I knew Theresa Garnero was someone special before I even met her. She not only won the honor of AADE Diabetes Educator of the Year in 2004-2005, but she also recently won the Inspired by Diabetes contest -- for a "Pin the Pancreas on the Piggy" game, no less. She also contributed to this year's DiabetesMine Design Challenge, with a completely goofy product idea called the "Pet Pancreas" that says silly D-things when you press a button. What kind of diabetes educator was this woman, anyway?
The great kind, I found out. She's incredibly knowledgeable, but has also made it her personal mission to "inject some humor into this thing."
I spent a morning chatting with Theresa last week, to find out what makes her tick. After reading this, I'm pretty sure you'll love her too.
Theresa, you don't have diabetes, but you're an award-winning CDE and self-described "diabetes junkie." Can you tell us a little about how you got here?
When I was younger, I was actually into track and field and volleyball, and I was a competitive figure skater. Being an athlete with that kind of discipline helped to groom me for being an overachiever early in life.
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I skated from age 13 to 16, and trained with Debbie Thomas, Brian Boitano — a lot of big names. I was a national hopeful, skating six hours a day, but then I cracked a hip and had to get off the ice.
For a while I took took piano and thought I might be a jazz pianist. But music is unpredictable, and I needed a career to support me. I thought, I don't ever want to be dependent on anyone. So I went to Monterey Peninsula Colleague and became an associate RN before going on to earn my BA and MA through the University of Phoenix extension program. I worked in a convalescent hospital, and then later as a hospital nursing assistant and emergency technician.
Getting into diabetes was a happy accident, I'd say. Ten years ago I was at a point where I was wondering what I was going to do with my life; I was actually planning to move to Rome. I had already cashed in all my retirement funds. Then a colleague named Annette McElroy, who was Editor in Chief of this nursing journal called 'Nursing Insight' called me and said, 'come take my job in diabetes.' She was also a CDE. She was going to retire. On a whim I applied and I got the job. And seven years later I was educator of the year, so obviously found my niche. (laughs)
OK, but why a "diabetes junkie"? What's unique about your approach?
When I was writing for that publication, they said, 'You're funny — Why don't you draw a cartoon or something, to break up the copy space?' I had forgotten that when I was 7 years old I wanted to be cartoonist. I sent in that letter to Highlights Magazine where you draw the picture they publish, and I waited by the mailbox every day after school. Two years later I finally got a letter from the Disney Company saying, 'you're too young to participate...' or somesuch. I thought: 'Up yours.'
Now I finally had a chance to be a cartoonist, so why not about diabetes?
Annette turned out to be the catalyst that got me into diabetes education, writing and cartooning — all of which are now mainstays of my life. Was it destiny? I don't know, but I love it.
So what do you think made you really stand out to be chosen as AADE diabetes educator of the year in 2004-2005?
They look for an educator whose gone above and beyond the 8-5 job, who's reached out into community, and had an impact. I suppose my diabetes cartoons, and using humor to promote self-management efforts, accomplished that.
When I was a newbie to diabetes, I was taken aback by all the doom and gloom. It was so heavy-handed in those days — telling patients you'll lose a leg, you'll go blind. Remember, 10 years ago, all the books in the bookstore were black and white. I thought it needed some color, it needed the lighter side. That's what I tried to accomplish with my DIABETease book, published in November 2003. I wanted someone who is freaked out by diabetes to be able to pick it up and feel better.
That book was self-financed and self-published, and I donate half my profits to research, equally divided bet Type 1 and Type 2 — because I'm a Libra (chuckles). I basically took the ADA treatment guidelines and used those to drive a lot of the cartoons.
(Note: Theresa was also recently elected to the Board of Directors for AADE)
You seem to have a ton of creative ideas for making diabetes management more fun. Can you share some?
For people who come into our program, we try to animate the self-care behaviors. You know the AADE has seven self-care behaviors. Even most educators cannot name the seven. They would prob have better luck naming the seven dwarfs.
But to make it make it fun, we actually have people draw the seven behaviors — an apple for healthy eating, a tennis shoe for being active, a glucometer for monitoring, a candle for healthy coping — and we remind them it's not just about glucose, but your blood pressure and cholesterol as well. We use cartoons throughout the program.
We also have the patients pull out their keys, and we say, 'We're going to add seven keys to your keychain, the keys to health, and you can pull them out whenever you want...'
I actually added one behavior: humor, because laughing lowers your glucose, just as stress raises it. I researched Norman Cousins' work on how humor affects health. Forty years ago, he started humor therapy on the premise that if negative thoughts are proven to have negative physiological effects, on the flip-side, wouldn't positive thoughts produce positive physiological effects?
He was bedridden, and given a prognosis of three months to live. He accepted the diagnosis, but not the prognosis, prescribed himself to 'laughter medicine,' and he recovered.
Not that laughing will give you more insulin, but it helps you cope and do better.
But diabetes management is such an intense long-term commitment. How can we keep it up?
I think the 'diabetes management' is an oxymoron. We say that term all the time, but it's an oversimplification. We need to emphasize that the keys are in your hands, but there are going to be slips. When you slip (not IF you slip), you can pull out those keys and get back on track.
