Take Steps Against Diabetes: What You Can Do NOW Hello, and welcome to our program, Take Steps Against Diabetes: What You Can Do NOW. M. Elson, MD, MME

DISCLOSURE STATEMENT I have no financial conflicts of interest I AM interested in promoting YOUR health I have been to Spain! And the food was great!

When It Comes to Diabetes, You Have Power Diabetes is a serious disease. You have the power to fight it! You can start taking steps NOW to delay or prevent diabetes and its complications. When it comes to diabetes, there’s bad news and good news. The bad news is that diabetes is a serious disease that can cause life-threatening health problems. But the good news is that whether you already have diabetes or you’re trying to avoid developing it, you have more power over it than you may realize. Diabetes is a disease that can respond quite dramatically to preventive strategies. People who have diabetes can take steps to get it under control and lower the risk of dangerous complications. And people who don’t have it can take steps to cut their chances of ever developing it. What are those steps? Today we’ll take look at some of them. We’ll show you exactly what you can do, not just to prevent or delay diabetes and its complications, but to boost your overall health and wellness. Get ready to start making some simple changes that have a major impact on your health! Sources: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Preventing Diabetes Problems—What You Need to Know: http://diabetes.niddk.nih.gov/dm/pubs/preventing_ES/index.aspx Diabetes Overview: http://diabetes.niddk.nih.gov/dm/pubs/overview/index.aspx#what American Diabetes Association Small Steps for Your Health: http://www.diabetes.org/diabetes-basics/prevention/checkup-america/small-steps.html Centers for Disease Control and Prevention Basics About Diabetes: http://www.cdc.gov/diabetes/consumer/learn.htm American Academy of Family Physicians Diabetes Overview: http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes.html

Start by Educating Yourself Important things to learn: Should you be tested for diabetes? What is diabetes? If you have diabetes, how can you manage it? What is pre-diabetes? What can you do to delay or prevent diabetes and its complications? Who is at risk? The best first step you can take to lower diabetes risk is to learn about the disease.

What Is Blood Sugar? During digestion, food is converted into glucose, a sugar your body uses for energy. The hormone insulin ushers glucose (blood sugar) into your cells for fuel. Diabetes affects how your body uses blood sugar to fuel your body. Let’s start with the phrase “blood sugar.” You’ve probably heard the terms “blood sugar” and “blood glucose.” Here’s what they mean. When you eat and digest food, your body breaks down most of the food into glucose, a type of sugar, and releases it into your bloodstream. Glucose is your body’s fuel. The glucose in your blood is referred to as blood glucose or, more commonly, blood sugar. A hormone called insulin allows blood sugar to enter the cells of your body, where it is used for energy. Sources: Centers for Disease Control and Prevention Basics About Diabetes: http://www.cdc.gov/diabetes/consumer/learn.htm WebMD Type 2 Diabetes Overview: http://diabetes.webmd.com/guide/type-2-diabetes American Academy of Family Physicians Diabetes Overview: http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes.html National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Overview: http://diabetes.niddk.nih.gov/dm/pubs/overview/index.aspx#what

What Is Diabetes? In people with diabetes, insulin doesn’t work properly, or their bodies don’t make enough insulin. When insulin doesn’t do its job effectively, cells don’t get the glucose they need for fuel. When glucose can’t get into the cells, it builds up in the blood and can harm the body. This is called having high blood glucose, or high blood sugar. Diabetes occurs when your body doesn’t make enough insulin, or when it is unable to use insulin effectively to get blood sugar into your cells for fuel. In people with diabetes, several things can happen: 1. The pancreas, an organ in the abdomen, doesn’t make enough insulin. 2. Cells don’t respond to insulin as well as they should, preventing some of the glucose in the blood from entering cells. This is called insulin resistance. 3. When glucose can’t get into cells, it builds up in the blood instead. This is called high blood glucose, or high blood sugar. Having too much glucose in your blood over long periods of time can cause serious damage to your blood vessels, nerves, and organs. Sources: Centers for Disease Control and Prevention Basics About Diabetes: http://www.cdc.gov/diabetes/consumer/learn.htm WebMD Type 2 Diabetes Overview: http://diabetes.webmd.com/guide/type-2-diabetes American Academy of Family Physicians Diabetes Overview: http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes.html National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Overview: http://diabetes.niddk.nih.gov/dm/pubs/overview/index.aspx#what

