Based on Themes from the Film The Debilitator

A Discussion Guide for Living Well with Diabetes

New Beginnings

November 2005

A joint program of the Centers for Disease Control and Prevention and the National Institutes of Health.

http://www.ndep.nih.gov
New Beginnings: A Discussion Guide for 


Living Well with Diabetes


Based on Themes from the Film The Debilitator 

2005 
Acknowledgments


Many National Diabetes Education Program partners contributed to the development of this guide. The following people formed a core writing and review team that 

helped research, write, and refine drafts of the manuscript and enlisted the involvement of school personnel and parents in reviewing the guide. Their dedication and 

assistance were invaluable. 

Albert Einstein College of Medicine 

Janet O. Brown, RN, MSN, MPH 

Center for Substance Abuse Treatment 

Clifton Mitchell 

Georgia Division of Public Health 

Magon M. Mbadugha, MS, RD, LD 

Healing Our Village 

Lenore Coleman, PhD 

Mississippi State Department of Health 

Victor Sutton, MPPA 

Morehouse School of Medicine 

Elvan Catherine Daniels, MD 

National Urban League 

Sandra Goodridge, MS, MA 

Ohio Department of Health 

Thomas Joyce, MA 

The Links, Incorporated 

Mary Clark, MEd 

University of Illinois at Chicago 

Caswell Evans, DDS, MPH 

U.S. Department of Agriculture 

Gladys Gary Vaughn, PhD 

National Diabetes 

Education 

Program Staff 

CDC Division of Diabetes Translation 

Jane Kelly, MD 

Sabrina Harper, MS 

National Institutes of Health 

National Institute of Diabetes & 

Digestive & Kidney Diseases 

Joanne Gallivan, MS, RD 

In addition, the National Diabetes 

Education Program would like to thank 

the following individuals, who reviewed 

portions of this discussion guide: 

Pamela Allweiss, MD, MPH 

Quanza Brooks-Griffin, MPA 

Ann Bullock, MD 

Kristina Ernst, RN, CDE 

Portia Jackson, MPH 

Michelle Owens, PhD 

Betsy Rodriguez, MSN, CDE 

Dawn Satterfield, PhD, MSN, CDE 
Disclaimer


The Debilitator is an independently produced film created by Millennium Filmworks. 

The film is not an NDEP product, and as such, the NDEP does not have the rights 

to use, reproduce, or broadcast the film. The NDEP is not responsible for the content 

of The Debilitator film, and reference to this film does not imply an endorsement 

of products developed by the organizations that funded and created this film. 

Information on obtaining this film is provided solely as a service for users of this 

NDEP discussion guide. It is possible to use this discussion guide without access 

to the film. Contact Millennium Filmworks at http://www. 

millenniumfilmworksinc.org for further information on obtaining the film. 

Photographs in the discussion guide that are related to The Debilitator film were 

provided by Millennium Filmworks, Inc. 
Contents 

 

Contents


Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1


How to Use This Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7


Session One. Overview: The Debilitator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13


Session Two. What’s Going On in the Family? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19


Session Three. Be Smart About Your Heart: Know Your ABCs . . . . . . . . . . . . . . . . . 23


Session Four. Every Day Is a New Beginning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31


 Handout for Session Four: Emotional Stages of Change


Session Five. Diabetes Detection: Could I Have Diabetes Right Now...


and Not Know It? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39


 Handout for Session Five: Diabetes Detection Initiative Risk Test


Session Six. You Can Be Your Own Worst Enemy or Your Own Best Friend . . . . . . 45


 Handout for Session Six: Home Exercise


Session Seven. Emotional “Short Circuits” and “Brain Shutdown” . . . . . . . . . . . . . 53


Session Eight. Children and Family: How Can They Understand?. . . . . . . . . . . . . . . 59


 Handout for Session Eight: Effects of Diabetes 

Session Nine. Fear of “the Needle” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65


 Handout for Session Nine: Myths and Facts About Insulin


Handout for Session Nine: What You Might “Know” About Diabetes:


Myths and Facts


Session Ten. Working with Your Doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73


Session Eleven. A Frightening Future: The Rise of Type 2 Diabetes in Youth. . . . . . .81


 Handout for Session Eleven: Obesity Maps and Diabetes Maps


 Handout for Session Eleven: Eating Healthily, Moving More

 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Session Twelve. Spirituality as a Guide and Support . . . . . . . . . . . . . . . . . . . . . . . . . 89


Session Thirteen. What Are My Patients Thinking? A Session for


Health Care Providers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95


 Handout for Session Thirteen: The 5As

 Handout for Session Thirteen: Role-Playing Exercise


Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103


Creating Your Own Panel Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107


References and Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109


NDEP Publications Order Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113


State-Based Programs to Reduce the Burden of Diabetes . . . . . . . . . . . . . . . . . . . . .119

introDuCtion 

 

Introduction


A discussion facilitator is the person who takes the lead 

in guiding the discussion. This person could be a diabetes 

educator but doesn’t have to be. Experience acting as 

a group facilitator is helpful but not essential, because 

these sessions do not need to be held in a formal setting. 

They could be explored in a more informal and intimate 

setting, such as a family gathering. 
How to Use This Guide 

Frequently Asked Questions 
 

how to use this guiDe 

How to Use This Guide


Welcome to this new discussion guide from the National 

Diabetes Education Program (NDEP). This guide was 

developed to expand on themes and educational opportunities brought out in The Debilitator, a public television 

docudrama developed by independent film company 

Millennium Filmworks. 

This film and discussion guide focus on an often 

overlooked aspect of diabetes—the impact that emotions can have on how people give and receive information about diabetes, whether they seek help, and, 

ultimately, what influences them to take action to control 

or prevent diabetes. Our experience participating in pilot 

test screenings of the film The Debilitator has told us 

that people want to talk about it afterward: about their 

personal experiences and the emotions that accompany 

living with diabetes. This guide is intended to help facilitate the discussion by providing stimulus questions, 

group and individual exercises, and role-playing 

experiences. 

The material in this discussion guide is divided into 13 

modules to be used by facilitators in leading sessions 

on topics drawn from The Debilitator. This film is about 

Calvin Dixon, an African American man with neglected 

diabetes who dreams that he dies of a heart attack. The 

dream prompts him to share his fears with his family and 

to accept their help in taking action to control his diabetes. 

The modules for the sessions, all formatted in the same 

manner, include background information, learning 

objectives, materials needed, suggestions for stimulation questions, and points to bring out in the discussion. 

An estimated time is given, but only for the discussion. 

An additional 30 minutes is needed for watching the 

film. Many modules contain classroom and homework 

exercises, and some include optional activities. You may 

choose among these activities based on the interests of 

the group, the amount of time that you have, and your 

expertise as a discussion leader. Some handouts for the 

sessions are included in this discussion guide kit and may 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

be photocopied for participants; others must be ordered 

from the NDEP ahead of time or downloaded from the 

Internet at http://www.ndep.nih.gov 

Each module is designed to stand alone. You can use 

any one of the modules if you are meeting with a group 

only once, or you can use the modules as a series if you 

are meeting several times with the same group. The 

overview session is designed to bring out facts about 

diabetes and to probe emotions evoked by viewing The 

Debilitator. The session is “scripted”; that is, it contains 

detailed notes on what you can say to the group to facilitate discussion. You may want to use that module if you 

are meeting on a one-time basis with a group and the 

participants don’t know each other. The other modules 

in the guide focus more closely on specific scenes in 

the film and can be used in a support group, in an educational meeting, or in any other group that is meeting 

more than once. Those modules assume that the group 

members have already met together at least once. They 

are not as heavily scripted as the overview session, but 

they all include points that we suggest you bring out during the discussion. 

Key to Icons Used in This Guide 

1. Play film, or replay scene in film. 

2. Distribute/review handout(s). 

3. Make sure the following points are brought out 

in the discussion. 
 

how to use this guiDe 

4. Be alert to a sensitive topic (e.g., spirituality, 

discussion of emotions). 

5. Time needed for discussion. 

6. Classroom exercise or activity. 

7. Homework exercise/home exercise. 

Only the final module requires special medical training, 

and any factual information about diabetes that you may 

need is included in the handouts. However, the NDEP 

strongly encourages inviting a medical person (health 

care provider or certified diabetes educator) to participate in any sessions that you conduct to provide support 

for the discussion and to answer any specific medical 

questions that may arise. The final module is designed 

specifically to be used to lead a session for health care 

providers. We recommend that this session be facilitated 

by a health care provider who is currently involved in 

clinical care. 

Also contained in this guide are a group of frequently 

asked questions and their answers, a section on troubleshooting to help you handle unexpected situations during 

the sessions, a list of suggestions for creating your own 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

panel discussion, a References and Resources section, 

a form for ordering NDEP materials, and a list of statebased programs to prevent and control diabetes. 

Please submit questions or comments about this guide to 

Dr. Jane Kelly, director of the National Diabetes Education Program (NDEP), Centers for Disease Control and 

Prevention (CDC), at jkelly@cdc.gov, or fax 770-488-5195. 

THANK YOU 
 

frequentLy AskeD questions 

Frequently Asked Questions


What is the film The Debilitator about? 

The Debilitator tells the story of Calvin Dixon, an African 

American man with neglected diabetes who has a bad 

dream about dying of a heart attack. When he wakes up, 

his fears prompt him to tell his family about his diabetes 

and to get help in dealing with his diabetes and taking 

proper care of himself. Diabetes can be a “debilitator” in 

that it can wear down, or debilitate, a person’s energy, 

health, and well-being, but it doesn’t have to. One can 

beat “the debilitator.” As Calvin Dixon says, “I’m going 

to beat the odds.” 

What is the discussion guide all about? 

The discussion guide contains materials that show facilitators how to lead a discussion among a small group of 

people (for example, a support group, a diabetes class, 

a church group, or a “lunch-and-learn” session at work) 

about the events in the film. The guide contains 13 modules on different topics drawn from Calvin Dixon’s story. 

The final module is a communications training module 

for health care providers to help them understand more 

about what their patients are experiencing. 

Lots of videos and booklets about diabetes are available 

nowadays. How are these materials different? 

By telling the story of one man and how he deals with 

learning that he has diabetes, The Debilitator connects 

emotionally with the audience. The discussion guide 

focuses on the emotions that Calvin Dixon experiences, 

how he shares his feelings with his family, and how he 

interacts with his doctor. 

This film is about an African American man and his 

family. The people in the group I’ll lead may not be 

African American. Do the film and discussion guide 

still apply to them? 

Yes. Human emotions are universal. This story focuses 

on an African American man, but the emotional issues 

and lessons learned apply to all of us. It might be worthwhile for your group to talk about how some things in the 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

film might be expressed differently in your family, your 

culture, or your community group. 

I am a Diabetes Educator. How can I use this film? 

As a diabetes educator, you have a fundamental role in 

providing and teaching diabetes self-management. You 

can use The Debilitator film and discussion guide in a 

variety of settings (e.g., clinics, community organizations, 

support groups, diabetes retreats) to help your clients 

•	 Acknowledge the emotional aspects of diabetes and 

how they can hinder or support diabetes self-care. 

•	 Better understand the importance of diabetes care 

and self-management. 

•	 Formulate a plan for adopting diabetes self-care 

behaviors. 

I am the program director/coordinator of the state 

Diabetes Prevention and Control Program (DPCP). 

How can I use this material? 

DPCPs can work collaboratively with communities, 

municipalities, regions, clinics, health insurance companies, churches, and hospitals, among others, to address 

the many facets of diabetes, such as risk factors and the 

connection between diabetes and cardiovascular diseases. Settings in which DPCPs can use The Debilitator 

and the discussion guide are 

4 Coalitions. Support and foster the development of 

coalitions to address diabetes and cardiovascular 

diseases. 

4 Diabetes Education and Training Programs for 

Professionals. Provide opportunities to promote 

best practices and standards of care among those 

responsible for providing medical care to people living 

with diabetes. 

4 Provider Education. 

1.	 Patient Education Tools—Distribute the film to 

providers and professionals statewide, or hold 

luncheon meetings to discuss the film. 
 

frequentLy AskeD questions 

2.	 Continuing Education Unit (CEU)—Provide 

educational training sessions on the emotional 

impact of living with diabetes and on ways to 

improve communications between health care 

providers and people living with diabetes and 

cardiovascular diseases. 

Note: The NDEP does not provide continuing medical 

education (CME) or CEU credit, but your organization 

may find that these discussion modules fit into already 

scheduled and approved CEU/CME programs. 

4 Clinic Support for Indigent Diabetes Care. 

4 Public Education Activities. 

4 Health Care Systems. Provide training, support, 

and resources for primary care centers to improve 

diabetes care. 

4 Community Interventions. Use the discussion guide 

in churches and in other community settings to promote wellness, physical activity, and weight and blood 

pressure control for people with diabetes. 

I am a business owner. What does this discussion guide 

have to offer me? 

Poorly controlled diabetes has a huge effect on your 

most important resource: your employees. Investing in 

improved diabetes control can pay off in heightened productivity, decreased absenteeism, lower medical costs, 

and healthier retirees. Many businesses already have 

wellness coordinators or occupational health nurses who 

could lead discussion groups. Smaller businesses that 

may not have these personnel may have a few employees who would be willing to lead these discussions as 

“brown bag” lunch sessions. More information and suggestions for things that you as a business owner can do 

to help prevent and control diabetes among your employees can be found at http://www.diabetesatwork.org. 

I work at a community college. Can we use this material 

in our adult enrichment courses? 

Yes, you may use the NDEP discussion guide. All NDEP 

materials are in the public domain, so you can photocopy 
0 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

and use any of these materials without concern about 

copyright infringement. You may add other materials or 

adapt these materials to your needs for an adult enrichment course, and you may put your logo on the materials 

alongside the NDEP logo. You must contact Millennium 

Filmworks for information on the rights to show the film. 

I run a clinic (or I am a hospital administrator). How can I 

use this material? 

The modules in this discussion guide can be used in training health care providers to improve communication with 

their patients. Consider showing the film and leading a 

discussion at a noontime conference or at a weekly CME 

event. Improved communications between health care 

providers and patients have been noted to reduce lawsuits 

and to enhance clinical care. You might even consider 

holding discussions that bring patients and providers 

together as a learning experience for both groups. The 

final module, a communications training module, has been 

specially designed to help health care providers understand more about what their patients are experiencing. 

Note: As stated earlier, the NDEP does not provide 

CME or CEU credit, but your organization may find that 

these discussion modules fit into already scheduled and 

approved CEU/CME programs. 

I want to lead a group, but I don’t know that much about 

diabetes. Will this film and accompanying guide give me 

all the facts that I need to know about the disease? 

Some facts about diabetes are presented, but you don’t 

need to have extensive knowledge of diabetes to lead 

a group. (For a list of common medical terms related to 

diabetes, visit http://www.cdc.gov/diabetes/pubs/tcyd/ 

appendix.htm.) Most of the material in the discussion 

guide is focused on emotions and behavior—how people 

can recognize the emotions that stop them from doing 

the things that are healthy for them, and what they can 

do to change. If at all possible, invite a medical person 

(health care provider or certified diabetes educator) to 

participate in any sessions that you conduct to provide 

support for the discussion and to answer any specific 

medical questions that may arise. 
frequentLy AskeD questions 

 

I have diabetes and want to learn more about it, and 

perhaps even lead a discussion, but I don’t have a diabetes support group, and I don’t go to diabetes education 

classes. Where can I use this material? 

You can use the film and discussion guide anywhere that 

people get together. You can show the film at a community event, such as a health fair, and then choose one 

module to discuss. Or you can simply get family and 

friends together as a group. You may want to ask your 

local hospital, clinic, or American Diabetes Association 

(ADA) chapter to help you organize a group. Your state 

Diabetes Prevention and Control Program may know of 

programs in your areas or may help you start a program. 

Refer to the contact list for DPCPs in this discussion guide 

kit. Or visit http://www.cdc.gov/diabetes for the most 

up-to-date contact list for your state. 

What do I need to do to hold a discussion group? 

How do I get started? 

Most written materials needed to hold a discussion 

group are included in this guide. (Some materials for 

the sessions must be downloaded from the Internet or 

ordered from the NDEP.) The film The Debilitator can be 

obtained from Millennium Filmworks at http://www. 

millenniumfilmworksinc.org. The discussion guide 

and other NDEP materials are available free of charge. 

Download them from the National Diabetes Education 

Program Web site http://www.cdc.gov/diabetes/ndep, 

order them online from http://www.ndep.nih.gov, or 

order them by phone by calling 1-800-438-5383. 

Where do I go for more information? 

Refer to the References and Resources section at the 

back of this discussion guide. 
Session One


Overview: The Debilitator 
overview session: The DebiliTaTor 

i ili

 

Session One 

Overv ew: The Deb tator 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

This module for the overview session focuses largely on 

reinforcing some facts about diabetes and on probing 

emotions evoked by viewing the film The Debilitator. This 

module is a good choice if you are working with a group 

on a one-time basis and the participants don’t know each 

other. It also works well as the first session in a series of 

sessions over weeks or months with the same participants. 

For your convenience, this first session is heavily scripted; 

it contains detailed notes on what you can say to the 

group to facilitate discussion. Feel free to use either this 

script or your own words to lead the discussion. 

Background 

Diabetes is the sixth leading cause of death in the United 

States. Diabetes is also a major contributor to heart disease, which is the nation’s number one cause of death. 

Diabetes and its complications disproportionately affect 

African Americans. The more that people understand 

about diabetes, how it causes complications, and what 

they can do to control and prevent it, the better equipped 

they will be to take action. The film The Debilitator can 

be used to raise awareness of diabetes, to educate viewers about the link between diabetes and heart disease, 

and to direct viewers to action steps that they can take to 

control and prevent diabetes. Diabetes can be a “debilitator” because it can wear down (or debilitate) a person’s 

energy and well-being, but as Calvin Dixon shows, this 

does not have to happen. A person can take charge and 

control diabetes. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Objectives 

1.	 To describe the actions that a person can take to control type 2 diabetes. 

2.	 To discuss the role of the family in supporting a person with diabetes. 

Time needed for the session: a minimum 

of 60 minutes (including 30 minutes for 

watching the film). 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor. 

•	 Handout: NDEP brochure 4 Steps to Control Your 

Diabetes for Life (at least one copy for each participant). Use the NDEP Publications Order Form at the 

end of this guide to order this handout and other 

NDEP materials referenced in this guide by fax or mail, 

or go to the Web site http://www.ndep.nih.gov to 

order online or to download the materials. 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

Conduct a facilitated discussion (group discussion with a 

leader asking stimulation questions). 

Introduction


1.	 Say: Hello. I’d like to welcome you all here today 

for our group discussion on the effects of diabetes 

on people with the disease, their families, and their 

friends. Before we get started, I’d like to ask you a few 

questions. [Request that participants raise their hand 

in response to your questions .] How many of you 

either have diabetes or have someone in your immediate family with diabetes? Okay, keep your hands 
overview session: The DebiliTaTor 

 

raised. How many of you others have a close friend 

or coworker with diabetes? [Most of the group should 

have their hands raised . Instruct everyone to look 

around the room at the number of people affected by 

diabetes .] 

Wow, it’s amazing to see how many people are 

affected by diabetes. According to the Centers for 

Disease Control and Prevention (CDC), there are 

one million new cases of diabetes in the United 

States each year. I want you all to think about this 

fact for a minute. This disease is very serious and 

has complications that can cause heart disease, 

blindness, impotence, and many more health conditions. But before we go more deeply into our 

discussion of diabetes, let’s introduce ourselves. My 

name is , and 

I’ll be facilitating our discussion today. I’m glad that 

you are here to share your story and learn more about 

diabetes. [Ask participants to introduce themselves .] 

Now, let’s get back to this discussion. Some people 

don’t realize how serious diabetes is. Did you know 

that diabetes is the sixth leading cause of death in the 

United States, and that there is a strong link between 

diabetes and heart disease? In fact, more people with 

diabetes die of heart disease than of any other cause. 

We have to do something to help educate each other 

about how to prevent and control diabetes. 

2.	 Say: We’re going to watch a 30-minute film called The 

Debilitator. It’s about an African American man and 

his life with diabetes. After we watch the film, we’ll 

have a short discussion. Your comments are all very 

important, so I ask that we please respect each other 

and our time here by speaking one at a time. The discussion should last about minutes or so. [Let 

the group know how much time you have allotted for 

discussion—usually 30 to 60 minutes .] 

Optional if your organization has the resources: 

Say: After the film and discussion, you’ll receive a small 

token of our appreciation for your participation and your 

willingness to learn about diabetes. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

3.	 Ask the group: Are there any questions at this point? 

If not, let’s get started. You may want to take notes as 

you watch the film. 

Optional if your organization has the resources: 

Say: Refreshments are on the table, so please help yourselves. [Make sure that only healthful snacks are served .] 

Show the Film 

After-Film Discussion 

[When the film is over, look out at the participants to see 

if any are eager to speak . If so, let them comment on the 

film . If not, move on to the first question .] 

1.	 Say: Wow. That was a powerful film. It had a lot of 

key messages for Calvin and his family. Tell me how 

this film made you feel and why. [In all cases, wait for 

open, voluntary responses; call on people who look as 

if they have something to say . When necessary, probe 

for the following emotions: fear, sadness, and hope . 

Allow each participant about 3 minutes to express his 

or her feelings and then move to the next person .] 

2.	 Ask: What role did the family members play in the life 

of this man with diabetes? How important were the 

family members to Calvin’s survival? [Probe your audience by giving a few lead-in examples of the family’s 

role; for instance, the mother’s choice of what to cook 

for dinner, the children exercising with their father, and 

the family making sure that Calvin takes his medications regularly .] 

3.	 Ask: Can you relate to this family? In what ways? 

[Discuss relationships within families, and ask members of the group to share their personal stories 

relating to a family member or close friend .] 

4.	 Ask: If you had been in Calvin’s shoes, how many of 

you would have actually listened to the doctor and 

gone to the diabetes support group meeting? [If you 

need to probe for comments, call on different people 

in the group .] 
overview session: The DebiliTaTor 

 

5.	 Ask: Does anyone have any suggestions on how 

to help someone in your family who is living with 

diabetes? 

[Don’t ask more than five questions about the movie . If 

your group is having a good discussion not related to the 

questions above, feel free to go with the flow—just as 

long as the comments contribute to the understanding of 

diabetes .] 

6.	 Say: Now let’s get to the fun part of the session. Let’s 

do some role playing. 

7.	 Ask: Could I have two volunteers—one man and one 

woman? [You may need to select two people if no one 

volunteers .] I want you two to pretend that you are 

Calvin and his wife. Calvin wants to eat some cake for 

dessert, but his wife is reluctant because she is worried about his health. [Allow the volunteers to act out 

this scene in their own way . Offer to give them 5 minutes to prepare if desired . Tell them that they have 5 

minutes to perform the role-playing scene .] 

8.	 Say [at the end of the act]: That was great. Thanks! 

Does anyone have any comments or questions about 

the skit? 

Make sure that the following points are brought out 

in the discussion: 

•	 Nagging or fear tactics are usually not helpful. 

•	 Nagging, anger, and fear may push people further 

away emotionally. 

•	 Emotional support and understanding are needed 

for behavior change. 

[If needed, ask for two more volunteers to role-play a 

scene without using fear tactics, anger, or nagging .] 

9.	 Say: We’re getting close to the end of the session now. 

We’re almost finished. I just have one more question 

for you. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

10. Ask: Are there things that you’ll do differently in 

your own life or your family’s life now that you have 

watched this film and have attended this discussion? 

Conclusion


Say: We want to thank each of you for participating in our 

group discussion. The information that we have shared 

is of enormous value to you and your lives. Please go 

out and spread the message of diabetes control and 

prevention. Does anybody have any questions before we 

wrap up? [Answer questions briefly .] Then we thank you 

[optional: “and would like to give you a small gift as a 

thank you for your time spent with us this evening”]. 

[Healthful incentive gifts might include water bottles, 

pedometers, healthful snacks, or other healthful-behavior 

reminders from your organization (e .g ., a refrigerator 

magnet reminder) .] 

