UNIT ONE LESSON 2 Managing Diabetes Welcome participants back to the second session. Ask them to share how they have supported their partner over the past week. Ask for their suggestion on other ways they can support each other. UNIT ONE LESSON 2 Managing Diabetes

Objectives At the end of the lesson, participants should be able to: State the benefits of managing diabetes Identify problems related to poor diabetes management Explain practices that help manage diabetes Set goals related to diabetes management Describe feelings and experiences of living with diabetes Identify ways to modify everyday recipes to fit into the diabetes meal plan Read and briefly describe objectives to participants.

L-esson

Benefits of Managing Diabetes When your blood glucose is close to normal, you are more likely to: Have more energy Be less tired and thirsty Urinate less often Heal better and have fewer skin or bladder infections Have fewer problems with your eyesight, feet and gums Start by showing “dLife – Avoiding Complications” (this is an optional activity) at http://link.brightcove.com/services/player/bcpid1078599942?bclid=979465398&bctid=36995881%20C:\Documents%20and%20Settings\user\My%20Documents\internal.html Tell participants: Taking ownership of your diabetes involves managing your diabetes. In this session, we will begin to develop an image of the “big picture” of what is needed to manage your diabetes. Let us begin by looking at the benefits of managing your blood glucose. Managing your diabetes prevents many of the complications associated with the disease.

Problems with Not Managing Diabetes Heart disease -- cardiovascular disease People with diabetes are 2 to 4 times more likely to get heart disease and 5 times more likely to have a stroke Read information on slide.

Problems with Not Managing Diabetes Blindness -- retinopathy People with diabetes are at higher risk of developing blindness Most people with diabetes have minor eye disorders Having regular eye exams keep problems minor This image shows diabetic retinopathy. Show “dLife – Retinopathy” (this is an optional activity) at http://link.brightcove.com/services/player/bcpid1078599942?bclid=979465398&bctid=36995881%20C:\Documents%20and%20Settings\user\My%20Documents\internal.html

Diabetic Eye Disease The picture at the left shows a scene as it might be viewed by a person with diabetic retinopathy. The picture on the right shows a scene as it might be viewed by someone with normal vision. Source: National Eye Institute, National Institutes of Health, Ref#: EDA01 source: National Eye Institute, National Institutes of Health Ref#: EDA01

Problems with Not Managing Diabetes Nerve damage -- neuropathy About 60 to 70 percent of people with diabetes develop nerve problems Nerve problems can occur throughout the body. Symptoms include loss of feeling in the hands, arms, feet, and legs. Nerve problems can also occur in sexual organs. Read information on slide. Ask participants if they know of individuals with diabetes who have experienced similar problems. Allow time for sharing.

Problems with Not Managing Diabetes Kidney damage -- nephropathy Read information on slide. Ask participants if they could identify other problems related to poor management of diabetes (e.g., high blood pressure, dental problems). Mention that the consequences of not managing diabetes are serious. Ask participants: What lifestyle changes would you have to make to prevent poor management of diabetes? Have you made these changes in the last six months?

Practices that Help Manage Diabetes Physical activity Nutrition and meal planning Adjust or add diabetes medications as needed Work with your health care team Type 2 diabetes can be managed by different methods. Some individuals who are newly diagnosed with diabetes need to develop a new eating and exercise plan. Other individuals need the new eating and exercise plan, as well as medication and insulin. Your doctor determines what works best for you. It is important for people with diabetes to see their doctors regularly. Allow time for participants to discuss what method they use to manage their diabetes and whether they see their doctors as a means of managing their diabetes.

Physical Activity Being physically active every day: Helps prevent weight gain Improves blood glucose control Lowers your risk for heart disease and stroke Regular exercise increases sensitivity to insulin and lowers insulin resistance. It also helps you deal with stress, lower A1C levels, decrease triglyceride levels, and increase HDL (good) cholesterol. Talk with your doctor about the types of activities that are suitable for you.

Nutrition and Meal Planning Eating healthy is similar for a person with or without diabetes Eat a variety of food. Balanced amount of carbohydrates, protein and fats Eat three meals and a snack at regular times throughout the day Try not to skip meals Pay attention to what you eat by keeping a food record Read information on slide. Meal planning helps people with diabetes reach their personal blood glucose goals. It is important to keep a record of what and when you eat. There are different types of plans that individuals use, such as the exchange list, carbohydrate counting, the plate method, and so on. We will do more of this in a later session. Ask participants to identify some changes they need to make in their eating habits. Why is it important to make these changes?

