BY PEGGY PECK
 "When you ask about exercise or diet, ask yourself: 'Did I exercise today? What am I eating?'" America Bracho, M.D., tells family physicians during her Assembly lecture on helping people with diabetes. |
For family physicians who claim they can successfully manage people with diabetes, America Bracho, M.D., executive director of Latino Health Access, Santa Ana, Calif., has this message: "Control is in the hands of the person affected by diabetes, not the health care provider."
Bracho, who lectured Oct. 2 at the Assembly on the topic "Helping People with Diabetes Help Themselves," said physicians and other health care professionals need to rethink the way they address diabetes, beginning with the terminology used. "We need to separate the person from the disease," she said, noting that rather than using terms like "diabetics" or "patients with diabetes," health care professionals should say "people with diabetes" or "people affected by diabetes."
What's your lifestyle?
The next step for physicians is to take a hard look at their own lifestyles. Bracho noted that this message was driven home when she worked with an HIV education program. "We had a great educator who would lecture about safe sex and the use of condoms -- and then he would take a break to smoke," she said. "So what did that behavior say about his own commitment to a healthy life?" In the end, she said, the HIV educator's actions undermined his message in the community.
"So when you ask about exercise or diet," she said, "ask yourself: 'Did I exercise today? What am I eating?'"
Simplify nutritional info
Even physicians who are good examples of healthy living are likely to have difficulty delivering the healthy eating message to people with diabetes because "nutrition information is complex," Bracho said. To illustrate the point, she noted how Latino Health Access explains carbohydrates during its 12-week course for people with diabetes.
"We tell our patients that carbs break down into sugars. Four grams of carbohydrates equal one sugar cube," she said. With that knowledge, she attacks nutritional information from labels: a package of tortillas has 25 grams of carbohydrates, which equals six sugar cubes, while three Oreos have 24 grams of carbohydrates, again six sugar cubes. Even SnackWells, which are labeled as diet snacks, have "23 grams of carbs -- six sugar cubes -- so you can see how frustrating it can be for the person with diabetes," she said. But as difficult as the process can be, "learning how to eat is the key to freedom for people with diabetes," she said.
Put patient fears foremost
Although physicians tend to be concerned about comorbidities such as heart disease, people with diabetes are more likely to worry about "blindness, amputations and kidney disease," said Bracho. Education programs need to address these fears.
The Latino Health Access course focuses on the need for people with diabetes to take charge of their eye and foot health. "We tell them that the body has little pipes and big pipes. Diabetes clogs up these pipes, but just like in a home, the little pipes get clogged before the big pipes," she said. They are told that "little pipes" are found in the eyes and in the toes, so regular eye exams are necessary to protect their eyes. And they are told to take off their shoes and ask their doctors to check their feet, she said.
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