Homework Exercise 

Distribute the NDEP brochure 4 Steps to Control Your 

Diabetes for Life as take-home reading, and ask participants to discuss the brochure’s contents with family 

members and friends. 
Session Two


What’s Going On in the Family? 
i i il

session two: whAt’s going on in the fAmiLy? 

 

Session Two 

What’s Go ng On n the Fam y? 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

Background 

Poorly controlled diabetes can result in devastating 

complications, such as stroke, heart attack, amputation, 

kidney disease, blindness, and death. After a death from 

diabetes, surviving family members can experience many 

emotions that can be either punishing or empowering. 

Facing these emotions is an important part of the grieving process that enables people to move on to positive 

action. Coping with diabetes complications (e.g., amputation, blindness, or kidney failure) also involves a grieving 

process that is important in accepting the challenge of 

living with diabetes. 

Objectives 

1.	 To identify some of the emotions that family members 

may experience when a loved one has diabetes. 

2.	 To identify ways that family members can help or hurt 

themselves in coping with complications of diabetes 

or a death in the family from diabetes. 

Time needed for discussion: 45 to 60 minutes. 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor. 
20 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

•	 The Troubleshooting section of this guide [for your 

review before leading this session]. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

Tell the group: Think about the funeral scene in the film 

The Debilitator. [You may wish to replay that scene in the 

film to refresh participants’ memories .] 

Consider using the following questions to guide the 

discussion: 

1.	 Ask the group: How do you think Calvin’s daughter 

Latosha feels? How do you think his son Bobby feels? 

How does Calvin’s wife Monica feel? 

Make sure that the following points are brought out 

in the discussion: 

•	 Survivor guilt. Sometimes people feel guilty that 

they couldn’t do more for the person before he or 

she died, and they blame themselves in a way that 

is not constructive. 

•	 Anger. This is a normal emotion that may evoke the 

question “Why did he leave us?” 

•	 Worry about financial issues. 

•	 Blaming the victim. This blame may lead to 

statements such as “He knew he wasn’t taking care 

of himself.” 

2.	 Ask the group: Is there any way to turn these emotions into positive actions? 
session two: whAt’s going on in the fAmiLy? 

2 

Make sure that the following points are brought out 

in the discussion: 

•	 Sometimes it takes a tragedy to wake us up to the 

need to make changes. 

•	 You can turn anger into action. Anger can give rise 

to positive resolutions, such as “There’s no way I 

am going to let this happen again!” 

•	 Blaming the victim is never useful. People who 

develop diabetes are not “bad,” and it is not 

helpful to look at them and their behavior as “being 

good” or “being bad.” What is helpful is learning 

to problem-solve. 

•	 Children may be more likely to verbalize accusatory 

statements such as “Why did you go and leave 

me?” but adults often feel this way, too. Blaming 

others and feeling guilty are not helpful and often 

prevent people from going on to more positive 

action. 

•	 Just talking honestly about emotions helps. Once 

people have had a chance to talk about their pain 

and fears, they can move on to finding solutions. 

3.	 Ask the group: Are any of you willing to share a story 

of how diabetes affected your family, and how you 

dealt with the emotions that arose? [Be prepared for 

participants to express a lot of emotion here . Crying 

is OK, and it can be important in the healing process . 

You may want to read the Troubleshooting section in 

this guide before leading this discussion.] 

4.	 Ask the group: Does anybody have any suggestions 

about what family members can do to cope with grief 

when a loved one dies of diabetes? 

Make sure that the following points are brought out 

in the discussion: 

•	 Seek help if you are grieving. Go to a counselor, 

talk to your spiritual advisor or religious leader, 

or ask your local hospice organization for 

suggestions. 
22 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 Share your grief with loved ones. Don’t be afraid to 

open up and talk. 

5.	 Ask the group: Does anybody have any suggestions 

about what family members can do to cope when a 

loved one develops a serious complication from 

diabetes? 

Make sure that the following points are brought out 

in the discussion: 

•	 Accompany the person with diabetes to his or her 

doctor’s appointments so that you can learn more. 

•	 Ask for a referral to a physical therapist, occupational 

therapist, or mental health counselor to help you 

and your family member deal with the physical and 

mental stress of a diabetes complication. 

•	 Go to a diabetes support group on your own, or 

with the person who has diabetes. 

Resources 

Share with the group the resources listed in the 

References and Resources section at the end of this 

discussion guide. Consider making photocopies of the 

materials in that section as handouts for each participant. 
Session Three


Be Smart About Your Heart: 

Know Your ABCs 
session three: Be smArt ABout your heArt 

2 

Session Three 

Be Smart About Your Heart: 

Know Your ABCs 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

Background 

Heart disease and stroke kill two-thirds of people with 

diabetes. Blood sugar (blood glucose) control is very 

important for preventing these complications and others, 

but so are blood pressure and cholesterol control. 

Objectives 

1.	 To identify some of the signs and symptoms of heart 

disease. 

2.	 To name the ABCs of diabetes. 

3.	 To discuss why control of the ABCs of diabetes is 

important. 

4.	 To identify some practical day-to-day actions that 

people with diabetes can take to control the ABCs. 

Time needed for discussion: 45 to 60 minutes. 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor. 

•	 Handout: NDEP brochure Be Smart About Your Heart . 

Control the ABCs of Diabetes: A1C, Blood Pressure, and 

Cholesterol (at least one copy for each participant). 
2 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Order the brochure by fax or mail using the NDEP 

Publications Order Form at the end of this guide, order 

the brochure online from http://www.ndep.nih.gov, or 

download it for photocopying from http://ndep.nih. 

gov/diabetes/pubs/ControlABC_broch_Eng.pdf. 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

Make sure to cover these important points during 

the session: 

•	 The number one cause of death among people with 

diabetes is heart disease. 

•	 The ABCs of diabetes are A1C, Blood pressure, and 

Cholesterol. 

•	 A1C (formerly known as hemoglobin A1C) measures 

average blood sugar (blood glucose) control over the 

past 3 months. The goal for a person with diabetes is 

to have an A1C level of less than 7.0. 

•	 Controlling blood pressure is also very important in 

people with diabetes. High blood pressure increases 

the work that the heart must do to push the blood 

through the body, and it can lead to heart attack, 

stroke, and eye and kidney disease. The goal for 

blood pressure for someone with diabetes is less 

than 130/80. 

•	 Cholesterol is a fat that clogs up the arteries and 

makes it harder for blood to flow through them. A 

high level of LDL cholesterol (the “bad” cholesterol) 

increases the risk of a heart attack, a stroke, and circulation problems. The goal for LDL cholesterol for 

someone with diabetes is less than 100. For people 

with multiple risk factors (for example, diabetes, high 
session three: Be smArt ABout your heArt 

2 

blood pressure, and tobacco use), the goal for LDL 

cholesterol is less than 70. 

1.	 Tell the group: Think back to the funeral scene in the 

film. [You may want to replay that scene in the film to 

refresh participants’ memories .] 

Consider using the following questions to encourage 

discussion of the important points for this session: 

•	 Were you surprised that Calvin dies of a heart 

attack in his dream? Were you aware of the link 

between diabetes and heart disease? 

•	 Why do you think that people with diabetes are 

more likely than people without diabetes to have 

heart disease and stroke? 

2.	 Tell the group: Think now about the scene in which 

Calvin tells his daughter, “I’ll be all right....I’ll mow the 

lawn later and that will be my exercise, and that will 

bring my blood sugar down.” [You may want to replay 

that scene in the film .] 

Consider using the following questions for


discussion:


•	 Ask: What do you think, or how do you feel, about 

the fact that (in his dream) Calvin dies of a heart 

attack while mowing the lawn? 

Potential reactions include: 

–	 What was his family supposed to do? He went 

out to exercise, and he dropped dead! 

–	 I thought that he was dying of heat stroke 

because he was sweating. 

–	 This scene is proof that exercise is dangerous. I 

don’t want to die while getting exercise. Wasn’t 

there a famous exercise guy who died while 

running? 

•	 Say: So there may be some mixed messages in 

this scene about exercise. Did Calvin have early 

warning signs that he might be having trouble with 

his heart? 
2 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Make sure that the following points are brought out 

in the discussion: 

•	 Swelling in the feet and trouble breathing when 

lying flat in bed can be signs of heart trouble. 

•	 Even if no symptoms occur, high blood sugar and 

high blood pressure by themselves are risk factors 

for heart attack and stroke. 

3.	 Ask: Now that we know about these early warning 

signs, does anyone have any suggestions about what 

Calvin could have done to avoid having a heart attack 

while mowing the lawn? 

Make sure that the following points are brought out 

in the discussion: 

•	 He could have talked to his doctor about how to 

start increasing his physical activity safely. 

•	 He could have talked to his doctor about how to 

get his blood sugar and his blood pressure under 

control before exercising heavily. 

•	 He could have asked his doctor about his swollen 

feet and his shortness of breath. 

•	 He could have talked to his doctor about other 

actions to take to protect his heart (for example, 

taking baby aspirin, or giving up tobacco if he 

smokes or chews). 

•	 He could have talked to his doctor about whether 

he needed an exercise treadmill test or other tests 

of his heart’s function. 

•	 He could have learned the early warning signs of a 

heart attack. 

4.	 Ask: Can anybody name some benefits of getting 

regular physical activity, especially for people with 

diabetes? 
session three: Be smArt ABout your heArt 

2 

Make sure that the discussion brings out the fact that 

physical activity can 

•	 Lower your blood sugar. 

•	 Lower your blood pressure. 

•	 Reduce stress. 

•	 Help you sleep better. 

5.	 Say: So, with all these benefits of increased physical 

activity, why did Calvin die while mowing the lawn in 

his dream? 

Make sure that the following points are brought out 

in the discussion: 

•	 His blood sugar and blood pressure may have been 

too high at the time because he was not taking his 

medication, not eating right, or not taking care of 

himself in general. 

•	 He started strenuous physical activity abruptly, and 

it was too much for him. 

•	 He may not have recognized, or he may have been 

ignoring, early warning signs of a heart attack 

(chest pressure, nausea, shortness of breath, 

dizziness, sweating). 

6.	 Tell the group: Now I’d like you to think now about the 

scene with Calvin and Dr. Goodson. [You may want to 

replay that scene in the film .] 

Consider using the following questions for discussion: 

•	 Ask: Can anybody remember the points that Dr. 

Goodson made about how to take care of your 

diabetes? 

Make sure that the following points are brought 

out in the discussion: 

–	 Control your blood sugar. 

–	 Get regular check-ups from your doctor. 
2 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

–	 Take medicines as directed. 

–	 Eat healthful meals. 

–	 Get regular physical activity. 

•	 Ask: Can anyone tell me what A1C means? [A1C 

measures average blood sugar (blood glucose) 

over the past 3 months .] Do you remember how 

Dr. Goodson and Calvin Dixon described A1C? [It 

is like a batting average .] Can anyone tell me what 

the A1C goal is for a person with diabetes? [The 

A1C goal is less than 7 .0 .] 

Classroom Exercise 

1.	 Say: Checking your blood sugar with a fingerstick 

tells you what your blood sugar is at that moment. 

When you check your own blood sugar at home with 

a glucose monitor, that gives you a snapshot of what 

your blood sugar is at the moment. But you want to 

know the bigger picture, not just a snapshot. The A1C 

measurement can tell you the 3-month average of all 

those ups and downs. 

2.	 Ask: Can anyone tell me what your average blood 

sugar is if your A1C is 7.0? 

Make sure that the following points are brought out 

in the discussion: 

•	 An A1C of 7.0 corresponds to an average blood 

sugar of 150 over the past 3 months. 

•	 This does not mean that the goal for a fasting 

blood sugar level (first thing in the morning before 

you eat) is 150. 

•	 It is best to start the day with a fasting blood sugar 

of 80 to 120. 

3.	 Say: The film didn’t give much information about 

blood pressure and cholesterol. Does anyone know 

what the ABCs of diabetes are? [It’s OK to drop hints if 

no one comes up with the answer right away .] 
session three: Be smArt ABout your heArt 

2 

Make sure that the following points are brought out 

in the discussion: 

•	 A = A1C. 

•	 B = Blood pressure. 

•	 C = Cholesterol. 

4.	 Say: We just talked about the goal for A1C. What was 

that goal again? [Less than 7 .0 .] 

5.	 Ask: Does anyone know what the goals are for blood 

pressure and LDL cholesterol for someone with 

diabetes? 

Make sure that the following points are brought out 

in the discussion: 

•	 The goal for blood pressure is less than 130/80. 

•	 The goal for LDL cholesterol is less than 100. 

6.	 Ask: Can anyone name some actions that you can take 

to reach your ABCs? 

Make sure that the following points are brought out 

in the discussion: 

•	 Take the medicines prescribed by your doctor. 

•	 Eat less fat (lard, butter, fatty meats, grease,


fried foods).


•	 Eat less salt. 

•	 Be physically active. 

•	 Lose some weight. 

•	 Eat more fresh fruits and vegetables. 

Distribute and Review Handout 

Distribute the NDEP brochures If You Have Diabetes, Know 

Your Blood Sugar Numbers and Be Smart About Your Heart . 

Control the ABCs of Diabetes: A1C, Blood Pressure, and 

Cholesterol to each participant. Tell the participants to take the 

brochure home and discuss its contents with family members 

and friends. 
Session Four


Every Day Is a New Beginning 
i i

session four: every DAy is A new Beginning 

 

Session Four 

Every Day Is a New Beg nn ng 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

Background 

Learning to live with diabetes is not easy. Managing diabetes means making changes in eating habits, probably 

increasing physical activity, possibly taking medications, 

and dealing with the emotions that may arise from living 

with a chronic disease. Behavior change does not happen 

overnight. A person usually goes through many emotional stages in accepting and making diabetes-related 

changes. Family and social support is very important in 

making these transitions smoothly. 

Objectives 

1.	 To discuss some of the emotional barriers to making a 

behavior change. 

2.	 To identify ways in which family members can help a 

person with diabetes make healthy lifestyle changes 

and to identify actions that family members should 

avoid because they may discourage a person from 

making these behavior changes. 

3.	 To discuss the emotional stages of change that a 

person may go through when confronting a chronic 

illness or serious life event. 

Time needed for discussion: 45 to 60 minutes. 
2 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor. 

•	 Handout: Emotional Stages of Change (included in 

this discussion guide kit; make at least one copy for 

each participant). 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

Make sure to cover these important points during 

this session: 

•	 Many people go through several emotional stages 

before they can learn to live healthfully with diabetes. 

Most people, at some time, go through these general 

stages: 

–	 Denial. 

–	 Depression. 

–	 Anger. 

–	 Bargaining. 

–	 Acceptance. 

•	 People don’t always go through the stages in this 

order. They may experience them in a different 

sequence, or they may waver back and forth between 

emotions. Also, they may experience different emotional stages for different reasons; for example, they 

may accept that they need to walk more but may be 

angry about glucose monitoring or in denial about 

preventing complications. 
session four: every DAy is A new Beginning 

 

–	 Family interactions can help or hurt a person 

experiencing these emotional stages. Role playing 

and discussion are important ways to learn what is 

helpful and what is not. Interactions may be hurtful 

if they are not based on an understanding of the 

challenges that a person faces in dealing with 

diabetes. It is a normal human reaction to push 

back when someone is nagging you, yelling at you, 

or being sarcastic toward you. Helpful interactions 

are based on accepting that living with diabetes is 

hard. These helpful interactions may include gentle 

reminders, but they may also involve looking 

for ways to identify barriers, assisting in finding 

solutions, and offering motivation and support for 

making behavior changes. 

–	 Emotions such as fear, anxiety, sense of loss, grief, 

and anger all present barriers to making healthy 

lifestyle changes and performing daily self-care 

tasks necessary for controlling diabetes. For a 

person with diabetes, or for his or her family and 

friends, expressing these emotions is not “giving 

in” to diabetes. It is a healthy step towards dealing 

with these emotions so that one can move on to 

a course of action. An emotion that is stuck in a 

person’s heart or head could be absorbing a lot of 

energy that could be channeled into taking control 

of diabetes. 

1.	 Tell the group: Think about the scene in Calvin Dixon’s 

dream in which Calvin’s daughter Latosha confronts 

him while he is watching TV in the living room. [You 

may want to replay the scene to refresh participants’ 

memories .] 

2.	 Ask: Does anyone have any general comments about 

this scene? [If so, lead off the discussion with those 

points . If not, proceed to the first discussion question 

below .] 

3.	 Ask: What emotions do you think Calvin is experiencing? What emotions do you think Latosha is 

experiencing? 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Make sure that the discussion brings out the


following points:


•	 Denial. Calvin is ignoring his symptoms: his feet 

are swelling up, he is short of breath, he is not 

checking his blood sugar, and he is not paying 

attention to what he eats. 

•	 Depression. This emotion is not obvious in this 

scene, but it might be playing a part in Calvin’s 

choice of food. Many people use food to try to 

cope with depression. 

•	 Anger. Both Latosha and her father are showing 

some anger about the situation. 

•	 Bargaining. Calvin says, “I’ll be all right...I’ll mow 

the lawn later and that will be my exercise...” 

4.	 Ask: Does anyone have any suggestions for handling 

these emotions? What could Latosha say to help 

her father? What could Calvin do to deal with these 

emotions? 

Make sure that the discussion covers the


following points:


•	 In dealing with all of these emotions, nagging 

or yelling is usually NOT helpful and can push 

a person away. What can be helpful are gentle 

reminders, assisting with problem solving, and 

offering motivation and support for making 

behavior changes. 

•	 For denial, avoid arguing. Make a factual statement 

about how diabetes can affect a person’s health, 

and then state that the final decision about making 

changes lies with the person with diabetes. Tell 

the person that you know that he or she can make 

these changes. It is good to let the person know 

that you are concerned and that you want to 

know how you can help. It is OK to offer reading 

materials for him or her to consider reading later. 

•	 For depression, ask the person to identify barriers 

to overcoming this emotion, and help him or her 

brainstorm about solutions. 
session four: every DAy is A new Beginning 

 

–	 Be on the lookout for lack of self-confidence (“I 

don’t know how...” or “I can’t do...”). Ask the 

person to identify what he or she CAN do. 

–	 Be on the lookout for lack of social support (“No 

one understands...” “I’m the only one who can 

do...”). Ask the person if he or she can think of 

one person to turn to for help. 

–	 Sometimes guilt or fear of failure is a sign of 

depression (“I can’t face the doctor if my blood 

sugar is high again.” “It’s no use. Every time I 

try, I mess up.”). 

•	 For anger, you need to “defuse” the situation. 

Yelling back at the person doesn’t help. Letting 

the person know why you are worried does. Point 

out the methods that seemed to work in the past, 

and ask what you can do to help the person get 

back on track. Don’t tell the person what to do— 

remember that Calvin needed to make his own 

decision—but ask what he or she has tried before, 

what worked, and how you can be supportive. 

Encourage the person to name barriers out loud, 

and then ask if you can help him or her make a 

plan to overcome them. 

–	 The person may say, “I can’t go for a walk. 

Who’s going to stay home with Bobby?” 

–	 You may then reply, “Well, we all think that 

going for a walk would be better for you right 

now, and we want to help. Why don’t we all 

go for a walk together?” or, “Can you think of 

someone else who can stay with Bobby?” 

It is OK to make suggestions, but it is usually best 

simply to help the person come up with his or her 

own solutions to overcoming barriers. 

•	 For bargaining, coax the person into reality if what 

he or she proposes doesn’t sound like a good idea. 

Again, don’t TELL the person what to do—ASK. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

–	 You may say something like, “I can’t help but be 

a little worried. Can we call Dr. XXX to make an 

appointment about your foot swelling?” 

–	 Talk about the positive aspects of making 

changes. You may say, “Your feet will feel better 

if we can do something about that swelling.” 

–	 Correct the person’s misperceptions, such as: 

“I don’t want to bother the doctor.” You might 

reply, “You’re not bothering the doctor. The 

doctor wants to know what’s going on with 

you.” 

5.	 Ask: Would anybody like to volunteer to do some role 

playing? I’d like you to recreate the scene between 

Calvin and his daughter, except this time act as though 

each character is very angry. For example, imagine 

that Calvin says, “Leave me alone. I don’t need my 

children telling me what I can and can’t do! My breathing is none of your business!” See if Latosha can 

“defuse” the situation. [Ask for suggestions from the 

group . Then have volunteers recreate the scene using 

these suggestions .] 

6.	 Say: In this same scene in the film, Calvin and Latosha 

also talk about his not taking his medicine. What are 

some reasons that people don’t take their medicines? 

Reasons may include: 

•	 Lack of understanding of what the medicine is for, 

and why it is important to take it. 

•	 Fear of side effects. 

•	 Actual experience of side effects. 

•	 High cost of the medicine. 

•	 Denial, depression, anger, and bargaining emotions 

previously discussed. 

•	 Inconvenience of refilling the prescription for the 

medicine. 
session four: every DAy is A new Beginning 

 

•	 Inconvenience of needing to see the doctor for 

a refill. 

7.	 Ask: Does anyone have any suggestions for what 

actions people with diabetes can take so that their 

medicines will work better for them? 

Suggestions may include: 

•	 Bring a written list of questions about the 


medicines to the doctor.


•	 Talk to the pharmacist about the medicines. 

•	 Be honest with the doctor and the pharmacist 

about fears, concerns, and side effects related to 

the medicines. 

•	 Tell the doctor and the pharmacist about any 

problems with the cost of the medicines. Maybe 

they can help with getting the medicine less 

expensively or switching to another medicine. 

8.	 Tell the group: These same issues apply to overcoming barriers to changing diet and physical activity 

behaviors. Getting support from family and friends, 

discussing these barriers with medical professionals, 

and learning ways to make healthy lifestyle changes 

are important, just as taking medicines is important. 

Optional Classroom Activity 

Consider trying another role play about Calvin and his 

medication. Ask volunteers to play Calvin making a list of his 

questions and concerns for the doctor and the pharmacist 

and practicing what he will say to each of them. 

Homework Exercise 

Give out copies of the handout Emotional Stages of Change. 

If there is time in the session, you may want to read some 

statements from the brochure aloud. Ask participants to look 

at the brochure at home, discuss it with family or friends, and 

come up with a few statements of their own for each emotional stage of change. Participants may also be interested in 

the NDEP brochure “Tips for Helping a Person with Diabetes,” 

available from http://www.ndep.nih.gov/diabetes/pubs/ 

TipsHelping_Eng.pdf 
hAnDout for session four: emotionAL stAges of ChAnge 

 

Handout for Session Four 

Emotional Stages of Change


People don’t accept a diagnosis of diabetes overnight. Being told that you have 

diabetes is a frightening experience. Many people close their ears and cannot hear 

anything about diabetes until they have worked through their emotions. 

Adjusting to the diagnosis of diabetes can be like riding an emotional roller coaster. 

People with diabetes have ups and downs not only in blood sugar but in mood, and 

they can go back and forth between several emotional stages before they finally 

reach an acceptance of their diabetes. These stages include denial, anger, bargaining, depression, and finally acceptance. Each stage is described below. 

Denial. The person refuses to believe that he or she could have diabetes, or refuses 

to accept that it is a serious condition that requires making some changes. 

Can you think of other things that people in denial might say?

 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Depression. Feeling hopeless, helpless, worthless, and guilty is all part of depression. Depression can also express itself as self-hatred. The symptoms of depression 

sometimes can be subtle and hard to recognize. Not everyone with depression cries 

all the time or acts irrationally. Some people overeat or turn to alcohol or drugs to 

try to deal with depression. People experiencing depression may even kill themselves in a way by ignoring their health problems and slowly allowing themselves 

to die. Depression can lead to a worsening of diabetes if people become unable to 

make decisions or to take care of their diabetes. 

