People from as far away as Eureka and even Alaska come to UCSF to learn how to better manage diabetes. Diabetic adults and children, ranging from preschoolers to high schoolers, visit the Diabetes Teaching Center throughout the year to attend workshops on diabetes management. They learn not only how to gain control of treatment, but also gain invaluable support from one another on how to cope with a disease that strikes 15.7 million Americans.

Amy Sczepanski learns how to use a new glucose
monitor at December’s diabetes education workshop
for children.

For 20 years, the Diabetes Teaching Center has been conducting the workshops, which span a four-day period, for people with both Type I and Type II diabetes. Last fall, the Center began teaching one- and two-day diabetes management classes in foreign languages -- Chinese, Spanish and Russian -- that tackle language, as well as cultural, barriers.

The foreign language classes have been popular so far and seem to be filling a need in the ethnically rich Bay Area. “The classes have always been full and they’ve been a lot of fun,” said Gloria Yee, a registered nurse and the business coordinator for the Center. “Up to now there have not been any real formal classes, all have been one-to-ones, so to have a group of people together has been phenomenal. The group gets support from each other that an educator could not provide.”

Usually, the programs begin with an icebreaker, a way of introducing members of the group and making them feel comfortable. But that’s hardly necessary in the foreign language classes, Yee says. “We ask people where they’re from. If it’s the Chinese class we ask where they’re from in China, Hong Kong, what village, when they came to America, and inevitably someone is from the same area,” Yee says.

“It’s the same thing in the Russian class. No matter how great your program is you can’t provide that -- people bringing in this wonderful information for each other. But it’s great because they don’t feel so isolated. It’s not such a weird thing that they have diabetes, look at all these other people who have diabetes too.”

Diabetes educators Maureen McGrath, left, and
Gloria Yee.

The foreign language classes not only address the isolation and language barriers that may inhibit the diabetic’s self-care but also the special cultural and ethnic traditions that can create obstacles for diabetics.

“With special language classes we gear towards special ethnic foods,” Yee says. “Chinese food has its own type of carbohydrate counting and foods are very different. For example, you would not see in a regular nutrition book how many grams of carbs a pork bun has or a special noodle. So I would address all those special issues.”

Yee tells of one particular culture where hosts must eat with the guests. “It’s not time for you to eat or your blood sugars are not at the time where you need to eat but you feel you have to eat because you have company,” Yee explains. “Authority helps. I’ve literally said ‘OK, I’m going to write you a note so you can tell your guests that you can’t eat because the doctors and nurses say it’s not time for you to eat yet.’”

The foreign language classes teach “survival skills” and serve as an introduction to diabetes care. More intensive four-day classes are offered in English for adults and children which delve into the issues of diabetes management. These classes include a full physical with a physician, discussion of current research in diabetes, blood glucose checks, carbohydrate counting, introduction to the latest devices for delivering insulin and monitoring blood glucose, nutritional information, as well as counseling with a clinical social worker.

“Our program is really a luxury -- to really spend time with them, to feel out what their obstacles are,” says Maureen McGrath, program coordinator and nurse practitioner. “The regimen is demanding -- four shots a day, at least four blood sugars a day, carbohydrate counts and how to adjust your insulin for increased activity and increased carbohydrates.” Because of all of the factors involved in diabetes care, the program cannot address all of the diabetics’ individual issues but it can address the major principles of care. “When you ask people to make major lifestyle changes, we know -- we’re not naive -- it takes more than four days.”

A significant aspect of the classes is that they are taught by diabetics. Both Yee and McGrath have Type I diabetes, which used to be known as juvenile diabetes, and have been living with the disease for most of their lives.

“Another thing that’s a little bit unusual about our program is that we have a physician involved every day,” McGrath says. “It’s really a full team--physician, nurses, dietitian, social worker, pharmacist, researcher.” The center’s educators have found through follow-up visits that the program’s graduates improve their health. “We’ve seen tremendous results,” McGrath said.

Much of what McGrath and Yee teach the diabetics in their classes is based on a landmark study that showed that retinopathy, or eye disease, which is common among diabetics, could be decreased by 75 percent with intensive therapy. The Diabetes Control and Complications Trial (DCCT), which began in the early 1980s, included 1400 people, some of whom practiced intensive therapy, meaning three to four shots of insulin a day, four to six glucose tests a day and a monthly checkup with a team of caregivers. The other participants were on conventional therapy, with one to two shots a day and urine checks and quarterly checkups. After almost a decade of study, the researchers found not only that the risk for eye disease was drastically decreased with intensive therapy, but that all complications of diabetes were reduced.

Since Peggy Huang, a registered nurse and certified diabetes educator, started the education program in the School of Nursing in 1979, its physicians and researchers, such as the late Peter Forsham, a leading researcher in diabetes and former director of the Metabolic Research Unit, believed in this type of therapy. “There has always been this real heavy slant towards intensive therapy at UCSF,” McGrath said. “Peter Forsham was at UCSF for something like 40 years and he was a diabetic. He believed in this tight control, this intensive therapy. He really pushed the idea of multiple injections, kind of eating what you wanted but knowing the carbohydrate content of the food, from before we had the tools to do this.”

And the tools have improved remarkably in recent years. Parents at the December class for children with diabetes talked about blood glucose meters, commenting on how painless and easy they were to use on their children. Families constantly shared information about their treatment regimens and continually asked Yee and McGrath questions about glucose levels, insulin delivery devices, different types of insulin and so on. They also learned about research being conducted at UCSF, some of which might make insulin injections a thing of the past. (Previous Daybreak story)

McGrath and Yee say the center has become a continuous resource for the program’s graduates, who call back with questions as much as 15 years after completing the class. It creates an extra workload for the educators but also heightens their sense of purpose. “The thank-you letters are so touching,” Yee said. “For example, we had a 24-year-old patient with major complications who took the class. She was legally blind and could not walk anymore. She wrote a letter saying that she could now see the hope. I was touched.”

By Paula Murphy

1st appeared 1/7/98

RETURN TO TOP