How Many People Have Diabetes? 25.8 million people in the U.S. have diabetes (8.3 percent of the population). This includes 1.6 million children and teens. 7 million people have undiagnosed diabetes—they have diabetes, but they don’t know it. Diabetes is a very common disease. If you don’t have it, you probably know someone who does. [Optional: Let’s have a show of hands. Who’s here today because you or someone in your family has diabetes? Who’s here because you’re concerned about you or someone in your family developing it?] As you can see from these statistics, diabetes is very prevalent in the United States. Source: National Institute of Diabetes and Digestive and Kidney Diseases National Diabetes Statistics, 2011: http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.aspx

Diabetes by Type Type 1 diabetes Gestational diabetes Type 2 diabetes also called insulin-dependent diabetes or juvenile-onset diabetes develops during pregnancy usually goes away after delivery Type 2 diabetes also called adult-onset diabetes, although children and teens can also get it There are several kinds of diabetes, which is also referred to as diabetes mellitus. Type 1 diabetes is also called insulin-dependent diabetes, juvenile-onset diabetes, or childhood diabetes. Type 1 diabetes usually develops in children and teens, although adults may also get it. Only about 5 percent of people with diabetes have type 1 diabetes. Type 1 diabetes occurs when the immune system destroys the cells in the pancreas (pancreatic beta cells) that make insulin. There’s no known way to prevent type 1 diabetes. Type 2 diabetes is often referred to as adult-onset diabetes, even though children and teens can also get it. Although it usually develops later in life, it has been increasing dramatically in children and teens as their obesity rates go up. Type 2 diabetes accounts for 90 percent to 95 percent of diabetes diagnoses. Although there’s no absolutely surefire way to prevent type 2 diabetes, there are many steps you can take to reduce your risk of developing it. Gestational diabetes develops in 2 percent to 10 percent of women during pregnancy. It disappears after delivery in 90 percent to 95 percent of women. Women with gestational diabetes have a 35 percent to 60 percent chance of developing type 2 diabetes in the next 10 to 20 years. Other kinds of diabetes, which are rare, result from genetic syndromes, certain illnesses and infections, and other causes. They make up 1 percent to 5 percent of cases. Sources: Centers for Disease Control and Prevention Basics About Diabetes: http://www.cdc.gov/diabetes/consumer/learn.htm WebMD Type 2 Diabetes Overview: http://diabetes.webmd.com/guide/type-2-diabetes American Academy of Family Physicians Diabetes Overview: http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes.html National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Overview: http://diabetes.niddk.nih.gov/dm/pubs/overview/index.aspx#what

Type 2 Is the Most Common Kind of Diabetes Type 2 diabetes is the most common kind of diabetes. From this point on in the presentation, when we refer to “diabetes” we are talking about “type 2 diabetes.” Source: National Institute of Diabetes and Digestive and Kidney Diseases National Diabetes Statistics, 2011: http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.aspx

You Have Power! You can start taking steps today to prevent or delay diabetes and its complications. You can make small changes that deliver big health rewards. You have the power to alter your health! Now that you know some of the basics about diabetes, you can start to protect yourself. If you are at risk of developing diabetes, you can take steps that really may prevent or delay it. And if you already have diabetes, you can take steps to move your blood sugar levels back toward normal and prevent or delay dangerous complications.

Risk Factors for Diabetes Being overweight or obese Age (45 or older) A family history of diabetes Excess belly fat A diagnosis of pre-diabetes Inactivity (exercising fewer than three times a week) Certain ethnic backgrounds (African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino) High blood pressure (140/90 or higher) Low HDL (“good”) cholesterol (35 or lower) High triglycerides (250 or higher) Pregnancy A history of gestational diabetes or giving birth to a large baby (9 pounds or more) Insulin resistance Cardiovascular disease or polycystic ovary syndrome This slide shows some of the risk factors for diabetes. It’s important to remember that having one or more of these risk factors doesn’t guarantee that you’ll get diabetes; it just means your risk is higher than in people without those risk factors. It’s also important to know that it’s possible to develop diabetes even without having several risk factors. Notice that people of certain ethnic backgrounds have a higher risk of diabetes. Compared to non-Hispanic whites, the risk of diagnosed diabetes is: 18 percent higher among Asian Americans. 66 percent higher among Hispanics/Latinos. 77 percent higher among non-Hispanic blacks. Sources: Centers for Disease Control Prevent Diabetes: http://www.cdc.gov/diabetes/consumer/prevent.htm National Diabetes Education Program http://ndep.nih.gov/diabetes-facts/index.aspx

