Lessons in Diabetes Education from the Dog Pack

Lessons in Diabetes Education from the Dog Pack

Cesar Milan from “the Dog Whisperer” immigrated from Mexico to America with one dream in his mind… to train Lassie. He worked many jobs before scoring his first job as a dog groomer. He could approach a dog that wouldn’t allow anyone else near. Cesar says, “Humans don’t understand a dog cannot be rushed. If you want to get inside a dog’s personal space, you need to approach at the pace comfortable for the dog – not what’s comfortable for your own work schedule.” I noticed this had some interesting parallels to my own job as a diabetes educator. Talking about the relationship with our body is personal. How many of our patients are we rushing through these vulnerable moments?

Through dog grooming, Cesar gathered enough money to relocate in LA. He began to work as a dog walker (something relatively uncommon at that time). He had little difficulty finding potential clients, “Because I am an immigrant, I know how to hustle. So, I wasn’t just walking one dog at a time. I was walking 30 or 40 dogs at a time - most of them off leash. Pit Bulls, German shepherds, and Rottweilers – never straying from my side. They thought I was crazy.” Cesar quickly became known as an urban legend. Who was this Mexican man walking a pack of 50 strong through the LA ghetto? Affluent neighborhoods began to hear of his skill and started to seek him out for training. Are your difficult patients following you as willingly as your eager patients? Is anyone talking about your teaching?

After his first couple of jobs training dogs, he realized his work in the United States would be different than what he did in Mexico. Dogs didn’t need training, their owners needed it! He started to develop a plan for dog/owner rehabilitation rather than dog training. “I’m going to train PEOPLE and REHABILITATE dogs.” American owners treat their dogs as children, creating a culture with many possessions but few natural instincts. Meanwhile, dogs in Mexico were poor without birthday parties and houses, but Cesar noticed they were healthier emotionally and physically. They knew what it was to be a dog. American privilege can be a problem of its own. Cooking, sleeping, and exercising are becoming extinct now that we have cheap, easy options to fill our time. How many households have a TV or iphone? How many of our patients have too many options on a menu? Free food at work? Addictions to caffeine? We need to find new ways to help them deal with our privileged lifestyles.

“If you come from selfishness, ego and envy – you’re not going to be clear about what you want.” Cesar’s dog rehabilitation program includes three core principles: 1) Exercise (the walk), 2) Discipline (rules, boundaries, and limitations), and 3) Affection. The walk may seem simple, but it’s not just about taking your pooch outdoors. It’s about finding a time of day where you and the dog practice moving as a team. Discipline is equally important – but we fail to value boundaries and limitations in a culture where “Treat yo’ self” mentality prevails. For the owners, Cesar helped explain how they were a part of their dog’s instability. Once this became apparent, the owner was able to surrender their old ways and follow a new direction to create a healthier environment. In diabetes education, I can see how the body needs to be rehabilitated, but the owner might passively or actively avoid acknowledging the instability present. Avoidance is uncomfortable to address, but it’s important because it prevents care. “Care leads to awareness. Awareness leads to surrender. Surrender leads to learning, and learning leads to execution of a new kind of life” We need to get our patients to a state of mind ready for change. What instability have you been able to address in patients you’ve seen?

When a dog has a fear, an obsession, or any of the many behavior problems Cesar is called to fix, most of the time the issue is not a “personality quirk.” Cesar says the issue is an unfulfilled and unhappy dog. Too often, we quickly assess situations and call them a normal part of who they are without challenging it.  Maybe eating a bowl of chocolate ice cream at night seems like a quirky harmless habit for one of your patients. It might be a simple solution for them to stop, but they keep guarding it. Let’s be sure to ask what the ice cream provides beyond just being a tasty treat. As a diabetes educator, have you stumbled on something bigger than you expected? How did you react?

Last, Cesar’s best tool for training - “The number one tool you have to work with a dog is not a leash, collar, or treat – it’s your energy.” As the leader of a pack, we cannot hesitate to react to situations and listen to our pack. They are depending on us to have a strategy forward. Your dog needs consistent signals to trust what you say is what you mean. Many patients worry about feeling judged or wrong when they come to diabetes education. For this, I’ve learned to be mindful of my own energy. Never think a patient won’t do something before you ask them to do it. Set clear strategies and approach any unmet expectations with curiosity rather than judgement. What tricks do you have as an educator to help patients feel more comfortable?

To be honest, I’m 118 pages in to a 297 page book and I cannot put it down.

How many other disciplines relate directly or indirectly to what we’re trying to do as diabetes educators? I’m curious if anyone else has found an unexpected teacher in an unexpected place and willing to share.

Please comment below.


Lessons in Diabetes Education from the Dog Pack

February 5, 2019 04:11 PM by Lisa Laird, RN, BSN, CDE, FAADE


This is excellent. So much to consider. Going a little deeper with the patients, being curious, is a way in and lowers defense mechanisms. 'Tell me more about that...' another tool in opening up.

Behavior with the pups is far more responsive to 'all positive dog training' leaving no place for blame and shame. Thoughts?

Some things I've uncovered: Textures in food preference-there's a lot behind that, right? And I will ask a patient who consumes huge amounts of food about satiety. More on that?

Thank you for your expertise! and for sharing from fields other than our own.

Lessons in Diabetes Education from the Dog Pack

February 6, 2019 12:59 PM by Patricia Adams, RN,CDE


This is wonderful, maybe one of the best inspirational writing I've read.  Thank you for sharing.  Let us know when you finish the book and if you have more to add.

Curiosity is Key!

February 7, 2019 07:11 PM by Sarah Burbee, LD,RD,CDE,RDN

Lisa, I totally agree. Curiosity can neutralize situations that might otherwise elicit shame. Great point! 

I use a fair amount of positive reinforcement, although I will frequently mirror back to the patient what their choices indicate about their values. I find this type of reflection to be more helpful than just being a cheerleader for them. (We have a lot of values on the East Coast, so this can strike a chord for many). I try to keep my analysis as practical and open as possible, but it can be very uncomfortable for them to consider what their words actually mean. 

I’m sure it’s different if you’re working with kids or people with type 1 diabetes who have a lifetime of dealing with diabetes. Adults frequently try to act as though they are outside the age requiring rules and boundaries. At some point in life, we become the parent for our inner child. Picking up that work is hard! 

Pat, thank you for the compliment! 

I’m interested to find where other people have found parallels to our work. Please leave comment!


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