Unexpected Encounter Prompts Successful Diabetes Program

By Kris Himmelberger

It was a chance encounter that led to development of a promising diabetes-control program that might improve the health of many San Quentin inmates, says inmate Clinton Martin.

In the summer of 2012, San Quentin’s Chief Medical Executive Dr. E. Tootell was chairing a meeting for the Breast Cancer Walk. She happened to ask Martin if he knew any inmates who were diabetics, because she had wanted to get a diabetic program going for several years.

“It just so happens that I am a diabetic,” said Martin.

One year after the inception of the diabetes class, Tootell declares, “The class has been a success.”

According to Tootell, 10 percent of San Quentin’s prison population has diabetes, a potentially debilitating disease that prevents the individuals from metabolizing sugar appropriately.

Prison meals are rich in sugar and simple carbohydrates, which presents a problem for diabetics. Most medical authorities say these foods are detrimental to diabetics. By continuously consuming refined foods such as sugar, white bread, and sugary soft drinks, a person can develop insulin resistance, says Dr. Shari Lieberman, the author of the Glycemic Index Food Guide.

San Quentin’s diabetic population is slightly higher than the U.S. population, which according to researcher Mark Kane is approximately 8.3 percent. Kane wrote an assessment of the San Quentin program in support of his master’s degree in public health.

Tootell conceived the idea for a diabetes class in 2008. She observed that most of her patients diagnosed with diabetes and other chronic illnesses had very little understanding of their disease. “I wanted the program to be targeted toward the general population and based on a balance of diet, exercise, and medication,” she said.

She thought it would be beneficial to have an inmate with diabetes help facilitate the classes. “Control of diabetes is a way of life. There is only so much that I can explain about diabetes to prisoners, not knowing what it’s like to live in prison,” she said.

Shortly after his meeting with Tootell, Martin started working on curriculum. He was able to draw on some of the material from the diabetic class he took in Soledad State Prison. Martin wanted to improve the class and see glucometers issued to inmates so they could monitor their blood sugar.

Glucometers and the small needles called lancets used to draw blood from fingers have been previously banned under prison policy, because they can be used as a weapon or tattooing device.

Diabetic prisoners also must contend with scheduling conflicts, because medications, including insulin, are issued only at designated times. Prison officials consider syringes to be a controlled item, and certain medications used to manage diabetic nerve conditions may be used to induce a high.

But Centinela State Prison developed a pilot program that was accepted by the California Department of Correction and Rehabilitation for use in all prisons.

Participants in the San Quentin program are required to attend a weekly class. They are also required to maintain a food log and monitor their blood sugar on a daily basis.

During the class, Dr. Tootell analyses the food log with the participants. She found the kitchen food was healthier than the food the inmates prepared themselves.

“Diabetes is complicated to detect because there are no symptoms,” Tootell said. “As it progresses, individuals can experience thirst, frequent urination, and even weight loss.”

Early in 2002, inmate Haro Agakian was working as a visiting room porter when he got dizzy and fell. “At the hospital, I learned I had pancreatitis and the blood test showed I had Type II diabetes.” Physicians put Agakian on a medication called metformin. After several years of taking medication, he lost 15 to 20 pounds and was taken off medication.

The diabetes program is comprised of two levels—basic and advanced.

The basic course consists of two-hour sessions held over 11 weeks. It “covers the core principle,” said inmate facilitator Martin. “Participants are taught the difference between Type I and II diabetes. They receive general dietary information and learn how to read food labels. They even learn about neuropathy, and how exercise helps.”

Martin emphasized that keeping the food log was the most important tool.

The advanced course is 18 training sessions, held over 36 weeks.

A pharmacy technician, who assists with the class and happens to be diabetic herself, said, “I even learned something from three classes. Being a part of these classes, I learned how to balance my sugar. I think that this program should be taught at Kaiser (the health maintenance organization).”

Master candidate Kane observed both that advanced course participants and waiting list respondents voiced dissatisfaction with the prison meals. They said the food is rich in sugar and carbohydrates, and they have no healthy alternatives. The biggest concern was the daily box lunch.

Inmate D. Williams, who recommends the class, took the basic and advanced versions to learn more about neuropathy, a condition that deadens the nerves. He said, “The chow hall food is largely starchy, and there are no alternatives. For me, tracking and counting carbs is important because we don’t have a diabetic diet.”

Language also plays a role in health mindfulness. Inmate P. Felciano, who immigrated to the United State from Cuba, said, “There are many people who have trouble comprehending English that would benefit from this program being taught in Spanish.”

In his assessment of the San Quentin program, Kane concluded, “respondents from both groups reported significantly higher medication adherence rates compared to the general public.”

He added, “Research demonstrates the difficulty with encouraging participants to increase their levels of exercise with lifestyle management and education. However, both the advanced and waiting list respondents demonstrated high levels of exercise and blood glucose monitoring.”

Dr. Tootell said the diabetic class has been a good experience. She recommends diabetes screening for anybody age 35 or over.

If you would like information on diabetes or if you think you might be exhibiting signs of diabetes, you can request a diabetes test by submitting a 7362 (Medical Request Form).

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