Taking Steps to Prevent Type 2 Diabetes Type 2 diabetes is serious, common, costly, and controllable. But we know from research that it can be delayed or prevented. This workshop is designed to teach you how to prevent or reduce your risks of developing type 2 diabetes. Among individuals at high risk for developing type 2 diabetes, structured programs such as this one emphasizing lifestyle changes including moderate weight loss (7% body weight) and regular physical activity (150 minutes per week) with dietary strategies including reduced calories and reduced intake of dietary fat, can reduce the risk for developing diabetes and are therefore recommended.

What is Type 2 Diabetes? The body may make insulin but it doesn’t work effectively Sugar builds up in the blood, causing diabetes Uncontrolled diabetes over a long period of time can lead to serious health problems Type 2 can be treated with healthy eating and increased physical activity and sometimes medications Checking blood sugars helps the person manage diabetes.

Signs & Symptoms of Type 2 Diabetes Thirst Hunger Unexplained tiredness More urination than usual Blurred vision Sores that won’t heal Dry itchy skin Many people have no symptoms Some people have some of the symptoms, some may have none and some will try to explain away their symptoms.

Why is Type 2 Diabetes on the Increase? Inactivity Overweight Poor eating habits Living longer Increase in ethnic diversity Larger portion sizes

Who Is At Risk? Age 45 or older Overweight Inactive Ethnic or minority population Family history of diabetes Excess abdominal fat High blood pressure Pre-diabetes High blood fats Darkening of the skin Polycystic ovary syndrome History of Gestational Diabetes or large baby Excess fat in the abdomen is an independent risk factor for disease. Women over 35 inches are at risk. Men over 40 inches are at risk. Darkening of the skin, back of the neck and skin folds is called acanthosis nigricans, it appears as dirty spots and can not be washed off. PCOS is a hormonal imbalance which may cause hyperinsulinemia, facial hair, overweight, infertility Giving birth to a baby that weighs more than nine pounds.

Could You be at Risk for Diabetes? Where do you start? ADA Risk Test (paper or online) www.diabetes.org Distribute a paper risk test of your choice and allow each participant to complete. Call 1-800- DIABETES (342-2383)

What Was Your Score? Low Risk – 3 to 9 points Maintain healthy weight Regular exercise Keep up the good work High Risk – 10+ points High risk for diabetes Go see your doctor Take steps to improve your score Review the ADA paper test and direct people to the bottom of the page where the score is located. Reference: Could You Have Diabetes Take the Test. Know the Score -014B

Pre-Diabetes Higher than normal blood sugars, but not high enough to diagnose. Some people may think that pre-diabetes is borderline diabetes but there is no such diagnosis as a touch of sugar or borderline diabetes. Distribute the KDN pre-diabetes care tool.

Diagnosis of Diabetes Normal, Fasting Pre-Diabetes, Fasting Diabetes, Below 100 mg/dl Between 100-125 mg/dl Higher than 126 mg/dl at 2 different times

The Good News . . . Research shows that lifestyle changes can be very effective in preventing or delaying type 2 diabetes. NEWS Lifestyle changes may reduce risk by 58%. A 5-10% weight loss. Exercising 30 minutes a day, 5 days a week for a total of 150 minutes per week.

How Can You Reduce Your Risk? Get physically active Healthy eating Weight management Adopt healthy habits Regular check-ups Manage stress Refer to an effective ongoing support program for weight loss of 5-10% of body weight, and increase physical activity to at least 150 minutes per week of moderate activity such as walking. Individuals who have prediabetes or diabetes should receive individualized medical nutritional therapy (MNT) as needed to achieve treatment goals, preferably provided by a registered dietitian familiar with the components of diabetes MNT. In overweight and obese insulin resistant individuals, modest weight loss has been shown to reduce insulin resistance. Thus, weight loss is recommended for all overweight or obese individuals who have or are at risk for diabetes.

Getting Physically Active Aim for 150 minutes per week of moderate physical activity (example 30 minutes of exercise five days a week = 150 minutes) Walking Swimming Dancing Running Biking Jogging Physical activity may be in increments of a minimum of 10 minutes, 3 times daily. It is important to include flexibility, strengthening and aerobic activity. Suggested Teaching Aids: Fat and muscle models

Moving Safely Check with your doctor before you start an exercise program Always warm up and cool down to prevent injury Start out slowly Investing five minutes to warm up your muscles and an additional five minutes to cool down your muscles is important to prevent muscle injury.