Do You Have Pre-Diabetes? People with pre-diabetes have blood sugar levels that are higher than they should be, but not high enough to be considered diabetes. Pre-diabetes is exactly what it sounds like: A diabetes-like condition that develops before diabetes. Pre-diabetes exists in people whose blood sugar levels are higher than they should be, but not high enough to be considered diabetes. It is also referred to as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). If you have pre-diabetes, you are likely to develop diabetes unless you take steps to prevent it. If you have pre-diabetes, you also have a higher risk of heart disease. Sources: Centers for Disease Control Prevent Diabetes: http://www.cdc.gov/diabetes/consumer/prevent.htm National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Overview: http://diabetes.niddk.nih.gov/dm/pubs/overview/index.aspx#what

How Many People Have Pre-Diabetes? 79 million American adults have pre-diabetes. 35 percent of adults age 20 or older 50 percent of adults age 65 or older Pre-diabetes is quite prevalent in the U.S., especially among people over age 65. Sources: National Institute of Diabetes and Digestive and Kidney Diseases National Diabetes Statistics, 2011: http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.aspx Diagnosis of Diabetes and Pre-diabetes: http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/index.aspx Centers for Disease Control and Prevention Pre-diabetes: http://www.cdc.gov/diabetes/consumer/prediabetes.htm

Pre-Diabetes Is a Warning Without making changes to improve their health, 15 percent to 30 percent of people with pre-diabetes will develop diabetes within five years. It can be upsetting to learn that you have pre-diabetes. But it’s also an opportunity to start making lifestyle changes that can prevent you from developing diabetes. Sources: National Institute of Diabetes and Digestive and Kidney Diseases Prediabetes: What You Need to Know http://diabetes.niddk.nih.gov/dm/pubs/prediabetes_ES/index.aspx Preventing Diabetes Problems: What You Need to Know http://diabetes.niddk.nih.gov/dm/pubs/preventing_ES/index.aspx

Excess Weight Is a Major Risk Factor for Diabetes Being overweight or obese is the No. 1 risk factor for developing diabetes. Being overweight makes you seven times more likely to develop diabetes. Being obese makes you 20 to 40 times more likely to develop diabetes. Being overweight or obese is the leading risk factor for diabetes. Compared to someone with a healthy weight, being overweight or obese makes a person much more likely to develop diabetes. Excess weight can prevent your body from making and using insulin properly. It also raises your likelihood of getting cardiovascular disease. Sources: Centers for Disease Control and Prevention Prevent Diabetes: http://www.cdc.gov/diabetes/consumer/prevent.htm Harvard School of Public Health: Simple Steps to Preventing Diabetes http://www.hsph.harvard.edu/nutritionsource/preventing-diabetes-full-story/

How Do You Weigh In? Does your weight raise your diabetes risk? Height Weight (women) Weight (men) 5'0" 143 154 5'1" 146 157 5'2" 150 160 5'3" 162 5'4" 165 5'5" 161 168 5'6" 164 172 5'7" 175 5'8" 179 5'9" 182 5'10" 178 186 5'11" 190 6'0" 194 How Do You Weigh In? Does your weight raise your diabetes risk? Check your weight on this chart. If it is at or above the amount listed next to your height, your weight may put you at risk. Use this chart to determine whether your weight is raising your likelihood of diabetes. Source: American Academy of Family Physicians Diabetes Overview http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes.html

Measure Your Waist Having excess belly fat is another diabetes risk factor. Anyone of any age who has excess belly fat (a waist measurement of 40 inches or more for men, or 35 inches or more for women) is at risk even if he or she is not overweight. Having belly fat (fat around the waist) is another risk factor for diabetes. Belly fat produces hormones and other substances that interfere with the action of insulin and raise heart disease risk. It can contribute to insulin resistance, a condition that occurs when the body produces insulin but does not use it effectively, allowing glucose to build up in the blood. Here’s how to tell if you have too much belly fat: Place a tape measure around your bare abdomen just above the hip bone. The tape should be snug but not digging into the skin. The tape should be parallel to the floor. Relax, exhale, and measure. Source: National Institute of Diabetes and Digestive and Kidney Diseases Insulin Resistance and Prediabetes: http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.aspx

