When Mary, aged 50, found out from her nurse practitioner that she had type 2 diabetes, she was actually relieved. It helped explain the symptoms—tiredness, hunger and a vaginal yeast infection—that wouldn’t go away. The nurse practitioner encouraged Mary to lose a few pounds, become more active and return for a follow-up visit in three months.

FOLLOW UP

Three months later, Mary hadn’t lost weight and was finding it hard to change her eating habits. She was a bit more active, however. She walked more sets of stairs and parked farther away from where she was going.

Much of the problem for Mary was due to her hectic life. She worked full time and still had two of her three children at home.

Plus, she was involved with many activities in her church and the children’s school. Mary had never been good at making her needs a priority.

TIME TO ACT

For two years, Mary did little about her diabetes. She was in denial. Then, one day, she got a wake-up call. She had chest pain and thought it was a heart attack. She went straight to her nurse practitioner. After a few tests, Mary was assured that what she experienced was not a heart attack. However, her nurse practitioner did note that now not only was her blood glucose high (at 246), but her LDL and blood pressure also were high (LDL was 139, the goal is at or under 100), blood pressure was 137/86 mm/Hg (the goal is at or under 130/80 mm/Hg). Mary was prescribed a medicine for each condition. But her practitioner reminded her that the best actions for her to take were to lose ten pounds and become more active.

Mary now was ready to take action. She asked for a referral to a diabetes education program. Mary wanted to learn more about diabetes. She wanted to get support to make these hard lifestyle changes. Mary scheduled a visit as soon as she got home.

SMALL CHANGES LEAD TO BIG RESULTS

Two weeks later, Mary found herself in a group of seven people. Many were in her situation. She learned a lot about diabetes and the steps to take to get her blood glucose, blood pressure and LDL under control. She also learned about the long-term problems from diabetes that could occur if she continued with her denial and lack of activity.

She met with a dietitian who asked about her current eating and activity habits. She asked what Mary felt were the easiest and hardest things in her life to change. She then asked Mary if she was willing to make a few changes to eat healthier and become more active. The dietitian encouraged Mary to focus on losing just a few pounds by making a few changes in her eating and activity habits. She didn’t need to lose all thirty pounds, go on a strict diet or become a long-distance runner. The dietitian asked Mary to come up with three steps she was willing to take on NOW.

Three realistic changes:

1. Three days each week, Mary would eat breakfast at home rather than eating a large muffin and cappuccino from the local bakery. She would either take two slices of whole wheat bread with cheese and a small apple to eat in the car or have a bowl of cereal with low-fat milk and a small banana at home.
2. She agreed to reduce the number of meals she ate out to fewer than six each week. When eating out she would try these tips:
   • At fast food hamburger restaurants she would order a single small burger, share an order of French fries, order a side salad and drink water. At other restaurants she would consider having a soup and salad or salad and healthy appetizer, rather than a large entrée. Or she would order an entrée and take half of it home.
3. To increase activity, Mary agreed to:
   • take at least one 15-minute walk at least four times per week, either when she woke up or after dinner
   • park farther away from the elevator in the parking garage at work and walk up the four flights to her office four days per week

Mary left the diabetes education program feeling good. She didn’t feel like she had to change her life completely. Most importantly, she felt that she could succeed at these small changes.

ONE MONTH LATER

Mary returned to the diabetes group. The dietitian asked her about how she did. Mary felt down because she had fallen short on a few of her goals. She was able to put into action the plan for breakfast, but when it came to restaurant meals her success was about fifty-fifty. Sometimes, her old favorites just “called out to her.” Becoming active was the hardest thing to change. She got the extra activity at work, but she was only getting in two walks per week. The dietitian encouraged Mary to pat herself on the back for the changes she did make. She reminded her that managing diabetes is about making small changes over time.

The dietitian asked Mary if she would like to adjust or change any of her goals for the next few months. Mary wanted to continue to work toward the same goals.

THREE MONTHS LATER

Mary was excited to see her nurse practitioner to discuss her progress. In three months, Mary had lost six pounds. She was walking about 20 minutes four days each week and had found a friend in the neighborhood to walk with. And the proof was in the numbers. Mary’s blood glucose was down. She knew it would be because she was checking it at home. Her A1C decreased from 8.5 to 7.3 percent. Her LDL decreased to 97, and her blood pressure was 134/78 mm/Hg.

Clearly, some of Mary’s improvements were because of her new medicines. But Mary knew that much of her success was thanks to her hard work at making tough lifestyle changes. She knew that this was just the beginning of the battle she had to wage each day to stay healthy for her next fifty years and not let diabetes get the best of her.