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Session 7 - Protect Your Heart: Take Good Care of Your Diabetes for Life

Objectives

By the end of this session, group members will learn:

  • What diabetes is and how it affects the body
  • The symptoms of diabetes
  • That diabetes is a major risk factor for heart disease
  • The levels of blood glucose and what they mean
  • How to prevent and control diabetes
  • The amount of sugar in common beverages

Materials and Supplies

To conduct this session, you will need:

  • "With Every Heartbeat Is Life" manual and picture cards
  • Blackboard and chalk or several large pieces of paper, a marker, and tape
  • Two bottles of water*
  • Red food coloring*
  • One cup of corn syrup*
  • A box of sugar cubes*
  • Three manila file folders for activity display*
  • Pictures of drinks listed*
  • Glue*
  • (Optional) Note: Arrange for a health professional or a diabetes educator to come to the session to measure group members' blood glucose levels.

 

Handouts

Give group members these handouts during this session:

* Prepare before the session.

Prepare this list before the session. You may find information at your local health department, hospital, or clinic.

Session Outline

Introducing the Session

  1. Welcome
  2. Review of Last Week's Session
  3. About This Session

Conducting the Session

  1. The Facts Don't Lie
  2. What Is Diabetes?
  3. Types of Diabetes
  4. Risk Factors for Diabetes
  5. Symptoms of Diabetes
  6. Blood Glucose Levels
    1. Hypoglycemia
    2. Hyperglycemia
  7. Complications of Diabetes
  8. ABCs of Diabetes Control
  9. Food Label Activity—Sugar
  10. Think Before You Drink—Hidden Sugar in Drinks Activity
  11. Staying Healthy With Diabetes––Group Activity
  12. Soul Food Makeover: Strawberry and Pineapple Delight Recipe

Review of Today's Key Points

Weekly Pledge

Closing


Introducing the Session

  1. Welcome
    • Welcome group members to the session.
  2. Review of Last Week's Session
    • Say:
      At the last session, we talked about aiming for a healthy weight.
    • Ask these questions:

      Q: Does anyone remember why a healthy weight is important to your heart health?
      A: Keeping a healthy weight reduces your risk of heart disease, stroke, high blood pressure, high blood cholesterol, diabetes, and some cancers.

      Q: What is the healthiest way to lose weight?
      A: The healthiest way to lose weight is to eat smaller portions of a variety of foods lower in fat and calories. You also need to do at least 60 minutes of physical activity on all or most days of the week.

      Q: How does the food label help people who are trying to lose weight?
      A: The food label tells you the serving size and the number of calories in a serving.

    • Say:
      At the end of the last session, you made a pledge to do something to help you keep or reach a healthy weight. What problems did you have? How did you deal with any problems?
    • Note: Allow 2 minutes for group members to respond.
    • Ask:
      Has anyone completed the family health history?
    • Note: Give a prize to group members who have completed the family health history.
    • Say:
      Does anyone want to share what you have learned about your family health history?
    • Note: Allow 5 minutes for group members to respond.
  3. About This Session
    • Say:
      Singer Ella Fitzgerald said, "Just don't give up trying to do what you really want to do. Where there is love and inspiration, I don't think you can go wrong."
    • Ask:
      What does this quote mean to you?
    • Note: Allow a moment for group members to respond.
    • Say:
      In today's session, we will learn what we can do to prevent and control diabetes. If you have diabetes, you will need to work closely with a doctor, a registered dietitian, or a certified diabetes educator to help you monitor and control your blood glucose (blood sugar).

Conducting the Session

  1. The Facts Don't Lie
    • Say:
      • Diabetes is a serious problem for African American families. It affects men, women, and children.
      • Diabetes is increasing among African Americans. About one in eight adult African Americans has diabetes.
      • Diabetes is a chronic disease that slowly damages the body. Although it has no cure, complications can be prevented.
      • Diabetes is a major risk factor for heart disease.
      • Heart disease is the leading cause of death for people with diabetes. About 3 in 10 African Americans age 35 or older with diabetes also have heart disease.
      • African Americans are more likely to have diabetes and to die from diabetes than whites of a similar age.
  2. What Is Diabetes?
    • Say:
      Now we will talk about what diabetes is and the types of diabetes.
    • Give group members the "What Is Diabetes?" handout.
    • Say:
      Diabetes happens when the body does not make enough insulin or cannot use it well, causing glucose to build up in the blood. Too much glucose in the blood is not good for your health. As a result, the body does not function well.
    • Show picture card 7.1.
    • Say:
      In a healthy body, the food we eat goes to the stomach where it is digested. The food is broken down into glucose. Blood glucose is also called blood sugar.
      The blood takes the glucose to the cells of your body, where it is turned into the energy needed for daily life. However, glucose cannot enter the cells alone. Insulin, a hormone made in the pancreas, helps glucose enter the cells.
    • Show picture card 7.2.
    • Say:
      Diabetes happens when the body does not produce enough insulin, or when the cells cannot use the insulin well. This means that the glucose cannot enter the cells and builds up in the blood. People who have high levels of glucose in their blood have diabetes.
    • What Is Prediabetes?