One thing I'm working on is a new book coming out through the ADA in Fall: "Your First Year with Diabetes: What to Do Month-to-Month." It's geared mainly at Type 2s — when you're first diagnosed, you think, 'Just tell me what to do?' It walks you through all the variables each week, because we know that diabetes doesn't come in a nice neat package. Type 1s can certainly benefit as well. I'm tired of them getting disenfranchised, so I definitely tried to include them. Anyone who's newly diagnosed, or wants to ramp up their game, can pick it up.
Anther project of mine is Dance Out Diabetes, a nonprofit foundation I'm forming that will provide a place where people can go and dance in a good, diabetes-friendly environment. I'm putting together an advisory board now. The ultimate goal is to get people moving in a way and place they enjoy. When you look at what's missing, it's exercise. Why? Because it's drudgery and there's not enough time.
You can take a dance class at the YMCA, but the YMCA has white walls, and it's usually during the day, and who wants to shake their bon-bon at 10 in the morning? The other alternative is to drink a bunch of caffeine, stay up late, and go to a club environment where people are drinking and smoking — and that's not helping you.
We want to create dance halls for all ages, kids to adults, where the music changes periodically. We don't want money to be an issue. Maybe we'll ask for a dollar at the door, but if I had my druthers the government would pay people to come, pay them to exercise, and save the healthcare dollar they'd need otherwise.
I'm also hoping to market my Pet Pancreas product. Basically it's the pancreas as a Magic 8 Ball. I need to find a company that wants to get it out there. It's just a fun, goofy way to make a little light of diabetes.
Tell us about winning the Inspired by Diabetes contest. What's that been like?
It was just an honor to rub elbows with such talented artists. I read the application and thought, 'Inspired by Diabetes?' I am!
Then I thought, how can I create something that will connect all the effected people — patients living with it, those at risk, the community members who don't have a clue about diabetes, all the crazy researchers and mad scientists in the labs (those I can barely carry on a conversation with because they're so deep into it), and also the doctors and educators working with patients? Because our work is very serious... What can be the glue to bring it all together?
It's the pancreas, it's got to be the pancreas. Let's try to make it fun using the laugh-learn connection. I had the idea for 'Peggy the Piggy' who's been giving to diabetes for a long time, through her pancreas. It's ironic. I'm a vegetarian, so it's just wrong that I should be drawing that. (more laughter)
Seeing my work at the MOMA (San Francisco Museum of Modern Art) was a career highlight. My grandfather was a sculptor, and my mother is an incredible artist. So I was so excited to say, 'OMG, Mom, my work is going to be at MOMA!'
So after all the hoopla settles down, you'll go back to your day job of seeing patients, correct? What does a typical day in the life of a CDE look like? What are some challenges?
There really is no typical day. That's what makes the job so challenging and rewarding: there's no clear cut path to diabetes success. Rather, it's partnering with the person who has it, and seeing what they bring to table.
The shape of my day depends on whether I'm seeing people one-on-one or in a classroom setting. I'm manager of the largest diabetes center in California, the Center for Diabetes Services at CPMC (California Pacific Medical Center), so I do a lot of administrative stuff. I do also see patients, because we're in a pandemic and I need to roll up my sleeves. Yesterday I saw patients all day, analyzing CGM data.
Some challenges are for example, Type 2 patients who need insulin. It can be difficult convincing them of the benefits and dispelling the myths... and trying to convince their physician to start them on insulin without crossing swords. If the patient's on three different pills and their A1c is still 9, they probably need insulin. We have to have the skill to share what we know from a science background, and also collaborate with the doctors. We're trying to partner with everybody.
The other challenge is just knowing that only 10% of PWDs ever get education. The people who make it into our program tend to have a higher motivation level... But the art of it is working with them to see what's going to fit into their lives, and to find some way to make a difference in their health.
In your opinion, what needs to be fixed most in diabetes education today? And how can we fix it?
I think it's access — and reimbursement goes hand in hand. So many people don't have insurance coverage, so the access to education and good care isn't there.
Getting diagnosed without diabetes education is crazy. It would be like you're a teenager, and some adult says, 'here's the car keys, now go drive...' without giving you any training. If some doctor says, 'OK, you have diabetes. Now go watch your diet,' you've got to be thinking, 'What the hell does that mean...?' It's just wrong that it's so cumbersome and so challenging for patients to get to a CDE. One thing we've started to do at CPMC is offering evening classes and support groups. People don't have to register, they can just show up. That's one example of breaking down the barriers.
The second thing is exercise. We pay lip service to it, but there aren't enough exercise programs that are accessible. If it's not fun, if it's drudgery, people are turned off and won't come back. If we make it fun, they'll come back.
Finally, what's the single most important message you'd like to get across to patients?
No. 1 is: You are not alone. Don't go it alone. There's power in numbers. Find people to help you, whether it's a CDE, physician, researcher, or Internet sites or communities.
Every person living with diabetes has the opportunity every day, every hour to do something for their health. But you need the resources to help you. So get all the help that you can to deal with it.
Thanks, Theresa! My take: we just need more Theresas.