3Type 2 Diabetes is a Growing Problem In Ontario, 1,169,000 people have been diagnosed with type 1 or type 2 diabetesIn the next 10 years, about 12% of people in Ontario will be diagnosed with diabetesPeople from certain ethnic groups are at higher riskType 2 diabetes can be preventedThe number of people living with diabetes has increased dramatically in the past 20 years. In Ontario, 1,169,000 people have been diagnosed with either type 1 or type 2 diabetes in Over the next ten years, this number is expected to increase to 1,903,000 or 11.9 per cent of the population of Ontario.Research also shows that people from certain ethnic groups (Aboriginal, Hispanic, Asian, South Asian or African descent) are at a higher risk of developing type II diabetes.But diabetes can be prevented with changes to diet, weight and exercise.Hux JE, Mei T. Patters of prevalence and incidence of diabetes. In Diabetes in Ontario: an ICES Practice Atlas. Hux JE,Booth GL, Sluaghter PM, Laupacis A, Eds. Toronto, Canada, Institute of Clinical Evaluative Science 2003 pManuel DG, Rosella LCA, Tuna M, Bennett C. How many Canadians will be diagnosed with diabetes between 2007 and 2017? Available fromAssessing population risk. ICES Investigative Report. Toronto: Institute for Clinical Evaluative Sciences; 2010.Choi BCK, Shi F. Risk factors for diabetes mellitus by age and sex: Results of the national population health survey.Diabetologia 2001;44(10):
4What You Will Learn Today What is diabetes? Why is it a problem?What causes diabetes?What are the 3 types of diabetes?Am I at risk?What are the signs and symptoms?How do I know if I have diabetes?How can I prevent diabetes?With healthy eating that suits my cultureWith physical activity that suits my lifestyle
5What is Diabetes?A condition that occurs when you have too much glucose or sugar in your bloodAffects over 1 million people in OntarioCannot be cured but can be prevented or managed
6Why is Diabetes a Problem? Diabetes causes serious health problems such asHeart disease and strokeKidney diseaseEye diseaseNerve damageIf diabetes is not treated or managed properly, it can cause extra problems or complications.
7What Causes Diabetes? Glucose Insulin High blood sugar when you eat, your body breaks food into glucose or sugar to create energyInsulina hormone made in the pancreas helps glucose enter your body’s cellsHigh blood sugaroccurs when your body stops producing insulin, doesn’t produce enough insulin or doesn’t use it properlyWhen a person without diabetes eats, the body breaks down the food you eat into glucose, which is a form of sugar, to be used as energy or stored for later use. Glucose enters your blood with help from a hormone called insulin. Insulin is a hormone that is made in an organ of your body called the pancreas. Insulin helps your body control the level of glucose (sugar) in your blood by helping to move glucose into the body’s cells, where it is used as fuel.Diabetes is a condition that develops if your body stops producing insulin (Type 1 Diabetes), doesn’t produce enough insulin or doesn’t use insulin properly (Type 2 Diabetes). Since insulin affects the glucose/sugar levels in your blood; when you have diabetes, you will have higher levels of glucose. When this happens, you get too much glucose or sugar in your blood than normal and glucose cannot enter the cells to be used as energy. Space needed in PDF
8Pre-diabetesHigher than normal blood sugar but below levels that would diagnose diabetesPeople with pre-diabetes have increase risk for developing diabetes. If managed well at this stage, diabetes can be prevented or delayedIncreased risk for developing diabetesDiabetes can be prevented or delayedPeople with pre-diabetes have higher than normal blood sugar level that is not yet categorized as diabetes. They are at risk of developing diabetes but they can control blood sugar levels with healthy, balanced food choices and exercise. Pre-diabetes can be diagnosed by a health care provider.