How’s Your Blood Sugar? Ask your provider if you should be tested! Is your blood sugar high? If you don’t know, either because you’ve never been tested or you haven’t been tested in a while, ask your doctor if it’s time for a blood test. Usually, doctors test anyone over age 45, and anyone under age 45 who is overweight or obese and who has other risk factors for diabetes. Source: National Institute of Diabetes and Digestive and Kidney Diseases Diagnosis of Diabetes and Prediabetes: http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/index.aspx

Ways to Test for Diabetes We use three main kinds of blood testing to check for diabetes: A1C test Fasting Plasma Glucose (FPG) test Oral Glucose Tolerance Test (OGTT) Doctors use blood testing to diagnose diabetes. A small sample of blood is taken from a patient’s arm and sent to a lab for analysis. Typically, these three tests are used to determine whether someone has diabetes: The A1C test (also called hemoglobin A1c test, HbA1c test, or the glycohemoglobin test). The A1C test measures average levels of blood glucose over the previous three months. The Fasting Plasma Glucose (FPG) test is the most commonly used diabetes diagnosis test. It measures the level of glucose in the blood of a patient who has fasted for a designated amount of time (typically 8 hours). It is usually given in the morning. The Oral Glucose Tolerance Test (OGTT) measures the level of glucose in the blood of a patient who has fasted for a designated amount of time (typically 8 hours), then has drunk a liquid containing a certain amount of glucose (usually 75 grams), and then has fasted an additional 2 hours. Another test, the Random Plasma Glucose test, is used infrequently. Doctors often use more than one type of test to make a diagnosis. The type of tests used depend on the kind of diabetes being tested for. Source: National Institute of Diabetes and Digestive and Kidney Diseases Diagnosis of Diabetes and Pre-diabetes: http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/index.aspx

Be on the Lookout for Diabetes Symptoms Frequent urination Excessive thirst Extreme hunger Unexplained weight loss Sudden vision changes Tingling or numbness in hands or feet Fatigue Very dry, itchy skin Sores that are slow to heal More infections than usual, especially in the skin, gums, bladder, or vagina Confusion or dizziness Breath that smells like nail polish remover Darkening of skin around the neck or in the armpits An absence of menstrual periods Unexplained nausea, vomiting, or stomach pain This slide gives a list of diabetes symptoms. If you have any of these symptoms, be sure to tell your doctor. It’s important to remember that although these are the most common symptoms, some people with diabetes show no obvious signs of the disease. The only way to know for sure if you have diabetes is to have your doctor test your blood sugar. Sources: American Diabetes Association Diabetes Symptoms: http://www.diabetes.org/diabetes-basics/symptoms/ Centers for Disease Control and Prevention Basics About Diabetes: http://www.cdc.gov/diabetes/consumer/learn.htm

Now That You Know Your Risk You can start taking steps toward lowering it!

Good News About Prevention The Diabetes Prevention Program (DPP), a major research study, found that people with pre-diabetes could delay or prevent diabetes without taking medication. Participants in the DPP who lost weight through diet and exercise cut their diabetes risk by 58 percent. The Diabetes Prevention Program (DPP) was a major multicenter clinical research study aimed at discovering whether modest weight loss through diet and exercise or treatment with the oral diabetes drug metformin (Glucophage) could prevent or delay the onset of type 2 diabetes. The study looked at 3,234 participants who were overweight and had pre-diabetes. It took place in 27 clinical centers around the United States. Participants were divided into three groups: Group 1—the lifestyle intervention group—received intensive training in diet, physical activity, and behavior modification. Group 2—the medication group—received 850 mg daily of metformin. Group 3—the control group—received placebo pills instead of metformin. (A fourth group received a different drug, but that intervention was stopped when the drug was shown to cause liver damage.) The results showed the following: Group 1: The people who changed their diet and exercise reduced the risk of diabetes by 58 percent. (Those over age 60 lowered their risk even more—by 71 percent). Group 2: The people taking metformin lowered their risk by 31 percent. Sources: The Diabetes Prevention Program DPP Executive Summary: http://www.bsc.gwu.edu/dpp/aboutdpp.htmlvdoc Centers for Disease Control and Prevention Prevent Diabetes: http://www.cdc.gov/diabetes/consumer/prevent.htm

