Salvador Ramirez didn’t know why he felt so tired all the time.

Ramirez used to be able to get up at 5 a.m., while on vacation, spend all day exploring, then head back to the hotel at midnight without missing a beat. But about 11 years ago he could barely get out of bed before 10 a.m. and found himself urinating more often.

That’s when he decided to get a checkup with a doctor in El Paso. A blood test revealed that his sugar levels far exceeded the normal range. He was diagnosed with type 2 diabetes.

Thanks to medication and healthier eating habits, the now 62-year-old has gotten better at managing his blood sugar levels. He credits The Diabetes Garage, a program from the University of Texas at El Paso, for helping him stay on track.

Jeannie Concha, an assistant professor of public health sciences at UTEP, held the first workshop in 2018 to teach men how to manage their diabetes by likening it to how they maintain their car. UTEP offers multiple, month-long programs throughout the year along with an annual “open garage” for participants to meet up.

Nearly 17% of El Paso adults have diabetes, which is higher than the state average, according to 2020 data from Healthy Paso del Norte, an organization that tracks health trends in the region.

Concha’s inspiration for the program came from lowrider car culture, which Mexican Americans popularized during the 1940s in the barrios of East Los Angeles. Pachucos, the zoot suitors who emerged from El Paso, helped pioneer the lowrider lifestyle.

“Mexican American communities didn’t see they were represented in mainstream culture, so they created their own visual and cars were a thing that brought families together,” Concha said. “People draw images on their cars as a way of telling their family story … but also it bonds families, fathers and sons, who work on cars together.”

Connecting car culture to diabetes education 

More than 200 men have completed The Diabetes Garage since its inception. While she didn’t start developing The Diabetes Garage until 2017, the idea was planted much earlier.

Concha has been researching diabetes since the late 1990s. Around this time she began talking to her brothers and father in El Paso about their health. When she asked them if they had gone to the doctor for a checkup, they would say no. In response, she asked them why they checked the oil in their cars every three months but wouldn’t check their bodies.

A couple months later, one of her brothers went to the doctor for a checkup, she remembered. It was an “aha-moment” for both of them, she said.

Nationwide, more than 14% of Mexican American adults have diabetes, twice the percentage of non-Hispanic white adults, according to the U.S. Department of Health and Human Services. A late 2021 survey conducted by the Pew Research Center also found that Hispanic men are less likely than Hispanic women to say they have seen a health care provider within the last year.

From 2010 to 2012, Concha ran a New Mexico health program called Project HOPE, which screened people for diabetes, obesity and cardiovascular disease. When talking to men with high blood sugar, she realized once again that using car terms was helpful for explaining diabetes.

When she moved back to El Paso and took an assistant professor position at UTEP, she knew the city was ideal for launching The Diabetes Garage as some of Texas’ earliest lowrider car clubs formed in El Paso. Every year car clubs from all over Texas, the Southwest and Ciudad Juárez display their lowriders at Lincoln Park.

Concha consulted with a mechanic to form analogies comparing auto parts to body parts. And soon after, she and her team set up shop at the city’s car shows to recruit workshop participants.

That’s how Francisco “Frank” Camacho, 49, learned about The Diabetes Garage in March. His crew, the PoderosO car and motorcycle club in El Paso, had set up customized Harley-Davidsons at Lincoln Park and he noticed The Diabetes Garage booth across from them.

Camacho grew up in Segundo Barrio, a historic neighborhood in El Paso’s South Side, where before he and his friends could afford cars and motorcycles, they transformed bicycles into lowriders.

Diabetes runs in his family. His grandparents, mother and brother all have it. Eight years ago, Camacho was diagnosed with diabetes too.

It took a while for him to adjust and he struggled day-to-day, he admitted. Diabetes is a chronic disease, so he tries to make choices – like cutting down on soda and taking walks with his daughter in the evenings – that are long-term, not just for one day, he explained. The Diabetes Garage workshops, which have gone virtual since the start of the pandemic, are convenient because he can do them from home, he said.

“Since I like to tinker with cars, you gotta know how the car works to deal with it or fix it,” Camacho said. “If something is wrong with your engine, you gotta know how it works. Looking at my body like that, as a car, and things I got to do to fix and make it better, like run longer, made me think of it in a different view.”

Risk factors for developing type 2 diabetes include a parent or sibling with diabetes, higher body weight and low physical activity.

Diabetes occurs when the body cannot make or has a hard time using its own insulin, a hormone produced in the pancreas to regulate glucose, the sugar that comes from food. Insulin opens the body’s cells to allow sugar to enter, which the body uses to create energy.

When someone doesn’t make enough insulin, or their body resists insulin, too much sugar stays in their bloodstream, which can eventually lead to diabetes. Symptoms of diabetes include fatigue, feeling more thirsty than usual and frequent urination. People with diabetes can develop other health complications, from heart attacks to kidney problems.

In The Diabetes Garage workshops, participants learn that insulin is like the gas pedal. Pressing on the gas pedal opens the throttle to allow gas to enter and make its way to the engine, where internal combustion occurs to convert fuel energy. But with diabetes, the gas pedal can face resistance – such as fat buildup blocking the cell doors from opening, keeping sugar in the bloodstream.

Making adjustments after a diabetes diagnosis

Once someone develops diabetes, the disease can worsen over time. Ramirez injects himself with insulin twice a day, and once a week takes dulaglutide, a medication that helps the body release insulin it’s already making.

It was difficult for his family to understand at first that taking medication doesn’t mean it’s “too late,” he said. His parents thought that taking insulin meant he was already dying, so it’s been an educational experience not only for him, but his family.

Ramirez has changed his eating habits to help manage his diabetes. In the past when he traveled for work, he would skip lunch. On the way back to the hotel he would pick up a 3-liter soda, a large pizza and a 6-pack of beer for dinner.

There’s a misconception that when people have diabetes, they have to give up many foods or can’t eat sweets, he said. The Diabetes Garage taught him about portion control and how to read food labels. While diet affects diabetes, it doesn’t stop him from eating what he likes – he just eats with balance in mind.

At the family cookout he will have one plate instead of three and he’s started eating more fish, not just red meat. He still drinks beer and whiskey, but drinks less alcohol and more water than before. Instead of eating chips and chocolates straight out of the bag, he pours chips into a smaller bowl and only has a square or two of chocolate at time.

After being diagnosed with diabetes and making adjustments to his lifestyle, his weight has dropped from 238 to 167 pounds, he said.

“I have my days, but my energy is a lot better,” Ramirez said. “It’s nothing like before I got diagnosed with diabetes and was worn out all the time.”

Since launching in El Paso, The Diabetes Garage has expanded to San Antonio and Harlingen, a city in the Rio Grande Valley.

The program, offered in English and Spanish, consists of four, two-hour workshops held on Zoom once a week, plus a health assessment at the beginning and the end of the program. Each participant receives a free “toolbox” that includes a glucometer and handbook.