2.  Excessive urination (polyuria)  Excessive thirst (polydipsia)  Weight loss  Vision changes  Hunger  Fatigue  Long term risks include heart disease, stroke, neuropathy, kidney failure, and death.

3.  A chronic condition in which sugars in the blood are elevated.  In Type II, the body is resistant to insulin and the pancreas cannot produce enough insulin to combat the resistance, causing a buildup of glucose in the blood.  Type II Diabetes accounts for 95% of alldiabetes cases.

4.  Risk factors for developing type 2 diabetes include:  Family history of diabetes  Poor Diet  Physical Inactivity  Obesity  Older Age  Blood tests to diagnose are hemoglobin a1c and fasting blood glucose.

5.  Statistics are derived from:  Centers for Disease Control (CDC)  Indian Health Services (IHS)  U.S. Renal Data System of the National Institutes of Health  U.S. Census Bureau  National Patient Information Reporting System

6.  Statistics are derived through:  National Health and Nutrition Examination Survey (NHANES)  Indian Health Services data  National Health Interview Survey  U.S. population estimates  This data is applied to the population estimates to determine the amount afflicted with type 2 diabetes.

7.  Randomly selects a sample of 5,000 Americans.  It includes an in-home interview, which asks about health status, diet, and disease history, and a health examination, which is performed by a mobile health center.  Each person selected for the survey represents approximately 65,000 other residents with similar vital statistics including age, gender, and ethnicity

8.  Minority populations are at higher risk of developing Type 2 Diabetes  African Americans  Latinos  Native Americans  Asian Americans/Pacific Islanders  “Diabetes is a rapidly growing health challenge among Asians and Pacific Islanders who have immigrated to the United States, affecting about 10 percent of Asian Americans… The higher rate of type 2 diabetes in Asian descents results from a combination of genetics and environmental influences (AADI, 2010).”

9.  Type II Diabetes can be either prevented or delayed through lifestyle changes  According to the Centers for Disease Control, “a large prevention study of people at high risk for diabetes, showed that lifestyle intervention to lose weight and increase physical activity reduced the development of type 2 diabetes by 58% during a 3-year period (2011).”

10.  Precontemplation – lack of willingness to initiate change  Contemplation – limited or denial of knowledge  Preparation – individual is ready to make a change and is planning for changes.  Action – they have begun making changes and are working on sustaining them.  Maintenance – the new changes have become habit and their new lifestyle

11.  Intrapersonal Factors – An individual’s knowledge, attitude, and skills.  Interpersonal Factors – people around an individual  Institutional Factors – school/workplace  Community Factors – the larger community  Public Policy – regulations and limitations that affect an individual’s behavior.

12.  Use of Ecological Model to design programs and interventions at a community level  Action Communities for Health, Innovation, and EnVironmental changE (ACHIEVE)  Creating more public policy in the hopes of making communities healthier, in turn helping individuals make healthy choices  As some research suggests, “Healthy eating patterns and physical activity levels are not likely to occur or persist without convenient sources of healthy foods and attractive and safe settings for exercise (Fisher et al., 2005).”

13.  Lifestyle Management Programs  Through employers, insurance companies, or private contractors.  The focus is on diet, exercise, and regular monitoring of blood glucose levels with a physician.  A study was done through the Diabetes Prevention Program that focused on prevention for people at high-risk of developing diabetes.  The study found that lifestyle changes to increase physical activity and lose weight reduced the incidence of diabetes by 58% over a 3 year period and a 71% reduction among adults aged 61 and older (CDC, 2011).

14.  American Diabetes Assocation. (2012). Facts About Type 2. Retrieved September 15, 2012 from http://www.diabetes.org/diabetes-basics/type-2/facts-about- type-2.html http://www.diabetes.org/diabetes-basics/type-2/facts-about- type-2.html  Asian American Diabetes Initiative (2010). Diabetes in Asian Americans. Boston, MA: Joslin Diabetes Center.  Centers for Disease Control. (2012). Health Communities Program. Retrieved October 18, 2012 from http://www.cdc.gov/healthycommunitiesprogram/ http://www.cdc.gov/healthycommunitiesprogram/  Centers for Disease Control. (2011). National Diabetes Fact Sheet, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control.  Centers for Disease Control (2011). National Health and Nutrition Examination Survey. Retrieved September 23, 2012 from http://www.cdc.gov/nchs/nhanes/about_nhanes.htm http://www.cdc.gov/nchs/nhanes/about_nhanes.htm

15.  Fisher, E.B., Brownson, C.A., O’Toole, M.L., Shetty, G., Anwuri, V.V., and Glasgow, R.E. (2005). Ecological Approaches to Self- Management: The Case of Diabetes. Retrieved October 8, 2012 from http://journal.diabetes.org/diabetesspectrum/00v13n3/pg125.ht m http://journal.diabetes.org/diabetesspectrum/00v13n3/pg125.ht m  Indian Health Services (2012). Division of Diabetes Treatment and Prevention. Retrieved September 23, 2012 from http://www.ihs.gov/MedicalPrograms/Diabetes/ http://www.ihs.gov/MedicalPrograms/Diabetes/  Mayo Clinic (2012). Diabetes. Retrieved September 30, 2012 from http://www.mayoclinic.com/health/diabetes/DS01121/DSECTI ON=causes http://www.mayoclinic.com/health/diabetes/DS01121/DSECTI ON=causes  National Institute of Diabetes and Digestive and Kidney Diseases (2011). National Diabetes Information Clearinghouse. Retrieved September 23, 2012 from http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.aspx http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.aspx

16.  National Library of Medicine (2011). Type 2 Diabetes. Retrieved September 30, 2012 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356/  Ruggiero, L. (2000). Helping People With Diabetes Change Behavior: From Theory to Practice. Retrieved October 8, 2012 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449392/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449392/  Schneider, M. J. (2011). Introduction to Public Health (3 rd Ed.). Sudbury, MA: Jones and Bartlett Publishers.  World Health Organization (2012). Diabetes. Retrieved September 30, 2012 from http://www.who.int/mediacentre/factsheets/fs312/en/ http://www.who.int/mediacentre/factsheets/fs312/en/