A Little Weight Loss Brings Big Rewards Participants in the DPP study lost just 5 percent to 7 percent of their body weight through exercise and diet. For someone who weighs 200 pounds, that’s only 10 to 14 pounds. The results from the DPP study showed that people can lower their diabetes risk by making relatively small changes. People who are overweight or obese don’t have to lose enormous amounts of weight in order to boost their health. Losing just 5 percent to 7 percent of their body weight through exercise and diet can have an enormously positive benefit. Not only does it trim your risk of diabetes, but weight loss can lower your likelihood of heart disease, stroke, and some kinds of cancer. In fact, researchers at the Harvard School of Public Health have found that 90 percent of cases of type 2 diabetes can be avoided by making changes in diet, exercise, weight, and smoking. You really can make a difference in your health! Sources: The Diabetes Prevention Program DPP Executive Summary: http://www.bsc.gwu.edu/dpp/aboutdpp.htmlvdoc Centers for Disease Control and Prevention Prevent Diabetes: http://www.cdc.gov/diabetes/consumer/prevent.htm Harvard School of Public Health http://www.hsph.harvard.edu/nutritionsource/preventing-diabetes-full-story/ National Institute of Diabetes and Digestive and Kidney Diseases Insulin Resistance and Prediabetes: http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.aspx American Diabetes Association Diabetes and Cancer: http://www.diabetes.org/diabetes-basics/prevention/checkup-america/diabetes-and-cancer.html

How Can You Lower Your Weight? Healthy Diet + Exercise = Weight Loss

Start With a Healthy Diet The best way to start trimming your weight is to follow a healthy diet. A healthy diet contains healthy amounts of whole grains, fruits, vegetables, lean protein, and low-fat dairy foods. It is low in fat, cholesterol, salt, and added sugar. It contains the right amount of food and calories for you: enough to give your body the energy and nutrients it needs, without the extra calories that contribute to excess weight. A healthy diet also provides plenty of fiber. High-fiber foods (fruits, vegetables, legumes, whole grains, nuts, and seeds) help control blood sugar and lower your risk of diabetes, heart disease, and some forms of cancer. Sources: American Diabetes Association Healthy Eating: http://www.diabetes.org/diabetes-basics/prevention/checkup-america/healthy-eating.html Mayo Clinic Diabetes Prevention, 5 Tips for Taking Control: http://www.mayoclinic.com/health/diabetes-prevention/DA00127 U. S. Department of Agriculture ChooseMyPlate.gov graphic: http://blogs.usda.gov/2011/06/02/usda-unveils-new-simple-tips-to-stay-healthy-active-and-fit/

Choose Whole-Grain Foods Instead of… Choose… Sugary cereals Whole-grain cereals, bran cereals, oatmeal White rice Brown rice White bread, bagels, rolls, tortillas, crackers Whole-grain bread, bagels, rolls, tortillas, crackers White pasta Whole-grain pasta White flour Whole-grain flour Chips, pretzels Air-popped popcorn without butter Grains contain a wide variety of nutrients, including heart-healthy B vitamins and magnesium. They’re also a rich source of fiber, which helps keep blood sugar stable. Fiber is an excellent weapon in the fight against diabetes. In a major study, women who ate two to three servings of whole-grain foods daily were 30 percent less likely to develop type 2 diabetes than those who rarely ate whole grains. The bran and fiber in whole grains lead to slower release of glucose into the blood. “White” grains (white bread, white rice, etc.) cause a fast release of glucose into the blood, causing damaging spikes in blood sugar. Whenever possible, choose whole-grain foods over refined foods. The refining process removes most of the grains’ health-boosting nutrients and fiber. Sources: American Dietetic Association Choose Whole Grains: http://www.eatright.org/Public/content.aspx?id=6442471695 U.S. Department of Agriculture What Foods are in the Grains Group?: http://www.choosemyplate.gov/food-groups/grains.html Harvard School of Public Health Simple Steps to Preventing Diabetes: http://www.hsph.harvard.edu/nutritionsource/preventing-diabetes-full-story/

Great Grains Try these delicious, nutritious whole grains: Buckwheat Bulgur Millet Quinoa Sorghum Whole rye Barley Instead of rice or potatoes, try experimenting with different kinds of grains. They are delicious as a side dish, served with stir-fries, or added to salads, stews, and soups. To save time, cook extra grains and freeze leftovers for future use. Sources: American Dietetic Association Choose Whole Grains: http://www.eatright.org/Public/content.aspx?id=6442471695 U.S. Department of Agriculture What Foods are in the Grains Group?: http://www.choosemyplate.gov/food-groups/grains.html