9Three Types of Diabetes GestationalType 1Type 2Gestational : develops when a woman is pregnantType 1: Also called insulin-dependent diabetesOften begins in childhood or teen years before the age of 30Type 2: Most commonAlso called adult-onset diabetes
10Gestational Diabetes Temporary condition Occurs during pregnancy Increases the risk of developing type 2 diabetes later in life, for both mom and babyAffects approximately 4% of all pregnancies. If a pregnant woman is diagnosed with gestational diabetes, both she and her child are at higher risk of developing diabetes in the future.
11Type 1Usually diagnosed before the age of 30, in childhood and teen yearsOccurs when the pancreas stops producing insulinPeople with Type 1 Diabetes must take insulinType 1 diabetes is also called insulin-dependent diabetes. It usually begins before the age of 30. It develops suddenly when the pancreas does not make insulin or makes very little insulin. Approximately 10% of people with diabetes have type 1. We don’t know the cause. It is not preventable and it is not caused by eating too much sugar. It can be managed with healthy eating and exercise and patients must use medication such as insulin injections or insulin pump.
12Type 2 Most common – 90% of diabetic cases Usually develops in adults over 40Occurs when the pancreas doesn’t make enough insulin or insulin doesn’t work properlyPatients can manage diabetes with healthy diet, physical activity or medicationsThis is the most common type of diabetes. It is also called adult-onset diabetes. It usually develops in adults over 40 but more and more children in the high risk groups are being diagnosed. It is caused when the body can not make enough insulin or can not use the insulin it makes properly. It is often caused by poor food choices and lack of exercise. Type 2 diabetes develops slowly and can be prevented by making healthy food choices, being more physically active and by achieving a healthy weight . Thin people also get diagnosed with type 2. Also, I want to stay away from the term ‘diet’.
13High Risk Groups East Asians South Asians Hispanic Caribbean and AfricanRecent immigrants to Canada are at high risk for diabetes compared with long-term residents of Ontario. The groups that show the highest risk are people from countries in South Asia, the Pacific Islands, Latin America, the Caribbean and Africa. Women who were recent immigrants had rates of diabetes equal to or higher than immigrant men from the same regions, except for women from sub-Saharan Africa.Type 2 diabetes is the 5th leading cause of death in Asian North Americans.South Asian immigrants from countries such as Sri Lanka, Pakistan, India, and Bangladesh are up to 7 times more likely to be diagnosed with type 2 diabetes than Caucasians. Hispanic people are nearly twice as likely to be diagnosed with diabetes as Caucasians. Obesity rates in children of Hispanic descent are also increasing and more children are being diagnosed with type 2 diabetes.Recent immigrants of African and South-Asian countries are at the highest risk of developing type 2 diabetes, in Ontario. . Type 2 diabetes accounts for 90-95% of diagnosed cases of diabetes in people of African and Caribbean descent Canadian Diabetes Association.Healthy eating and increasing physical activity have been identified as important healthcare goals for each of these groups.
14Check each item that applies to you: Am I At Risk?Cannot ChangeCheck each item that applies to you:My family background is Caribbean, African, Hispanic, South Asian or East Asian.I have a parent, brother or sister with diabetes.I had gestational diabetes when I was pregnant.I gave birth to a baby who weighed over 4 kilograms (9 pounds) at birth.I have been diagnosed with any of the following conditions:• Polycystic ovary syndrome• Acanthosis nigricans (darkened patches of skin)• Schizophrenia.1 out of 3 people who have diabetes don’t know it. To find out if you are at risk for type 2 diabetes, look at this list of risk factors. Check off the items that apply to you.Everyone who is over 40 should have blood glucose levels tested every 3 years. You should get your blood glucose tested more often if you belong to one of these high risk groups. These are factors that you cannot change.
15Am I At Risk? Check each item that applies to you: Can ChangeAm I At Risk? Check each item that applies to you:I have high blood pressure.I am overweight, especially around the waist.I have high cholesterol or other fats in my blood.I have higher than normal glucose levels in my blood.I have health problems that are linked to diabetes such as diabetes eye, nerve or kidney problems.Look at this list of risk factors and check off any that apply to you.Canadian Diabetes Association. About diabetes Available from: These factors are things that you can change.
