A motorcycle accident at age 20 left Rick Hawkins, now 65, with limited use of his legs. It never stopped him from pursuing his passions, like working on cars or camping.
As he began to enjoy the relaxing and social life of retirement, though, Hawkins gained some weight and lost some mobility — that is, until he decided to sign up for the Diabetes Prevention Program through UCHealth. There, he shed the extra pounds he’d put on over the past few years and reduced the risk for further limitations that diabetes might have imposed.
Life as a paraplegic
Hawkins loves classic vehicles. He attended Denver Automotive School but after the accident, he pursued electronics and computer web design degrees while maintaining his passion for cars.
As a young man, he managed to get around on crutches but as he got older, he needed his wheelchair more.
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“I’d used my arms to get in and out of my chair, so I could work on my cars,” Hawkins explained.
Having access to a freight scale at his job, Hawkins would wheel himself onto the scale to get a weight: 255 pounds. Then he subtracted the weight of his 34-pound wheelchair to get an accurate body weight.
In retirement, he spent more time in his chair and his body and his mobility began to change.
“I was having trouble getting my shoes on because of a big blob here,” he said, gesturing to his stomach.
Like many, recognizing deteriorating health is a lot easier than taking action to be healthier.
One day, Hawkins and Sue Bordwell — who’s been by Hawkins’ side for 17 years — and a relative went to an appointment at UCHealth Heart and Vascular Clinic – Harmony Campus. As they waited, Hawkins noticed a scale in the corner and wheeled himself onto the platform. The display read 269 pounds.
Hawkins couldn’t believe it, even after he subtracted the weight of his wheelchair. He’d always been around 220 pounds — no wonder he wasn’t able to get his shoes on by himself anymore, he thought.
Meanwhile, Bordwell also was thinking about her health. She cooked fairly healthy meals, they didn’t drink soda or smoke cigarettes, and she only drank alcohol on occasion (though Hawkins does enjoy an occasional craft beer).
Admittedly, the couple indulged in less healthy foods while on car-club road trips and eating out with friends. That lifestyle had an effect on Bordwell’s A1C level, which her doctor said was at 5.7%.
What is A1C and prediabetes range?
To monitor diabetes risk, physicians look at a patient’s A1C result, which is a measurement of the average blood sugar level over three months.
Levels ranging between 5.7% to 6.4% are in the “prediabetes” range, while 6.5% or higher is diagnostic for Type 2 diabetes.
Unlike Type 1 diabetes, in which the body does not produce insulin, Type 2 diabetes arises when the body makes less insulin and stops using it properly — often called insulin-resistant diabetes. Type 2 is the most common form of diabetes, and most people who have it have metabolic syndrome, with elevated blood sugar, high blood pressure, high cholesterol and increased abdominal girth.
Type 2 is treated with lifestyle changes and often requires medication and insulin to keep blood sugar under control.
But just a 5 to 7% weight loss can lower the risk for developing Type 2 diabetes by 58%, and that reduction jumps to 71% for those over the age of 60, according to National Diabetes Prevention Program research.
How to I prevent type 2 diabetes?
With her doctor’s concerns on her mind, Bordwell clicked on a story link about a Cheyenne, Wyoming, man who had taken a diabetes prevention program at UCHealth in northern Colorado and reduced his risk for diabetes.
As she helped Hawkins get his shoes on, she decided to bring it up. He didn’t reject the idea at all.
“It was something we could do together because of the year-long commitment,” he said. “I didn’t know my (A1C) level at that time, but I knew I could learn better health habits.”
Getting signed up for DPP
The Diabetes Prevention Program is a Center for Disease Control and Prevention-recognized lifestyle change program, proven to prevent or delay Type 2 diabetes. An A1C in the prediabetes range is one criterion for enrollment and other health risks are considered as well. The program is a once in a lifetime covered benefit by Medicare.
Since Bordwell’s A1C level was in the prediabetes range and she was already on Medicare, she easily qualified for the program. Hawkins’ Medicare wouldn’t pay for his program, though, since his A1C level was only at 4.7%. But he decided to sign up anyway and pay the program fee himself.
UCHealth’s self-pay rate for the Diabetes Prevention Program is comparable to the Medicare rate, and it offers payment plans.
“I didn’t want to be a fat guy in a wheelchair anymore — it was hard to get around,” Hawkins admitted.
The diabetes prevention class
The class meets 24 times over the course of 12 months — weekly for the first 13 classes, covering nutrition and physical activity, with a strong focus on making lasting behavioral changes. Then class then meets less frequently, every two weeks, then every three weeks, and monthly for the last six months.
“It wasn’t so much about weight loss but me being more aware this year of what I was putting in my mouth,” Hawkins said.
But that “real awareness” Hawkins achieved did in fact help him lose weight — about four pounds per week for the first couple of months. He admitted his biggest change that first month was to eliminate beer.
“I just wanted to see if I could do it,” he said with a grin.
Making habit-forming changes to address prediabetes
But he and Bordwell made other lifestyle modifications as well. First off, Hawkins said that after the first month with no alcohol, he now limits his enjoyment of beer to two when he goes out with friends.
“I eat a lot more salads too,” he said, adding that instead of automatically saying, “Yes, I’ll take the fries with that,” he asks for other options and picks a healthier choice.
“And we stopped eating so much bread and are getting more exercise,” Bordwell added.
“The goals of the (diabetes prevention) program are to increase physical activity to at least 150 minutes per week and achieve weight loss of just 5% of their starting body weight,” said Jenifer Bowman, a registered dietitian who serves as the class instructor and lifestyle coach.
Although Hawkins can’t do the same types of exercises that Bordwell can, the class provided him with alternative exercises. And with the lost weight and added exercise, Hawkins said he’s feeling much better.
“Even though Rick (Hawkins) has a disability that limits his choices for physical activity, he was able to increase his activity within his own abilities to achieve the exercise goal of the program,” Bowman said. “His efforts and achievements served as motivation for the other class participants, including myself.”
Eleven months into the program, Hawkins has gone from 235 pounds to 210 pounds.
In it together for the long haul
Bowman said Hawkins had the mindset that helps people succeed in DPP.
“Instead of comparing ourselves to others, focusing on our weaknesses and placing limitations on our abilities, we should take a more positive approach and start with what is doable and achievable — then see where this takes us,” she said.
The class structure — a set group of people meeting for a year, building camaraderie through sharing challenges and successes — makes the commitment not so cumbersome.
“We laugh together, catch up — like old friends,” Bordwell said.
And having each other’s support has also made things easier.
Continuing to keep diabetes prevention top of mind
As their program nears its end, Hawkins and Bordwell admit they’ll have to continue to make their health a priority to maintain the progress they’ve made. The holiday season wasn’t easy, and some weight returned. The two said they’ll work on the skills they learned together. Bordwell also has the option of returning to class for a second year.
“Medicare will cover a second year of classes as long as the participant meets and maintains at least a 5% weight loss from their starting weight,” said Teresa Reichert, data (and class registration) coordinator for UCHealth Diabetes and Medical Nutrition Therapy in northern Colorado.
If a person opts for a second year, Medicare requires attendance at a minimum of two classes each quarter.
“They can choose from different class topics offered in the second year as a refresher and extra support from the lifestyle coach,” she said.
Bordwell is not sure she’ll take advantage of the second year, but she and Hawkins are in agreement that the past year has moved them toward a more enjoyable — and healthy — retirement.