Eat a Rainbow of Fruits and Vegetables Diets that contain lots of fiber-rich fruits and vegetables may reduce the risk of heart disease, obesity, and diabetes. Vegetables are packed with vitamins, minerals, and fiber. Eating a diet rich in vegetables not only helps lower diabetes risk, but it may help prevent other diseases such as cancer and heart disease. Include lots of vegetables in your diet, including spinach, broccoli, green beans, eggplant, cauliflower, leeks, bok choy, watercress, kale, bell peppers, tomatoes, squash, cucumber, and salad greens. If you have diabetes, limit starchy vegetables such as beets, potatoes, sweet potatoes, taro, and corn. Like vegetables, fruits contain a wealth of vitamins, minerals, fiber, and other nutrients. Choose fresh, frozen, or canned fruits without any added sugar. Some great fruits to include in your diet are apples, apricots, berries, melons, cherries, citrus fruits, peaches, pears, and plums. Limit juices, even those that are 100 percent fruit juice, because they can cause blood sugar levels to spike. Sources: U.S. Department of Agriculture Why is it Important to Eat Vegetables?: http://www.choosemyplate.gov/food-groups/vegetables-why.html Fruits: http://www.choosemyplate.gov/food-groups/fruits.html American Diabetes Association Non-Starchy Vegetables: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/non-starchy-vegetables.html Fruits: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/fruits.html

Pick Powerful Proteins Choose low-fat or lean protein sources, such as: Lean meat, poultry, fish, and shellfish Low-fat or nonfat dairy (milk, cheese) Soy foods Eggs Nuts and seeds Dried beans, legumes, peas, and lentils Protein contributes to the health of your cells, tissues, and organs. Eating protein at meals and snacks also helps keep blood sugar levels stable. Choose lean, low-fat, or non-fat protein sources whenever possible. When it comes to beef, try to cut back. Studies have shown that choosing healthier protein sources (nuts, low-fat dairy, poultry, fish, legumes) lowers diabetes risk by up to 35 percent. Sources: U.S. Department of Agriculture Protein Foods: http://www.choosemyplate.gov/food-groups/protein-foods-why.html American Diabetes Association Lean Meats: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/meat-and-plant-based-protein.html Harvard School of Public Health Simple Steps to Preventing Diabetes: http://www.hsph.harvard.edu/nutritionsource/preventing-diabetes-full-story/

Choose Healthy Fats “Good” fats: “Bad” fats: Polyunsaturated Saturated Monounsaturated Trans fat Omega-3 Not all fats are created equal. Polyunsaturated fats and monounsaturated fats lower your cholesterol and your risk of heart disease. Foods with “good” fats include some vegetable oils (olive, canola, sunflower, soybean, safflower, corn), nuts, avocados, olives, seeds, and fish. Omega-3 fats, another kind of “good” fats, help keep your heart, eyes, and brain healthy. They are found mostly in fatty fish (salmon, tuna, herring, trout, mackerel, sardines). Saturated and trans fats raise your cholesterol and your risk of heart disease. Foods with “bad” fats include fatty meats, poultry skin, full-fat dairy products, palm and coconut oil, commercially made bakery items, fried foods, many margarines, and sweet or salty junk foods. Sources: Harvard School of Public Health Simple Steps to Preventing Diabetes: http://www.hsph.harvard.edu/nutritionsource/preventing-diabetes-full-story/ WebMD Get the Skinny on Fats: http://www.webmd.com/diet/features/skinny-fat-good-fats-bad-fats Mayo Clinic Dietary Fats—Know Which Types to Choose: http://www.webmd.com/diet/features/skinny-fat-good-fats-bad-fats