Begin with a Healthy Eating Plan Include whole grains, fruits, vegetables, and lean protein Eat less fat Eat heart-healthy fish about twice a week Whole grains, fruits, vegetables, and dried peas and beans all contain fiber. There are two types of fiber: soluble and insoluble. Insoluble fiber (whole wheat) prevents constipation. Soluble fiber lowers cholesterol and improves blood glucose levels. People with diabetes are more likely to develop heart disease. This means they need to reduce their intake of saturated and trans fats which are related to increased risk for cardiovascular problems.

Steps to Control and Manage Diabetes Check your blood glucose Take your medication as prescribed by your doctor Checking your blood glucose allows you to see how certain foods, physical activity, and medication affect your blood glucose level. Ask participants if they check their blood glucose or take medication as prescribed by their doctors. These practices help control and manage diabetes.

Develop a Health Care Team Doctor (an endocrindologist if available) Nurse (RN), CDE if available Registered Dietitian (RD), CDE if available Pharmacist, CDE if available Eye doctor (ophthalmologist) Foot doctor (podiatrist) Dentist Social worker Mental health counselor Read information on slide Ask participants how many have a health care team. Help participants figure out ways to develop a health care team. CDE stands for certified diabetes educator

Diabetes Education Series: Managing Diabetes E-mpowerment Diabetes Education Series: Managing Diabetes At this time, show the Diabetes Education Series CD and select the section on “Managing Diabetes”

Diabetes Education Series Describe your experiences and feelings related to managing your diabetes. What was most difficult for you? What are ways that you could overcome some of these difficulties? Allow time for participants to share their feelings and experiences.

A-ction Did you accomplish the goal you set last week? Set a goal to help you manage your diabetes. 1. Ask participants how they did in accomplishing their goals from last week. For those who accomplished their goals, ask what actions were successful. Provide incentives for those who met their goals. For those who did not accomplish their goals, ask if they took steps to meet their goals. If they did, acknowledge that they are moving in the right direction. 2. Move onto setting a new goal for this week. Talk with your participants about how goal setting can help them with diabetes management. 3. Tell participants to set a goal that they can accomplish in the upcoming week. 4. This week, the goal should be related to diabetes management. 5. The participants can record their goals on the Goal Setting Worksheet (found in the Appendix for Lesson 1 and should be in their folders from last week). NOTE: You may have to do the writing for some participants. 6. Discuss SMART goals. Is your goal Specific, Measurable, Action-oriented, Realistic, and Time framed? 7. Select goals from some of the participants to share with the group. Let participants know that they are in control of the management of their diabetes.

R-eal-Life Problem Solving Troy’s Story The answers to the PowerPoint questions can be found in the appendix for this lesson. Show the next slide as you read the story.

Troy’s Story Troy was diagnosed with diabetes six months ago after a hike in the Red River Gorge ended up in a visit to a local hospital. His friends told him of the mountainous terrain and that he should look forward to a challenging hike. About 15 minutes into the hike, Troy felt dizzy and had to rest for some time. He made several attempts to continue on the course, but each time he started to move he felt worse. Two of his friends decided to take him to the nearest hospital. After several tests over a two-day period, he was told that he had type 2 diabetes. He took the news in stride and with the encouragement of family and friends, he made the decision that he will “beat” the disease. He realized that there is so much he needs to learn about diabetes and how to manage the disease.

Questions about Troy’s Story What is Troy’s problem? Why is this a problem for Troy? What are some things that Troy needs to do to solve his problem? (List as many suggestions as possible.) What might be the best way to solve his problem at this point? Why? What is Troy’s problem? He has been diagnosed with diabetes; (b) He does not have a good understanding of the disease.   Why is this a problem for Troy? The first step in managing diabetes is understanding the disease. What are some things that Troy needs to do to solve his problem? (List as many suggestions as possible.) Educate himself about the disease; (b) Work with his doctor and registered dietitian (RD). His doctor should help him set target goals for blood glucose and an RD will help create a meal plan that is suitable for him; (c) Be physically active; (d) Learn how to monitor his blood glucose; (e) Take medication as prescribed; (f) Find support to cope with his diabetes. What might be the best way to solve his problem at this point? Why? Allow participants to suggest any of the suggestions above as the best way to solve Troy’s problem. They should give a reason as to why they think this is the best solution.