    • Ask:
      What is prediabetes?
    • Note: Allow a minute for group members to respond.
    • Add these answers if they are not mentioned.
      • Prediabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be diabetes.
      • People with prediabetes are more likely to develop diabetes within the next 10 years.
      • People with prediabetes are also more likely to have a heart attack or stroke.
  3. Types of Diabetes
    • Show picture card 7.3.
    • Say:
      When a person does not have diabetes, the pancreas produces a healthy amount of insulin, which the body can use. This is shown in the first picture.
    • Say:
      There are two main types of diabetes.
    • Say:
      Type 1 diabetes:
      • Happens when the pancreas no longer produces insulin. This is shown in the second picture.
      • Requires an insulin pump or shots every day.
      • Is usually found in children, adolescents, or young adults.
      • Affects about 5 to 10 percent of those with diabetes.
    • Say:
      Type 2 diabetes:
      • Happens when some insulin is produced, but the body cannot use it well. This is shown in the third picture.
      • Happens more often in people who are overweight and physically inactive.
      • Is usually treated with pills, or sometimes, insulin shots.
      • Can occur at any age, but it is more common after age 40.
      • Is common among African Americans
      • Is increasing among children, especially if they are overweight and African American.
      • Affects 90 to 95 percent of people with diabetes.
    • Say:
      Gestational diabetes is a special class of type 2 diabetes.
      • Some pregnant women develop this kind of diabetes, but it usually disappears after the baby is born.
      • Overweight women and women who have a family history of diabetes are also at higher risk for gestational diabetes.
      • Women who have had gestational diabetes have a much higher chance of developing type 2 diabetes later in life. Their children are also at a higher risk for becoming overweight and developing diabetes.
    • Say:
      We have talked about healthy living throughout the sessions. Type 2 diabetes can be prevented and controlled by making healthy food choices, being physically active, and taking medication as prescribed by your doctor. If you have diabetes, it is important to be under a doctor's care and to check your blood glucose as your doctor tells you.
    • Say:
      Now we are going to do an activity to better understand what diabetes is. We will see the difference between normal blood and blood with a high glucose level.
    • Before the session:

    Prepare the Blood Glucose Demonstration

    1. Put two clear plastic bottles on the table.
    2. Add 1 cup of water and 3 drops of red food coloring into one of the bottles. This represents blood with normal blood glucose.
    3. Add 1 cup of corn syrup and 3 drops of red food coloring into the other bottle. This represents blood with high blood glucose.
    • Show the plain water bottle, and slowly tilt it from side to side to show the smooth movement of the liquid.
    • Say:
      Notice how the blood moves easily and freely. This represents the blood of someone with normal blood glucose.
    • Show the bottle with corn syrup, and slowly tilt the bottle from side to side to show the slow movement of the liquid.
    • Say:
      Notice how slowly the blood moves and how thick it is when the blood glucose level is high. This represents the blood of someone with high blood glucose. The glucose stays in the blood instead of being used by the body's cells and muscles. This shows high blood glucose.
  4. Risk Factors for Diabetes
    • Ask:
      What are some risk factors that increase your chances of getting diabetes?
    • Note: Allow about 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.
    • Show picture card 7.4.
    • Give group members the "Are You at Risk for Type 2 Diabetes?" handout. As you read each risk factor, ask group members to make a check mark next to the risk factors that they have.
    • Say:
      Your risk of getting diabetes increases if you:
      • Are overweight——especially extra weight around the waist. Nearly 8 out of 10 African American women are overweight or obese.
      • Are fairly inactive (exercise fewer than three times a week).
      • Have a parent, brother, or sister with diabetes.
      • Are African American, Latino, American Indian, Asian American, or Pacific Islander.
      • Have had gestational diabetes or have given birth to a baby weighing more than 9 pounds. African American women are more likely to have had gestational diabetes than white women.
      • Have blood pressure that is 140/90 mmHg (millimeters of mercury) or higher or have been told by a health care provider that you have high blood pressure.
      • Have cholesterol levels that are not normal—HDL (high-density lipoprotein) cholesterol ("good" cholesterol) is 35 mg/dL (milligrams per deciliter) or lower, or triglyceride level is 250 mg/dL or higher.
    • Say:
      The good news is that, if you are at risk for diabetes, you can prevent or delay getting diabetes by being physically active and having a healthy weight.

