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BRINKLEY—Educating people on diabetes isn't easy, but according to Denise Reynolds, an RN at the White River Rural Health Center, the solution is "helping them make the small changes."

The key word being small.

"A serving of juice is four ounces," Reynolds said, pointing to various examples of serving sizes. "A small tortilla or slice of bread is one serving. Meat is three ounces. Think about that. The 12-ounce steak you might eat out is actually enough for four people."

It doesn't take a giant leap to see that portions are out of control and more people are eating fast food, but those aren't the only challenges.

"People are more sedentary," Peggy Barker, a diabetes educator at White River, said. "It used to be that people worked outside or walked to school or were just more active, but they aren't. That's the double whammy. People are eating more and doing less. And what we are seeing is more people being diagnosed with diabetes younger and younger."

Diabetes is especially a problem in the Delta. White River serves a five-county area encompassing Jackson, Woodruff, Monroe, Prairie and White counties.

The flat farming land that runs through eastern Arkansas has a large African American population. A study commissioned by the Arkansas Minority Health Commission in 2003 found a 152 percent disparity in the mortality rates of African American diabetics as compared to Caucasian diabetics. It also found a higher number of amputees among African American diabetics.

The total number of persons with diabetes in the five-county area is hard to measure.

"So many people out there might be, but they don't know," Reynolds said. "They haven't been diagnosed or have had the blood tests."

Reynolds added that a testing program at a local Fred's has been very popular.

Diabetes can not only cause serious physical problems – it can kill.

So the diabetes educators in Brinkley and elsewhere are using the ABCs as a teaching tool, but not the way you might think.

"We use A, it's actually A1c (a measure of average blood sugar), and then B, C, D, E and F," Reynolds said. "B being blood pressure, C is for cholesterol. D is for drugs; E for exercise and F is food. It helps people remember."

Diabetes education is important at White River, a Community Health Centers of Arkansas clinic, and it also important for Brinkley, a farm town and Interstate 40 stop, which raised over $45,000 to help renovate the facility. The renovations added a kitchen, classroom space and an exercise area.

Dr. West Allen, who serves as medical director for White River, knows the importance of having the kitchen.

"It has definitely helped," West said. "We are showing them hands-on and that there is food that actually tastes good on the diabetic diet."

Diabetes education isn't just happening at White River. In Pine Bluff, Jefferson Comprehensive Care System teaches diabetes education and also has a twice-monthly breakfast with a group discussion to go over different aspects, said Margaret Washington, an advanced practice nurse for the clinic.

"We do a lot of self-management," Washington said. "We tell them what we are expecting and let them set goals and monitor that when they come to the clinic."

It's been working. "The ones who participate, they do see an improvement."

Washington added the program has been going for less than a year and they are seeing eight to 10 patients.

At Marshall's Boston Mountain clinic, Melanie Campbell, the clinic's director, said the focus isn't all on diabetes.

"We are working on all of the chronic diseases," she said. "So not just diabetes, but cardiovascular disease and depression."

Boston Mountain was also aided by a new facility. "We built a new building in Marshall," Campbell said. "That left us with an old building that was sitting empty. We got a grant that allowed us to get exercise equipment and the plan for the wellness center was born."

Campbell is hoping that the center opens in March. "Marshall is a small town and you don't have anything like a gym around here. We'll be able to get the community in and also the people who work at the clinic."

According to Campbell, "A lot of research has been done on the advantages of exercise to improve mental health."

Campbell also says that another important benefit of exercise is that "it teaches self-management skills. Not just for mental health, but for any patient with a chronic disease."




February 2007

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