Questions about Troy’s Story Please find the Real-Life Problem Solving handout for this lesson in your folder These questions will help with your understanding of Troy’s story The handout with completed answers can be found in the Appendix for this lesson. The handout for participants to complete should be in their folders. The questions can be completed as group work or take-home work.

N-utrition Menu: Whole Wheat Pancakes Egg Omelet Strawberry fans Sugar-free syrup Skim milk Tell participants to find the recipe Whole Wheat Pancakes, the recipe Egg Omelet and also the handout Tips to Help You Stay Healthy in their folders. As you prepare the recipe, discuss the handout. Tip: To keep pancakes warm, stack them on an ovenproof plate. Cover them loosely with foil. Keep in a 200-degree oven.   Information to share with participants: Why does the recipe call for whole grain and all purpose flour? Whole wheat flour will add fiber and slow digestion. Whole grain flour alone creates a different texture. Using half whole wheat flour and half all purpose flour will make pancakes fluffier than using all whole wheat. If you or your family is not accustomed to the heavier texture it may not be appealing. Adding whole wheat and other whole grains to recipes is a good way of meeting the dietary guidelines goal to make half your grains whole grains. What is the difference between baking powder and baking soda? Both are leavening agents, meaning they make the products rise. Baking soda is sodium bicarbonate and activates when liquid is added. Baking powder includes baking soda but also has an acidifying agent (cream of tartar) and a starch. Some baking powders (double acting) begin creating carbon dioxide when liquid is added and again as the temperature rises. For more information see http://chemistry.about.com/cs/foodchemistry/f/blbaking.htm How much liquid is in one large egg? One large egg is ¼ cup liquid. How much liquid is in a fourth of an egg? ¼ of an egg is 1 tablespoon. Compare using an egg to an egg substitute (price, taste, nutritional content, and ease of use). Egg substitute would make it easier if making one serving. What is the purpose of the brown sugar? Brown sugar contributes to the characteristic pleasant caramel flavor and light yellow to dark brown color. No-Calorie brown sugar Sweetners will reduce calories and carbs. Could the brown sugar be omitted and a sugar-free syrup used instead? Yes. Omelet Information: Many omelets have ham, cheese or Bacon Bits®. Using reduced-fat cheese and veggies makes it healthier. Chopped tomatoes or salsa can be added for more vegetables. The use of egg whites instead of whole eggs in the recipe reduces the intake of cholesterol. People shy away from eggs due to cholesterol. What beneficial nutrients are in eggs? Protein, vitamin A, folate, iron. How many eggs per day (including use in other recipes and products) are suggested? One per day. For more information go to the University of Michigan Integrated Medicine Website at http://www.med.umich.edu/umim/food-pyramid/eggs.htm Why should a person with diabetes use fresh fruits instead of fruit juice? Fresh fruit has more fiber than juices and, therefore, fills you up more. Fiber (soluble fiber found in oats, fruits and dried peas and beans) may lower blood glucose. Fruits contain carbohydrates in the form of sugar and they must be counted as part of the carbohydrates in your meal plan.

See you next week! Topic: Physical Activity and Diabetes You are in control Work at reaching your goal Take some time to allow participants to share what they learned this week. Allow the group to discuss ways in which they can support each other.

Author: Ingrid Adams, Ph. D Author: Ingrid Adams, Ph.D., Assistant Professor , Nutrition and Food Science, University of Kentucky Date: References: Other Contributors Margaret E. Cook-Newell, Ph.D., R.D., L.D., CDE   Irene Hong-McAtee, MD, MCR Adrienne Glodt, B.S., Graduate Student Laura Hieronymus, MSEd, APRN, BC-ADM, CDE Cheryl Case, M.S., Harrison County Ann Hollon, M.A., Wolfe County Hazel Forsythe, Ph.D., R.D., L.D., CFCS Stephen D. Perry, M.S., R.D., L.D. Pam Sigler, M.S. Lynn Blankenship, M.S., Metcalfe County Theresa Scott, M.A., Floyd County Tamara Thomas, M.S., Franklin County Rusty Manseau, B.A., Graphic Artist