16Signs of Diabetes Feeling more thirsty Frequent urination Sudden weight change (gain or loss)Feeling tired more than usualBlurred visionFrequent infectionsCuts and bruises that heal slowlyTingling or no feeling in your hands or feetThis is a list of signs that you may have diabetes or high blood glucose levels. Remember: many people who have diabetes show none of these symptoms. Don't just watch for these signs — know the risk factors for diabetes.
17How Do I Know If I Have Diabetes? Review the list of risk factorsTalk to your health care provider about your risk for developing diabetes and about prevention strategiesAsk your health care provider to check your blood glucose, blood pressure and blood cholesterolIf you have any of the symptoms listed, speak with your health care provider and ask them to check your blood glucose, blood pressure and cholersterol.
18Can I Prevent Diabetes? Yes! Find out if you are at risk Lose a small amount of weight/maintain a healthy weightBe more physically activeEat healthy regular, balanced meals and snacks.Type 1 diabetes cannot be prevented but type 2 diabetes can be prevented or delayed. People at high risk for type 2 diabetes can reduce the risk of progressing from impaired glucose tolerance to type 2 diabetes by almost 60% if they eat healthy foods and lose as little as 5% of their body weight (for example, a 140 pound person would lose 7 pounds; a 200 pound person would lose 10 pounds). Weight loss can be achieved if people engage in moderate to vigorous physical activity for 150 minutes per week (i.e. by walking 30 minutes 5 days a week) and by making healthy food choices.
19Be Active! lowering blood sugar level lowering blood pressure Being physically active helps you by:lowering blood sugar levellowering blood pressurehelping you to lose weight and keep it off.Physical activity may help you prevent type 2 diabetes. It does this by:Lowering blood sugar by improving your body's ability to use insulinLowering blood pressureHelping you to lose weight and keep it off.Canada’s Physical Activity Guide for Older Adults recommends choosing activities that build endurance, increase flexibility, and improve strength and balance. Any amount of physical activity will help, but to have even greater health benefits, it’s important to increase activity to reach a goal of 30 minutes a day, 5 days a week to a total of 150 minutes/week
20Be More Active! Discussion: What activities do you do now? What activities do you enjoy?What stops you from being active?What helps you to get out and be active?Ask participants to talk aboutWhat activities they do now? (E.g.walk children to school, carry groceries, housework, gardening)what activities they enjoy now (e.g. walking, dancing, yoga)What stops them from being active (e.g. child care, weather outside, no fitness facilities)How can they overcome those barriersWhat helps them to get out and be active. Prompts: find a friend, get off the bus a stop early, add music, etc.
21Make a Plan Choose an activity you enjoy Start slowly—5 to 10 minutes a dayIncrease to 30 minutes a day, 5 days a week for a total of 150 minutes per weekWalk, skate, climb stairs, dance.Next step: Build your musclesDo sit-ups, push-ups, climb stairs, dig in the garden.Keep track of your progress.Encourage participants to make a plan to begin to be more active. Research shows that people who set goals are much more likely to achieve them. Encourage participants to set a SMART goal: Specific, Measurable, Attainable, Realistic, with a Time Frame.If participants are not already active, and plan to do anything more than walking, they should consult a physician before starting.OptionDistribute and ask participants to fill out:goal sheetPhysical Activity Fact Sheet (select: Physical Activity)
22Stretch Break!Option: Invite participants to stand. Lead them in simple stretching exercises or yoga stretches (see Resources).Remind participants to stretch slowly, without bouncing.Remind participants to breathe in and exhale.Modify the activities to accommodate participants’ needs and limitations. (eg. remain seated while they stretch.)