      It is important to be physically active for 30 minutes on most days and to lose even a small amount of weight. For example, someone who weighs 200 pounds would benefit from losing 10 to 15 pounds.
  5. Symptoms of Diabetes
    • Ask:
      Does anyone know the signs or symptoms of diabetes?
    • Note: Allow 3 to 5 minutes for group members to respond.
    • Give group members the "Symptoms of Diabetes" handout.
    • Show picture card 7.5.
    • Say:
      Now let's review the symptoms of diabetes:
      • Feeling tired
      • Increased thirst
      • Frequent urination
      • Increased hunger
      • Unexplained weight loss
      • Sores that don't heal
      • Very dry skin
      • "Pins and needles" feeling in feet
      • Blurry vision
      • Feeling irritable
    • Say:
      Often, people with type 2 diabetes have no symptoms. If you have one or more symptoms, see your doctor right away.
  6. Blood Glucose Levels
    • Show picture card 7.6.
    • Say:
      To find out if you have diabetes, you can take a fasting blood glucose test at the doctor's office or at a lab.
    • Say:
      • A fasting blood glucose level below 100 mg/dL is normal. You are in good shape.
      • A fasting blood glucose level of 100 to 125 mg/dL is prediabetes. This is a warning that you are at risk for developing type 2 diabetes. It is time to lose weight and be physically active at least 5 days a week.
      • A fasting blood glucose level of 126 mg/dL or higher means that you have diabetes. If you have diabetes, you should work with your doctor and other health care providers to learn to control it. It is important to work with your doctor to learn the ABCs (A1C test, blood pressure, and cholesterol) of controlling diabetes. We will learn about the ABCs of diabetes control later in this session.
    • Say:
      You can also get a nonfasting glucose test at health fairs and other sites in your community. This is done using a glucometer and a small amount of blood. A nonfasting blood glucose level of 200 mg/dL or higher could mean that you have diabetes. See your doctor to get a fasting blood glucose test. You must fast for at least 8 hours before the test.
    More Information: Fasting Blood Glucose Levels
    Level Fasting Blood Glucose 1—2 Hours After Meals Results
    Normal 70—99 mg/dL 70—139 mg/dL Good for you!
    Prediabetes 100—125 mg/dL 140—199 mg/dL This is a warning that you are at risk for type 2 diabetes. A blood glucose level in this range is higher than normal, but not high enough to be diabetes. You need to take action to prevent diabetes.
    Diabetes 126 mg/dL or higher 200 mg/dL or higher You have diabetes. Work with your doctor and other health care providers to control the ABCs of diabetes (A1C, blood pressure, and cholesterol).
    • Say:
      People with diabetes may experience problems if their blood glucose levels get too low or too high.
    1. Hypoglycemia
      • Say:
        Hypoglycemia is a condition that develops when a person's blood glucose level is too low. People with diabetes may develop hypoglycemia.
      • Say:
        People with diabetes may develop hypoglycemia when they:
        • Skip or delay a meal or eat very little.
        • Take too much insulin or oral diabetes medicine.
        • Do too much physical activity.
        • Drink alcohol.
      • Say:
        The symptoms of hypoglycemia are:
        • Having a headache
        • Feeling shaky
        • Feeling anxious
        • Feeling dizzy
        • Feeling weak
        • Feeling irritable
      • Say:
        People with diabetes should talk to their health care providers to learn what to do for low blood glucose.
      • Say:
        People with diabetes may suffer from hypoglycemia. If your blood glucose is less than 70 mg/dL, your health care provider may tell you to do one of the following:
        • Drink 1/2 cup of fruit juice.
        • Drink 1 cup of milk.
        • Take two to three glucose tablets.
        • Eat 2 teaspoons of sugar or honey.
    2. Hyperglycemia
      • Say:
        Hyperglycemia is a condition that occurs when a person's blood glucose level is too high. People with diabetes may develop hyperglycemia when they:
        • Eat too much food.
        • Are less active than usual.