Can you think of other things that people experiencing the emotional 

stage of depression might say? 
hAnDout for session four: emotionAL stAges of ChAnge 

 

Anger. Life is not fair, but dealing with this fact by becoming angry is usually not 

helpful. Anger often leads to blaming, striking out, and actions that further isolate a 

person from his or her support system: family, friends, and doctors. Some people 

learn to harness their anger and turn it into action. Statements such as “I’m not 

going to let this diabetes hold me down!” can be a very positive direction in which 

to channel anger. 

Or, learn to harness anger and turn it into action: 

Can you think of other things that people experiencing the emotional 

stage of anger might say? 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Bargaining. Trying to make a deal with oneself, or with fate, is a normal human reaction to bad news. But sometimes it leads to unrealistic thoughts, such as, “I promise 

I won’t yell at my daughter anymore...then this diabetes will go away.” “If I pray 

hard enough, I’ll be cured.” 

Can you think of other things that people experiencing the emotional 

stage of bargaining might say? 
hAnDout for session four: emotionAL stAges of ChAnge 

 

Acceptance. A final emotional stage is accepting the diagnosis of diabetes and the 

changes a person must make in life to keep diabetes under control. Acceptance 

doesn’t necessarily mean that a person is happy with the diagnosis, but learning to 

live with diabetes can be a source of inner personal strength. A person may reach 

this stage in general, but then may slip back into another stage if a new complication or problem related to diabetes occurs, or if life becomes more stressful in 

other ways. 

What else might a person in the emotional stage of acceptance say?

Session Five


Diabetes Detection: Could I Have 

Diabetes Right Now and 

Not Know It? 
session five: DiABetes DeteCtion 

Di i ld I 

i i

 

Session Five 

abetes Detect on: Cou

Have D abetes R ght Now... 

and Not Know It? 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

Background 

Approximately 18.2 million people in the United States 

have diabetes, and about one-third of them don’t even 

know that they have it. Diabetes may go unrecognized 

for many years because the person with diabetes either 

experiences no symptoms, doesn’t tell his or her doctor 

about the symptoms, or thinks that the symptoms are 

from something else (such as getting older or feeling 

stressed). 

Objectives 

1.	 To discuss how diabetes can damage the body silently 

when a person does not know he or she has it. 

2.	 To use the Diabetes Detection Initiative Risk Test to 

determine whether one is at increased risk. 

3.	 To describe the symptoms of diabetes. 

Time needed for discussion: 30 to 45 minutes. 
0 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor. 

•	 Handout: Diabetes Detection Initiative Risk Test 

included in this discussion guide kit; make at least 

one copy for each participant. The brochure may also 

be downloaded from http://www.ndep.nih.gov/ddi/ 

resources/risktest.pdf. 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

1.	 Tell the group: I’d like you to think about how Calvin 

was diagnosed with diabetes. 

2.	 Ask: When was he first told that he had diabetes? 

Make sure that the discussion covers the


following points:


•	 He was told one year earlier by another doctor but 

then never went back to that doctor. 

•	 He had been given medicines and a blood glucose 

machine but had never used them 

3.	 Tell the group: Think back to the doctor’s office scene 

in the film. [You may consider replaying this scene to 

refresh participants’ memories .] 

4.	 Ask: How did Calvin respond when Dr. Goodson asked 

him if he had ever been told that he had diabetes? 
session five: DiABetes DeteCtion 

 

Make sure that the discussion brings out these three 

things that Calvin said or asked: 

•	 “I didn’t believe it, so I never went back.” (He just 

didn’t believe it.) 

•	 “Isn’t diabetes just what we call sugar?” (He didn’t 

take the diagnosis seriously.) 

•	 “Am I dying?” (Now he is really worried because 

the diabetes has gone on for so long.) 

5.	 Ask: What did Calvin tell his family after that first 

doctor’s appointment? Did he tell them later that the 

first doctor had told him that he had diabetes? 

Make sure that the discussion brings out the


following points:


•	 Calvin’s wife first learns that Calvin has diabetes 

when she sees his medicines from Dr. Goodson’s 

office. He didn’t share much information with her 

from his appointment with the first doctor a year 

earlier. 

•	 Calvin’s daughter asked, “Didn’t you have a blood 

glucose test a few months ago?” but it appeared 

that she thought that the results at that time were 

normal. 

Note: In the dream, Calvin’s daughter seems to 

know that Calvin has diabetes, but later during the 

dinner conversation, it appears that the diagnosis 

is news to all of the family. Don’t get stuck on this 

point if participants express confusion about it. 

Suggest that dreams don’t show exactly what is 

happening in real life but instead show what is in 

a person’s subconscious—what a person is afraid 

of or worried about, or simply what’s on the 

person’s mind. 

6.	 Ask the group: Can you see this same thing happening 

in your family? If you found out that you had diabetes, 

would you tell your family? Why or why not? 
2 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Responses might include 

•	 Yes, we are very open in my family, and we talk 

about medical problems. 

•	 No, people in my family don’t want to worry one 

another (or worry Mom, or one particular person in 

the family), so we don’t talk about problems. 

•	 Yes, I couldn’t keep being on medication a secret 

from my family, and I wouldn’t want to. 

•	 No, I would be ashamed. Or I’d be afraid I’d get an 

“I told you so” lecture, or that I’d be a bad example 

for my kids if I let them know I had diabetes. 

•	 Yes, I’d be afraid that if I had a low blood sugar 

reaction or some problem, they wouldn’t know 

what to do unless I’d told them about my diabetes. 

•	 No, everyone would be worried all the time about 

me, or nagging me, and that would drive me crazy. 

•	 Others? 

Brainstorming Activity 

Explore with the group what could be done to turn those 

“No, I wouldn’t tell them” answers into “Yes, I would 

want to talk to them about my diabetes” answers. 

1.	 Ask: Does anyone remember what symptoms of diabetes Calvin is having? 

Answers might include: 

•	 Tired all the time. 

•	 Going to the bathroom a lot (urinating a lot). 

2.	 Ask: Can anyone name other symptoms of diabetes? 

Answers might include: 

•	 Blurred vision. 

•	 Thirsty all the time. 
session five: DiABetes DeteCtion 

 

•	 Vaginal yeast infections in women. 

•	 Others? 

3.	 Ask: Are there other things that can cause these 

symptoms? 

Answers might include: 

•	 Yes, lots of things, such as depression, getting 

older, or infections. 

4.	 Ask: Do you think that a person could have diabetes 

and have no symptoms at all? [Answer: Diabetes can 

occur with no symptoms, or the symptoms can be 

attributed to other causes .] 

Answers might include: 

•	 Yes, diabetes can “sneak up” on you slowly, so you 

don’t notice the changes. 

•	 Yes, a lot of those symptoms don’t show up until 

your blood sugar is very high. 

•	 No, don’t you think a person could feel it if his or 

her blood sugar was up? 

Note: Some people insist that they can “just tell” what 

their blood sugar is without measuring it. There is no 

scientific proof of this assertion, but it is probably not 

worthwhile to argue with participants about this point 

during this session. The point of the session is that it 

is possible to have diabetes and not know it; it is possible to have no symptoms while diabetes is silently 

causing damage. 

Classroom Exercise 

Pass out copies of the Diabetes Detection Initiative Risk 

Test. Ask participants to spend 5 minutes taking the test 

and figuring out their scores. 

1.	 Ask the group: Now that you have taken this risk test, 

are any of you willing to share your feelings about 

talking to your doctor about getting tested for diabetes? 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Homework Exercise 

Suggest that participants take their copy of the risk test 

home to discuss it with family and friends and to encourage those people to take the test themselves and figure 

out their scores. 
hAnDout for session five: DiABetes DeteCtion initiAtive risk test 

 
new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

 
Session Six


You Can Be Your Own Worst Enemy 

or Your Own Best Friend 
i

session six: own worst enemy or own Best frienD 

 

Session Six 

You Can Be Your Own 

Worst Enemy...or Your 

Own Best Fr end 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

Background 

Stress can bring out the worst or best in a person. 

Sometimes people actually punish themselves in stressful situations by doing things that are bad for their health 

or destructive to their self-esteem. 

Objectives 

1.	 To discuss ways in which Calvin shows behaviors and 

attitudes that work against him. 

2.	 To describe ways in which Calvin acts as his own best 

friend to help him deal with stress. 

3.	 To discuss how a person can be his or her own worst 

enemy or best friend. 

4.	 To identify ways in which a person can break selfdestructive habits and build positive ones. 

Time needed for discussion: 45 to 60 minutes. 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 Pens or pencils, paper, and an envelope for each 

member of the group (including the facilitator). 

•	 Stamps for mailing each envelope. 

•	 Handout: Home Exercise (included in this discussion 

guide kit; make one copy for each participant). 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

Introduce the session with this background concept: 

Stress can bring out the worst or best in a person. 

Sometimes people actually punish themselves in stressful situations by doing things that are bad for their health 

or destructive to their self-esteem. 

1.	 Tell the group: I’d like you to identify some of the 

things Calvin does that work against him, and why he 

does them. Sometimes the “reason” a person does 

something is not a factual explanation but an attitude 

or an emotion. [You may want to write key words from 

the discussion on a flipchart or blackboard .] 

Make sure that the discussion brings out the following points about the actions that Calvin takes 

that work against him and make him his own worst 

enemy: 

•	 Action: In Calvin’s dream, Calvin’s daughter finds 

him eating large portions of unhealthful foods 

while he is sitting in front of the TV. 

Possible reasons: 

–	 He’s tired, and this is how he relaxes. 

–	 These foods taste good. 

–	 He eats more when he is stressed or tired. 
session six: own worst enemy or own Best frienD 

 

–	 He doesn’t want to think about whether the 

foods are healthful or not. 

–	 Others? 

•	 Action: Calvin tells his daughter to leave him alone 

when she tries to help him. 

Possible reasons: 

–	 He knows that she’s right, but he doesn’t 

want to think about what she is saying and is 

annoyed. 

–	 He doesn’t want to face his diabetes. 

–	 It’s the wrong time for this discussion because 

he’s tired. 

–	 He feels that she is nagging or accusing him. 

–	 Others? 

•	 Action: The first time that Calvin is told that he has 

diabetes, he hides this fact from his wife. 

Possible reasons: 

–	 Denial. He doesn’t want to believe the 


diagnosis.


–	 He doesn’t want to worry her. Perhaps he is 

worried about his job as a truck driver or about 

his insurance. 

–	 Others? 

•	 Action: Calvin doesn’t go back to the first doctor 

for follow-up. 

Possible reasons: 

–	 Denial. He doesn’t want to believe that it’s 

important to do so. 

–	 Excuses. Maybe Calvin doesn’t want to take 

the time off from work, or maybe his work 

schedule makes it hard for him to keep a 

regular appointment. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

2.	 Ask: But aren’t these the excuses that your own worst 

enemy would give? 

3.	 Ask the group: What does it mean to be your own 

best friend? What kind of actions does a best friend 

take to help you out? 

Make sure that the discussion brings out the


following points:


•	 A best friend is kind but doesn’t let you make 

excuses. 

•	 A best friend helps you decide what you want to do 

without telling you what to do. 

•	 A best friend might not be as hard on you as you 

are on yourself, but he or she would still point out 

the things that you are doing that are harmful. For 

example, a best friend might suggest that it’s no 

use feeling guilty about past overeating, but that 

you might want to get rid of those potato chips you 

have in the house if you really plan to quit “pigging 

out” in front of the TV. 

•	 A best friend reminds you to think about what’s 

most important to you. 

4.	 Ask the group: In the film, how does Calvin show that 

he can also be his own best friend? 

Make sure that the discussion brings out the


following points:


•	 Action: Calvin faces thinking about the bad dream 

that he had. 

Possible reasons: 

–	 He knows deep inside that there is some truth 

to the dream. 

–	 He wants to protect his family from losing him. 

–	 The dream “shook him up” enough that now 

he’s ready to face reality and do something 

about his diabetes. 

–	 Others? 
session six: own worst enemy or own Best frienD 

 

•	 Action: Calvin listens to and thinks about the 

doctor’s advice. 

Possible reasons: 

–	 He is willing to try something new because 

what he has been doing isn’t working well for 

his health. 

–	 He is willing to take charge and to take action. 

–	 He is willing to ask for help. 

–	 Others? 

•	 Action: Calvin shares his concerns with his family 

members. 

Possible reasons: 

–	 They are important to him. 

–	 They can help. 

–	 They can give more help if they know what’s 

going on. 

–	 He doesn’t want to scare them, but he thinks 

that they should know what he’s feeling. 

–	 His dream had a serious impact on him and 

gave him the push that he needed to go to the 

doctor, and he wants them to know about it. 

–	 Others? 

5.	 Ask the group: Are you ever your own worst enemy? 

Can you give examples? 

Examples might include: 

•	 Feeling guilty. 

•	 Telling yourself that you are no good, that you 

can’t do anything right, that you brought this on 

yourself, and that you’ll never change. 

•	 Worrying about everyone else, so that you don’t 

take care of yourself. 
0 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 Feeling fearful of facing the truth. 

•	 Seeking out people who are even worse off than 

you (so that you can feel better), but who lead you 

to do unhealthy things (such as drinking too much 

alcohol, being angry at everyone, and blaming 

others instead of making changes). 

•	 Being angry (at yourself, at others, at how unfair 

life is). 

•	 Others? 

6.	 Ask: Are you ever your own best friend? Can you give 

examples? 

Examples might include: 

•	 Telling yourself you can do it (power of positive 

thinking). 

•	 “Patting yourself on the back” for making good 

changes, including small ones. 

•	 Giving yourself credit for problem-solving. 

•	 Asking for what you need (such as help with 

getting more physical activity, restaurant food that 

is prepared healthfully, or kind words instead of 

criticisms from friends and family). 

•	 Sharing your fears (instead of always trying to be 

the “pillar of strength” for everyone else). 

•	 Seeking out positive people who have energy and 

an upbeat attitude. 

•	 Telling yourself that you deserve to have a healthy 

body, a second chance, time to yourself, the right 

to love yourself the way you are, and the right to 

ask for help. 

7.	 Ask: How can you be your own best friend? 

If the following points haven’t already been addressed 

in discussion, consider bringing them out now: 

•	 Don’t beat up on yourself. 
session six: own worst enemy or own Best frienD 

 

•	 But don’t let yourself get away with excuses, either. 

Excuses are your own worst enemy talking. 

•	 Be kind to yourself. Imagine putting an arm around 

yourself and thinking about what you could say 

that would be helpful. Everyone needs comfort, 

but can it be from a hot bath, from a phone call to 

an old friend, or from a walk alone with the dog 

instead of from eating? 

•	 Sometimes being your own best friend means 

allowing yourself to grieve—letting your emotions 

out about loss (of independence, of a loved one, 

of your health) or about your fears (of possible 

complications of diabetes, of disability, of death) so 

that you can move on. A best friend wouldn’t tell 

you to “just hold it all in.” 

8.	 Ask the group: Think back to a very stressful time 

in your life. Imagine that you can go back in time to 

comfort yourself, to offer help, or even just to offer a 

shoulder to cry on. What would you tell yourself? 

9.	 Ask: Is anyone willing to share a story or an example? 

Classroom Exercises 

1.	 Your Own Best Friend Versus Your Own Worst Enemy 

Consider using the mental image of a best friend leaning over one shoulder and a worst enemy hovering 

over the other. A worst enemy doesn’t just tempt you 

with overeating or other unhealthy behaviors; he or 

she also beats up on you emotionally so that you keep 

hurting yourself. A best friend puts a comforting arm 

around your shoulder, offers a kind helping hand, and 

asks you to forgive yourself so that you can do better 

next time. 

Note: This next exercise provides the opportunity for 

participants to learn how to coach themselves with 

positive and comforting thoughts by asking them to 

imagine being their own best friend. Having the leader 

collect the participants’ letters and mail them later can 
2 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

help boost morale and remind people of this


technique.


2.	 Letter-Writing Exercise 

•	 Hand out paper, pens or pencils, and envelopes. 

•	 Ask participants to address the envelopes to 


themselves.


•	 Ask participants to take 5 to 10 minutes to imagine 

being their own best friend. 

•	 Ask each person to write a letter to himself or 

herself as his or her own best friend. 

•	 Ask participants to seal the letter inside the selfaddressed envelope and turn it in to the discussion 

leader/facilitator. 

•	 Mail the letters 2 days after the session. 

Home Exercise 

1.	 Give out one copy of the handout Home Exercise to 

each participant. 

2.	 If there is time, review some of the worst enemy/best 

friend examples from the handout. 

3.	 Ask group members to take the handout home and 

to fill out the reverse side of the handout with some 

of their own worst enemy/best friend examples. 

Ask them to record how they sometimes act as their 

own worst enemy, how they can also be their own 

best friend, and what they would say to themselves 

to help with frustrations or in times of struggle. 

(Note: Consider asking participants to bring their completed form back to the next session to discuss and 

share ideas.) 
hAnDout for session six: home exerCise 

 

Handout for Session Six 

Home Exercise


Being Your Own Worst Enemy Being Your Own Best Friend 

Feeling guilty. Telling yourself to give yourself a break and 

to do things differently next time. 

Telling yourself that you are no good, can’t 

do anything right, brought this on yourself, 

and will never change. 

Reminding yourself that everybody makes 

mistakes sometimes, that it’s never too late 

to make a change; telling yourself that you 

can do it (power of positive thinking). 

Worrying about everyone else, so that you 

don’t take care of yourself. 

Reminding yourself that you have to take 

care of yourself if you are going to be there 

for your family. 

Being fearful of facing the truth. Seeking support from friends, family, 

and faith. 

Seeking out people who are even worse off 

than you (so that you can feel better), but 

who lead you to do unhealthy things (such 

as drinking too much alcohol, being angry 

at everyone, blaming others instead of making changes). 

Seeking out positive people who have 

energy and an upbeat attitude. 

Belittling everything and thinking that, even 

when you make a change, it is always too 

small and is never enough (for example, 

criticizing yourself for losing only 5 pounds 

when you want to lose 50). 

“Patting yourself on the back” for making 

good changes, including small steps; giving 

yourself credit for problem-solving. 

Feeling that you can’t look weak because 

everyone looks up to you and you would 

lose respect if you asked for help. 

Sharing your fears and not always trying to 

be the “pillar of strength” for everyone else; 

realizing that people respect those who are 

self-confident enough to ask for help. 

Feeling that standing up for yourself is selfish and that you will embarrass yourself or 

your family (for example, that you’ll insult 

the hostess if you make your requirements 

for healthful food known). 

Asking for what you need (for example, help 

with getting physical activity, healthfully 

prepared food, or kind words instead of 

criticisms). 

Providing excuses for others’ behavior. Not blaming yourself (“they’re right, I 

deserve it”) but speaking directly; telling 

others to suggest ways that they can help 

instead of offering criticisms. 

WRITE IN YOUR OWN EXAMPLES ON THE REVERSE SIDE 
Session Seven


Emotional “Short Circuits” and 

“Brain Shutdown” 
session seven: emotionAL “short CirCuits” AnD “BrAin shutDown” 

i i i

i

 

Session Seven 

Emot onal “Short C rcu ts” 

and “Bra n Shutdown” 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

Background 

Strong emotions can set off the “fight or flight” response 

of the nervous system. This response, which relies on 

animal instinct instead of thought-out decisions, is helpful in a sudden emergency when a person needs to react 

quickly by running away or fighting back. But when these 

strong emotions remain with people all the time because 

they are upset about something (such as having a chronic 

medical condition like diabetes) and have trouble dealing 

with it, the feelings can be destructive. Hiding these emotions doesn’t help. Finding a way to bring them out and 

face them often does help. 

Objectives 

1.	 To discuss ways that the people in film The Debilitator 

deal with their emotions. 

2.	 To describe what is happening when a person can’t 

think clearly because of strong emotions. 

3.	 To discuss effective and ineffective ways of dealing 

with strong emotions. 

Time needed for discussion: 45 to 60 minutes. 

Materials 

•	 DVD of the film The Debilitator. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 DVD player/TV monitor. 

•	 Small memo pads (3 x 5 inch)—one for each participant—and pens or pencils. 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

Begin the session by discussing how the characters in the 

film The Debilitator deal with their emotions around living 

with diabetes. 

1.	 Tell the group: Think about the last scene of the film, 

which shows people interacting in the diabetes support group. [You may choose to replay the scene to 

refresh participants’ memories .] 

2.	 Ask: Which characters are experiencing strong emotions, and how are they dealing with them? 

Examples might include: 

•	 The African American teenage boy who says, “I 

honestly wish that I was normal like all my other 

friends.” This boy seems stunned and depressed 

about his diabetes. His quiet statement about just 

wanting to be normal is disturbing and makes us 

wonder how much emotion he is holding in. 

Ask: How can holding in these emotions work 

against him? 

•	 The Latina who says, “The blood vessels in my 

eyes are not getting enough oxygen.... I don’t want 

to go blind.” She seems fearful of her future. Fear 

can paralyze people or spur them to action. 

Ask: How is she is dealing with her fear of 

blindness? 
session seven: emotionAL “short CirCuits” AnD “BrAin shutDown” 

 

•	 The white man who says, “I’ve had diabetes for 

about 3 years.... About 6 months ago I had to have 

my foot amputated.” 

Ask: What is going on with his emotions? How 

could they be working against him? 

Possible responses: 

–	 Maybe he had diabetes for a long time but 

couldn’t face thinking about it or didn’t take it 

seriously until he had a serious complication 

(the nerve or blood vessel damage that led to 

the amputation). 

–	 Maybe he was afraid to go to the doctor so his 

diabetes went untreated for years. 

3.	 Ask the group: Where do the people in the support 

group in this film get their strength? Can you recall 

positive attitudes about living with diabetes that the 

other people in the support group shared? 

Examples might include: 

•	 The older African American woman who says, “I’ve 

had diabetes for 10 years, but I don’t claim it. It’s 

my faith that keeps me physically, emotionally, and 

spiritually strong.” 

•	 The white woman with type 1 diabetes who says, 

“Diabetes does not need to be a debilitator.” Her 

attitude is a “take charge” one: take control of your 

diabetes so that it does not control you. 

•	 Calvin says, “I’m going to beat the odds.” He 

has been told about all of the possible serious 

complications of diabetes, but he also knows that 

the statistics do not mean that he will inevitably 

have complications or die from diabetes. 

4.	 Ask the group: Which one of these characters do you 

relate to the most and why? 

Continue the session by discussing how emotions can 

“short-circuit” the brain and cause “brain shutdown.” 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

5.	 Tell the group: Think back to your childhood. Were 

you ever suddenly called on in class to answer a question or do a math problem, and your mind went blank? 

What is going on in a situation like that? Your brain, 

in a sense, short-circuits when you are experiencing 

powerful emotions. It’s hard to think clearly, to make 

decisions, and to deal with things that you could normally handle when your brain short-circuits and shuts 

down. You have to let the emotions out and work 

through them to get your brain back on track. 

6.	 Ask the group: Have you ever had the feeling of a 

lump in your throat, a feeling of tightness as if you 

were closed in, or a feeling that you couldn’t think 

straight because you were upset and were holding in 

your emotions? What did you do that helped? 

Answers might include: 

•	 Yelling. 

•	 Having a good cry. 

•	 Talking to someone. 

•	 Praying. 

7.	 Ask: What are some other things that a person can 

do to deal with these strong emotions that can shortcircuit the brain and hinder a person’s ability to make 

good decisions? 

Make sure that the discussion brings out positive 

actions that people can take to calm their emotions and to increase their decision-making ability. 

Examples might include: 

•	 Exercising. Exercise has a calming effect that helps 

you think clearly. 

•	 Writing in a diary or journal, or writing a letter to 

yourself. 

•	 Talking with others in a support group. 

•	 Giving yourself permission to cry. You may feel 

much better after you let those tears flow, and you 
session seven: emotionAL “short CirCuits” AnD “BrAin shutDown” 

 

may then be able to do what you need to do to 

help safeguard your health. 

•	 Sharing your emotions with your family. Your 

family members are the most important people in 

your life, so don’t shut them out! 

8.	 Ask: What are some negative things people do to 

try to get rid of the panicky feeling that comes from 

strong emotions and that works against them? 