23Healthy Eating – Why Does It Help? Things that lower glucoseRegular balanced meals and snacksExerciseThings that raise glucoseFood, activity and medications are not balancedFeeling sick or under stress.Healthy eating may prevent and/or delay the onset of type 2 diabetes. To successfully prevent diabetes, explain how foods and nutrition affect participants’.Blood glucose levels go up and down throughout the day. Things that lower blood glucose includesRegular balanced meals and snacks- Participants should eat at least 3 of the Canada’s Food Guide food groups at each meal and have at least 1-2 of the Canada’s Food Guide food groups for snacks.Exercise- Participants should be moderately to vigorously active for 150 minutes per week (or 30 minutes a day, 5 times a week).Blood glucose may increase when food, activity and medications are not balanced or when you are sick or under stress.
24Healthy Eating – Make a Plan Choose more:high fibre foods likewhole grain rotis, breads, cereals, brown rice, beans and lentils, dahl,fresh, colourful fruit and vegetables (fresh or frozen) such as broccoli, spinach, sweet potato, mango and carrots.lean meats, chicken, fish, low fat milk, yogurt, soy beverage, and tofuwaterThese foods help you keep your blood glucose within the target range, manage your cholesterol, reduce your risk of heart attack and stroke, and stay at a healthy weight.Choose high fibre foods like 100% whole grain breads, cereals, barley, brown rice, whole wheat pasta, oat bran, and wheat bran, fresh, colourful fruit and vegetables, beans and lentils. Choose lower fat sources of protein whole grain rotis, breads, cereals, brown rice, beans and lentils, dahl,Choose fresh, colourful fruit and vegetables (fresh or frozen) such as broccoli, spinach, sweet potato, mango and carrots.Eat lean meats such as chicken, fish, low fat milk, yogurt, soy beverage, and tofuwater.
25Healthy Eating – Make a Plan Eat less:sweet food like sugar, honey, jam, regular pop, juice, candy, chocolate bars, pie, iced cookies, and cakes.high fat food like fried food, samosas, pakoras, fried dumplings, butter, and margarine.alcoholLimit:sweet foods--they raise your blood glucose and can lead to weight gain.high fat foods, especially those high in saturated fats or containing trans fats. They can cause you to gain weightalcohol is high in calories and may contribute to weight gain. Limit alcohol use to no more than one to two drinks per day.
26Healthy Eating – 2 Ways to Plan Plate MethodHandy Portion GuideThere are two ways to plan meals that are commonly used in diabetes education: the Plate Method and the Handy Portion Guide. People from cultures in which meals are served in shared dishes may find the Plate Method less useful. Describe each method.Plate method:The largest part of the meal should be non-starchy vegetables (eg spinach, carrots, cabbage, bok choy, broccoli, tomato salsa, cucumber)In one of the smaller sections add whole grains (eg. whole grain bread, high-fibre cereal, pasta, dal, tortillas,cooked beans and peas, potatoes, green peas, corn, lima beans, sweet potatoes, winter squash)In the remaining section add low-fat protein (eg. fish, lean meats, eggs, tofu and beans or lentils and nuts). Finish the meal with a piece of fruit or a 1/2 cup fruit salad.The hand method of meal planning uses the hand as a way of measuring each type of food. Quantities are listed in the illustrationPlus 250 ml (8 ounces) low-fat milk or alternative with each meal
27Healthy Eating – Vegetables Plate MethodHandy Portionspinach, carrots, lettuce, greens, cabbage, bok choygreen beans, broccoli, cauliflower, tomatoes,vegetable juice, salsa, onion, cucumber, beets, okra,mushrooms, peppers, turnipUsing either method of meal planning, you should eat at least 2 kinds of non-starchy vegetables the size of 2 fists or to fill half a plate. Eat at least one dark green and one orange vegetable each day. Choose dark green vegetables such as broccoli, romaine lettuce and spinach. Eat orange vegetables such as carrots, sweet potatoes and winter squash.Examples include:spinach, carrots, lettuce, greens, cabbage, bok choygreen beans, broccoli, cauliflower, tomatoes,vegetable juice, salsa, onion, cucumber, beets, okra,mushrooms, peppers, turnip
