1. 1 Seva Foundation, Native American Diabetes Project P.O. Box 225, Winnebago, NE 68071 1786 Fifth Street, Berkeley, CA 94710 www.seva.org

2. 2 OBJECTIVES: Session 1 Introduce the Diabetes Wellness Project Introduce the Circles Introduce the Circle members Complete Pre-Test Questionnaire Distribute homework of Dietary Recall Log

3. 3 Collect the Dietary Recall Log Watch the Diabetes Wellness video Look at people’s perceptions of diabetes Learn diabetes myths from fact OBJECTIVES: Session 2

4. 4 MYTHS OF DIABETES Diabetes has always been with us, is in all of our families, and is inevitable in our lives Nothing that we can do can influence our chances of getting diabetes or help control our disease once we get diabetes

5. 5 If I must take insulin for diabetes, I will have a poorer outcome than someone that doesn’t. Giving myself a shot of insulin is extremely painful. Once a person develops a complication from diabetes, there is nothing that can be done Diabetes only affects the body, and not the mind MYTHS OF DIABETES

6. 6 OBJECTIVES: Session 3 Understand different types of diabetes Know who is at risk of diabetes Recognize the warning signs of diabetes Know how to prevent diabetes

7. 7 HOW THE BODY USES FOOD NORMALLY

8. 8 TYPE I DIABETES

9. 9 TYPE II DIABETES

10. 10 Gestational Diabetes: Only when pregnant Secondary Diabetes: Damage to the Pancreas OTHER TYPES OF DIABETES

11. 11 American Indian and Alaska Native (12.2% versus 5.2% of the general population) African American (10.8% versus 5.2% of the general population) Hispanic American (10.6% versus 5.2% of the general population) RISK FACTORS

12. 12 RISK FACTORS Family members with diabetes Overweight Over age 45 Don’t exercise regularly Women who had gestational diabetes or a nine pound plus baby

13. 13 WARNING SIGNS OF DIABETES Frequent Urination Excessive Thirst Extreme Hunger Dramatic Weight Loss Irritability Weakness and Fatigue Nausea and Vomiting Excess Weight Drowsiness Blurred Vision Skin Infections Itching Slow Healing of Cuts

14. 14 HEALTHY EATING HELPS: Balance glucose levels Improve the body’s use of insulin Lower blood pressure

15. 15 EXERCISE HELPS: Lower blood glucose levels Increase circulation Lower blood pressure Decrease weight

16. 16 OBJECTIVES: Session 4 Learn the symptoms of diabetes Know how to prevent diabetes from getting worse Hear one person’s experience with diabetes

17. 17 SYMPTOMS AND Feet and Fingers Eyes Kidney Disease Heart Disease and Stroke Impotence Mouth, Gum, and Skin Infections Smoking Pregnancy TREATMENTS

18. 18 Dietary guidelines Exercise Medical testing and supervision Blood tests Urine tests Medication/pills Insulin Glycated hemoglobin test or the hemoglobin A1c test SECONDARY PREVENTION

19. 19 OBJECTIVES: Session 5 Learn how to read food labels Learn about which foods we should eat more often How to shop for healthy foods in our community

20. 20 OBJECTIVES: Session 6 Learn healthy food preparation Learn how to cook with less fat How to cook with less sugar

21. 21 OBJECTIVES: Session 7 Discussion of what foods are traditional Health benefits of traditional foods How to get traditional food How to prepare traditional foods

22. 22 Learn about suggested routine medical care Learn about suggested specialized medical care See how exercise affects glucose levels OBJECTIVES: Session 8

23. 23 OBJECTIVES: Session 9 Grieving process as it relates to diabetes Emotional aspects of diabetes Taking care of yourself emotionally Spirituality as it relates to diabetes

24. 24 GRIEVING PROCESS First Stage: Denial Second Stage: Anger “I can’t believe this is happening to me.” “I’m really mad that I got diabetes too. Why me and not someone else?”

25. 25 GRIEVING PROCESS Third Stage: Bargaining Fourth Stage: Depression Fifth Stage: Acceptance “If I eat like I’m supposed to now, maybe it will just go away.” “I cried myself to sleep because now I worry about who will take care of my family if I get too sick.” “I know what I have to do so I can be around to play with my grandchildren.”

26. 26 OBJECTIVES: Session 10 Diabetes effects on the family How a family can deal with diabetes in healthy ways How alcoholism and diabetes both affect a family

27. 27 WHAT DO YOU CONSIDER TO BE YOUR COMMUNITY?

28. 28 OBJECTIVES: Session 11 Define community Brainstorm ideas on how to confront diabetes Plan how to change diabetes in our community

29. 29 OBJECTIVES: Session 12 Complete Post-Test Questionnaire Complete Evaluation Celebration

30. 30 These materials were produced with support from the National Institutes of Nursing Research grant #RO1NR04722, Felicia Schanche Hodge. Dr.PH, Principal Investigator, Center for American Indian Research and Education (CAIRE), University of Minnesota; Lorelei De Cora RN BSN, Field Project Director, Seva Foundation - Native American Diabetes Project; Betty Geishirt-Cantrell, MSSW, MBA, Project Director, CAIRE, University of Minnesota; and Arnell Hinkle, RD, MPH, Collaborating Investigator, CANFit. Thank you to the Centers for Disease Control - Division of Diabetes Translation for funding support to reprint these materials.