lives in Aberdeen, exercises by walking several times a week and pedaling her stationary bike.

Richard Delise developed type 2 diabetes after having surgery to remove a pituitary gland tumor. Last year, he was diagnosed with type 1 diabetes as well. He has been taking pills for one type and insulin shots for the other. His doctor also recommended that he participate in the Diabetes Self-Management Program, and he started going in February.

“At the time, I was taking 10 units of insulin in the morning and 10 at night,” Delise says. “Now (at the time of an interview in March), I’m taking just five units morning and night because of watching my weight, watching what I eat and exercising. I’ve lost weight and I’m feeling great.”

Delise, a 48-year-old Pinehurst resident, says that the Self-Management Program staff did more than just educate him about his disease.

“They motivated me and shook me up,” he says. “They showed me what my problems were and what I needed to do to solve them. I can’t say enough about them.”

Ron Archer believes that anybody can find the self-discipline to control their diabetes if they truly understand its terrible consequences.

“Every single person who has diabetes will have complications if they don’t get their blood sugar down,” he says. “It’s that simple. There is no escaping it.”

Of course, doing what’s needed to get the blood sugar down and keep it down is a lot easier said than done for most people. But Archer, Delise and Owens-Trott are living proof that the benefits are worth the effort.

“I had always been under the impression that if you were diabetic, you were doomed,” says Owens-Trott. “But the people there (at the Diabetes Self-Management Program) educated me that there are so many things you can do about it. Going to those classes was the most enlightening thing I could have done.”