28Healthy Eating – Grains & Starches Plate MethodHandy PortionYou get carbohydrates or starches from grains, bread, rice, pasta, fruit and vegetables like corn, potatoes and yams. Foods in this group provide energy and fibre for your body and help you feel full. Choose foods that are higher in fibre, such as whole grain breads. Choose an amount that fills about one quarter of your plate, or an amount the size of your fist for each grain, starch or fruit.whole grain bread, cereal , rice, noodles, potatoes, corn, pasta.low-fat crackers and snack chips, pretzels, and fat-free popcorn
29Healthy Eating – Meat & Alternatives Plate MethodHandy PortionMeat and alternatives provide protein which helps to build tissues and muscles. It’s important to remember that most protein sources also contain fat. Choose protein sources that are lower in fat. Good sources of protein, include fish, lean meats, skinless chicken, low-fat cheeses, eggs, paneer or tofu and beans or lentils.Choose portions that are about the size of one quarter of your plate, or the size of your palm and the thickness of your little finger.Cook in low-fat ways. Steam, broil, bake, barbecue, roast or poach foods instead of frying. If you fry, use lower-fat products such as vegetable oil instead of lard.Fish, lean meats, eggs, or tofu beans or lentils
30Healthy Eating – Milk & Alternatives Plate MethodHandy PortionMilk and fortified soy products help build strong bones. Choose lower fat milk and milk products such as skim, 1% or 2% milk, low-fat soy, rice or almond milk, as well as yogurt with less than 2% milk fat.
31Healthy Eating – Make a Plan Tips for Meal-planningEat regular, balanced meals.Eat at the table.Eat slowly.Eat healthy portions.Choose healthy drinks like waterEat small snacks like pre-cut vegetables or fruit to control hunger.Eat regular, balanced meals.Eating 3 meals a day can help control blood glucose levels.Eat meals 4 to 6 hours apart.Eat at the table rather than in front of a screen (TV or computer).Eat slowly.It takes your brain about 20 minutes to know that your stomach is full.Choose healthy, balanced portions(see the Plate Method or Handy Portions Guide)Drink water if you are thirsty. Regular pop and fruit juice raise blood glucose levels.Eat small snacks like pre-cut vegetables or fruit to control hunger.
32Healthy Meals For Your Culture Discussion:How many meals do you eat each day?Do your meals fit the Healthy Meal plan?How can you change your meals to make them healthier?Discussion: To encourage consumption of healthy foods that are familiar and culturally acceptable ask participants about their eating habits.How many meals do you eat each day?Do your meals fit the Healthy Meal plan?How can you change your meals to make them healthier?If possible, bring food samples or pictures to the workshop.
33Make Simple Changes Reduce Fat, Salt and Sugar Include More Bake, boil, steam or poach instead of frying with fatSwitch to lean cuts of meat or vegetarian alternativesReduce salt by choosing no sodium or low-sodium products and rinsing canned beans and vegetables.Reduce sugar in recipesMake smaller baked goods (muffins, cookies, biscuits)Include Morevegetableswhole grainshigh fibre foodslegumes, tofuLow fat dairy products and alternativesbalance between food typesIf participants make simple changes to recipes that they use already, they can increase the amount of fibre and vegetables they eat and reduce the salt, fat and calories. The next slides (34-37) show examples of how participants can make simple changes to create healthier meals.The examples represent traditional ways of eating and may not be samples of what participants typically eat in a Canadian setting. However, they are provided as a starting point to generate further discussion and exploration of participants’ eating habits.
34Tips for Planning East Asian Meals Instead of……try this healthier meal1 bowl pork broth with Chinese herbs Stir fried beef with broccoli and cashews1 cup bok choy stir-fried in 2 tbsp. peanut oil2 bowls rice with soy sauce Moon cake 1 can cola1 bowl pork broth with Chinese herbs (fat–skimmed off)Stir fried chicken with broccoli and carrots1 cup bok choy steamed1 bowl rice with no sodium or low sodium soy sauce 1 small orangePlain teaAsk participants to look at the sample meal. According to the Plate method or Handy Method is it a healthy, balanced meal?Ask them to look at the modified meal.What ingredients or foods were reduced, removed or switched to create the healthier meal in column 2?