Make sure that the discussion brings out the


following points:


•	 Overeating or binging, especially on junk 

food. Many people do feel calmer when they 

stuff themselves with food, but what they’re 

experiencing is a vicious cycle. 

•	 Drinking alcohol. 

•	 Yelling at your children, your spouse, or your 

friends. 

•	 Hitting someone or something. 

•	 Staring at the television. 

Classroom Exercise 

1.	 Hand out 3 x 5 inch memo pads (one for each participant) and pens or pencils. 

2.	 Ask participants to write their names on their pads. 

Emphasize that this book now belongs to them, and 

that it is small enough to keep with them all the time 

in a purse, or in the pocket of a shirt or jacket. 

3.	 Spend 10 minutes now in a quiet thinking exercise. 

Ask all participants to write down a brief description 

of at least one time when they experienced the brain 

shutdown caused by strong emotions. Then have 

them write down one positive action that they think 

they could take if this situation were to arise again. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

4.	 After 10 minutes has passed, ask if anyone needs 

more time. If yes, give 5 minutes more, and then call 

the group back together. 

5.	 Ask: Is anyone willing to share a story about when 

you experienced “brain shutdown” and what you did? 

If no one responds, you may share a story of your 

own, you can point out what Calvin did, or you can 

do both. Calvin could have just allowed his dream to 

play over and over in his head without doing anything 

except worrying about his diabetes. Instead, he talked 

to his family, and he told his story at a support group. 

He voiced his fears. 

Homework Exercise 

Remind participants to keep their memo pads with them 

and to write down the following: 

•	 Any situations in which they experienced brain shutdown and couldn’t make a decision because they were 

upset. 

•	 What they did (or were tempted to do) in that situation, such as yelling, overeating, or hiding from others. 

•	 What they plan to do to deal more positively with 

strong emotions in the future. 

Tell participants that they may also use the memo 

pad as a personal journal or diary, or to write a letter 

to themselves. 

If the group meets again, consider asking the participants 

at future sessions to share how they have been using 

their memo pads and what changes this writing exercise 

has brought them. 
Session Eight


Children and Family: How 

Can They Understand? 
il il

session eight: ChiLDren AnD fAmiLy 

 

Session Eight 

Ch dren and Fam y: How 

Can They Understand? 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

Background 

Many people are afraid to burden their family with their 

fears or medical concerns. Often people make assumptions that children won’t be able to understand, and that 

it is better to protect them from information about health 

problems. Some people assume that family members 

won’t be willing or able to make lifestyle changes that 

would be better for the person with diabetes—better, in 

fact, for everyone in the family. 

Objectives 

1.	 To discuss what emotional expectations people have 

from their families. 

2.	 To describe how Calvin deals with sharing information 

about his diabetes, and about his fears, with his family. 

3.	 To discuss the role that family can play in making 

major decisions about health and lifestyle. 

Time needed for discussion: 45 to 60 minutes. 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor. 
0 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 Handout: Web page Effects of Diabetes (a copy of 

the Web page is included in this discussion guide kit; 

make at least one copy for each participant). 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

1.	 Tell the group: Think about the opening scene in the 

film at the funeral and about Calvin’s son Bobby. [You 

may want to replay the scene from the film to refresh 

participants’ memories .] 

Consider using the following questions to guide the 

discussion: 

•	 Ask: Does anyone remember what Bobby says to 

his father as Calvin is lying in the coffin? 

Response: 

–	 Calvin’s son says to him at the funeral, “Why 

did you have to die?” 

•	 Ask: What emotions is Bobby feeling? 

Make sure that the discussion identifies the 

following emotions that Bobby is experiencing: 

–	 Loss. 

–	 Fear (“What are we going to do now?”). 

–	 Confusion, and maybe resentment or anger 

(“Why did you have to die?”). 

–	 Others? 

•	 Ask: What do you think children understand about 

death, and what can they handle? 
session eight: ChiLDren AnD fAmiLy 

 

Make sure that the discussion brings out the 

following points: 

–	 It depends on the age of the child. A six-yearold may have “magical (unrealistic) thinking,” 

in which he believes that his father may 

come back to life. A 10-year-old has a better 

understanding of death as being permanent. 

–	 Children at any age, and even adults, can 

believe that they are somehow at fault for the 

person’s death. They may feel guilty for something that they did or said or thought, even if it 

has no relationship to the actual cause of death. 

2.	 Tell the group: Think about the scene in which Calvin 

calls his family together and says, “I don’t want to 

scare you, but I do want to talk to you all about it [diabetes].” [You may want to replay the scene in the film 

before beginning this discussion .] 

3.	 Ask: 

•	 How did you feel when Calvin talks to his family 

about his dream? 

•	 Do you think that having this conversation will help 

Calvin live with diabetes? 

•	 What do you think of the approach Calvin chooses? 

Can you imagine having this conversation with 

your family? Why or why not? 

Make sure that the discussion brings out the


following points:


•	 You can hurt yourself or your family members by 

not talking to them about diabetes because you are 

afraid that the information may scare them. 

•	 Sometimes just talking about something may not 

seem as if it would do much good, but getting 

something off your chest can be a huge relief. 
2 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 It is hard to live with diabetes if you are carrying 

around the knowledge of your condition as a 

big secret or a big burden in your heart without 

sharing it. 

4.	 Ask: 

•	 Do you think that people you know would share 

this kind of emotional information with their 

families, their spouses, and their children? 

•	 Do you think that there are any risks or things to 

consider when talking to family members about 

serious health topics that may affect you? 

Make sure that the discussion brings out the


following points:


•	 An important way to follow up with your children 

is to make sure that they are OK emotionally after 

you have told them about your diabetes. Ask them 

later what they thought about the conversation, 

what they think caused the diabetes, and what 

they think is going to happen to you. Children may 

have unvoiced fears of their own that they need to 

express. 

•	 In the film, Calvin’s son Bobby asks, “Dad, does 

this mean we can’t play football and basketball 

anymore?” The family may be concerned that a 

person with diabetes has to be protected from 

exertion. They may misunderstand what is helpful 

and healthful and what is not. 

•	 In the film, Calvin’s daughter asked him, “Didn’t 

you have a blood glucose test a few months ago?” 

Family members may not feel that the subject that 

you are bringing up is news because they don’t 

realize how your attitude toward your diabetes has 

changed. Calvin could have responded, “Yes, but I 

didn’t take it seriously then, and now I do.” 
session eight: ChiLDren AnD fAmiLy 

 

5.	 Tell the group: Think now about the scene in which 

Beverly Goodson has a conversation with her mother. 

[You may choose to replay this scene before the


discussion .]


6.	 Ask: What emotions do you think are coming into play 

in this scene? 

Examples may include the following emotions: 

•	 Denial. Beverly’s mother keeps changing the 

subject, saying, “Oh baby, let’s talk about you.” 

•	 Fatalism. People may have the feeling that there 

is nothing a person can do to prevent diabetes 

complications. Beverly’s mother says, “I just want 

to see you married with children before I die.” At 

some level she is afraid, and she is worried about 

her diabetes, but she also feels that her situation is 

in the hands of fate and is not under her control. 

•	 Anxiety. People may push away responsibility 

for their own health because they are focused on 

taking care of others. Mrs. Goodson says, “I’m not 

worried about me; I’m worried about you.” How 

often does this situation come up in your family? 

How can this situation work against a person with 

diabetes? 

•	 Frustration. Beverly Goodson tells her mother that 

this year at medical school has been very hard 

because everything she learns about diabetes 

makes her think of her mother. But Beverly sounds 

very frustrated when she says this. What can 

she do to turn her frustrated concern into helpful 

action? Perhaps she can take one or more of the 

following actions: 

–	 Bring the subject up again later when her 

mother is calmer. 

–	 Write her mother a note telling her again why 

she is worried and saying that she loves her and 

wants to help. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

–	 Suggest at least one practical thing that the two 

of them can do (for example, go to a doctor’s 

appointment together). 

7.	 Ask: Do you ever have conversations like this in your 

family? What do you do that is helpful or not helpful? 

Homework Exercise 

Distribute copies of the Web page Effects of Diabetes. 

Ask participants to choose among the following optional 

activities based on the ages of the children in their families (who may be grandchildren or nieces and nephews), 

the kinds of activities that they like to do with friends and 

family members, and the kind of support system that 

they have. 

•	 Check out the Web site http://www.cdc.gov/diabetes/ 

human_body.htm with your family or friends. (If you 

don’t have a computer at home or at work, your public 

library has computers that you can use, and the staff 

will show you how to find this Web site.) Click on the 

human figure to find out more about how diabetes can 

affect different parts of the body and what you can do 

to prevent complications. 

•	 Find the following items on the Internet: free 

music that you can download and move to, such 

as Movimiento Por Su Vida on the Web site http:// 

www.cdc.gov/diabetes/ndep, or the many free 

materials that you can order from the Web site http:// 

www.ndep.nih.gov. (If using the Internet is new to 

you, have the library support staff, your children, or a 

computer-knowledgeable friend show you how.) The 

Web site http://www.diabetesatwork.org has lesson 

plans and information on managing diabetes while at 

work. The point of this activity is not just to get educational materials—it is also to get your family involved 

in learning more and talking more about diabetes. 

•	 Visit the American Diabetes Association (ADA) Web 

site and check out the “Family Resource Network” 

that connects families dealing with diabetes with each 

other: http://www.diabetes.org/for-parents-and-kids/ 

living-with-diabetes/family-resource-network.jsp. 
hAnDout for session eight: effeCts of DiABetes 

 

Handout for Session Eight 

Effects of Diabetes 

Here’s a sample from the Web site 

http://www.cdc.gov/diabetes/human_body.htm 

Hi, I’m Frank 

Effects of Diabetes 

Diabetes can affect any part on your body. 

The good news is that you can prevent most 

of these problems by keeping your blood 

glucose (blood sugar) under control, eating healthy, being more physically active, 

and working with your health care provider 

to keep your blood pressure and cholesterol 

under control and getting necessary screening tests. Click on the figure at right to learn 

more about how diabetes can affect your 

body—remember: you can prevent these 

complications. 

Visit these Web sites for more information: 

http://www.ndep.nih.gov 

http://www.diabetesatwork.org/lessons.htm 

http://www.diabetes.org/for-parents-and-kids/living-with-diabetes/ 

family-resource-network.jsp 

http://www.diabetes.org 
Session Nine


Fear of “the Needle” 
session nine: feAr of “the neeDLe” 

l

 

Session Nine 

Fear of “the Need e” 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

Background 

Many people with diabetes use insulin to help keep their 

blood sugar (blood glucose) under control. There are 

many myths about insulin use. Some people think that 

a person has a “worse kind of diabetes” if he or she 

uses insulin. Insulin is the fastest, most effective way for 

someone with very high blood sugar to get it down to a 

normal range. Insulin alone or in combination with pills 

may be the best choice for many people with diabetes. 

Yet many people are afraid to use insulin. Why? 

Objectives 

1.	 To discuss what fears people have of using insulin. 

2.	 To discuss insulin myths versus realities. 

3.	 To describe what diabetes “self-management” means 

in terms of checking blood sugar, giving insulin, and 

problem solving. 

Time needed for discussion: 30 to 45 minutes 

without the optional section on glucose 

monitoring; 45 to 60 minutes if discussion of 

self-monitoring of blood glucose is included. 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 Handouts: Myths and Facts About Insulin and What 

You Might “Know” About Diabetes: Myths and Facts 

(the handouts are included in this discussion guide kit; 

make at least one copy for each participant). 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

1.	 Tell the group: Think about the scene in which Calvin 

is in the doctor’s office. [You may want to replay the 

scene to refresh participants’ memories .] 

Consider using the following questions to guide the 

discussion: 

•	 Ask: What is Calvin’s attitude in general in the 

doctor’s office? 

Examples of his attitude might include: 

–	 Suspicion. He asks the nurse, “How long have 

you been doing this?” 

–	 Reluctance. He is not initially interested in a 

support group, saying “Let me think about it.” 

He reluctantly agrees to return for a follow-up 

appointment with the doctor. 

–	 Concern and maybe some disbelief. He asks 

about his blood pressure reading: “Is that high?” 

•	 Tell the group: Think about Calvin’s reaction when 

he is told that he needs to use insulin. What does 

Calvin say to the doctor? 

Possible responses include: 

–	 “You’re putting me on insulin? That’s using the 

needle, right?” 
session nine: feAr of “the neeDLe” 

 

Ask: Is Calvin perhaps expressing disbelief, 

shock, dismay, or other emotions? 

–	 “I can’t believe I have to take insulin.” 

Ask: What is Calvin feeling? Disappointment or 

disgust? Shock? Denial? Other emotions? 

•	 Ask: What are some other common reactions that 

people have when they are advised that they need 

to use insulin? 

Possible responses include: 

–	 Fear of the needle. 

–	 Feeling more out of control or overwhelmed. 

–	 Feeling that insulin is the end of the road— that 

if they are using insulin, their diabetes is more 

serious. 

–	 Fatalism—feeling that if they are on insulin, 

there’s no use watching what they eat anymore. 

–	 Worry about whether being on insulin will 

change important things in their lives, such as 

whether they can still hold the same job. This 

concern about keeping a job can be a serious 

one for some people—those who have a 

commercial driver’s license, for example. 

–	 Fear of what others might think, or fear that 

people will think that they are “skin popping” or 

abusing drugs. 

–	 Others? 

•	 Ask: Is there anyone here who uses insulin and 

is willing to tell us what it is like? [If anyone 

volunteers, ask:] How did you feel when you first 

started using insulin? 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

You may wish to bring out the following points in 

the discussion: 

–	 “Using the needle” may sound awful, but the 

needle is very small—smaller than the one used 

to draw blood or even the one used to give 

children their “baby shots.” 

–	 There are a lot more kinds of insulin and ways 

to give it than there used to be, so you and your 

doctor can find a system that works for you. 

–	 It may be scary to take insulin when you first 

start, but most people adjust and don’t find it 

hard to do over time. 

–	 Some people do have a difficult time accepting 

the use of insulin. Don’t be afraid to talk to your 

doctor if you are afraid or are having a hard 

time with it. 

–	 Some people just refuse to use insulin, but 

such a refusal may mean that their blood sugar 

stays out of control and that they are risking 

complications. 

–	 Some people are embarrassed about using 

insulin and try to hide their use, but there is 

nothing to be ashamed of—no more than if 

you were taking any other kind of medicine. 

Think whether you would feel this way if you 

had to take medicine for arthritis pain or acid 

indigestion. 

–	 It can be a hassle to have to take insulin at 

specific times each day, or to have to match up 

your insulin dosage with the amount of food 

that you eat. But doing so is just trying to get as 

close as possible to what your body would do 

naturally if you didn’t have diabetes. 

–	 Some people complain that using insulin causes 

them to gain weight. Although insulin can 

stimulate appetite, it is overeating that causes 

weight gain. Choose vegetables or low calorie 

foods when you are hungry. 
session nine: feAr of “the neeDLe” 

 

2.	 Tell the group: Let’s talk about some facts about 

insulin. 

3.	 Ask: What is the doctor’s response when Calvin says, 

“I can’t believe I have to take insulin”? 

Response: 

•	 “Insulin is really the best thing for you now.” 

4.	 Ask: Why does the doctor say this to Calvin? 

Make sure that the following points are brought out 

in discussion: 

•	 Insulin can bring down a high blood sugar level 

faster than any other medication. 

•	 Calvin’s blood sugar is so high (400) that insulin 

will work better than other medications. 

•	 It is dangerous to leave Calvin’s blood sugar so 

high. He and his doctor need to take action. 

•	 Using insulin will give Calvin’s pancreas “a rest.” 

•	 Calvin may be able to control his blood sugar 

without insulin later. 

5.	 Tell the group: The doctor also says, “The needle is so 

small you really can’t feel it.” How true do you think 

this statement is? 

Make sure that the following points are brought out 

in discussion: 

•	 The needle is small, but it is still a needle. It takes 

time to get used to the idea of injecting insulin. 

•	 For many people, the issue is not so much the pain 

of the needle, but fear about what it means to use 

insulin. 

•	 Using a needle may seem scary in part because it 

is a different way of taking medicine. Most people 

take medicine in the form of pills. But insulin is not 

the only medicine that is taken by injection. Other 

medicines may also be injected because they work 
0 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

faster or more reliably when taken this way. Some 

people give themselves injections of medicine 

to stop a migraine headache. If they can do this 

to stop a headache, you can do this to control 

your blood sugar and stop the complications of 

diabetes. 

Brainstorming Exercise 

Ask the group to think about Calvin’s reaction to starting 

insulin and about the things that you have talked about 

in your discussion of insulin. Then ask participants what 

advice they would have for themselves, or for someone 

starting insulin, to help calm fears and other emotions. 

Discussion of Self-Monitoring 

of Blood Sugar 

1.	 Tell the group: The nurse checked Calvin’s blood 

sugar, but no one in the film talked about self-monitoring—checking your own blood glucose at home with a 

glucose meter. 

Note: The purpose of this discussion session is to 

share experiences and talk about emotions related to 

diabetes care, not to provide details of home glucose 

monitoring. A session on home glucose monitoring 

and how to use the results is best taught by a certified 

diabetes educator or health care provider. 

2.	 Ask: Why do you think no one in the film talked about 

self-monitoring? 

Make sure that the discussion brings out the 

following points: 

•	 There may not have been enough time in the film 

to discuss everything about diabetes care. 

•	 There is only so much that Calvin can take in about 

diabetes at one time. 
session nine: feAr of “the neeDLe” 

 

•	 Dr. Goodson says that she will set up a session for 

Calvin with a diabetes educator. That is probably 

when he will learn about self-monitoring. 

•	 Self-monitoring is very important, even though it 

isn’t covered in the film. 

Note: A participant may comment that he or she finds 

that doing a fingerstick for self-monitoring hurts more 

than injecting insulin. If so, you can acknowledge that 

many people feel this way. You can encourage participants to talk to their doctor or diabetes educator about 

this issue. Explain that new lancets are available that 

may make it easier and less painful for them to check 

their blood sugar. 

Homework Exercise 

Give each participant a copy of the two handouts: Myths 


and Facts About Insulin and What You Might “Know” 


About Diabetes: Myths and Facts. Ask participants to 


review these handouts at home and to think of any ques­


tions that are not covered. Tell them to use the two 


handouts to help them come up with questions to take


to their next doctor’s appointment.


Participants may also be interested in the NDEP


brochure “Tips for Helping a Person with Diabetes,“ 


available from http://www.ndep.nih.gov/diabetes/pubs/


KnowNumbers_Eng.pdf

hAnDout for session nine: myths AnD fACts ABout insuLin 

 

Handout for Session Nine 

Myths and Facts About Insulin 

Myth: Using insulin means that your diabetes is “really bad.” 

FACT: Diabetes is a serious condition whether you use insulin, pills, or both. It is still 

serious even if it is controlled by food planning and physical activity alone. 

Myth: You are “at the end of the road” if you are using insulin. 

FACT: Insulin may be used at any time to help control diabetes. Some health care 

providers prescribe insulin when diabetes is first diagnosed, just as Dr. Goodson did 

for Calvin Dixon. Using insulin doesn’t mean that you have a “worse kind” of diabetes than others who don’t use insulin. 

Myth: Insulin makes you fat. 

FACT: Some people complain that using insulin causes them to gain weight. 

Although insulin can stimulate the appetite, it is overeating that causes weight gain. 

Choose vegetables or low calorie foods when you are hungry. 

Myth: Some people can’t give themselves insulin. 

FACT: Special devices are now available that help people with disabilities to give 

themselves insulin. Even blind people can measure insulin and give it to themselves 

accurately. If you have trouble seeing the amount of insulin to be drawn up into the 

syringe, or if you have any difficulty dealing with the syringe, talk to your doctor or 

diabetes educator about your needs. 

Myth: Insulin is dangerous. 

FACT: Any medicine can have side effects. It is important to know what the side 

effects are and how to avoid them so that you can learn to use insulin safely. 

Myth: Once you start insulin, you must always stay on insulin. 

FACT: There are many treatments for people with diabetes. Some people start on 

insulin injections and later switch to other medications taken as pills. Some are able 

to decrease the amount of medication they take once their diabetes is under control. 

Some even can stop certain medications IF they are able to lose enough weight. 

Write Down Your Questions 

Do you have a question about insulin? Are you unsure whether something is a myth 

or fact? Write it here (or on the reverse side of this page) and take it to your next 

doctor’s appointment. 
hAnDout for session nine: whAt you might “know” ABout DiABetes 

 

Handout for Session Nine 

What You Might “Know” About Diabetes


Myths and Facts 

“I have a touch of sugar.” 

There is no such thing as a “touch of sugar.” You cannot have a “touch of sugar,” 

just as a person cannot be a “touch” pregnant. Having “a touch of sugar” means 

having diabetes—plain and simple. 

“I am only borderline.” 

CAUTION: Diabetes Ahead! There is no “borderline” with diabetes—you either 

have the disease or not. The term “borderline” only serves as an excuse for people 

who don’t want to think about the reality of living with diabetes. 

“You can’t prevent diabetes.” 

Yes, you can. Studies show that people with prediabetes (blood sugar higher than 

normal but not in the diabetes range) can prevent or delay diabetes. If your doctor 

tells you that you have “a touch of sugar,” ask him if you have prediabetes or diabetes. There’s a big difference. For more information, visit http://www.ndep.nih. 

gov/diabetes/prev/prevention.htm. 

“By drinking water, I can wash away the extra sugar in my blood and cure diabetes.” 

Although you can wash away spilled sugar from a table, the body’s own sugar, 

glucose, cannot be washed away by drinking water. However, you can control your 

diabetes by eating a healthy diet, staying physically active, losing weight if you are 

overweight, seeing your doctor regularly, taking any medications as prescribed, 

and monitoring your blood sugar regularly. 

“I have sugar in my eye.” 

Uncontrolled diabetes can cause problems with vision, including blindness. 

Controlling the disease can prevent or delay complications with eyesight. 

“Insulin is a cure for diabetes.” 

Insulin is not a cure for diabetes. At this point, there is no cure for diabetes—only 

medicine and behaviors that help to control it. Insulin helps to control diabetes by 

keeping the body’s sugar, glucose, from building up in the bloodstream. 

“If I’m not taking medicines for diabetes, it must not be serious.” 

Not everyone who has diabetes needs to take insulin, but diabetes is always serious. If the body can produce insulin, other steps can be taken to help keep the 

insulin working effectively. These steps include regular physical activity, a healthy 

diet, oral medications (pills), and regular doctor’s visits. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

“I have diabetes and I’ve seen its effect on family members. I know there is 

nothing I can do about it.” 

Remember, diabetes is serious, common, and costly but controllable. There are 

many actions that people with diabetes can take to live a full life, while preventing or delaying complications. Taking care of yourself by making healthy lifestyle 

changes, such as regular physical activity and a healthy diet, is the key to living 

well, even with diabetes. 
Session Ten


Working with Your Doctor 
i i

session ten: working with your DoCtor 

 

Session Ten 

Work ng w th Your Doctor 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

Background 

Many people find it hard to participate in their health care. 

They may not be sure what questions to ask the doctor, 

or they may feel that the doctor is in too great a hurry and 

doesn’t have the time to answer their questions. 

Objectives 

1.	 To describe the interactions between Calvin and the 

staff at the doctor’s office. 

2.	 To discuss how a person can get the most out of a 

visit to the doctor. 

3.	 To make the link between diabetes and heart disease. 

Time needed for discussion: 45 to 60 minutes. 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor. 

•	 Handout: National Diabetes Education Program 

(NDEP) brochure 4 Steps to Control Your Diabetes for 

Life (at least one copy for each participant). Order the 

brochure by fax or mail using the NDEP Publications 

Order Form at the end of this guide, or download it 

from the Web site http://www.ndep.nih.gov/diabetes/ 

control/4Steps.htm. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

1.	 Tell the group: Today we are going to talk about two 

scenes from the film The Debilitator: the scene with 

the radio show entitled “The Good Doctor,” and 

the scene in which Calvin goes to see Dr. Beverly 

Goodson. [You may choose to replay these scenes to 

refresh the participants’ memories .] 

