By Avelino “Al” Cisneros, Jr., First Mile Care DPP Participant

I joined the First Mile Care Diabetes Prevention Program (DPP) nine months ago, at the recommendation of my physician. Since that time, my A1C blood sugar level has dropped. My blood pressure is now consistently in the normal range and I’ve been able to stop taking medication. Oh, yeah, and I’ve lost 30 pounds and two pants sizes. I feel fit and healthy for the first time in years.

The First Mile Care DPP works for me because it’s not a struggle or burden. I watch what I consume, and everything else takes care of itself.

How I got here

A little about me — I just turned 69 years old and live in a small town north of Houston. I retired a few years ago after 40 years with Union Pacific Railroad, having most recently served as vice president of Mexican operations. 


Last year I went for my annual checkup.  My longtime physician, Dr. Clifford Yut, who practices in The Woodlands, was concerned that my glucose levels in the A1C test kept rising each year.  He had prescribed medication, but it wasn’t helping.  He warned me that if I didn’t address it, I would develop diabetes. That’s when I first heard about the CDC-proven Diabetes Prevention Program offered by First Mile Care. If he hadn’t recommended the program to me, I would probably have continued as I was. Like many men, I needed some prodding by an expert to take my health seriously.

I had never tried any type of wellness program or diet plan. I had never even heard of “prediabetes” in spite of the fact that my aunts on my father’s side had diabetes and there are cardiac issues in my maternal line. My wife is a retired registered nurse, but even she hadn’t been able to steer my eating and fitness habits into a healthy path, although she was conscientious about cooking with healthy ingredients. She couldn’t get me to change habits I’d picked up during my dozen years of commuting weekly to Mexico, such as social eating and drinking late at night with colleagues and not getting enough exercise. Even after I retired, I still wanted three big meals a day, out of habit, although I was no longer expending the same amount of energy.

Learning to make smarter choices

My First Mile Care DPP coach, Sandra Huskey, has been instrumental in getting me to make smarter choices about what I eat and to shop more wisely. She drives home the point that there is no such thing as “good” food or “bad” food. The First Mile Care program doesn’t require me to give up anything, only to calculate calories and make sure I get enough exercise to offset my caloric intake. I’ve found food journaling to be extremely helpful, and have continued to practice it even after the required period ended. I review my journal on a weekly basis to see where I succeeded and where I succumbed to temptation.

Coach Sandra encourages us all to read labels carefully, track calories in our food journals or apps, and make wise decisions based on whether an item is really worth how long it will take to burn off the calories. I never used to look at food labels or packaging. When my wife asked me to pick up bread and butter at the grocery store, I grabbed the first thing I saw to get out of there as quickly as possible. I never considered basing my choices on sodium and fat and carbohydrate levels.

I’ve also become attuned to where tempting foods and empty calories are placed on shelves. For example, if I go into a convenience store to grab a coffee, there are doughnuts nearby, or candy by the cash register. So instead of giving into sugar cravings and grabbing the things nearest me, I walk a couple of aisles back and find a healthier snack like unsalted nuts or celery sticks.

My coach has taught me to look for substitutions and little tricks so I still get to savor my pleasures, like buying the mini-empanadas at my favorite Argentine restaurant instead of the big ones. I now avoid eating potatoes and rice at the same meal, stay away from sweet yams, and make a point of choosing a smaller piece of meat and removing the fat. If I eat chips, I don’t finish off a big bag. If my grandkids want pizza, I have one slice instead of two — or else cut back on something else and get in some walking to make up for that extra slice. 

The hardest thing for me to control has been beer and bread. I still eat bread, but a half-slice of toast instead of a half a loaf of French bread in one sitting. I finally decided to cut out beer altogether, but mainly because I calculated how much I was spending per month with only a bulging waistline to show for it! Now I drink a lot of water with lemon.

Neighborly advice

An advantage of the First Mile Care program is that it promotes a sense of neighborly community. Not only is my coach from my general area north of Houston, so are the other members of my small group. As a result, as we go through our lifestyle transformation together; we have this foundation of common references that puts everyone at ease and automatically makes you feel more comfortable with each other, even if we come from different backgrounds, cultures, and even countries.  We reinforce each other’s decisions, provide encouragement to the folks who are struggling, and celebrate overcoming temptations. My classmates have become friends, so I look forward to spending time with them in-person now that COVID-19 restrictions have been lifted. 

The local aspect of the group is also really helpful for sharing tips on the best walking trails, what’s in season at the farmer’s market, which grocery store is having a sale or offers specialty products. We help each other overcome our little humps, too. For example, if you’re not from Houston, you might not realize how incredibly debilitating the humidity is, or how vicious the mosquitoes are at dusk. But my coach and classmates knew exactly why I was having trouble exercising in the early evening. They recommended that, as an early riser, I should try walking at dawn. Now I walk a mile — two turns around the retention ponds in my neighborhood — and can be back home in time for breakfast and “Good Morning America.” I make a point of walking whenever I can, instead of sitting, and can work up a real sweat by gardening. I now realize there are so many easy forms of movement that burn calories and “count” towards my fitness goals.

Everybody’s happy

First Mile Care has truly changed my life.  My DPP coach has given me the building blocks I need to maintain good health not only while I’m in the program, but for the long term. The program just fits me like a glove, as it reinforces the little healthy choices that my wife spent years trying — unsuccessfully — to impress on me.

My wife is pretty pleased with me now, though, despite the fact that I ignored her advice for years and it took a third party, my doctor, to get me to address my worsening condition. My wife still checks my blood pressure daily, but she has seen the downward trend since I started the DPP. She now admits that she was worried about my health last year, especially when the doctor jacked up my B.P. medication dosage but it still didn’t work. 

Not long ago, I asked a tailor to tighten my baggy pants. He refused, saying “You look like a clown!” He could only make them fit by pulling the pockets close together and bunching the material in back.  He told me it was time to break down and buy new ones. I still have a couple of months to go before completing the year-long First Mile Care program. I’ve already told my wife to expect to go shopping with me for more new pants and belts!

I went for my annual physical exam recently, and my doctor was elated at my weight loss and lower A1C and blood pressure levels. He said, “If everybody followed the principles of First Mile Care, I’d be out of a job.

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!