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And that is where diabetes education enters the scene.


The educator’s big challenge is convincing people to forfeit their American lifestyle and diet, in favor of healthful food, more exercise and daily efforts to maintain normal or near-normal blood-sugar levels.

Janice Koshinsky, diabetes program manager at the Lions Diabetes Center, and dietitian Carla DeJesus must be equal parts educators, psychologists and motivators.

“We have patients who say their doctor wants them to lose 50 to 70 pounds,” she said. “We ask them, ‘What do you think is reasonable?’ They set their goals, and we help them meet them,” Koshinsky said. “We are looking for progress, not perfection.”

Along the way, the educators address various obstacles, including depression. One man, DeJesus said, rarely left his house. Once he finally arrived for education, she convinced him to consider counting carbohydrates to better control blood sugar. That led to her advice to reduce consumption of his favorite sugar beverage from one gallon to a half gallon a day. More recently he agreed to use the diet version.

“He is really depressed and finally opened up to me,” she said. “He said, ‘I can’t believe how much I’m saying to you.’ We were able to get to the root of what was causing him not to care for his diabetes.”

People know they should eat healthy food and exercise, but Koshinsky asked rhetorically, “How many people do what’s best?”


Studies show that patients who undergo diabetes education are more likely to reach ABC targets.

“The biggest challenge is people who never get here,” Koshinsky said. “They don’t understand the benefits and don’t choose to come. Even if they have an attitude when they get here, if you spend enough time with the patient, an educator can move them along the continuum of readiness. Maybe they will go home and make an effort.”

Another problem is convincing physicians to send patients for diabetes education upon diagnosis rather than waiting for complications to occur. In those cases, DeJesus said, the head-shaking reality is “why didn’t the doc tell the patient to come sooner? It’s sad.”

But the focus is potential not frustration. Feedback is important. Knowledge is power. Diabetes educators can help patients reach ABC targets better than physicians burdened by limited appointment time.

“Once they understand the number and have good targets, they are engaged,” Koshinsky said.

Once scared, now empowered, Nash represents the success of diabetes education.

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