2.	 Tell the group: Think back to the radio program “The 

Good Doctor.” The radio program host says of the 

physician guest on the show, “He speaks the truth— 

straight from the heart.” Some people think that 

health care workers shouldn’t tell people the harsh 

truth about the risk of heart disease and the complications of diabetes because it’s too scary. 

3.	 Ask: What do you think health care providers should do? 

Make sure to make the following points during the 

discussion: 

•	 Scare tactics alone are not effective and can push 

people away. 

•	 People need to know the truth, and they have a 

right to know. 

•	 Some ways and times for giving information are 

better than others. 

4.	 Tell the group: On the show “The Good Doctor,” the 

heart doctor made several statements that could be 

shocking. 

5.	 Ask: How did you feel when you heard the doctor say: 

•	 “Others [some people with diabetes] are just time 

bombs waiting to explode.” 
session ten: working with your DoCtor 

 

•	 “Doctors...think that people will never change, so 

they don’t tell people what to do.” 

Begin a discussion with participants about making the 

most of their doctor visits. 

6.	 Tell the group: When Calvin calls Dr. Goodson’s 

office for an appointment, he is lucky. The office has 

an open appointment time that day, and he is seen 

right away. 

7.	 Ask the group: Has that been your experience with 

making an appointment? 

•	 What do you think Calvin should have done if he 

had not been able to get an appointment for a 

month or more? 

•	 What would you do? 

Answers might include: 

•	 Go to the emergency room. 

•	 Stay home and take it easy until you can see


the doctor.


•	 Make an appointment to see another doctor. 

•	 Try home remedies or nonprescription medications. 

•	 Go to a naturopath or traditional healer. 

•	 Pray that things will get better soon. 

Make sure that the discussion brings out the 

following points: 

•	 Don’t wait too long for an appointment. Ask if 

another doctor in the practice can see you as a 

walk-in or for just one appointment until you can 

see your regular doctor. Ask the receptionist to call 

you if the office has any last-minute cancellations. 

•	 Emergency rooms are just for emergencies. Don’t 

use them as walk-in clinics or for regular care (for 

example, for refilling prescriptions). Try to think 

ahead and make appointments with your regular 

doctor. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 If you don’t have a health care provider, seek 

one out and establish regular follow-up care. 

Community health centers that accept Medicaid or 

Medicare, or that provide sliding scale payments 

for people without insurance, are located 

throughout the country. 

•	 If you are having chest pressure or increased 

shortness of breath, DON’T WAIT. Go to the 

emergency room if you have no other choice. 

•	 It is best to talk to your doctor first before trying 

home remedies or nonprescription medications. 

•	 Working with other healers (such as a massage 

therapist or a naturopath) can help you feel better, 

but such visits are not a substitute for seeing your 

doctor or other health care provider (such as a 

nurse practitioner or a physician assistant). 

8.	 Tell the group: Think about Calvin’s visit to Dr. 

Goodson. Is there anything that he could have done to 

get more out of this appointment? 

Answers might include the following: 

•	 He could have brought the first doctor’s name and 

contact information so that Dr. Goodson could get 

his medical records. 

•	 He could have brought any medicines that were 

prescribed for him by the first doctor, even if he is 

not taking them now. 

•	 He could have brought a list of questions that he 

wanted to ask. 

•	 He could have brought his wife or other family 

member for emotional support and also because 

“two sets of ears are better than one” for absorbing 

information during a doctor’s visit. 

9.	 Ask: How can you get the most out of your visits to 

the doctor and to other health care providers? 
session ten: working with your DoCtor 

 

Make sure that the discussion brings out the 

following points: 

•	 Think about your questions ahead of time. Perhaps 

write them down and give the list to the doctor at 

the start of the appointment. 

•	 Bring a list of your medicines and a description of 

how you are taking them (for example, how many 

pills you take and at what time of day). 

•	 Be honest. If you miss taking many of your pills, 

just say so and state why (for example, you can’t 

remember to take the one at bedtime, or the 

medicine upsets your stomach if you take it in the 

morning). 

•	 Tell your doctor about any nonprescription 

medicines, vitamins, and herbal remedies that you 

are taking. 

•	 Bring along your blood glucose monitoring 

booklet in which you write down your blood sugar 

measurements. 

•	 Discuss with the doctor what your goals are— 

what your blood sugar, blood pressure, and 

cholesterol should be, and what can you do to get 

them under control. 

•	 Discuss other routine tests that people with 

diabetes should have: eye and foot exams, as 

well as measurement of A1C, blood pressure, and 

cholesterol. 

Optional Activity: Discussing 

Diabetes ABCs and Heart Disease 

Note: Another module in this guide, “Be Smart About 

Your Heart: Know Your ABCs,” also discusses the link 

between diabetes and heart disease. 

1.	 Tell the group: Think about the scene in which Calvin 

dies of a heart attack in his dream. [You may choose 

to replay this scene to refresh participants’ memories .] 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

2.	 Ask: How realistic do you think this scene is? What are 

the symptoms of a heart attack? 

Make sure that the discussion brings out the


following points:


•	 Usually people have some warning symptoms of a 

heart attack that increase with time. 

•	 People don’t usually die suddenly as the first sign 

of heart trouble, but it is possible to do so. 

•	 A person might not recognize that his or her 


symptoms are from heart disease. Typical 


symptoms include:


–	 Chest pressure—NOT a sharp pain. 

–	 Shortness of breath. 

–	 Nausea, possibly vomiting. 

–	 Sweating. 

–	 A feeling of impending doom. 

•	 Not just men are at risk for heart attacks. Women 

have heart attacks, too. In fact, women with 

diabetes are even more likely than men with 

diabetes to die of a heart attack. 

3.	 Ask the group: What do you think about the fact that 

Calvin has a heart attack when he is doing something 

that he thinks is good for him—getting exercise? 

Make sure that the discussion brings out the


following points:


•	 Calvin’s blood pressure and blood sugar are out of 

control. 

•	 He doesn’t stop when he first starts to feel bad. 

•	 It looks as if he is mowing the lawn during the 

hottest part of the day (or maybe the heart attack 

is causing him to sweat). He should have chosen a 

cooler part of the day to exercise outdoors. 
session ten: working with your DoCtor 

 

•	 Before you begin an exercise program, it is best to 

talk to your doctor to find out what is safe for you. 

Classroom Exercise 

Give each participant a copy the NDEP brochure 4 Steps 

to Control Your Diabetes for Life. Tell participants that 

they have 5 to 10 minutes to look through the brochure 

before you call the group back together. Explain that the 

material in the brochure may help them think of questions that they would like to ask their doctor. After 5 or 

10 minutes (depending on how much time is left in the 

session), ask if anyone needs more time. If yes, give 

an additional 5 minutes, and then call the group back 

together. 

Ask: Is anyone willing to share a question that you’ve 

decided to ask your doctor at your next appointment? 

If no one suggests a question, consider choosing 

a question directly from the NDEP brochure 4 Steps 

to Control Your Diabetes for Life for discussion, if 

time permits. 

Homework 

Ask each of the participants to take home a brochure and 

to write down at least one question that they plan to ask 

the doctor at their next appointment. Suggest that they 

may also find it helpful to ask others (family and friends) 

to read the brochure and talk about it together. 
Session Eleven


A Frightening Future: The Rise of 

Type 2 Diabetes in Youth 
i i i

i

session eLeven: the rise of type 2 DiABetes in youth 

 

Session Eleven 

A Fr ghten ng Future: The R se 

of Type 2 D abetes in Youth 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

Background 

There are three main types of diabetes: 

1.	 Type 1 diabetes, in which a person’s pancreas makes 

no insulin, and the person must take insulin to survive. 

This type used to be called juvenile onset diabetes 

because it was the type that typically occurred in children, but it has been renamed because it can occur at 

any age. 

2.	 Type 2 diabetes, in which a person’s pancreas makes 

insulin, but either not enough insulin is produced to 

meet the body’s needs or the body is “insulin resistant” and cannot use the insulin in the right way. 

Being overweight and getting little physical activity 

put at person a higher risk of developing type 2 diabetes. This type used to be called adult onset diabetes 

because it was rarely seen in children, but today the 

name is not accurate because more and more children 

and teenagers are developing type 2 diabetes. The 

number of children who are overweight or obese is 

increasing in the United States, which may be contributing to this rise in type 2 diabetes in youth. 

3.	 Gestational diabetes develops during pregnancy, but 

then blood sugar levels return to normal after the 

pregnancy. Women who have had gestational diabetes have a higher risk of developing type 2 diabetes 

later. Children who are born to women who have had 
2 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

gestational diabetes during the pregnancy are also at 

a higher risk of later developing type 2 diabetes. 

Objectives 

1.	 To describe the increase in the number of overweight 

children and teenagers in the United States. 

2.	 To discuss some of the possible reasons for these 

increases and their possible consequences. 

3.	 To discuss some actions that a person can take in his 

or her family and in the community to slow the epidemic of obesity in youth. 

Time needed for discussion: 45 to 60 minutes. 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor; overhead projector (optional). 

•	 Optional: Maps showing trends in rates of obesity 

and diabetes can be found as PowerPoint® slides on 

the CDC Web site http://www.cdc.gov/diabetes. 

You could either print these out to be prepared as 

overhead transparencies for use with an overhead 

projector or to be photocopied and given as handouts 

(one for each participant). If you have access to a computer and an LCD projector, you could show the entire 

series of slides and emphasize how rates of obesity 

and diabetes have increased over the past 20 years. 

•	 Handout: Am I at Risk for Type 2 Diabetes? (one copy 

for each participant). Order the brochure by fax or 

mail using the NDEP Publications Order Form at the 

end of this guide. The brochure may also be ordered 

online at http://www.ndep.nih.gov or downloaded for 

photocopying from http://www.ndep.nih.gov/ 

diabetes/prev/prevention.htm. 
session eLeven: the rise of type 2 DiABetes in youth 

 

•	 Handout: Eating Healthily, Moving More (included in 

this discussion guide kit; make at least one copy for 

each participant). 

•	 Handout: More Than 50 Ways to Prevent Diabetes 

(at least one copy for each participant). Order the 

brochure by fax or mail using the NDEP Publications 

Order Form at the end of this guide, order it online at 

http://www.ndep.nih.gov, or download it for photocopying at http://www.ndep.nih.gov/diabetes/pubs/ 

50Ways_tips.pdf. 

•	 Handout: Tips for Children with Type 2 Diabetes Series 

sheets on “What is Diabetes?,” “Be Active,” “Stay at 

a Healthy Weight,” and “Eat Healthy Foods” (at least 

one copy for each participant). Order the brochure by 

fax or mail using the NDEP Publications Order Form 

at the end of this guide, order it online at http://www. 

ndep.nih.gov, or download it for photocopying at 

http://www.ndep.nih.gov/diabetes/youth/youth.htm. 

•	 Handout: Diabetes in Children and Adolescents (at 

least one copy for each participant). Download the 

brochure for photocopying at http://www.ndep.nih. 

gov/diabetes/pubs/Youth_Factsheet.pdf. 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

1.	 Ask the group: Did you believe the doctor on the radio 

show in the film when he said that children as young 

as age 4 have developed type 2 diabetes? [This is true, 

unfortunately .] Why are we seeing more obesity in 

children? How does this increase in obesity relate 

to diabetes? 

Show the obesity and diabetes maps, or distribute the 

handout with links to download the maps. 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Make sure that the discussion brings out the


following points:


•	 CDC estimates that, if current trends continue, 

one in three children born today will develop 

diabetes in their lifetime. Not everyone who is 

overweight develops diabetes, and not everyone 

who has diabetes is overweight, but the two do 

tend to go hand-in-hand. Look at the maps. As the 

rate of overweight has gone up, so has the rate of 

diabetes. 

•	 The percentage of children in the United States 

who are overweight or obese has tripled in the past 

20 years. In 2000, 10.4 percent of children 2 to 5 

years old, 15.3 percent of children 6 to 11 years old, 

and 15.5 percent of adolescents 12 to 19 years old 

were overweight. 

•	 Even preschool children are affected. In children 

this young, overweight can’t be blamed on school 

lunches and lack of physical education in the 

schools! 

2.	 Ask: Do you think that Calvin’s children in the film are 

at risk of developing diabetes? Why or why not? 

3.	 Distribute the NDEP brochure Am I at Risk for Type 2 

Diabetes? for more information. Calvin’s children are 

at increased risk, but they can take steps to reduce 

that risk by leading a healthy lifestyle. 

Make sure that the discussion brings out the


following points:


•	 Several factors increase the children’s risk: 

–	 Being African American is a risk factor for 

developing diabetes. 

–	 Diabetes tends to run in families, and Calvin has 

diabetes. 

–	 Calvin’s son is showing interest in sedentary 

activities, which could reduce his physical 

activity. (Recall the scene in which he is 
session eLeven: the rise of type 2 DiABetes in youth 

 

playing video games instead of playing actively 

outside.) 

•	 Several factors decrease the children’s risk: 

–	 Calvin’s daughter eats healthily and exercises at 

the gym. 

–	 Neither son nor daughter looks overweight, 

and they lower their risk of developing diabetes 

by eating healthily and maintaining a healthy 

weight. 

4.	 Ask: After Calvin talks to his family members about 

his diabetes, what decisions do they make together 

that will help him control his diabetes and will also 

help them all live more healthily? 

Examples may include the following: 

•	 Calvin says, “Son, we’re going to spend more time 

together working out. I promise.” 

•	 Calvin plans to go running with his daughter on a 

trail through the park. 

•	 Calvin’s wife plans to cook healthful meals to 


benefit the whole family.


•	 The family looks for more information on diabetes 

and for more support. For example, at dinner 

Calvin’s wife mentions spirituality and talking to 

her pastor. 

5.	 Ask: Do you think that people in your family are at 

higher risk than most people of developing diabetes? 

Do you think that your family can make the same kinds 

of changes that Calvin’s family does? 

Make sure that the discussion brings out the


following points:


•	 It’s not always as easy to get children away from 

video games and outside playing as it was for Calvin. 

Ask: Does anyone have any suggestions for 

dealing with this situation? 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Possible responses: 

–	 Just sending the child outside to play should 

lead to more physical activity than watching 

TV does. You don’t have to tell the child exactly 

what game or activity to do. 

–	 Join your child outside. 

–	 If you can’t join your child, and you don’t feel 

comfortable having him or her play outside, 

you may be able to find other safe places where 

your child can be more active. 

•	 Limiting the number of hours for watching TV, 

using the computer, and playing video games is 

one method that has proved helpful in controlling 

children’s weight (partly because children then 

have less time to snack in front of the TV). 

•	 Going running in the park is not realistic for many 

people (for example, because they have arthritis 

in the knees, because they live in an unsafe 

neighborhood, or because they live in a climate 

that is too hot or too cold for running during part of 

the year). But everyone can find ways to increase 

physical activity, even inside the house. 

6.	 Say: Let’s brainstorm about what else you can do for 

physical activity with a buddy or with family members. 

Examples might include: 

•	 Walk in the shopping mall or on a school track. 

•	 Try roller skating at an indoor rink. 

•	 Walk the dog. If you don’t have one, do a good 

deed by walking an elderly neighbor’s dog on a 

regular basis. 

7.	 Tell the group: Many people may believe that eating healthily is too expensive for them. Does it cost 

Calvin’s family more to eat baked chicken and baked 

potatoes than to eat fried chicken and french fries? 
session eLeven: the rise of type 2 DiABetes in youth 

 

Classroom Exercise 

Ask participants to take 5 minutes to think of at least one 

thing that they can do when they go home to get their 

whole family eating more healthful meals, and one thing 

that they can do during the coming week to be more 

physically active. Remind them that their motivation is 

not just to improve their own health but also to teach 

healthier habits to members of the future generation. 

Note: Remind people in the group who live alone that 

they are not off the hook! Suggest to them that they can 

connect with family members by telephone to work on 

developing healthier habits, or they can choose to “buddy 

up” with someone at work, from church, from school, or 

from their neighborhood. If a holiday is coming up and 

they will be getting together with others, ask them to 

think about how they can make the event more healthful. 

Distribute the handout Eating Healthily, Moving More and 

have each person write down at least one idea in each 

category. 

At the end of 5 minutes, ask if anyone needs more time. If 

yes, give them 5 more minutes. Then ask if anyone would 

be willing to share what he or she has written down. 

Homework Exercise 

Ask participants to take home the handout Eating 

Healthily, Moving More and to think about adding one 

new idea to it each day. Distribute the handouts More 

than 50 Ways to Prevent Diabetes, Tips for Children with 

Type 2 Diabetes Series sheets, and Diabetes in Children 

and Adolescents to each participant to give them additional ideas. 

Optional: There are lots of resources for kids who 

are overweight from the Weight-control Information 

Network. Visit http://win.niddk.NIH.gov/publications/ 

index.htm#public 
hAnDout for session eLeven: oBesity mAps AnD DiABetes mAps 

 

Handout for Session Eleven 

Obesity Maps and Diabetes Maps


Overweight and Obesity: Obesity Trends: 

U.S. Obesity Trends 1985–2004 

Download at: 

http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/ 

Age-Adjusted Prevalence of Diagnosed Diabetes per 

100 Adult Population, by State, United States, 2004 

Download at: 

http://www.cdc.gov/diabetes/statistics/prev/state/fPrevalence2004Total.htm 
hAnDout for session eLeven: eAting heALthiLy, moving more 

 

Handout for Session Eleven 

Eating Healthily, Moving More 

Write down your ideas below: 

One thing that I can do this week to get my family to eat more healthful food is: 

One thing that I can do this week to get my family to be more physically active is: 
Session Twelve


Spirituality as a Guide and Support 
iri li i

session tweLve: spirituALity As A guiDe AnD support 

 

Session Twelve 

Sp tua ty as a Gu de 

and Support 

The NDEP strongly encourages inviting a medical 

person (health care provider or certified diabetes 

educator) to participate in any sessions that you 

conduct to provide support for the discussion and to 

answer any specific medical questions that may arise. 

Background 

Spirituality means many different things to different 

people, but it usually involves seeking strength, guidance, 

and support from a “higher power.” This support can 

help a person manage his or her diabetes. At the same 

time, it is important for people to recognize the practical 

aspects of diabetes care and to avoid placing their faith in 

unrealistic hopes. 

Objectives 

1.	 To describe ways in which spirituality, however it is 

experienced, can help provide support to making 

changes to live well with diabetes. 

2.	 To verbalize that depending on spirituality and “faith” 

alone is not adequate to control diabetes. 

3.	 To discuss what role spirituality can play in bringing 

family and community together to support a person in 

diabetes self-management. 

Time needed for discussion: 45 to 60 minutes. 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor. 
0 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

Special Note: Discussing religion can lead to tensions 

as members of the group express their differences in 

religious views, and these differences can split a group 

rather than unite it. On the other hand, many self-help 

groups recognize the value of relating to a “higher 

power,” and many people will feel comfortable talking 

about spirituality as that which gives them inner strength 

of spirit. You may want to consider polling the group 

before you introduce this topic to be sure that all participants agree that it is appropriate for discussion. You may 

also want to read the Troubleshooting section in this 

guide before proceeding with the discussion. 

1.	 Ask: Are there any scenes in the film The Debilitator in 

which spirituality plays a role? 

Examples might include: 

•	 The Dixon family members hold hands and say 

grace before the meal. 

•	 Calvin’s wife suggests that spirituality may be a 

good remedy for many illnesses. 

•	 The older African American woman in the support 

group says, “I’ve had diabetes for 10 years, but I 

don’t claim it. It’s my faith that keeps me physically, 

emotionally, and spiritually strong.” 

•	 In the first scene, the Dixon family is drawn 


together at the funeral in the church.


2.	 Ask: How does this spirituality help the people portrayed in The Debilitator? 
session tweLve: spirituALity As A guiDe AnD support 

 

Examples may be: 

•	 It draws the Dixon family members closer together 

(in the scene at the dinner table). 

•	 It is a possible source of support to give strength to 

the family and to the community. 

•	 It draws the community together (the community 

at Calvin’s funeral). 

3.	 Ask: Are there any ways that a person might have a 

misguided idea about spirituality that could hurt his or 

her efforts to control or prevent diabetes? 

Examples might include: 

•	 Waiting for a miracle that may never come instead 

of taking control of one’s diabetes and making 

changes. 

•	 Taking a fatalistic attitude, such as “It is God’s 

will,” instead of taking the attitude that “God helps 

those who help themselves.” 

•	 Mistaking normal emotional reactions (such as 

fear, denial, depression, and guilt) for spiritual 

events that lead to inaction. For example, denial or 

bargaining may be expressed as the belief that “if 

I pray hard enough, I will be cured.” Depression 

sometimes takes the form of guilt in a belief such 

as “God is punishing me.” 

•	 Others? 

Special Note: Some people may think of organized 

religion (such as a Christian church, a Muslim mosque, 

or a Jewish temple) when you discuss spirituality, and 

they may give examples that include specific beliefs 

or practices of faith-based institutions. For example, 

someone may jokingly note that church suppers can 

be the worst thing for people with diabetes because of 

the dishes served, such as fried chicken and macaroni 

and cheese. Others may give examples of behaviors 

that violate their religious views, such as gluttony as 

one of the seven deadly sins or alcohol use as an evil. 
2 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Consider acknowledging these examples as events or 

views belonging to specific religions, and try to refocus the discussion on the broad concept of spirituality. 

Avoid arguments over differing religious views. 

Be sure to bring out the point that talking to one’s 

health care provider and one’s spiritual advisor about 

fears and concerns can help. 

4.	 Ask: Are any of you willing to share how spirituality 

plays a role in your life? In keeping you healthy? 

Optional Homework Activities 

Ask each person to choose one of these optional activities to do at home: 

1.	 Participants can create their own special prayer, meditation mantra, or positive thought to recite at a special, 

quiet time of day: for example, in the morning when 

they first wake up, when they go for a walk, before a 

meal, as they go to pick their child up at school, when 

they drive home from work, at bedtime, or whatever 

the best time for them may be. The special thought 

should be something simple to remember that gives 

them inner strength, such as “Every day, in every way, 

I am getting stronger and stronger.” Or, “My blessings 

are many and my spirit is strong.” Or even, “I can do 

it. I know I can.” 

2.	 Participants can try the “full cup of coffee (or tea or 

water) exercise” every day for a week. Describe the 

exercise to the group by saying: “Don’t rush through 

that first cup of coffee or tea in the morning, and don’t 

grab a travel mug and go. Set aside time—even one 

minute—to sit with this morning drink as a spiritual 

time, however you experience it. Sit down, hold the cup 

in your hands, and focus. Ask yourself: From where can 

I draw my inner strength today? Where can I find more 

strength to nourish my spirit today? What do I want 

from my full cup today? How can I fill it tomorrow?” 

3.	 Consider asking members of the group to suggest 

other spiritual exercises that help them focus and 

draw strength. 
session tweLve: spirituALity As A guiDe AnD support 

 

Ask: How can these exercises help you control or prevent 

diabetes in your life? 

Examples might include: 

•	 By giving you the strength to resist overeating and 

other health-destructive habits. 

•	 By reducing chaos and stress in life so that you can 

focus on what you need to do. 

•	 By helping you to use the power of positive thinking to convince yourself that you can make changes, 

increase your physical activity, check your blood sugar 

by yourself, make that doctor’s appointment you need, 

face getting checked for diabetes, stop smoking, walk 

more, or whatever it is you need to do. 
Session Thirteen


What Are My Patients Thinking?


A Session for Health Care Providers

session thirteen: A session for heALth CAre proviDers 

 

Session Thirteen 

What Are My Patients 

Thinking? A Session for 

Health Care Providers 

Note: This session should be conducted for health 

care providers by a peer health care provider (e.g., a 

primary care physician should lead a discussion with 

other primary care physicians). 