Avoid Sugary Drinks 1.55-ounce Hershey’s bar = 24 grams of sugar (about 6 teaspoons) 12 ounces of Coca-Cola = 39 grams of sugar (about 10 teaspoons) 12-ounce serving of Nestea iced tea = 33 grams of sugar (about 8 teaspoons) 20-ounce bottle of Coca-Cola = 65 grams of sugar (about 16 teaspoons) Sugary soft drinks are one of the biggest sources of sugar and empty calories in the American diet. Rising consumption of sugary drinks is a major contributor to the obesity epidemic in the U.S. When you drink a sugar-sweetened soft drink, you’re consuming vast amounts of sugar. Every ounce of soda contains nearly a teaspoon of sugar! A standard can of cola contains more sugar than there is in one and a half standard-size chocolate bars! Avoid sugary sodas, fruit punches, fruit juice “cocktails,” sports drinks, and sugar-sweetened tea. Instead, choose water, seltzer with a splash of fruit juice, unsweetened tea, and other sugar-free beverages. Sources: Harvard School of Public Health Simple Steps to Preventing Diabetes: http://www.hsph.harvard.edu/nutritionsource/preventing-diabetes-full-story/ How Sweet Is It? http://www.hsph.harvard.edu/nutritionsource/files/2012/10/how-sweet-is-it-color.pdf Hershey’s Company http://www.hersheys.com/pure-products/details.aspx?id=3480&name=HERSHEYS+Milk+Chocolate+Bar Coca-Cola Company Nutrition Label for Coke: http://productnutrition.thecoca-colacompany.com/products/coca-cola?packagingId=15412 Nutrition Label for Nestea Iced Tea: http://productnutrition.thecoca-colacompany.com/products/nestea-iced-tea-lemon

Get Moving Becoming more active is another great way to reduce your weight, lower your diabetes risk, and boost your overall health. Moderate exercise should be a major part of your effort to lower the risk of diabetes and its complications. Findings from the Harvard School of Public Health’s Nurses’ Health Study and Health Professionals Follow-Up Study suggest that walking briskly for half an hour every day reduced the risk of developing type 2 diabetes by 30 percent. Exercise helps cut diabetes risk by assisting in weight control, lowering blood glucose, and helping your body use insulin more effectively. When you exercise, your muscles need fuel. They get their fuel by taking glucose from your blood. During a stint of moderate-level exercise, your muscles take in glucose at almost 20 times the normal rate! What’s more, exercise helps your heart by lowering blood pressure, raising “good” cholesterol, reducing “bad” cholesterol, strengthening your heart, and improving your blood circulation. It also increases flexibility in muscles and joints, strengthens your muscles, improves your mood, and relieves stress. Sources: WebMD Type 2 Diabetes and Exercise: http://diabetes.webmd.com/guide/exercise-guidelines Mayo Clinic Diabetes Prevention—5 Tips for Taking Control: http://www.mayoclinic.com/health/diabetes-prevention/DA00127 Harvard School of Public Health Simple Steps to Preventing Diabetes: http://www.hsph.harvard.edu/nutritionsource/preventing-diabetes-full-story/

How to Get Started Brisk walking is one of the best exercises you can do—even if you’re overweight or obese. Begin with a few minutes of walking each day, and build up from there. It’s OK to start slow! To get the health benefits of exercise, you don’t have to run marathons or spend hours sweating in a gym. Walking is a perfectly good exercise for health. It’s simple and inexpensive, requires no training, and needs no equipment other than a supportive pair of shoes. You can walk at any time of day, indoors or out, with friends or alone. Even people who are overweight or obese can boost their health by walking. Don’t worry if you’re not very fit—you don’t have to be fit to exercise. As long as you have your doctor’s OK, start by walking a few minutes a day—even five minutes a day is great. Do that for a week, and next week, walk for 10 minutes a day. As your fitness level increases and you begin making daily walks a habit, increase the length and frequency of your walks. Other great fitness activities include swimming, dancing, jogging, bicycle riding, exercise classes, and gym machines. Sources: Harvard School of Public Health Simple Steps to Preventing Diabetes http://www.hsph.harvard.edu/nutritionsource/preventing-diabetes-full-story/ American Diabetes Association Physical Activity: http://www.diabetes.org/diabetes-basics/prevention/checkup-america/activity.html

Make It a Goal If you use a pedometer, aim for 10,000 steps a day. Your eventual goal: 30 to 60 minutes of moderate exercise five or more days per week. If you use a pedometer, aim for 10,000 steps a day. Set weekly goals, and reward yourself when you reach them! In the DPP, participants who saw significant reductions in their diabetes risk exercised moderately 30 to 60 minutes a day, five to seven days a week. Studies have shown that half an hour of brisk walking per day can cut diabetes risk by 30 percent. You don’t have to jump in with both feet and start exercising that much right away. But if you can work up to half an hour per day, you’ll be taking a big step toward improving your health. Sources: American Diabetes Association Overweight: http://www.diabetes.org/diabetes-basics/prevention/checkup-america/overweight.html Mayo Clinic Diabetes Prevention: 5 Tips for Taking Control http://www.mayoclinic.com/health/diabetes-prevention/DA00127 Centers for Disease Control and Prevention Prevent Diabetes: http://www.cdc.gov/diabetes/consumer/prevent.htm Physical Activity: http://www.diabetes.org/diabetes-basics/prevention/checkup-america/activity.html