35Tips for Planning South Asian Meals Instead of……try this healthier meal2 potato parathas1 cup spinach paneer½ cup potato curry½ cup raita1 gulabjaman1 cup salty lassi3 tsp. oil used in cooking2 whole wheat chapati1 cup spinach paneer½ cup tomato dhal½ cup low fat yogurt raita½ gulabjaman½ mango ½ cup low fat yogurt2 tsp. oil used in cookingAsk participants to look at the sample meal. According to the Plate method or Handy Method is it a healthy, balanced meal?Ask them to look at the modified meal.What ingredients or foods were reduced, removed or switched to create the healthier meal in column 2?
36Tips for Planning Hispanic Meals Instead of……try this healthier meal¾ cup refried beans with chorizo sausage and cheese3 corn tortillas½ cup canned tomato salsa1 banana8 oz coffee with 3 oz milk3/4 cup boiled beans with peppers and low fat cheese2 corn tortillas½ cup tomato, avocado, pepper, cilantro salsa½ cup fresh fruit salad8 oz coffee with 3 oz low fat milkAsk participants to look at the sample meal. According to the Plate method or Handy Method is it a healthy, balanced meal?Ask them to look at the modified meal.What ingredients or foods were reduced, removed or switched to create the healthier meal in column 2?
37Tips for Planning Caribbean Meals Instead of……try this healthier meal2 fried eggs2 sausage patties2 buttermilk biscuits½ fried plantain with brown sugarcoffee with 3 t. sugar1 Tbsp. margarine2 boiled eggs1 sausage2 slices whole wheat toast1 cup cubed cantaloupecoffee with 1 t. sugar1 tsp. margarineAsk participants to look at the sample meal. According to the Plate method or Handy Method is it a healthy, balanced meal?Ask them to look at the modified meal.What ingredients or foods were reduced, removed or switched to create the healthier meal in column 2?
38Tips for Planning African Meals Instead of……try this healthier meal3 fried sambusa stuffed with ground beef and spices3 lamb kebabs in spiced yogurt sauce½ cup fried rice with vegetables and spices½ cup watermelon juice1 piece Halwa2 sambusa with onions, green pepper, carrots, spinach2 chicken kebabs in low fat yogurt½ cup boiled rice with spices½ cup plain tea½ piece Halwa1 guavaAsk participants to look at the sample meal. According to the Plate method or Handy Method is it a healthy, balanced meal?Ask them to look at the modified meal.What ingredients or foods were reduced, removed or switched to create the healthier meal in column 2?
39Multicultural Meals-Make a Plan! Vegetables: okra, spinach, broccoli, bok choi, salsa, green beansStarch: pasta, rice, potatoes, dahl , refried beans, plantain, corn, chapatti, tortillaProtein: chicken, fish, tofu, lentils, lambMilk: paneer ,cheese, milk, yogurtFruit: mango, apple, pomegranate, orangeThe previous examples represent traditional ways of eating and may not be samples of what participants typically eat in a Canadian setting. Discussion: How could participants combine foods from different cultures to create a healthy meal?
40Make a Plan! Study the list of risk factors for diabetes Be more active. Choose an activity you enjoyStart slowly—5 to 10 minutes a dayPlan a healthy menu for the weekKeep track of your progressLearn more about preventing diabetes.Encourage participants to make a plan to prevent or manage diabetes.Provide copies of the Participant Guide.Point out the list of resources.Encourage participants to go to EatRight Ontario to use the “My Meal Planner” tool.Provide any additional handouts from resource list.
41How to get more information EatRight Ontario Website:For questions about healthy eating, call EatRIght Ontario speak to a registered dietitian for freeLink to Stand up to Diabetes Website:Canadian Diabetes Association website