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South Texas Veterans Health Care System (STVHCS)

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Arming Vets at the South Texas VA

A dietician from the South Texas VA discusses portion size while standing in front of her class at Audie L. Murphy Hospital

South Texas VA Dietitian, and Certified Diabetes Educator, Cristina Elizondo gets into portion control for her class. The patients in her Tuesday class had multiple questions about the science behind balancing sugar levels.

By Steve Goetsch
Wednesday, November 25, 2015

With the exception of a spouse or two, the participants sprinkled throughout the Diabetes Self- Management Class at the South Texas VA have all held a weapon and had to defend a post at some time in their military careers.

The enemy they came to fight that Tuesday cannot be fought with an M-16. Invisible and methodical, quietly killing cells until the damage is done. It leaves behind bodies wrought with nerve pain, kidney disease, stroke and even amputations. The enemy is diabetes, and it is coming at an alarming rate.

The South Texas VA is not playing defense. They are taking the fight to the enemy and arming Veterans with their best weapon…education and behavior modification. Providing Veterans the tools they need for lifestyle changes that will defeat diabetes is a proactive approach that will not only provide good health outcomes, but improve access to care. 

In a cost study by the American Diabetes Association, they found that total costs of diagnosed diabetes have increased 41%, to $245 billion, with the direct costs at $176 billion. Those consist primarily of emergency care office visits and medications.

South Texas contributes to those statistics, but South Texas Registered Nurse and Diabetes Education Program Coordinator; Barbara Walz said that is where education has utility. “Educating patients and improving glycemic control has been shown to lower ED visits and decrease hospital admissions,” Walz explained. 

Nearly one in four Veterans treated at the VA has diabetes, some having contact with herbicides while in Vietnam contribute to their disease. Diabetes is when your body does not produce, or respond to insulin. Insulin brings sugar out of the bloodstream and into cells. As a result of high blood sugar levels, damage eventually occurs to blood vessels and organs. 

Navy Veteran Mike Herschel had the class recommended for him by his primary care provider. Herschel said that he knew a little something about diet and its impact on diabetes, but needed to update his information and get a little support as well.

“The way I was taught things and what they are teaching now is different,” Herschel said. “I knew a lot of the information; I have not been doing it as well as I should have been,” he added.

“I know how to count carbs, and I know to insulize for the carbohydrates that I eat, but I was cheating, so this class is a recommitment.”

South Texas dietitian stands in front of a room of people with props to explain how the body breaks down and processes food

South Texas VA Registered Dietitian, Charles Coleman uses props, and even a little humor to motivate his class. It isn't all sugary words. “If this was a class, you would all have “D’s, Coleman said.” "But this class is your opportunity to bring your grades up."

Besides support, Walz said the class is instructed in several topics:

   - Pathophysiology of diabetes

   - Medical Nutrition Therapy – how foods affect your glucose – what to eat, how much to eat

   - Importance of being active – increasing activity and the impact of exercise on glucose values

   - Medications – what medications, how they work, when they work and when to take them

   - Monitoring – when to check blood sugars, checking blood sugars and what they mean

   - Importance of logging glucose values and how the PCP interprets the numbers

   - Includes proper blood pressure and lipid values and ideas to achieve goals

   - Complications

   - Acute – recognizing, treating and preventing low and high glucose values

   - Long term – importance of proper checkups to prevent microvascular complications

   - Retinopathy, neuropathy, nephropathy

   - Problem solving – discuss and review scenarios and how to correct, prevent &/or overcome barriers

   - Healthy coping – discussion of what helps your DM control and what harms DM control

   - Risk Reduction – weight loss strategies, smoking cessation, examining feet, keeping PCP appointments


Audie Murphy Registered Dietician, Charles Coleman explained diabetes very simply to the class of Veterans and spouses. "The automatic processes that your body does with sugar are busted,” Coleman said.

Like Herschel, many of the participants were struggling to maintain a healthy lifestyle. “The only thing left that you have to control diabetes is located between your ears,” Coleman explained, adding that it comes down to making smart choices when it comes to diet and exercise.

The class meets every Tuesday, and is routinely full. That is understandable with more than 20 million Americans having the disease and another 40 million at risk for developing it. The class covers a variety of topics presented by a stable of experts like South Texas Veterans Health Care System (STVHCS) dietician Cristina Elizondo. She describes changing a patient’s behavior as a difficult and arduous process, but one that can be done. “You need to make small changes,” explained Elizondo. “Go step by step until you reach your goal, and then go set another one.”

That is more sound advice than what was received by one of the class participants who joked, “My doctor said if it tastes good, spit it out, if it tastes like cardboard, then you can eat it.”

The Veterans are in good hands at Audie Murphy. All three instructors; Walz, Coleman and Elizondo have earned certifications in Diabetes Education, known as a CDE.

After the laughter subsided, Elizondo said it is important to maintain a level of positivity during this transformation period, and that positivity leads to more successful outcomes.

Coleman said it starts with taking better care of you, and diabetes education is a good start. “If this was a class, you would all have “D’s.” But he also emphasized that it was important for the participants to realize the class was their opportunity to bring their grades up.

After he left the students with several handouts and a lot of new information, he left them with some promising stories of things to come. “I have had people follow this program that lost 70 pounds,” Coleman explained. “They went from 22 medications down to three.”

That is not just good news for the participants; it is also good news for the entire STVHCS. Managing and even reducing chronic illnesses with education means Audie L. Murphy will have additional resources to provide quality health care to as many Veterans as possible.

Walz’ goals for students are even simpler than that. When asked what the best part about teaching is, Walz simply responded, “Helping Veterans to be happy, healthy, productive old men and women.”

If you have been diagnosed with diabetes, and are interested in obtaining more information about the program, contact your PCP and ask if you are eligible for the class.





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