        • Have not taken their medicine.
        • Are sick or feel tension and stress.
      • Say:
        The symptoms of hyperglycemia are:
        • Increased thirst
        • Frequent urination
        • Dry skin
        • Increased hunger
        • Blurry vision
        • Feeling tired
        • Nausea
      • Say:
        • People with diabetes should talk to their health care providers about what to do if they experience the effects of high blood glucose.
        • If your blood glucose is too high, your health care provider may need to change your medication or eating plan.
  7. Complications of Diabetes
    • Say:
      Diabetes can cause changes in the body. These changes can cause problems, called complications. Can anyone name any complications of diabetes?
    • Note: Allow 3 to 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.
    • Say:
      Over time, diabetes can affect the large blood vessels in the brain, heart, legs, and feet. It also can affect the small blood vessels in the kidneys and eyes. Diabetes can lead to:
      • Heart attack
      • Stroke
      • Amputations of the feet or legs—Diabetes can cause nerve damage. The first sign of nerve damage is to lose sensation in the feet or legs. If you have nerve disease, you may lose feeling or have tingling or pain in the toes, feet, or legs.
      • Kidney disease—With diabetes, the excess glucose in the blood damages the blood vessels inside the kidneys. African Americans are four times more likely than whites to develop kidney failure, the final stage of kidney disease.
      • Eye disease—Diabetes can harm your vision or even cause blindness. People with diabetes need to have their eyes examined by a medical eye doctor once a year.
      • Dental problems—An increase in cavities and tooth infections is common in people with poor diabetes control. To prevent tooth decay, brush and floss your teeth every day. See your dentist every 6 months.
    • Say:
      Over time, diabetes can affect all parts of the nervous system. This can lead to:
      • Loss of strength in muscles
      • Changes in digestion, bladder control, and sexual function
      • Loss of feeling in feet—This is why you need to keep your feet clean, dry, soft, and protected.
    • Give out and review the "Tender Care for Your Feet" handout.
  8. ABCs of Diabetes Control
    • Say:
      If you have diabetes, controlling your blood glucose levels can help prevent or delay complications.
    • Say:
      We've learned that people with diabetes have a greater chance of having a heart attack or stroke. Let's find out how to take care of the heart with the ABCs of diabetes control.
    • Give and review the "Be Smart About Your Heart: Control the ABCs of Diabetes" handout.
    • Say:
      Be sure to ask your doctor:
      • What are my ABC numbers?
      • What should my ABC numbers be?
      • What actions should I take to control my ABC numbers?
    • Say:
      Knowing about diabetes can help prevent or delay it. For those who already have diabetes, diabetes education can help reduce the complications the disease can cause.
  9. Food Label Activity—Sugar
    • Say:
      People with diabetes should control their sugar intake because sugar is high in calories and contributes to weight gain. Eating too much sugar can also lead to increased blood glucose levels in those with diabetes.
    • Say:
      Now let's do an activity that will help us use food labels to find foods that have less sugar.
    • Give group members the "Read the Food Label for Sugar!" handout.
    • Say:
      This handout shows the amount of sugar in some drinks and food. Look at the bottom of the handout. Which drink has fewer grams of sugar—grape juice or unsweetened iced tea?
    • Answer:
      The unsweetened iced tea has less sugar. The grape juice has 32 grams of sugar in 1 cup, compared to 0 grams of sugar in 1 cup of iced tea.
    • Note: Unlike other nutrients, sugar does not have a Percent Daily Value on the food label.
    • Say:
      Let's try another activity. Pam needs our help.
    • Give group members the "Pam's Food Choices" handout.
    • Say:
      First, I am going to read about Pam's problem. Then we will use the food labels to find some solutions.