Background 

Being diagnosed with a chronic disease like diabetes can 

have a huge emotional impact on your patients. Some 

patients find it hard to listen and to remember what you 

as their health care provider have told them, because 

their minds are occupied with adjusting to their new 

diagnosis. Some patients may be very difficult to work 

with because they don’t follow your recommendations, 

they seem unconcerned or disbelieving, or they are even 

angry with you. This discussion is designed to explore 

what is going on in these instances, and how you can 

turn such difficult interactions into fruitful ones. 

Objectives 

1.	 To discuss the issue of “therapeutic nihilism”—the 

idea that some people won’tdo what you recommend, 

so why waste your time? 

2.	 To describe the interactions in the film between Calvin 

and the staff at Dr. Goodson’s office. 

3.	 To discuss possible ways of dealing with difficult situations that you encounter with your patients. 

Time needed for discussion: 30 to 60 minutes 

(depending on whether role-playing exercises 

are included). 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Materials 

•	 DVD of the film The Debilitator. 

•	 DVD player/TV monitor. 

•	 Handout: Emotional Stages of Change (included in 

Session Four of this discussion guide kit; make at least 

one copy for each participant). 

•	 Handout: Team Care: Comprehensive Lifetime 

Management for Diabetes (one copy for each participant). Order the monograph by fax or mail using 

the NDEP Publications Order Form at the end of this 

guide, order it online at http://www.ndep.nih.gov, or 

download it for photocopying at http://www.ndep. 

nih.gov/diabetes/pubs/TeamCare.pdf. 

•	 Handout: The 5As (included in this discussion guide 

kit; make one copy for each participant). 

•	 Handout: Role-Playing Exercise (included in this discussion guide kit; make one copy for each participant). 

•	 Optional: Flipchart or blackboard for writing down key 

words from discussion. 

Method 

•	 Conduct a facilitated discussion (group discussion 

with a leader asking stimulation questions). 

•	 Play the film, or select scenes from the film as needed. 

1.	 Tell the group: Think back to the scene in the film 

that depicts the radio program “The Good Doctor.” 

The radio show host introduces the cardiovascular 

surgeon guest speaker by saying, “He speaks the 

truth—straight from the heart.” 

Some health care providers believe that we shouldn’t 

scare patients by giving too many details of the possible complications of diabetes, because the long 

list can be discouraging. Other health care providers 

feel that we need to be more “hard-hitting” with our 

patients by emphasizing the risks of poorly controlled 
session thirteen: A session for heALth CAre proviDers 

 

diabetes. What do you think health care providers 

should do? 

Points to bring out in the discussion: 

•	 Scare tactics alone are not effective and can push 

patients away. 

•	 Patients need to know the truth, and they have a 

right to know. 

•	 A lot depends on the emotional state of the patient 

at the time of his or her visit with us and on his or 

her ideas about preventing complications. 

2.	 Ask the group: Are there some ways and times to give 

the patient information that are better than others? 

Points to bring out: 

•	 If the patient is in shock or in denial after you give 

the diagnosis of diabetes, he or she can’t focus on 

what you are saying. 

•	 Determine the patient’s understanding of and 

experience with diabetes. A patient with several 

relatives who have had complications of diabetes 

may view diabetes very fatalistically (e.g., the 

patient may believe that nothing can be done to 

improve his or her health or to prevent death). Or 

the patient may be very angry with the health care 

system. 

•	 Finding out what the patient’s greatest concerns 

are may provide you with a “hook” for helping him 

or her to make changes, accept medications, or do 

glucose self-monitoring. 

3.	 Ask the group: In the final scene of the film, Dr. 

Goodson is leading a support group. Is it realistic that 

the doctor would host the support group? 

Consider using the following questions: 

•	 Ask: In the film the doctor is portrayed in the role 

of support group leader as an ideal situation, but 

is this role realistic? Is it even ideal? Perhaps other 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

professionals are better at running support groups. 

Or perhaps participants are reluctant to talk about 

some matters in front of their doctors. 

•	 Ask: Are there ways in which the physician 

can become involved in the patients’ diabetes 

education and support without running the support 

group himself or herself? 

4.	 Tell the group: On “The Good Doctor” show in the 

film, the cardiovascular surgeon makes several statements that may be shocking. How did you feel when 

you heard him say the following? 

•	 “Others [people with diabetes] are just time bombs 

waiting to explode.” 

•	 “Doctors...think that people will never change, so 

they don’t tell people what to do.” 

Reactions from the group may include the following: 

•	 Anger. Participants may feel that the radio show 

host portrays the primary care physician in an 

unfavorable light or is laying unfair blame on 

physicians in general. 

•	 Frustration. Participants have probably all 

experienced the feeling that some patients don’t 

follow their recommendations, so why bother? 

•	 Disappointment. Participants may acknowledge 

that some patients do seem like “time bombs,” and 

they may wonder what they can do if patients do 

not follow their recommendations. 

Classroom Exercise: Stages of Change 

1.	 Tell the group: I’d like you to spend 5 minutes right 

now writing down some of the things that your most 

difficult patients—emotionally and behaviorally difficult, not clinically difficult—have said to you. If you 

can, also write down what you think a good reply 

might be. 
session thirteen: A session for heALth CAre proviDers 

 

2.	 Ask the group [at the end of 5 minutes]: Is anyone 

willing to share what they’ve written down? 

If yes, let participants spend some time sharing stories 

and ideas about responses. This part of the session 

sometimes gives frustrated clinicians an opportunity 

to “blow off steam.” After they have released this pentup emotion, they are in a better position to learn from 

the session. Try not to counter or disagree with any 

of the suggestions at this stage. Just let the group 

discuss them. 

If no one volunteers to share their written responses, 

you may share a clinical experience of your own, or 

you may use one of the hypothetical ones from the 

handout Role-Playing Exercises. 

3.	 Tell the group: Remember the stages of change that 

Dr. Kubler-Ross described in her book On Death 

and Dying? She described five basic stages: denial, 

depression, anger, bargaining, and acceptance. These 

five stages may represent too broad a generalization, 

because people experience many other emotions and 

stages of change. The stages don’t necessarily occur 

in this order, and not everyone experiences every 

stage. Nevertheless, it may be useful to consider how 

these stages apply to someone dealing with a chronic 

disease like diabetes. 

4.	 Distribute the handout Emotional Stages of Change. 

5.	 Ask the group: What emotions does Calvin express 

during the interactions (with his doctor, with the 

nurse, with family members, in the support group) in 

the film The Debilitator? 

Answers might include: 

•	 Denial (at the initial diagnosis): “I didn’t believe it, 

so I never went back.” 

•	 Disbelief (at the repeat diagnosis in Dr. Goodson’s 

office): “I can’t believe I have to take insulin!” 

•	 Fear (of what it means to have diabetes): “Am I 

going to die?” 
00 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

•	 Doubt (perhaps about the nurse’s experience when 

he asks, “How long have you been doing this?”). 

•	 Ambivalence (about going to a support group). 

•	 Depression. In the dream sequence, Calvin’s 

interaction with his daughter as he sits of the 

couch and overeats can be a sign of depression, as 

can feeling guilty. 

•	 Bargaining. In the dream sequence, Calvin tells his 

daughter that he will mow the lawn after he eats, 

and that this will be his exercise. He doesn’t say 

that he plans to change his eating behavior, but he 

bargains with her so that she will leave him alone. 

•	 Acceptance. Calvin shows acceptance of his diabetes 

when he shares his dream and his diagnosis with 

his family, and when he opens up at the support 

group. 

6.	 Point out to the participants that the characters’ negative emotions never get out of control in the film, but 

that similar situations with patients in their offices 

may be more extreme. 

Make sure to bring out in the discussion the following pitfalls to avoid when dealing with patients: 

•	 Becoming offended and getting into an argument. 

•	 Becoming defensive. 

•	 Trying to scare or threaten the patient into action. 

•	 Trying to force too much information on a patient 

who is not ready for it. 

•	 Blaming the patient. 

•	 Rejecting the patient’s ideas outright (for example, 

responding to an idea about an alternative healing 

method by saying, “That’s just a waste of time.”). 

•	 Dismissing the patient’s fears (for example, 

responding to the question “Am I going to die?” by 

saying, “Don’t be ridiculous!”). 
session thirteen: A session for heALth CAre proviDers 

0 

7.	 End the session on a positive note. Discuss the 

resources available for health care providers: 

•	 Make sure that the health care professionals in the 

group are aware of community resource personnel, 

such as diabetes educators, nutritionists, and 

diabetes control teams at the state and local health 

departments. 

•	 Address the availability of a team to help the doctor 

help a patient. Team members might include 

the primary care physician, a certified diabetes 

educator, a dietitian, a pharmacist, a podiatrist, a 

physical therapist, a mental health professional, a 

social worker, and a peer educator or community 

health worker. Distribute the handout Team Care: 

Comprehensive Lifetime Management for Diabetes . 

Explain that this monograph can guide the doctor 

in forming a diabetes team at his or her practice. 

•	 Address the doctors’ feelings about arranging for a 

team to care for a person with diabetes. 

Ask: What are some barriers to such an 

arrangement? Answers may include: 

–	 Lack of access to a team. 

–	 Reimbursement issues. 

–	 Lack of prior experience with team care. 

–	 The “hassle factor” of making arrangements 

with the patient’s health plan. 

Ask the group to brainstorm about solutions. 

Make sure that the following information is 

brought out in the discussion: 

–	 Tell participants about the availability of 

free resources from the National Diabetes 

Education Program on team care, such as 

the monograph Team Care: Comprehensive 

Lifetime Management for Diabetes and many 

other materials. 
02 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

–	 Refer participants to the Web site http://www. 

betterdiabetescare.nih.gov for more examples 

of team care and additional resources. 

8.	 Distribute the handout The 5As and say: You may find 

this handout on self-management support useful. The 

“5A” concept was first used in helping people to quit 

smoking, but the concept applies to diabetes prevention and control as well. 

Alternative or Additional 

Classroom Exercise 

Using the handout Role-Playing Exercise, ask for volunteers to role-play the part of the health care provider and 

the part of the patient. First, ask them to play the scene 

in a contentious manner that escalates as the two people 

fail to connect. Then, ask the same two participants (or a 

different set of participants, if desired) to role-play ways 

in which the health care provider could show respect for 

the patient, show an understanding of the patient’s emotional stage, and find a way to work with the patient. 
hAnDout for session thirteen: the 5As 

 

Handout for Session Thirteen 

The 5As 
hAnDout for session thirteen: roLe-pLAying exerCise 

 

Handout for Session Thirteen 

Role-Playing Exercise


Below are eight potential interactions (drawn from real clinical experiences with 

some details changed) that could take place between health care providers and their 

patients with diabetes. Ask participants to think about how each of these encounters 

might escalate, and about how the health care provider could defuse the situation. 

Then ask for two volunteers to choose one of the interactions and to act it out in front 

of the group. Have sets of volunteers act out as many interactions as time allows. 

1.	 Health Care Provider: We need to get you a glucose monitor so you can check 

your blood sugar at home. 

Patient: There’s no way I am using one of those! All you doctors ever want to do 

is give shots and run tests. You probably make money off those glucose monitor 

machines. You doctors are all alike. 

2.	 Health Care Provider: We’ll need to start you on insulin. 

Patient: I won’t start insulin. 

Health Care Provider: You need to start insulin. Your blood sugar is 400. 

Patient: That doesn’t matter. I am not taking the needle, and you can’t make me. 

3.	 Health Care Provider: We need to start you on these pills for your diabetes. 

Patient: I don’t want any of those toxic drugs. I only take all-natural remedies. 

4.	 Health Care Provider: Your blood pressure is high. You need to lose a few pounds. 

Patient: Are you saying I’m fat? I like having a little meat on my bones! I am so 

sick of you skinny know-it-alls telling me I’m fat! 

5.	 Health Care Provider: Tobacco and diabetes are a bad combination. If you don’t 

quit smoking, those cigarettes are going to kill you. 

Patient: (shrugging) The way I figure it, everybody’s got to die of something 

someday. 

6.	 Health Care Provider: If you don’t change the way you eat, your diabetes is going 

to get worse. 

Patient: (tearfully) I know, I know! I’m such a weak person, doctor. I am so sorry. I 

just hate it when I’m a bad girl [or boy] and overeat. Will you forgive me? 

7.	 Health Care Provider: Oh, and by the way, your lab tests came back, and you 

have diabetes. 

Patient: Oh my God! 

Health Care Provider: So we need to do some tests, and we might need to start 

you on some medicines. Let’s set you up to talk to the dietitian. I’ll ask the nurse 
 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

to teach you how to use the glucose monitor to check your blood sugar at home. 

Here’s a pamphlet for you that will tell you all about diabetes. 

Patient: (still in shock) I have diabetes? Are you sure? Oh, my God, I can’t 

believe it... 

8.	 Health Care Provider: How is your blood sugar doing? 

Patient: Oh, I don’t check it anymore. My cousin gave me this book on Ozone 

Therapy, so I don’t need to worry about my diabetes anymore. 
Troubleshooting 

Creating Your Own Panel Discussion 
trouBLeshooting 

0 

Troubleshooting


Every group has its ups and downs and often brings unexpected surprises. The 

group may have people who tend to dominate the discussion, as well as those who 

are quiet but have much to contribute. This section is intended to help you with 

some of the most frequently encountered situations in leading a group discussion. 

We don’t have a conference room in which to meet. 

You don’t need one. Someone’s living room, a local school classroom, or anywhere 

that people can sit and feel comfortable expressing their feelings will work. If you 

plan to show the film before a discussion, you will need a TV monitor and a DVD 

player, but you may also ask people to watch the film at home before the session if it 

is airing on a local public television station or if you can lend out the DVD of the film. 

Someone in the group has burst into tears! What do I do? 

This is a good sign. Those tears needed to come out. The rest of the group may be 

even more uncomfortable with tears than you are, so it helps to say something like, 

“Tears are important. We are dealing with a lot of big emotional issues. We are all 

among friends here, so don’t be afraid to cry here. Crying is part of the healing process that lets you go on.” 

People take cell phone calls, and they interrupt the discussion. 

At the beginning of the session ask everyone to turn off his or her cell phone or 

switch the phone to vibration mode with the ringer off. If people must take calls 

during the session, tell them that you must ask them to take the calls outside of the 

room, out of earshot. 

People bring their children, and the noise of the children playing is disruptive. 

Prepare ahead of time for this possibility. Even if you have told people not to bring 

children, it happens sometimes. Figure out what options you have for keeping the 

children busy and away from the group. If possible, arrange to have a VCR player 

or a DVD player and a TV monitor in another room playing a children’s video, or 

arrange for a babysitter to come during the session to keep the children from interrupting your session. Older children or teenagers could be invited to participate in 

the session. If the group meets regularly, ask the group how they want to deal with 

the situation. One possibility is to develop a rotating schedule that arranges for one 

person each session to stay with the children or to bring someone to stay with the 

children during the session. If you meet at a nearby school, the children may be able 

to play under supervision on the school playground. 

People expect food at sessions like this, or they bring food that’s not healthful. 

Food helps people to feel more relaxed, and you do want a comfortable setting in 

which people can open up. If this is a single session, provide water or sugarless 
0 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

drinks, fruit, perhaps vegetables and low-fat dip, or low-fat crackers and cheese. 

Pretzels are a lower fat choice than chips, but they are still high in salt and not the 

best choice for people with high blood pressure. If you are meeting regularly, discuss this food issue with the group at the first session and ask that only low-fat, 

low-sugar, healthful snacks are brought. 

One person is doing all the talking. 

There are a couple of ways to deal with this situation. Sometimes the person who is 

talking a lot is bringing out good points, and you don’t want him or her to stop, but 

you do want to make sure that everyone has a chance to speak. In that case, every 

once in a while, explain that you would like to go around the room and ask each 

person if he or she has anything to say on the topic being discussed. Or you can tell 

the group that you would like them to adopt some “ground rules” for the discussion. 

These ground rules would include the provisions that only one person speaks at a 

time, that there is to be no interrupting, that all opinions are welcome, that there are 

no right or wrong opinions, and any other provisions that the group deems appropriate. For example, one rule might be that one person may speak for only 2 minutes 

at a time. Two minutes should give plenty of time for relating an opinion, and even 

enough time for most personal stories. The “two minute rule” helps to ensure that 

everyone will have enough time to speak and that one person does not monopolize 

the discussion. 

If some participants continue to break the ground rules, remind the group of these 

rules. If a person continues to disrupt the class and can’t seem to understand that 

the ground rules apply to him or her, call a break in the session and then speak to 

the person individually during the break. Two choices for your conversation with this 

person are: 

1.	 If the person is difficult and disruptive, ask him or her to keep comments brief 

because others in the group want to speak. Consider establishing the “two minute rule” if you have not already done so. Tell the disruptive person that if he or 

she cannot follow this rule, you will have no choice but to ask him or her to leave. 

2.	 If you think that the person has goodwill but is having trouble with control, ask 

him or her to help with the class. You can enlist the person’s help with taking 

notes on the flipchart, distributing handouts, or other duties. Use the person’s 

energy and goodwill to help you. 

The DVD player isn’t working, and we can’t replay the scene. 

Try asking for a few volunteers to role-play the scene. It doesn’t matter if they don’t 

get it exactly right. Their role playing will show how they remember the emotions of 
trouBLeshooting 

0 

the scene, and that’s the point that we are trying to get at here. This situation might 

even give you a chance to have volunteers role-play the same scene in a few different ways. Ask the volunteers to role-play different emotions and different ways of 

helping Calvin. 

People are arguing and getting upset when they disagree. 

Remind folks that we are dealing with emotions here. There is no right or wrong 

concerning how someone feels—it just is the way that he or she feels. The point 

of this discussion is to bring out the many different kinds of emotions that people 

experience, to talk about how those emotions can help or hurt them, and to explore 

how to turn emotionally charged events into positive actions. Ask the group: “Can 

we turn all the powerful energy we are feeling during this discussion into something 

positive?” 

Someone has asked a question about her personal health—for example, whether 

she should worry about the chest pain she gets sometimes when she is upset. 

What should I do? 

Questions about personal symptoms must be directed back to the person’s health 

care provider. Don’t fall into the trap of trying to give medical advice. That is not 

your purpose in these sessions. 

A lot of medical questions are coming up, and I don’t know the answers, or I think I 

do but I’m not sure. Should I guess? 

No. Don’t guess. Don’t give information unless you are absolutely sure of the 

answer. Tell the group that you don’t know but will find out for them. You are 

strongly encouraged to invite a local health care provider or certified diabetes educator, or someone from the local American Diabetes Association (ADA) chapter, to 

a session. The focus of the modules in this discussion guide is on emotions and 

behavior—particularly what stops people from doing the right things to take care of 

themselves. But you don’t want to leave medical questions up in the air. You may 

be able to find the answers on the Web sites of the National Diabetes Education 

Program, the Centers for Disease Control and Prevention, or the National Institutes 

of Health, or from other Web sites listed in the References and Resource section at 

the back of this guidebook. See the following question. 

We want more information. Where can we get it? 

You can visit the many Web sites listed in the References and Resource section 

at the end of this guidebook. You can also call your local American Diabetes 

Association (ADA) chapter, or call the public inquiries line at the Centers for 

Disease Control and Prevention (CDC) at 1-877-CDC-DIAB or the National Diabetes 

Education Program (NDEP) at 1-800-438-5383 to order informational materials. 
0 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

We want to give you some comments. How can we do this? 

Do you have comments to make about this discussion guide? We’d love to have your 

opinions so that we can improve these materials in future revisions. Please either 

e-mail your comments to jkelly@cdc.gov or send them by regular mail to: 

Dr. Jane Kelly 

Director, National Diabetes Education Program 

Centers for Disease Control and Prevention (CDC) 

Division of Diabetes Translation 

Mailstop K-10 

4770 Buford Highway 

Atlanta, GA 30341 
CreAting your own pAneL DisCussion 

0 

Creating Your Own Panel Discussion


The one-hour film special The Debilitator broadcast on public television in Atlanta 

(WPBA) in April 2005 included a 30-minute panel discussion with a physician, an 

actor from the film who himself has diabetes, a diabetes educator/dietitian, a local 

religious leader, and a behavioral psychologist as discussion moderator. For your 

community event, you may choose to show the Calvin Dixon story first, and then 

have your own panel discussion by a panel of local health care providers, community leaders, and others. This format can be very effective. 

Here are a few suggestions for creating your own half-hour panel discussion: 

1.	 Think first about your goals for the panel. Is the main goal to raise awareness of 

diabetes, to begin discussion of the emotional and behavioral aspects of living 

with diabetes, to inspire community leaders to take action, to encourage people 

to share more with their families or with their doctors, or to communicate more 

basic facts about diabetes? 

2.	 Once you have established your primary goal, decide who would be the best 

people to communicate these objectives. Keep in mind, for example, that, if the 

topic is emotional support, a panel of medical experts might not be as capable of 

connecting with people as a person with diabetes would be. 

3.	 Limit the number of people on the panel. Three or four people may be enough. 

Five people plus a moderator speaking for only 5 minutes each would take up the 

entire half-hour with no time for questions. 

4.	 If the panel is speaking in front of a live audience, consider requesting that 

questions be submitted in writing on an index card and then turned in to the 

moderator to read aloud. This format will minimize disruptive, inappropriate 

questions (an unfortunate occurrence at some events). 

5.	 You don’t need to write a precise script for the panelists, but make sure that the 

moderator has a preplanned list of questions (at least one per panelist) to be 

used to begin the discussion. Also make sure that each panel member knows 

which initial questions will be directed to him or her. 

6.	 Include an “action item” (specific suggestions for what the viewing audience can 

do right now while they are feeling motivated) so that people know what steps 

they can take after the panel discussion concludes. Give a toll-free number that 

they can call for more information (a local call-in line or the NDEP number), give 

a Web site that they can visit, or at least make the recommendation that people 

talk with their own health care providers. You are welcome to use the same discussion questions that were used in the panel discussion at the end of the film 

The Debilitator. 
0 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

7.	 Don’t forget evaluation. Develop a form that you can hand out at the beginning 

and collect at the end of the session to find out whether people found the session 

helpful, what actions they are planning to take, what other topics they wish you 

had addressed, and so forth. This feedback will give you much needed information for planning future events, and it will be of greater interest to your sponsors 

than simply the number of people who attended or heard the program. 
References and Resources 

NDEP Publications Order Form 

State-Based Programs to Reduce the 

Burden of Diabetes 
referenCes AnD resourCes 

0 

References and Resources


Selected References 

1.	 Bonomi A, editor. To Come to Light: Perspectives on Chronic Illness in Modern 

Literature. Seattle: Whit Press; 2002. 

2.	 Brown SA. Interventions to promote diabetes self-management: state of the 

science. Diabetes Educator 1999;25:52-61. 

3.	 Institute of Medicine, Committee on Quality of Health Care in America. Crossing 

the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: 

The Institute; 2001. 

4.	 Emmons KM, Rollnick S. Motivational interviewing in health care settings. 

Opportunities and limitations. Am J Prev Med 2001;20:68-74. 

5.	 Feste C. 365 Daily Meditations for People with Diabetes. Alexandria: American 

Diabetes Association; 2004. 

6.	 Gavin J, Landrum S. Dr. Gavin’s Health Guide for African Americans. Alexandria: 

Small Steps Press; 2004. 

7.	 Gerteis M, Edgman-Levitan S, Daley J. Through the Patient’s Eyes. 

Understanding and Promoting Patient-Centered Care. San Francisco, CA: 

Jossey-Bass; 1993. 

8.	 Greenberger D, Padesky C. Mind over Mood: A Cognitive Therapy Treatment 

Manual for Clients. New York: The Guilford Press; 1995. 

9.	 Hammond DC, editor. Handbook of Hypnotic Suggestions and Metaphors. An 

American Society of Clinical Hypnosis Book. New York: W.W. Norton; 1990. 

10. Kubler-Ross E. On Death and Dying. New York, NY: Collier Books; 1969. 

11. Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician 

responses in primary care and surgical settings. JAMA 2002;284:1021-7. 