Make Exercise Count Talking and walking should be your rule– but no singing! Stop right away if you are dizzy, short of breath, sick to your stomach or in pain, seek medical help When people exercise they should be able to talk with their walking partner comfortably but if they are able to sing they are not exercising hard enough to get the full benefit from their physical activity.

Hints For Helping You Stick to Your Exercise Plan Choose an exercise you enjoy Find an exercise buddy Set goals you can reach Keep the cost low Exercise won’t just happen You have to plan for it!

Healthy Eating Choose a variety of healthy foods Select smaller serving sizes Eat 3 meals a day at regular times Make each meal about the same size It is important to space meals 4-5 hours apart. Resources: MyPyramid.gov KDPCP-Nutrition Basics Serving Size Handout Suggested Teaching Aids: Food Models Example of healthy plate

Healthier Eating Habits Eat more whole grains More Matters® - choose more vegetables & fruits Choose low fat foods Choose low fat dairy and yogurt Drink more water and sugar-free beverages Fruits and Veggies - More Matters- try to eat 5-9 servings of vegetables and fruits each day. A low fat food is defined as one that has 3 grams of fat or less per 100 calories.

Changing Eating Habits Use herbs and spices to limit sodium Choose healthier dessert Low fat yogurt, fruits Change recipes to reduce sugar and fat Handout- “How to Adapt Your Recipes”

Weight Management If overweight, losing 5-10% of body weight can reduce risks for Type 2 diabetes Safely lose weight with: Healthy eating Physical activity Among individuals at high risk for developing type 2 diabetes structured programs that emphasize lifestyle changes that include moderate weight loss (7% body weight) and regular physical activity (150 minutes per week) with dietary strategies including reduce calories, reduce intake of dietary fat can reduce the risk for developing diabetes. Slowly losing weight leads to sustainable weight loss.

Adopt Healthy Habits No tobacco Get plenty of sleep Wear your seatbelts/helmets Keep up to date on immunizations Limit alcohol intake Key immunizations for people with diabetes include an annual flu shot and a pneumonia vaccine.

Regular Check-ups See your doctor at least once a year for a complete check-up. Recommended age/gender appropriate screenings Regular dental and eye exams Resource: Gender Specific Screenings per PHPR guidelines For example: Women: Stay Healthy at Any Age and Men: Stay Healthy at Any Age from the Dept of Health and Human Services/ www.preventiveservicesahrq.gov.

Manage Stress Take time to relax Pace yourself and your activities Get enough sleep Make time for fun Regular physical activity Everyone has good stress and bad stress- it is when stress is out of balance that people have problems. People who get regular physical activity are more resilient to stress. Research shows that not getting enough sleep (about 7-8 hours for most people) can lead to chronic health problems.

Get Support Make it goal to adopt healthier habits Include family and friends Know and use your community resources Give a list of community resources.

Setting Personal Goals Choose small goals Be specific, realistic and patient Choose goals you can control Use non-food rewards Build on your successes

Examples of Personal Goals Example of weight management goal: I will lose 5 pounds, in five weeks by cutting out 500 calories every day. Example of physical activity goal: I will begin walking for 10-15 minutes per day, at least 5 days a week. Example of healthy habits goal: I will make an appointment for my regular check up by the end of this week. Give participants a chance to write their own personal goal. Goals should be written in positive language. They should be specific and measurable.

Preventing type 2 diabetes If there was a vaccine to prevent diabetes would you take it? There is no vaccine to take to prevent diabetes but as research has shown Type Two diabetes can be prevented by investing in a healthy diet, daily physical activity, and stress management. Another way to prevent type two diabetes -- if you are overweight lose 5-10% of your current body weight.

You Can Reduce Your Risk Get physically active Healthy eating Weight management Adopt healthy habits Regular check-ups Manage stress 27

What Can You Do to Prevent Type 2 Diabetes REVIEW! Get Physically Active Healthy Eating Weight Management Adopt Healthy Habits Lets play diabetes feud! Ask the audience to list the major ways they can reduce their risk for type 2 diabetes. This game is played similarly to Family Feud – So you may say something like “the survey says”--- click on the color bar to reveal the answer. What Can You Do to Prevent Type 2 Diabetes REVIEW! Get Physically Active Healthy Eating Weight Management Adopt Healthy Habits Get Regular Checkups Manage Stress Regular Check-ups Manage Stress