Take Breaks from Sitting Get up, stretch, and walk around for a couple of minutes every hour. Sitting for long periods of time raises diabetes risk, studies show. People who sit for long periods of time have a higher risk of diabetes, heart disease, and early death. If you sit a lot, get up every hour or so and take a brief walk—you’ll benefit from even short breaks. Source: Study: Sitting Raises Risk of Diabetes, Heart Disease, and Death http://www.medicalnewstoday.com/articles/257111.php http://www.sciencedaily.com/releases/2012/10/121015090048.htm

What Else Can You Do? Talk with your provider if you’re having trouble sleeping. Quit smoking. Reduce stress. Here are some other ways you can cut diabetes risk. Sleep problems, especially sleep apnea, increase the risk of obesity, diabetes, and insulin resistance. So if you’re having trouble sleeping, or if you’re exhausted during the day, talk with your doctor. If you smoke, try to stop. Smoking damages your lungs, heart, and blood vessels, raises bad cholesterol, raises blood pressure, and reduces oxygen circulation. It also boosts your risk of developing diabetes: Smokers are 50 percent more likely to develop diabetes than nonsmokers. And it increases the risk of diabetes-related complications such as eye damage and nerve damage, as well as heart disease and stroke. Stress raises your blood sugar and contributes to diabetes risk. Some good ways to reduce feelings of stress include meditation, social support, getting enough rest, exercise, and yoga. Sources: National Institute of Diabetes and Digestive and Kidney Diseases Insulin Resistance and Prediabetes: http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.aspx American Diabetes Association Diabetes and Cancer: http://www.diabetes.org/diabetes-basics/prevention/checkup-america/diabetes-and-cancer.html Harvard School of Public Health Simple Steps to Preventing Diabetes: http://www.hsph.harvard.edu/nutritionsource/preventing-diabetes-full-story/

If You Have Diabetes Control your blood sugar, and have it checked as recommended Follow your provider’s instructions about using diabetes medication Control your blood pressure (to help your kidneys) Educate yourself about how best to take care of your health Control your blood lipids If you already have diabetes, making the lifestyle changes we’ve been discussing can help you prevent or delay the onset of complications that can seriously erode your health and your quality of life. In addition, be sure to follow the guidelines on this slide. If you are having trouble with any part of your diabetes control program, ask your doctor to refer you to a certified diabetes educator who can sit down with you and teach you what you have to do to keep your diabetes in check. Source: American Academy of Family Physicians Diabetes Overview: http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes.html National Institutes of Health The Diabetes Epidemic Among Older Adults: http://www.ndep.nih.gov/media/fs_olderadult.pdf

Take Steps to Avoid the Complications of Diabetes Heart disease Limb amputations Stroke Gum disease High blood pressure Problems with everyday mobility Blindness Depression Kidney failure Nervous system damage Having too much sugar in the blood for long periods of time can damage organs, blood vessels, and nerves. This can lead to very serious complications, which are listed on this slide. By taking steps to live a healthier life, such as losing weight, eating a healthy diet, exercising, and quitting smoking, you can lower the likelihood of developing diabetes and its complications. Source: National Institute of Diabetes and Digestive and Kidney Diseases Preventing Diabetes Problems—What You Need to Know: http://diabetes.niddk.nih.gov/dm/pubs/preventing_ES/index.aspx Basics About Diabetes: http://www.cdc.gov/diabetes/consumer/learn.htm National Diabetes Statistics, 2011: http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.aspx Harvard School of Public Health Simple Steps to Preventing Diabetes: http://www.hsph.harvard.edu/nutritionsource/preventing-diabetes-full-story/

What Have You Learned? Remember, you have the power to reduce the risk of diabetes and its complications. By taking the steps outlined in this presentation, you can live a healthier, happier life.

Other Resources Your health care provider American Diabetes Association (www.diabetes.org) A registered dietitian or certified diabetes educator (www.ncbde.org) National Diabetes Education Program (www.ndep.nih.gov)