12. Lorig KR, Ritter P, Stewart AL, et al. Chronic disease self-management program: 

2-year health status and health care utilization outcomes. Med Care 2001;39: 

217-23. 

13. National Diabetes Fact Sheet United States (2003). Available at: http://www.cdc. 

gov/diabetes/pubs/pdf/ndfs_2003.pdf 
0 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

14. Peterson KA. Readiness to change and clinical success in a diabetes educational 

program. J Am Board Fam Pract 2002;15:266-71. 

15. Platt FW, Gordon GH. Field Guide to the Difficult Patient Interview. Philadelphia, 

PA: Lippincott, Williams & Wilkins; 1999. 

16. Resnicow K, DiIorio C, Soet JE, Ernst D, Borrelli B, Hecht J. Motivational interviewing in health promotion: it sounds like something is changing. Health Psych 

2002;21:444-51. 

17. Sapolsky RM. Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, StressRelated Diseases and Coping. New York: W. H. Freeman; 1998. 

18. Shea SC. Psychiatric Interviewing: The Art of Understanding: A Practical Guide 

for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses and Other 

Mental Health Professionals. Philadelphia, PA: W.B. Saunders Company, 1988. 

19. Smith RC, Hoppe RB. The patient’s story: integrating the patient- and physiciancentered approaches to interviewing. Ann Intern Med 1991;115:470-7. 

20. Strasburger VC Brown RT. Adolescent Medicine: A Practical Guide. Boston: Little, 

Brown and Company; 1991. 

21. Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA 1997;277:678-82. 

22. Centers for Disease Control and Prevention. Take Charge of Your Diabetes. 2003. 

3rd edition. Available at: http://www.cdc.gov/diabetes/pubs/tcyd/index.htm. 

23. Wegner DM. White Bears and Other Unwanted Thoughts: Suppression, Obsession 

and the Psychology of Mental Control. New York: Viking Penguin, Inc.; 1989. 

Recommended for Further Reading 

If you’re a diabetes educator, health care provider, or support group facilitator 

looking for more guidance, please look at the list below . From dietary advice to 

inspirational quotes, these selected readings from our reference list provide a nutsand-bolts compilation of resources for dealing with both the physical and emotional 

aspects of diabetes . 

1.	 Feste C. 365 Daily Meditations for People with Diabetes. Alexandria: American 

Diabetes Association; 2004. 

Written by Catherine Feste, a motivational speaker and health educator, this book 

is a collection of meditations designed to inspire hope and provide guidance for 

people living with diabetes. Feste weaves together quotes from sources as diverse 

as Albert Einstein, William Shakespeare, and Buddha with skillful storytelling, 
referenCes AnD resourCes 

 

creating a web of emotional and spiritual thoughts that has been described as a 

“support group in a book.” 

2.	 Gavin J, Landrum S. Dr. Gavin’s Health Guide for African Americans. Alexandria: 

Small Steps Press; 2004. 

Dr. James Gavin III, MD, PhD, Chair of the National Diabetes Education Program 

and past president of the American Diabetes Association, combines his passion for 

medicine and his knowledge of African American culture into a practical, easy-touse reference book on healthy lifestyles. The book covers everything from diabetes 

and other chronic diseases to the importance of emotions and family support as 

they relate to a person’s health. 

3.	 Take Charge of Your Diabetes . 3rd ed. 2003. (English-language patient guide) 

http://www.cdc.gov/diabetes/pubs/tcyd/index.htm 

Developed by the Centers for Disease Control and Prevention, Take Charge of Your 

Diabetes offers basic information about diabetes care and management. Topics 

include everything from managing blood sugar levels during sick days to avoiding diabetes-related complications. The book and its online version also provide an 

assortment of glucose logs for those wishing to keep track of their sugar levels. 

Selected Web Resources 

Diabetes Prevention Program, Lifestyle Balance 

http://www.bsc.gwu.edu/dpp/manuals.htmlvdoc 

Though The Debilitator film deals mostly with what to do when you have diabetes, 

understanding the importance of prevention is the ultimate key to leading a diabetesfree life. The Diabetes Prevention Program (DPP) Web site provides links to curriculum and information on the DPP in English and Spanish. 

Improving Chronic Illness Care, MacColl Institute for Healthcare Innovation 

http://www.improvingchroniccare.org 

Improving Chronic Illness Care, a national program of The Robert Wood Johnson 

Foundation, is dedicated to the idea that United States health care can do better. The 

99 million Americans who suffer from diabetes, depression, and other chronic conditions can lead healthier lives. Providers who care for chronically ill patients can be 

better supported with guidelines, specialty expertise, and information systems. 

National Diabetes Education Program 

http://www.ndep.nih.gov 

http://www.cdc.gov/diabetes/ndep 

http://www.diabetesatwork.org 

http://www.betterdiabetescare.nih.gov 
2 

new Beginnings: A DisCussion guiDe for Living weLL with DiABetes 

Centers for Disease Control and Prevention 

http://www.cdc.gov 

National Institute of Diabetes and Digestive and Kidney Diseases 

http://www.niddk.nih.gov 

U.S. Department of Health and Human Services, Steps to a HealthierUS, 

http://www.healthierus.gov 

The Web site provides links to a wide range of topics on nutrition, exercise, obesity, 

diabetes, and blood pressure. 

Links to non-Federal organizations are provided solely as a service to our users. 

Links do not constitute an endorsement of any organization by NDEP or the federal 

government, and none should be inferred. The NDEP is not responsible for the content of the individual organization Web pages. 
REFERENCES AND RESOURCES 113 

NDEP Publications & Resources 

The NDEP encourages you to visit the Web site www.ndep.nih.gov for descriptions 

of all items listed below, translations for various ethnic groups, and to find the 

newest products available to the public. 

Control Your Diabetes. For Life.: Publications & Resources for Consumers 

4 Steps to Control Your Diabetes. For Life. 

(NDEP-67)*

First 25 copies free. Each additional package of 25, $5. Limit two packages. 

7 Principles for Controlling Your Diabetes. For Life. 

(NDEP-17)*

First 25 copies free. Each additional package of 25, $5. Limit two packages. 

Control Your Diabetes. For Life. Tips for Feeling Better and Staying Healthy 

(NDEP-8)

First 25 copies free. Each additional package of 25, $5. Limit two packages. 

If You Have Diabetes, Know Your Blood Sugar Numbers 

(NDEP-10)*

First 25 copies free. Each additional package of 25, $5. Limit two packages. 

The Power to Control Diabetes Is in Your Hands 

(NDEP-38)*

First 25 copies free. Each additional package of 25, $5.

Expanded Medicare Coverage of Diabetes Services Fact Sheet 

(NDEP-77)

First 25 copies free. Each additional package of 25, $5. Limit two packages. 

Take Care of Your Feet for a Lifetime 

(NDEP-4)*

First 25 copies free. Each additional package of 25, $5. Limit two packages. 

Tips for Helping a Person with Diabetes 

(NDEP-57) *

First 25 copies free. Each additional package of 25, $5. Limit two packages. 

Recipe and Meal Planner Guide (Recetas y plan de comidas) 

(NDEP-51)*

A bilingual (English and Spanish) meal planner with food photography. Available online only at 

www.ndep.nih.gov. 

*Commercial Printer-Ready CDs Available. Call (800)860-8747. Visit www.ndep.nih.gov. Updated 1/05 
114 NEW BEGINNINGS: A DISCUSSION GUIDE FOR LIVING WELL WITH DIABETES 

Be Smart About Your Heart. Control the ABCs of Diabetes. 

Be Smart About Your Heart. Control the ABCs of Diabetes: A1C, Blood Pressure, and Cholesterol 

(NDEP-52)*

First 25 copies free. Each additional package of 25, $5. Limit two packages. 

If You Have Diabetes, Take Care of Your Heart (Si tiene diabetes, cuide su corazón) 

(NDEP-58)*

An easy-to-read, illustrated, bilingual (Spanish and English) booklet. First 25 copies free. Each additional 

package of 25, $5. Limit two packages. 

Small Steps. Big Rewards. Prevent Type 2 Diabetes 

Small Steps. Big Rewards. Your GAME PLAN for Preventing Type 2 Diabetes: Information for Patients 

(NDEP-60)*

This is a four-booklet package. Single set free. Each additional set, $4. Limit three sets. 

Small Steps. Big Rewards. Diabetes Prevention Tip Sheets for High Risk Audiences 

The tip sheets are tailored for groups at highest risk for diabetes and supplement the GAME PLAN kits. 

First 25 copies free. Each additional package of 25, $5. Limit: two packages of each tip sheet. 

More than 50 Ways to Prevent Diabetes (for African Americans) 

(NDEP–71) 

It's Not Too Late to Prevent Diabetes (for Older Adults) 

(NDEP–75) 

Get Real! You Don't Have to Knock Yourself Out to Prevent Diabetes (for General Audience) 

(NDEP–76) 

Publications and Resources for Children and Adolescents 

Helping the Student with Diabetes Succeed: A Guide for School Personnel 

(NDEP-61)*

Single copy free. Each additional copy, $3. Limit six copies. 

Tips for Kids with Type 2 Diabetes Series 

First 25 copies free. Each additional package of 25, $5. Limit two packages of each tip sheet. 

What Is Diabetes? Be Active Stay At a Healthy Weight Eat Healthy 

(NDEP-63) (NDEP-64) (NDEP-65) (NDEP-66) 

Control Your Diabetes. For Life. : Publications & Resources for 

Health Care Providers 

Diabetes Numbers at-a-Glance Card 

(NDEP-12)

Single copy free. Each additional package of 25, $5. Limit five packages. 

*Commercial Printer-Ready CDs Available. Call (800)860-8747. Visit www.ndep.nih.gov. Updated 1/05 
REFERENCES AND RESOURCES 115 

Guiding Principles of Diabetes Care 

(NDEP-16)

First six copies free. Each additional package of 25, $5.

Working Together to Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists, and Dental 

Professionals 

(NDEP-54)

Single copy free. Each additional copy, $1. Limit six copies. 

Working Together to Manage Diabetes: Poster 

(NDEP-55)

Single copy free. Limit one copy. 

Working Together to Manage Diabetes: Diabetes Medications Supplement 

(NDEP-54-S)

Single copy free. Each additional copy, $1. Limit six copies. 

Team Care: Comprehensive Lifetime Management for Diabetes 

(NDEP-37)

Single copy free. Each additional copy, $1. Limit six copies. 

Feet Can Last a Lifetime: A Health Care Provider's Guide to Preventing Diabetes Foot Problems 

(NDEP-2)

Single copy free. Each additional copy, $3. Limit six copies. 

The Power to Control Is in Your Hands, Health Care Practitioner’s Kit 

(NDEP-50)

Single kits free. Each additional kit, $1. Limit six kits. 

The Power to Control Diabetes Is in Your Hands. Poster 

(NDEP-40)

Single copy free. Each additional package of 25, $5. 

The Power to Control Diabetes Is in Your Hands. Countertop Display 

(NDEP-42)

Single copy free. Each additional package of 10, $5. 

www.BetterDiabetesCare.nih.gov 

This easy-to-use comprehensive resource will help health care providers, educators, policy makers, 

planners, and purchasers make important changes in systems of care for people with diabetes and achieve 

exciting results. 

Be Smart About Your Heart. Control the ABCs of Diabetes. 

Be Smart About Your Heart. Control the ABCs of Diabetes: A1C, Blood Pressure, and Cholesterol. 

Photocopy Master 

(NDEP-52PM)

Camera-ready version of NDEP-52. Single copy free. No bulk orders. 

If You Have Diabetes, Take Care of Your Heart. Flipchart Presentation (Si tiene diabetes, cuide su 

corazón. Presentación en rotafolio) 

(NDEP-58FC)

A bilingual presentation tool. Single copy free. Each additional copy, $4. Limit five copies. 

*Commercial Printer-Ready CDs Available. Call (800)860-8747. Visit www.ndep.nih.gov. Updated 1/05 
116 NEW BEGINNINGS: A DISCUSSION GUIDE FOR LIVING WELL WITH DIABETES 

Small Steps. Big Rewards. Prevent Type 2 Diabetes 

Small Steps. Big Rewards. Your GAME PLAN for Preventing Type 2 Diabetes: Health Care Provider 

Toolkit 

(NDEP-59)*

Single copy free. Each additional copy, $5. Limit three copies. 

Publications and Resources for Organizations 

Control Your Diabetes. For Life. Campaign Guide for Partners 

(NDEP-15)

This 58-page how-to guide is designed to help partner organizations disseminate the Control Your

Diabetes. For Life. campaign messages. Single copy free. Each additional copy, $3. 

Diabetes Community Partnership Guide 

(NDEP-21)

This how-to kit contains ideas, tools, and guidelines for community partnerships and diabetes activities. 

Single copy free. Each additional copy, $3. Limit six copies. 

Five Communities Reach Out Videotape (VHS) 

(NDEP-36) 

This powerful 22-minute video and accompanying guide show how different communities can work 

together and use available resources to improve diabetes control. The video can be used as part of a 

community action–planning workshop when combined with the NDEP publication Diabetes Community 

Partnership Guide (NDEP–21). Single copies $10 each. 

Making a Difference: The Business Community Takes on Diabetes 

(NDEP-33)*

This white paper is a call to action for business leaders to become involved in workplace and community

activities to control diabetes-related complications. Single copy free. Each additional copy, $1. 

Team Care: Comprehensive Lifetime Management for Diabetes 

(NDEP-37)

This report was created to help organizational leaders in health care systems and health care purchasers 

implement multidisciplinary team care for people with diabetes in all clinical settings. Single copy free. 

Each additional copy, $1. Limit six copies. 

www.DiabetesAtWork.org 

This online diabetes and health resource kit helps businesses and managed care companies to assess the 

impact of diabetes in the workplace. It also provides easy-to-understand information for employers to help 

their employees manage their diabetes and take steps toward reducing the risk for diabetes-related 

complications such as heart disease. 

*Commercial Printer-Ready CDs Available. Call (800)860-8747. Visit www.ndep.nih.gov. Updated 1/05 
NDEP PUBLICATIONS ORDER FORM 117 

NDEP Publications Order Form 

We regret that we cannot provide more than the limits noted. We hope the photocopy masters, commercial 

printer-ready CDs, and online versions will encourage you to create your own inventory. Remember: All our 

publications are copyright-free and are on the web at www.ndep.nih.gov. Duplicate and distribute as many 

copies of these materials as you like. In the space provided, please include the name/publication number, 

quantity and cost of the items(s) you would like to order. 

Quantity Cost 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

Total 

Method of Payment 

Check or money order enclosed ______. (Make checks payable to NDIC) 

information. 

Bulk orders must be 

dollars. 

for delivery. 

Please print clearly 

and provide all 

necessary mailing 

For credit card 

orders, we accept 

MasterCard or Visa 

only. 

prepaid in U.S. 

Please do not send 

cash. 

Allow 4 to 6 weeks 

Purchase order enclosed ____________. 

VISA ______ MasterCard _______ Credit card number _________________________________ 

Expiration date ____/____ (Mo/Yr) Card holder signature ________________________________ 

Name___________________________________________________________________________ 

Title/Organization_________________________________________________________________ 

Address_________________________________________________________________________ 

City_______________________________________________ State________________________ 

ZIP __________________________ Telephone_____________________________ 

Please return this order form with your payment to: 

National Diabetes Information Clearinghouse 

1 Information Way, Bethesda, MD 20892-3560 

Phone: 1-800-860-8747 (for bulk orders or CDs) or 1-800-438-5383 (for no cost orders) 

Fax: (703) 738-4929 

Email: ndic@info.niddk.nih.gov 

STATE-BASED PROGRAMS TO REDUCE THE BURDEN OF DIABETES 119 

STATE-BASED PROGRAMS TO REDUCE THE BURDEN OF DIABETES 

Alabama 

Director/Coordinator 

Sandra Langston, MPH 

Director, Diabetes Branch 

Alabama Department of Public Health 

201 Monroe Street, Suite 900 

Montgomery, AL 36130-3017 

(334) 206-2062 phone 

(334) 206-5324 fax 

slangston@adph.state.al.us 

Alaska 

Director 

VACANT 

Department of Health and Social 

Services 

3601 C Street, Suite 722 

PO Box 240249 

Anchorage, AK 99524-0249 

(907) 269-8447 phone 

(907) 561-1896 fax 

Coordinator 

Barbara Stillwater, RN, PhD 

Program Manager 

AK Diabetes Prevention and Control 

Program 

SOA-DHSS-DPH 

Section of Epidemiology 

3601 C Street, Suite 722 

PO Box 240249 

Anchorage, AK 99524 

(907) 269-8035 phone 

(907) 269-5446 fax 

barbara_stillwater@health.state.ak.us 

American Samoa 

Director 

Sivia F. Sunia 

Chief for Public Health Programs and 

Services 

American Samoa Government 

Pago Pago, AS 96799 

0-11-684 633-4606 phone 

0-11-684 633-5379 fax 

publichealth8@hotmail.com 

Coordinator 

Pasa Turituri, AS 

Department of Health Services 

American Samoa Government 

Pago Pago, AS 96799 

0-11-684-633-2186 phone 

0-11-684-633-5379 fax 

ptlevi@hotmail.com 

Arizona 

Director/Office Chief 

Margie Tate 

Arizona Department of Health Services 

2927 North 35th Avenue 

Phoenix, AZ 85017 

(602) 542-2829 phone 

(602) 542-1890 fax 

tatem@azdhs.gov 
120 NEW BEGINNINGS: A DISCUSSION GUIDE FOR LIVING WELL WITH DIABETES 

Coordinator 

Carmen Ramirez 

Arizona Department of Health Services 

Diabetes Prevention and Control 

150 North 18th Ave., Suite 310 

Phoenix, AZ 85007-3242 

(602) 542-2758 phone 

(602) 542-0512 fax 

ciocazm@azdhs.gov 

Program Manager 

M. Magda Ciocazan 

Arizona Department of Health Services 

Diabetes Prevention and Control 

150 N. 18th Ave, Suite 310 

Phoenix, AZ 85007-3242 

(602) 542-2758 phone 

(602) 542-0512 fax 

ciocazm@azdhs.gov 

Arkansas 

Director 

David Bourne, MD 

Arkansas State Department of Health 

4815 West Markham Street, Mail Slot 3 

Little Rock, AR 72205-3867 

(501) 661-2093 phone 

(501) 661-2070 fax 

Acting Coordinator 

Mitchell Simpson 

Arkansas State Department of Health 

4815 West Markham Street 

Mail Slot 11 

Little Rock, AR 72205-3867 

(501) 661-2334 phone 

(501) 661-2070 fax 

msimpson@healthyarkansas.com 

California 

Director 

Ann Albright, RD, PhD 

California Department of Health 

Services 

Diabetes Prevention and Control 

3

Program

rd Floor 

1616 Capitol Ave., Suite 74-342 

MS 7211 

PO Box 94273 

Sacramento, CA 94234-7320 

(916) 552-9884 phone 

(916) 552 9988 fax 

annalb@itsa.ucsf.edu 

Coordinator 

Susan Mele, BA, BS 

Administrative Manager and 

Media/Marketing Specialist 

California Department of Health 

Services 

Diabetes Prevention and Control 

Program, 3rd Floor 

1616 Capitol Avenue, Suite 74-317 

MS 7211 

PO Box 942732 

Sacramento, CA 94234-7320 

(916) 552-9942 phone 

(916) 552-9988 fax 

smele@dhs.ca.gov 
STATE-BASED PROGRAMS TO REDUCE THE BURDEN OF DIABETES 121 

Colorado 

Director 

Normie Morin Voilleque, PhD 

Colorado Department of Public Health 

 and Environment, DPCP 

4300 Cherry Creek Drive South 

Denver, CO 80246 

(303) 692-2505 phone 

(303) 782-0095 fax 

normie.morin@state.co.us 

Coordinator 

Dale Rogoff Greer, RN, MPH, CPHQ 

Colorado Department of Public Health 

 and Environment, DPCP 

4300 Cherry Creek Drive South 

Denver, CO 80246 

(303) 692-2577 phone 

(303) 782-0095 fax 

dale.greer@state.co.us 

Connecticut 

Director 

Rosa Biaggi, MPA, MPH 

State of Connecticut Department of 

Health 

410 Capitol Avenue MS #13 CMN 

PO Box 340308 

Hartford, CT 06134-0308 

(860) 509-7773 phone 

(806) 509-7286 fax 

rosa.biaggi@po.state.ct.us 

Coordinator 

Cindy Kozak, RD, MPH, CDE 

State of Connecticut Department of 

Health 

410 Capitol Avenue, MS-11 HLS 

PO Box 340308 

Hartford, CT 06134-0308 

(860) 509-7802 phone 

(860) 509-7854 fax 

cindy.kozak@po.state.ct.us 

Delaware 

Director 

Don Post, AS 

Blue Hen Corporate Center, Suite 201B 

655 South Bay Road 

Dover, DE 19901 

(302) 741-2900 phone 

(302) 741-2910 fax 

donald.post@state.de.us 

District of Columbia 

Project Director 

Stephanie Harper, MD, MPP 

825 N. Capital Street, NE, Suite 3137 

Washington, DC 20002 

(202) 442-5911 phone 

(202) 442-4825 fax 

sharper@dchealth.com 

Coordinator

James Copeland, MA, MPA, MPH, 

MS, CHES

825 N. Capital Street, NE, 3rd Floor 

Washington, DC 20002 

(202) 442-5902 phone 

(202) 442-4826 fax 

james.copeland@dc.gov 
122 NEW BEGINNINGS: A DISCUSSION GUIDE FOR LIVING WELL WITH DIABETES 

Federated States of Micronesia 

Director 

Nena S. Nena, MPH 

Acting Secretary, Department of Health 

Services 

PO Box 70, PS 

FMS National Government 

Palikir, Pohnpei, FM 96941 

(0-11-691) 320-2619 phone 

(0-11-691) 320-5263 fax 

nenas@mail.fm 

Coordinator 

Carter Apaisan, BA, BS, RN 

Department of Health Services 

PO Box 70, PS 

FMS National Government 

Palikir, Pohnpei, FM 96941 

(0-11-691) 320-2619/2643 phone 

(0-11-691) 320-5263 fax 

fsmdcp@mail.fm 

Florida 

Coordinator 

Tammie Johnson, MPH 

Florida Diabetes Control Program 

4025 Esplanade Way, Suite 130 

Tallahassee, FL 32399-1744 

(850) 245-4367 phone 

(850) 414-7497/6625 fax 

tammie_johnson@doh.state.fl.us 

Georgia 

Director/Coordinator 

Magon Mbadugha, MS, RD, LD 

2 Peachtree Street, 16th Floor 

Atlanta, GA 30303 

(404) 657-6637 phone 

(404) 657-6631 fax 

mmbadugha@dhr.state.ga.us 

Guam 

Director 

Charles Morris 

Bureau of Community Health Services 

PO Box 2816 

Hagatna, GU 96932 

(671) 635-7480 phone 

(671) 635-7377 fax 

Coordinator 

Marie Cruz 

Bureau of Community Health Services 

PO Box 2816 

Hagatna, GU 96932 

(671) 635-7479 phone 

(671) 637-7377 fax 

richmar8888@yahoo.com 

Hawaii 

Director 

Sandi Chang 

601 Kamokila Rd., Room 344 

Kapolei, HI 96707 

(808) 692-7482 phone 

(808) 587-3911 fax 

sschang@mail.health.state.hi.us 

mmnogues@mail.health.state.hi.us 

Coordinator 

Cristina Vocalan, RN 

State of Hawaii, Department of Health 

Diabetes and Chronic Disabling Disease 

Section 

601 Kamokila Blvd., Room 344 

Kapolei, HI 96707 

(808) 692-7475 phone 

(808) 692-7461 fax 

cristina.l.vocalan@doh.hawaii.gov 
STATE-BASED PROGRAMS TO REDUCE THE BURDEN OF DIABETES 123 