    Pam's Food Choices

    Pam has offered to go grocery shopping for her mother, Ms. Diane, who is home sick with the flu. Ms. Diane also has diabetes. Pam wants to buy foods that are lower in calories and sugar to help her mother. Look at the food labels. Help Pam select foods that are lower in sugar. Which foods should Pam buy? Write the number of your choice for each pair in the space between the labels. Then write the number of grams of sugar saved by this choice.

    Note: The correct answers to the questions are underlined.

    Cooked oatmeal or a toaster pastry

    Choosing the cooked oatmeal saves 16 grams of sugar.

    Gelatin or sugar-free gelatin

    Choosing the sugar-free gelatin saves 19 grams of sugar.

    Regular ice cream or fat-free, no-sugar-added ice cream

    Choosing the fat-free, no-sugar-added ice cream saves 13 grams of sugar.

    Diet soda or regular soda

    Choosing the diet soda saves 39 grams of sugar.

    • Think Before You Drink—Hidden Sugar in Drinks Activity
      • Say:
        Now let's do an activity to learn the sugar content in some common drinks.
      • Before the session
        1. Look at the box that appears below. Use drawings or empty cans or bottles to represent these drinks.
        2. Prepare five separate displays for each of the five drinks.
        3. Follow these instructions to prepare each display:
          • Cut a file folder in half and fold each part in half to make a card (tent).
          • Write the name of the drink on one side. On the other side, write the number of calories, grams of sugar, and teaspoons of sugar in the drink. Glue the cubes of sugar onto the folder to show the number of teaspoons of sugar in each drink. To find the number of teaspoons, divide the grams of sugar on the nutrition label by four. Examples of the displays.
        4. Hide the displays until it is time to do the activity.
      Serving Size Drink Amount of Sugar
      12 ounces Powdered drink mix with sugar 9 teaspoons (36 grams)
      12 ounces Diet soda 0 teaspoons (0 grams)
      12 ounces Grape juice 8 teaspoons (32 grams)
      12 ounces Regular soda 9 ¼ teaspoons (39 grams)
      12 ounces Lemonade 6 ¼ teaspoons (25 grams)

      Group Activity

      • Say:
        We are going to play a guessing game to learn how much sugar is in some common beverages.
      • Give group members the "Think Before You Drink—Hidden Sugar in Common Beverages" handout.
      • Show group members the front of each of the five cards that you prepared before the session, showing them the names of the beverages.
      • Say:
        Guess how many teaspoons of sugar are in each drink. Write your answers on the handout I gave you.
      • Note: Allow 2 minutes for group members to write down their answers.
      • Ask group members to share the amounts of sugar that they guessed. After the group members have shared the amounts they guessed, show them the actual number of teaspoons of sugar that are in each drink. Pass around the cards one by one.
      • Say:
        During the second part of this activity, you will learn how much sugar and how many calories are in your favorite drink.
      • Give group members the "How Much Sugar and Calories Are in Your Favorite Drink?" handout.
      • Say:
        Find your favorite drink on the list. Look to see how much sugar and calories are in it. Many drinks have a high amount of sugar and calories.
      • Say:
        As you can see, it is easy for people who choose drinks with sugar to get too many calories. Getting too many calories leads to weight gain. Try to drink more water or unsweetened drinks instead of drinks with added sugar or regular sodas.

       

  10. Staying Healthy With Diabetes—Group Activity
    • Note: This activity will help group members think about ways they can help their relatives and friends with diabetes stay healthy. You may select one or more stories to review.
    • Give group members the "Staying Healthy With Diabetes: Real-Life Stories" handout.
    • Divide group members into groups of three to five people and give each group a different story (handout) to discuss.
    • Say:
      Each group will read the story on the handout and think about ways to solve the problems described. Please choose one member of your group to read the story and the corresponding questions aloud to the group. Write down the group's answers to each of the questions.
    • Note: Allow 5 to 7 minutes for group members to do the activity.
    • Say:
      I would like one volunteer from each group to read the story and the answers to the questions aloud.
    • Note: After each volunteer reads the story and answers, ask the entire group if they have any other solutions to share.

    Staying Healthy With Diabetes: Real-Life Stories

    Scene 1: Harris Family Reunion

    Saturday is the Harris family reunion. Many relatives will bring lots of tasty foods and desserts such as cakes, ice cream, and pies. Harold has not been to a potluck meal since his doctor told him he has diabetes. He has worked hard to make changes in his eating habits. Now, Harold wonders what he and his wife Faith should bring to the family reunion and what foods he should eat while he's there.

    Note: Add the following answers to each question if they are not mentioned.

    • What can Harold bring to the reunion?
      • Water and diet soft drinks
      • Vegetables seasoned with lemon, a little bit of olive oil, and some herbs or spices
      • Steamed corn on the cob
      • Homemade dessert with fat-free and sugar-free ingredients
      • Fresh fruit salad
    • How can Harold stick to his new eating plan while he's at the reunion?
      • Eat smaller portions.
      • Do not have second helpings of high-calorie foods. Eat salad or fresh fruit if he is still hungry.
      • Cut back on sweet foods, high-fat foods, white sauces, gravies, and alcohol.
    • What else can Harold do?
      • Eat a healthy snack before the party, so he is not hungry.
      • Take a walk after eating.
      • Check his blood glucose 2 hours after eating to see how his food choices affected it.

