The Fresno charter bus driver credits the Community Diabetes Education Center for helping educate him. “When I got the call to come do the diabetes clinics and sit and learn…that’s when it was life changing,” Legger says. “My wife was real adamant about what I should eat, but I didn’t believe her until I came to the Center.”
 

Education helps most lower blood sugar

Legger’s results are typical for people who complete the 10 hours of diabetes management education at Community Medical Centers. Last year more than 1,600 patients from a five-county area received education on healthy eating habits and ways to better control their diabetes. Graduates of the program lowered their A1C levels – a measure of blood sugar levels over a 3-month period – an average of 1.6% and reduced their risk of diabetes complications by 34%.

Community Diabetes Education Center is staffed by registered nurses and registered dietitians and is the only American Diabetes Association-recognized education program in Fresno County. It’s part of the community benefit work the not-for-profit hospital system does annually in response to the region’s identified health needs. Obesity and diabetes are the second biggest health challenge listed in the regional Community Health Needs Assessment.

Last year Community provided $175.3 million in outreach and education, support for local service organizations, medical education and training, and in unreimbursed costs of medical care for the poor and underserved.

Located on the Community Regional Medical Center campus, the center provides care to a high percentage of patients who are otherwise unable to receive diabetes self-management education, including bilingual services to Spanish-speaking patients. More than half of Community’s diabetes center patients were covered by Medi-Cal.

“Diabetes management is tough because diabetes is a complex disease,” says Rosalva Reyes, a registered dietitian and diabetes educator. “We hope our patients develop an awareness of diabetes because the more they know about the disease, the more they take care of themselves.”
 

Diagnosis as shocking as diabetes statistics

Legger was shocked when his doctor told him he had diabetes: “I said, ‘What do you mean? I’m healthy. I work out five or six days a week. I’m not drinking or smoking. I don’t have diabetes.’”

Then he was worried: “The first thing I started thinking about was amputation.”

Legger and Izetta had seen a lot of people in wheelchairs missing feet as part of their street ministry work. Fresno County had the third highest rate of diabetes-related lower extremity amputations in California in 2018 (the last year statewide statistics were available) and at one time had the highest rates. An estimated 57% of county residents have Type 2 diabetes or prediabetes.

Diabetes strikes Blacks nearly twice as often as whites. In the latest California health rankings report, 14.4% of Blacks had diabetes and 12.4% of Hispanics had diabetes compared to 8% of whites.

“I wasn’t surprised,” Izetta says of Legger’s diagnosis. “I had seen it coming with what he was eating and I knew from my experiences with my family.” Both Izetta’s brother and father died of diabetes.
 

Symptoms are easily missed

Often referred to as a “silent killer” because symptoms are easily missed until it’s far advanced, Type 2 diabetes can cause kidney failure, blindness and heart disease. According to the World Health Organization, it’s one of the main causes of death globally. It’s the seventh leading cause of death in Fresno County, with rates 28% higher than the rest of California.

Legger has another name for it: “Diabetes is a creeper. It’s such a subtle thing. It’s not like a heart attack that, bam, hits you. It’s like a slow killer.”

Testing is key, Reyes says, because people often miss or ignore the symptoms of diabetes – frequent urination, increased thirst, fatigue and dizziness, eyesight changes and weight loss. “We encourage people to ask their doctors to check their A1C levels and ask if there is any indication of prediabetes,” she explained. “I call it the yellow light because people can really change things here. And it can be just as simple as walking and tweaking their diet.”

When left unchecked, diabetes complications can be serious, if not deadly. “Usually the first sign of advanced diabetes is neuropathy or nerve damage,” Reyes says. Patients who have this nerve damage often miss injuries and infections in their feet that progress until amputation is necessary. “It’s one of those diseases you can manage, and education is key,” she adds.
 

Better nutrition helped lower blood sugar

After he saw his blood sugar numbers, Legger was determined to do something about it. He just wasn’t sure how to do that, besides stepping up his exercise routine and taking medication. He knew his old eating habits of waiting most of the day for a meal while he was driving a bus and then grabbing whatever quick candy bar he could find had contributed to getting diabetes. Legger says he wasn’t sure how to eat right until he met Reyes.

“I didn’t know the differences between carbohydrates and vitamins. I could never separate what is good and what is bad,” says Legger. Reyes helped him learn to read labels to look for fiber and that if he wanted to grab a banana for a snack he should add peanut butter for protein to help balance his blood sugar.

“Ms. Rose was wanting me to take small portions, but eat constantly, like every two hours,” Legger continues, “My wife was also teaching me about good fats.”

He learned to like cottage cheese and avocado toast instead of sweet rolls for breakfast and to reach for almonds instead of candy for a snack.
 

Spreading the word of diabetes management

“Once he learned that he could manage it with diet and exercise and that he could reverse those numbers, he became very motivated to make those changes,” Reyes praises. “He started with me in August on medication and I believe it was by November when he had his A1C done. It had improved so much they discontinued his medication.”

Izetta and Legger are using his story and the information they get from Community Diabetes Education Center to help others at homeless shelters and senior centers when they do outreach ministry. “My hope is that they see if he can do it, they can do it,” says Izetta. “I think what happens is people get diabetes and they don’t get educated properly. My husband said ‘I’m not going to let this disease beat me and have my limbs cut off.’ He was determined to beat this.”

Reyes says helping patients like Legger is exactly why she became a dietitian. “It’s amazing to know that education is power,” she says. “Diabetes management education is about empowering our patients. Now they have resources, now they have the tools and the information to understand their numbers and the guidelines for their diets.”

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