Idaho 

Director 

VACANT 

Chief, Bureau of Health Promotion 

Department of Health and Welfare 

450 West State Street 

PO Box 83720-0036 

Boise, ID 83720-0036 

(208) 334-5933 phone 

(208) 334-6573 fax 

Coordinator 

MiMi Hartman, MA, RD, CDE 

Bureau of Health Promotion 

Department of Health and Welfare 

450 West State Street 

PO Box 83720 

Boise, ID 83720-0036 

(208) 334-4928 phone 

(208) 334-6573 fax 

hartmanm@idhw.state.id.us 

Illinois 

Director 

Penny Roth, MS, RD/LDN 

Division of Community Health and 

Prevention 

535 West Jefferson, 3rd Floor 

Springfield, IL 62702-5058 

(217) 782-2166 phone 

(217) 785-5247 fax 

DHSHPAT@dhs.state.il.us 

Coordinator

Cheryl A. Metheny, MS, RD, CDE, 

CLC 

Illinois Diabetes Prevention and Control 

Programs 

Department of Human Services 

102 E. De Young 

Marion, IL 62959 

(618) 993-7493 phone 

(618) 998-9145 fax 

dhsz0311@dhs.state.il.us 

Indiana 

Director 

Joyce Black, MS, RD 

2 North Meridian, 6th Floor 

Indianapolis, IN 46204 

(317) 233-7371 phone 

(317) 233-7127 fax 

jblack@isdh.state.in.us 

Coordinator 

Laura Heinrich, BS 

2 North Meridian, 6th Floor 

Indianapolis, IN 46204 

(317) 233-7449 phone 

(317) 233-7127 fax 

ltheinri@isdh.state.in.us 

Iowa 

Director 

Jill Geadelman, BSN, RN 

Iowa Department of Public Health 

Lucas State Office Building 

321 East 12th Street 

Des Moines, IA 50319-0075 

(515) 281-6646 phone 

(515) 281-4535 fax 

jgeadelm@idph.state.ia.us 
124 NEW BEGINNINGS: A DISCUSSION GUIDE FOR LIVING WELL WITH DIABETES 

Iowa 

Coordinator 

VACANT 

Bureau of Health Promotion and 

Disability 

Lucas State Office Building 

321 East 12th Street 

Des Moines, IA 50319-0075 

(515) 242-6204 phone 

(515) 281-4535 fax 

Kansas 

Director 

Paula F. Marmet, MS, RD 

Curtis State Office Building 

1000 SW Jackson, Suite 230 

Topeka, KS 66612-1274 

(785) 296-8126 phone 

(785) 296-8059 fax 

pmarmet@kdhe.state.ks.us 

Coordinator 

Kate Watson 

Curtis State Office Building 

1000 SW Jackson, Suite 230 

Topeka, KS 66612-1274 

(785) 291-3739 phone 

(785) 296-8059 fax 

kwatson@kdhe.state.ks.us 

ksummers@kdhe.state.ks.us 

Kentucky 

Director 

Curtis Rowe, MPH 

Kentucky Department for Public Health 

Diabetes Prevention and Control 

Program 

275 East Main Street, HS2W-E 

Frankfort, KY 40621-0001 

(502) 564-7996 phone 

(502) 564-4776 fax 

curtis.rowe@ky.gov 

Coordinator 

Theresa A. Renn, RN, BSN, CDE 

Nurse Administrator 

Kentucky Department for Public Health 

275 East Main Street, HS2W-E 

Frankfort, KY 40621-0001 

(502) 564-7996 phone 

(502) 564-4667 fax 

theresa.renn@ky.gov 

Louisiana 

Director 

Shawn B. Smith, MSW, GSW 

Louisiana Office of Public Health 

325 Loyola Avenue, Room 212 

New Orleans, LA 70112 

(504) 568-7016 phone 

(504) 568-7005 fax 

sbsmith@dhh.la.gov 

Coordinator 

Tia Gipson 

325 Loyola Avenue, Room 212 

New Orleans, Louisiana 70112 

(504) 568-7016 phone 

(504) 568-7005 fax 

tgipson@dhh.la.gov 
STATE-BASED PROGRAMS TO REDUCE THE BURDEN OF DIABETES 125 

Maine 

Director/Coordinator 

James F. Leonard, MSW 

Key Plaza, 4st Floor 

11 State House Station 

Augusta, ME 04333-0011 

(207) 287-2906 phone 

(207) 287-4631 fax 

james.f.leonard@Maine.gov 

Republic of the Marshall Islands 

Director 

Russell Edwards 

Ministry of Health & Environment 

PO Box 16 

Republic of the Marshall Islands 

Majuro, MH 96960 

(011-692) 625-7251 phone 

(011-692) 625-3432 fax 

russelledwards1@yahoo.com 

Acting Coordinator 

Janet Nemra 

PO Box 16 

Republic of the Marshall Islands 

Majuro, MH 96960 

(011-692) 625-3388 x2166 phone 

(011-692) 625-3432 fax 

jannemra@hotmail.com 

nutmohe@ntamar.net 

Maryland 

Director 

Pat Boehm, RN, MS, CNA 

Department of Health and Mental 

Hygiene 

300 W. Preston Street, Suite 200 

Baltimore, MD 21201 

(410) 767-5590 phone 

(410) 333-7411 fax 

boehmp@dhmh.state.md.us 

Coordinator 

Earl W. Schurman, BA, BS 

Division of Diabetes Control 

Department of Health and Mental 

Hygiene 

6 Saint Paul Street, Suite 603 

Baltimore, MD 21202 

(410) 767-6788 phone 

(410) 333-7411 fax 

schurmane@dhmh.state.md.us 

Massachusetts 

Director 

Nidu Menon 

Massachusetts Department of Public 

Health 

250 Washington Street, 4th Floor 

Boston, MA 02108-4619 

(617) 994-9807 phone 

(617) 624-5075 fax 

nidu.memon@state.ma.us 
126 NEW BEGINNINGS: A DISCUSSION GUIDE FOR LIVING WELL WITH DIABETES 

Michigan 

Director 

Denise Cyzman, MPH, RD 

Michigan Department of Community 

Health 

3423 N. Martin Luther King, Jr. Blvd. 

PO Box 30195 

Lansing, MI 48906 

(517) 335-8369 phone 

(517) 335-9461 fax 

cyzmand@michigan.gov 

Coordinator 

Dan Diepenhorst, MSW 

3423 N. Martin Luther King, Jr. Blvd. 

PO Box 30195 

Lansing, MI 48906 

(517) 335-8137 phone 

(517) 335-9461 fax 

diepenhorstd@michigan.gov 

Minnesota 

Director 

Donald B. Bishop, PhD 

Minnesota Department of Health 

PO Box 64882 

St. Paul, MN 55164-0882 

(651) 281-9839 phone 

(651) 281-9825 fax 

don.bishop@health.state.mn.us 

Coordinator 

Martha Roberts, MPH 

Minnesota Department of Health 

PO Box 64882 

St. Paul, Minnesota 55164-0882 

(651) 281-9842 phone 

(651) 281-9825 fax 

martha.roberts@health.state.mn.us 

Mississippi 

Director 

Cassandra Dove 

570 East Woodrow Wilson, Suite 301 

PO Box 1700 

Jackson, MS 39215-1700 

(601) 576-7784 phone 

(601) 576-7444 fax 

cassandra.dove@msdh.state.ms.us 

Coordinator 

VACANT 

570 E. Woodrow Wilson, Suite 301 

Jackson, MS 39215-1700 

(601) 576-7781 phone 

(601) 576-7444 fax 

Missouri 

Director 

Karen Battjes, MSW, MBA 

Missouri Department of Health and 

Senior Services 

Unit of Chronic Disease Control 

920 Wildwood, PO Box 570 

Jefferson City, MO 65102-0570 

(573) 751-8840 phone 

(573) 522-2898 fax 

battjk@dhss.mo.gov 

Coordinator 

Joan Anderson, BA, BS 

Missouri Department of Health and 

Senior Services 

Unit of Chronic Disease Control 

920 Wildwood, PO Box 570 

Jefferson City, MO 65102-0570 

(573) 522-2875 phone 

(573) 522-2898 fax 

anderj@dhss.mo.gov 
STATE-BASED PROGRAMS TO REDUCE THE BURDEN OF DIABETES 127 

Montana 

Director 

VACANT 

Montana Department of Public Health 

and Human Services 

1400 Broadway 

Cogswell Building, C-317 

PO Box 202951 

Helena, MT 59620-2951 

(406) 444-0593 phone 

(406) 444-1861 fax 

Coordinator 

Liz Johnson, RN, CNP 

Montana Department of Public Health 

and Human Services 

1400 Broadway 

Cogswell Building, C-317 

PO Box 202951 

Helena, MT 59620-2951 

(406) 444-0593 phone 

(406) 444-1861 fax 

lizj@state.mt.us 

Nebraska 

Director 

Dan Cillessen, MSW, MPH 

Nebraska Health and Human Services 

System 

301 Centennial Mall, South 

PO Box 95044 

Lincoln, NE 68509-5044 

(402) 471-9270 phone 

(402) 471-6446 fax 

dan.cillessen@hhss.ne.us 

Coordinator 

Kathy Goddard, RD, LMNT, CDE 

Nebraska Department of Health 

301 Centennial Mall, South 

PO Box 95044 

Lincoln, NE 68509-5044 

(402) 471-0194 phone 

(402) 471-6446 fax 

kathy.goddard@hhss.ne.gov 

Nevada 

Director 

Richard Whitley, MS 

Chief, Bureau of Community Health 

505 East King Street, Room 103 

Carson City, NV 89710-4774 

(775) 684-5947 phone 

(775) 684-5998 fax 

Coordinator 

Bill Kirby, MPA 

Bureau of Community Health 

505 E. King Street, Room 103 

Carson City, NV 89701-4774 

(775) 684-5949 phone 

(775) 684-5998 fax 

bkirby@nvhd.state.nv.us 

New Hampshire 

Director/Coordinator 

Kathy Berman, MPH 

Bureau Chief, Bureau of Health 

Promotion 

New Hampshire Department of Health 

and Human Services 

6 Hazen Drive 

Concord, NH 03301-6527 

(603) 271-5172 phone 

(603) 271-5199 fax 

kberman@dhhs.state.nh.us 
128 NEW BEGINNINGS: A DISCUSSION GUIDE FOR LIVING WELL WITH DIABETES 

New Jersey 

Director 

Elizabeth Solan, MPH, RN 

New Jersey Department of Health and 

Senior Services 

Family Health Services 

Chronic Disease Prevention and Control 

Services 

50 East State Street, 6th floor 

PO Box 364 

Trenton, NJ 08625-0364 

(609) 984-6137 phone 

(609) 292-9288 fax 

elizabeth.solan@doh.state.nj.us 

Coordinator 

Mary Ann Reiter, RD, MA 

New Jersey Department of Health and 

Senior Services 

Family Health Services 

Chronic Disease Prevention and Control 

Services 

50 East State Street, 6th Floor 

PO Box 364 

Trenton, NJ 08625-0364 

(609) 984-6137 phone 

(609) 292-9288 fax 

maryann.reiter@doh.state.nj.us 

New Mexico 

Director 

David Vigil, MBA 

Chief, Chronic Disease Bureau 

New Mexico Department of Health 

625 Silver Square, Suite 200 

Santa Fe, NM 87502 

(505) 841-5836 phone 

(505) 841-5865 fax 

david.vigil@doh.state.nm.us 

Coordinator 

Judith Gabriele 

Diabetes Prevention and Control 

Program 

New Mexico Department of Health 

810 W. San Mateo, Suite 200E 

Santa Fe, New Mexico 87502 

(505) 476-7613 phone 

(505) 476-7622 fax 

judith.gabriele@doh.state.nm.us 

New York 

Director 

David Hoffman, MEd 

Assistant Director 

Bureau of Chronic Disease Services 

New York State Department of Health 

Empire State Plaza Tower, Room 780 

Albany, New York 12237-0620 

(518) 474-0512 phone 

(518) 473-2853 fax 

dph01@health.state.ny.us 

Coordinator 

Maureen Spence, MS, RD 

Diabetes Control Program 

Bureau of Chronic Disease Services 

Corning Tower, Room 780 

Empire State Plaza 

Albany, New York 12237-0678 

(518) 474-1222 phone 

(518) 473-0642 fax 

mms07@health.state.ny.us 
STATE-BASED PROGRAMS TO REDUCE THE BURDEN OF DIABETES 129 

North Carolina 

Director 

Janet Reaves, RN, MPH 

Department of Health and Human 

Services 

Division of Public Health 

Diabetes Prevention and Control Unit 

Mail Service Center 1915 

Raleigh, NC 27699-1915 

(919) 715-3131 phone 

(919) 733-0488 fax 

janet.reaves@ncmail.net 

North Dakota 

Director 

Sherri L. Paxon, MT (ASCP) BB 

North Dakota Department of Health 

Division of Chronic Disease 

600 East Boulevard Ave., Dept. 301 

Bismarck, ND 58505-0200 

(701) 328-2367 phone 

(701) 328-1412 fax 

spaxon@state.nd.us 

Coordinator 

Sherri L. Paxon, MT (ASCP) BB 

Division of Chronic Disease 

North Dakota Department of Health 

Division of Chronic Disease 

600 East Boulevard Ave., Dept. 301 

Bismarck, ND 58505-0200 

(701) 328-2698 phone 

(701) 328-2036 fax 

spaxon@state.nd.us 

Commonwealth Northern Mariana 

Islands 

Director 

James U. Hofschneider, MD 

Secretary of Public Health 

PO Box 409 CK 

Saipan, MP 96950 

(1-670) 236-8201 phone 

Coordinator 

Lynn Tenorio, BS 

PO Box 409 CK 

Saipan, MP 96950 

(1-670) 236-8716 phone 

lynnft@hotmail.com 

Ohio 

Director/Coordinator 

Thomas Joyce, MA 

Ohio Department of Health 

Diabetes Unit, 8th Floor 

246 North High Street 

Columbus, OH 43266-0588 

(614) 466-2144 phone 

(614) 644-7740 fax 

tjoyce@gw.odh.state.oh.us 

Oklahoma 

Director 

Adeline Yerkes, RN, MPH 

Chief, Chronic Disease Service 

Oklahoma State Department of Health 

Chronic Disease Service 

1000 NE 10th Street 

Oklahoma City, OK 73117-1299 

(405) 271-4072 phone 

(405) 271-5181 fax 

adeliney@health.state.ok.us 
130 NEW BEGINNINGS: A DISCUSSION GUIDE FOR LIVING WELL WITH DIABETES 

Acting Coordinator 

Marshan Oliver-Marick, MPH, CHES 

Chronic Disease Service 

Oklahoma State Department of Health 

1000 NE 10th Street 

Oklahoma City, OK 73117-1299 

(405) 271-4072 ext. 57105 phone 

(405) 271-5315 fax 

marshano@health.ok.gov 

Oregon 

Director 

Jeannette R. Anderson 

800 NE Oregon Street 

Suite 730 

Portland, OR 97232-2162 

(503) 731-4273 phone 

(503) 731-4082 fax 

jeannette.r.anderson@state.or.us 

Coordinator 

Jamie Klein, MPH 

800 NE Oregon Street 

Suite 730 

Portland, OR 97232 

(503) 731-4273 phone 

(503) 731-4082 fax 

jamie.l.klein@state.or.us 

Republic of Palau 

Director 

Sandra Sumang Pierantozzi 

Vice President/Minister of Health 

Koror, PW 96940 

(0-11-680) 488-4804 phone 

(0-11-680) 488-1211/1725 fax 

dcp@palaunet.com 

Coordinator 

Augusta Rengiil, RN, MPH 

PO Box 6027 

Koror, Palau PW 96940 

(0-11-680) 488-4804 phone 

(0-11-680) 488-3115/1725 fax 

dcp@palaunet.com 

Pennsylvania 

Acting Director 

Jim Domen 

Pennsylvania Department of Health 

Division of Chronic Disease Intervention 

PO Box 90 

Harrisburg, PA 17108 

(717) 787-5876 phone 

(717) 772-0608 fax 

jdomen@state.pa.us 

Coordinator 

Letitia Leaks 

Pennsylvania Department of Health 

PO Box 90 

Harrisburg, PA 17108 

(717) 787-5876 phone 

(717) 772-0608 fax 

lleaks@state.pa.us 

Puerto Rico 

Director 

Pablo Monserrate Canino, MD 

Puerto Rico Department of Health 

Diabetes Prevention and Control 

Program 

PO Box 70184 

San Juan, PR 00936-8184 

(787) 274-5699 phone 

(787) 767-8008 fax 

pmonserrate@salud.gov.pr 
STATE-BASED PROGRAMS TO REDUCE THE BURDEN OF DIABETES 131 

Coordinator 

Leonardo Perez Rivera, MPH, CHES 

Puerto Rico Department of Health 

Diabetes Prevention and Control 

Program 

PO Box 70184 

San Juan, PR 00936-8184 

(787) 274-6893/94 phone 

(787) 767-8008 fax 

(787) 632-3826 cellular 

leperez@salud.gov.pr 

Rhode Island 

Director/Coordinator 

Dona Goldman, RN, MPH 

Rhode Island Department of Health 

3 Capitol Hill, Room 409 

Providence, RI 02908 

(401) 222-3442 phone 

(401) 222-4415 fax 

donag@doh.state.ri.us 

South Carolina 

Director 

Michael D. Byrd, PhD, MPH 

Bureau of Community Health and 

Chronic Disease Prevention 

2600 Bull Street, Heritage Bldg. 

Columbia, SC 29201 

(803) 545-4481 phone 

(803) 545-4921 fax 

byrdmd@dhec.sc.gov 

Coordinator 

Rhonda L. Hill, PhD, CHES 

Bureau of Community Health and 

Chronic Disease Prevention 

2600 Bull Street, Heritage Bldg. 

Columbia, SC 29201 

(803) 545-4469 phone 

(803) 545-4921 fax 

hillrl@dhec.sc.gov 

South Dakota 

Director 

Norma Schmidt, MA 

South Dakota Department of Health 

615 East 4th Street 

c/o 500 East Capitol Avenue 

Pierre, SD 57501-1700 

(605) 773-6189 phone 

(605) 773-5509 fax 

norma.schmidt@sate.sd.us 

Coordinator 

Colette Beshara, RN 

South Dakota Department of Health 

615 East 4th Street 

Pierre, SD 57501-1700 

(605) 773-7046 phone 

(605) 773-5509 fax 

colette.beshara@state.sd.us 
132 NEW BEGINNINGS: A DISCUSSION GUIDE FOR LIVING WELL WITH DIABETES 

Tennessee 

Coordinator 

Traci Patton 

Diabetes Prevention and Control 

6

Program 

425 5th Ave. N. 

th Floor Cordell Hull Building 

Nashville, TN 37247-5210 

(615) 741-0394 phone 

(615) 532-8478 fax 

traci.patton@state.tn.us 

Texas 

Director 

Jan Marie Ozias, PhD, RN 

Texas Department of State Health 

Services 

1100 West 49th Street 

Austin, TX 78756 

(512) 458-7490 phone 

(512) 458-7404 fax 

jan.ozias@dshs.state.tx.us 

Coordinator 

Carol Filer, RD 

Texas Department of State Health 

Services 

1100 West 49th Street 

Austin, TX 78756 

(512) 458-07490 phone 

(512) 458-4704 fax 

carol.filer@dshs.state.tx.us 

Utah 

Director/Coordinator 

Nancy Neff, MS 

Utah Department of Health 

288 North 1460 West, PO Box 142107 

Salt Lake City, UT 84114-2107 

(801) 538-6267 phone 

(801) 323-1574 fax 

nneff@utah.gov 

Vermont 

Director 

Ellen B. Thompson, MS 

Vermont Department of Health 

108 Cherry St., Suite 302 

PO Box 70 

Burlington, VT 05402-0070 

(802) 863-7606 phone 

(802) 651-1634 fax 

ethomps@vdh.state.vt.us 

Coordinator 

Robin Edelman, MS, RD, CDE 

Diabetes Program Administrator 

108 Cherry Street, PO Box 70 

Burlington, VT 05402-0070 

(802) 865-7708 phone 

(802) 651-1634 fax 

redelma@vdh.state.vt.us 

Virginia 

Director 

Ann Forburger, MS 

Virginia Department of Health 

Division of Chronic Disease Prevention 

and Control 

109 Governor Street, 10th Floor 

Richmond, VA 23219 

(804) 864-7871 phone 

(804) 864-7880 fax 

ann.forburger@vdh.virginia.gov 
STATE-BASED PROGRAMS TO REDUCE THE BURDEN OF DIABETES 133 

Virginia 

Coordinator 

Nancy Pribble, RD, IBCLC 

Division of Chronic Disease 

Prevention/Nutrition 

109 Governor Street, 10th Floor 

Richmond, VA 23219 

(804) 764-7872 phone 

(804) 864-7880 fax 

nancy.pribble@vdh.virginia.gov 

Virgin Islands 

Director 

Anne L. Thurland, MPH, CHES 

Director, Bureau of Health Education 

Virgin Islands Department of Health 

Charles Harwood Complex 

3500 Estate Richmond 

Christiansted, VI 00820-4370 

(note: when sending FedEx, the 

International Airway bill number must 

be included with the address) 

(340) 773-1311, ext 3145 phone 

(340) 773-8354 fax 

dbprev@islands.vi 

Project Manager 

Sandra Charles 

Virgin Islands Department of Health 

Charles Harwood Complex 

3500 Estate Richmond 

Christiansted, VI 00820-4370 

(note: when sending FedEx, the 

International Airway bill number must 

be included with the address) 

diabetesprog@islands.vi 

(340) 773-1311, ext. 3144 phone 

(340) 773-8354 fax 

diabetesprog@islands.vi 

Washington 

Director 

Jan Norman, RD, CDE 

Chronic Disease and Risk Reduction 

Washington Department of Health 

Airdustrial Park, Building 13, MS 7836 

Olympia, WA 98504-7836 

(360) 236-3686 phone 

(360) 236-3708 fax 

jan.norman@doh.wa.gov 

Coordinator 

Kathleen Clark, CDE, MS, RD 

Washington Diabetes Prevention and 

Control Program 

PO Box 47836 

Olympia, WA 98504 

(360) 236-3608 phone 

(360) 236-3708 fax 

kathleen.clark@doh.wa.gov 

West Virginia 

Director 

Jessica Wright, RN, MPH 

Bureau for Public Health 

Office of Epidemiology and Health 

Promotion 

350 Capitol Street, Room 319 

Charleston, WV 25301-3717 

(304) 558-7083 phone 

(304) 558-1553 fax 

jessicawright@wvdhhr.org 
134 NEW BEGINNINGS: A DISCUSSION GUIDE FOR LIVING WELL WITH DIABETES 

Coordinator 

Peggy Adams, RNC, MSN, CDE 

Bureau for Public Health 

Office of Epidemiology and Health 

Promotion 

350 Capitol Street, Room 319 

Charleston, WV 25301-3717 

(304) 558-0644 phone 

(304) 558-1553 fax 

peggyadams@wvdhhr.org 

Wisconsin 

Director/Coordinator 

Pat Zapp 

Wisconsin Diabetes Control Program 

1 West Wilson Street 

Room 218 

Madison, WI 53701-2659 

(608) 261-6871 phone 

(608) 266-8925 fax 

zappa@dhfs.state.wi.us 

Wyoming 

Director 

Karl Musgrave, DVM, MPH 

Prevention Health and Safety Division 

Wyoming Department of Health 

6101 N. Yellowstone Road, Room 259A 

Cheyenne, WY 82002 

(307) 777-3579 phone 

(307) 777-8604 fax 

kmusgr@state.wy.us 

Coordinator 

Star Morrison, MS, RD 

Wyoming Department of Health 

6101 N. Yellowstone Road, Room 259A 

Cheyenne, WY 82002 

(307) 777-3579 phone 

(307) 777-8604 fax 

smorri@state.wy.us 
The U.S. Department of Health and Human Services’ National Diabetes Education Program 

of the National Institutes of Health and Centers for Disease Control and Prevention jointly 

sponsor the program with the participation of over 200 partner organizations