Patients learn to control and live with diabetes

WILLMAR - For the first two days after learning in August that he has type 2 diabetes, Michael Moyers was depressed and grieving.

"I felt broken. I felt my body was broken," he said.

Then his wife urged him out of his funk. You can fix this, she told him.

With that, Moyers became one of the millions of Americans who are successfully managing this condition as a way of life.

"I'm starting to live healthier than I was before," he said. "Once you've gained control of it, then you've got a level of skill and confidence."

Mention chronic disease, and diabetes is among the first examples that come to mind. It's one of the most common: 21 million Americans have it and one out of every four Minnesotans.

Increasingly, it also has become a focus of efforts to hold down health care costs, reduce the burden of chronic disease and improve the quality of care these patients receive.

When it's well-managed, people with diabetes can live well. When it's not, they face the risk of costly and debilitating complications ranging from heart disease to blindness, limb loss and premature death.

That's why one of the first things Moyers did was to visit the Rice Diabetes and Nutrition Center to learn what he could do to control his disease.

Within a couple of months, he was able to start weaning himself off insulin and manage his diabetes through nutrition and exercise.

"It's very under control now," he said.

For people with diabetes, the bottom line is that they must take daily charge of themselves if they want to stay healthy, says Deb Lippert.

Lippert, a registered nurse, is coordinator of the Diabetes and Nutrition Center at Rice Memorial Hospital.

Last year the center saw nearly 800 patients, more than half of whom were newly diagnosed.

It's the task of the staff -- which includes nurses, nutrition counselors and an exercise physiologist -- to give them the knowledge they need to manage their disease.

Medical clinics might be rewarded when their patients with diabetes meet all the correct targets, but the mantle of personal responsibility still rests on the patients, Lippert said.

"They have to feel empowered," she said.

In the days after a new diagnosis of diabetes, patients typically want facts about their disease and skills, she said. "Then they start learning a little bit more about what it's going to take to manage this disease well. There's a challenge as you teach facts and skills to get people to look inwardly. For some people there's a big long list that can be horribly overwhelming."

The diabetes team helps patients break this down into something less intimidating.

"It's little tiny steps. It's goals they can set that are reasonable and can be accomplished," Lippert said.

Ashley Masseth, 15, has been living with type 1 diabetes for the past year.

She's had to learn how to check her blood glucose levels each day. She's learned how to balance what she eats and how much activity she gets.

"It's not as bad as I thought it would be," she said. Among her classmates, the fact that she has diabetes is "not really a big deal."

"Really, she can eat whatever she wants at this point, as long as she accounts for it," said her mother, BoLynda Masseth.

Wanda Carpenter has had type 2 diabetes for 20 years.

She remembers that when she was first diagnosed, her doctor handed her a sheet of paper outlining a diet and told her to come back in three weeks.

Today she can receive nutrition counseling whenever she needs it. She also now has an insulin pump, which has made it easier for her to control her blood glucose levels.

"It's a great invention," she said. "It gives me a lot of flexibility and it gives me great control."

Even after two decades, though, "it's still difficult," she said. "You do have to take a look at what you're doing and be mindful."

For Moyers, the nutritional record-keeping has been one of the most demanding aspects.

"You need to be meticulous about what you're eating and drinking," he said. "I never thought so much about eating in my whole life."

There's a hard day-to-day reality about living with diabetes, Lippert agreed.

"You occasionally go through periods where it's denial time. We want for people to be empowered, but that doesn't always mean it's like that every day," she said. "They beat themselves up regularly, asking 'What did I do? What caused this?'"

She often has to remind people that diabetes is partly genetic. And even with good management, the disease is not always predictable.

"Even caught early and doing everything right is no guarantee you aren't going to need medication or multiple medications or insulin down the road," she said.

Compared to 20 or 30 years ago, however, patients now have much more support and more options, Lippert said.

"Under the previous mentality, the expectation was they had to change their life," she said. "You don't have to make profound changes. There are a lot of tools to fit people's personal lifestyles."

Moyers has been grateful for the Diabetes and Nutrition Center.

"They are just wonderful people. They pick you up when you're down," he said. "If you catch it soon enough, like I did, you've got a chance to bounce back or at least get control of it."

Carpenter said her philosophy is never to use the word "can't."

"Life goes on and it can be good," she said.

"You can still have a normal healthy life," agreed BoLynda Masseth. "Your life is not going to end because you have diabetes."