Three years ago, Annie Manuel said she was devastated when her doctor diagnosed her with diabetes.

"You try to deny it, not accept it, but it's real," she said. "When my doctor told me, I even went for a second opinion; he told me the same thing, so I went back to my first doctor."

She wasn't so surprised. An older sister died from complications caused by diabetes.

Luckily, Manuel caught her diabetes relatively early. She suffered no numbing in the lower legs, feet and hands. She didn't need daily insulin shots.

Still, she has had to do work to stay healthy.

She admits now, the toughest thing she had to do was simply follow instructions.

The folks at the Grace Hill Water Tower Health Center at 4414 North Florissant Avenue — the facility has five sites around the area — assigned her a diabetes coach, Carmen Miller-Powell.

Miller-Powell would teach Manuel to manage her disease and then stay on her about following through.

"It was difficult at first," Manuel said. "But she told me what would happen if I didn't do it ... heart attack, stroke, blindness, insulin shots every day ..."

Miller-Powell is part of the "Better Self Management of Diabetes" program at Grace Hill.

"Coaching is education," Miller-Powell said. "I help people set goals and keep them. Miss Annie's goal was to lose weight and keep her blood sugar down."

Manuel got into an eight-week training program where she learned how to manage her diabetes with exercise, good diet and oral medication, including blood pressure meds because diabetes and hypertension are deadly bedfellows.

"I call her and ask her if she's exercising," Miller-Powell said. "I encourage her."

The training included dietary management, also — more fresh vegetables and fruit, shopping at farmers markets, baking and boiling and less frying. She gave Manuel exercise alternatives and other instructions.

A doctor could tell her all those things, Miller-Powell said. The difference is the follow-up.

She meets with Manuel regularly, but calls her almost daily; she has set up support group meetings between many of her clients who share stories of battling their diabetes. She gets regular reports on Manuel's blood sugar levels.

"My goal is for her diet to change and for her be more confident within herself and stick with self-management goals," Miller-Powell said.

"Some people don't work with it at all; they don't do anything," Miller-Powell said. "You can see that happen when you see them with heart attacks, lost limbs, blindness ...

"With me, we can talk about specifics and how to (end) bad habits."

Manuel talks about Miller-Powell more as a friend and not just a coach. "It's the coach," she said. "I do what she says."

She needed that because some of those bad habits were hard to break, for example, sodas — lots of sodas.

"That was hard," Manuel chuckled. "But I learned to think about how I felt after eating something that wasn't (good) for me."

So she now drinks lots of water and soda is a once-a-week treat, not a food group, the same for an occasional cookie.

"Now I exercise every day and I eat right," she said. "That's it. Exercise, eat right and take your medicine."

For exercise, she walks around her neighborhood, unless it's too hot or rainy, she says. "When I can't get outside, I walk up and down the steps 20 times. I rest, then do 20 more, then I do other exercises, like jumping jacks." She laughed, "No pushups.

"I used to eat the whole plate, large (portions) of meat and starches. Now, I eat half a plate and most of it is fresh vegetables."

Between eating right and exercise, her weight has dropped from 223 to 206. "It's hard," she laughed. "When you get in your 60s, weight doesn't want to leave. But I feel better, I can feel it in my arms, my legs ..."

What troubles her now is she sees her former self in her friends.

"I tell them to look at me," she said. "Friends don't listen. Just because you're well now doesn't mean you can't be in the situation I'm in. But they go on denying.

"Just like I used to do. Diabetes is nothing to play with."

Do you know a 'How I Did It'?

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Jackie Hutcherson, STL Health editor

St. Louis Post-Dispatch

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St. Louis, Mo. 63101-1099

E-mail • jhutcherson@post-dispatch.com