    Scene 2: Connie's New Shoes

    Connie bought a new pair of shoes a week ago. She wore them 2 days in a row because her feet felt fine. When she took off her shoes at the end of the second day, however, Connie noticed some red spots on both of her feet and blisters on the big toe of her right foot. She wonders what she needs to do about the red spots and blisters on her feet. Connie is concerned that she did not feel the sores on her feet. She also worries that her diabetes is not under control.

    Note: Share the answers to each question if they are not said.

    • What can Connie do about the sores on her feet?
      • People with diabetes need to see a health care provider if they see a cut, blisters, or signs of infection on their feet.
      • Connie should go for a foot screening, which includes inspection, testing for feeling, and other tests.
      • Because she can't feel sensation in her feet, Connie needs to practice personal foot care every day to look for changes and infections.
    • What should people with diabetes consider when buying shoes?
      • Medicare provides coverage of special shoes for people with diabetes. Check with your doctor to see if you qualify.
      • Buy new shoes carefully.
      • Choose shoes that fit well and are made of leather or canvas, with laces or straps, a smooth lining inside, rounded toes, low and firm heels, and soft insoles.
      • Have the salesperson measure both feet. Test the shoes by wearing them for at least 5 minutes in the store.
      • If the shoes hurt, don't buy them.
      • Break in new shoes slowly by wearing them for only 1 or 2 hours a day. Check for irritation or redness every time you remove your shoes and socks. Never wear new shoes all day long.

    Scene 3: What's Wrong With Angela?

    First visit: Angela and her cousin, Dawn, go shopping together on a Saturday afternoon. Angela has to stop frequently to use the restroom during the shopping trip, so Dawn, who is a community health worker, asks her if anything is wrong. Angela says she has been feeling tired and thirsty lately and she has been urinating often. Even though she is physically active, Angela wonders if she could have diabetes. She asks Dawn what she should do.

    Note: Add the following answers to each question if they are not mentioned.

    • What can Dawn tell Angela during this first visit?
      • Advise Angela to go to the clinic and have her blood glucose checked. If she has diabetes, she needs to be treated right away. Dawn cannot make a diagnosis.
      • Explain that people are more likely to have diabetes if they are overweight and inactive. Other risk factors that make someone more likely to have diabetes include having a parent or other family members with diabetes and being age 40 or older.

    Second visit: When Angela talks to her cousin again, she tells Dawn that she went to the doctor. The doctor confirmed that Angela has diabetes. Angela is afraid.

    • How can Dawn help Angela overcome her fear during this second visit?
      • Tell Angela that most people with diabetes may feel scared, depressed, or angry at one time or another.
      • Mention that some people with diabetes overcome their fears when they learn what they can do to control diabetes and stay healthy.
      • Tell Angela that she can prevent or slow down diabetes problems with good control of her blood glucose, blood pressure, and blood cholesterol. Advise her to visit the eye doctor to check for eye problems.
      • Encourage Angela to attend classes at the clinic and to join a support group that helps people with diabetes to stay healthy. It helps to talk with others who are living with diabetes.
      • Tell Angela that there is a close link between diabetes and heart disease. Encourage her to ask her doctor to check her blood pressure and cholesterol, and encourage Angela to learn ways to lower her chances for heart attack and stroke.
    • Soul Food Makeover: Strawberry and Pineapple Delight Recipe
      • Note: This activity will give group members a chance to try heart healthy recipes at home.
      • Give group members the "Soul Food Makeover: Strawberry and Pineapple Delight Recipe" handout.
      • Say:
        This recipe makes a dessert dish that you can bring to a family gathering or other event. The recipe has only 40 calories and 0 grams of fat per serving.
      • Ask group members to prepare the recipe during the coming week. Tell them that using the recipe will give them a chance to practice some of the ideas from the session.

Review of Today's Key Points

  • Say:
    Let's review what we learned today.
  • What is diabetes?
    • Diabetes happens when the body does not make enough insulin or cannot use it well, causing glucose to build up in the blood. As a result the body does not function well.
  • What are risk factors for diabetes?
    • Overweight
    • Family members with diabetes
    • Age 40 or older
    • Physical inactivity
    • Being African American, Latino, American Indian, Asian American, or Pacific Islander, because diabetes occurs more often in people from these groups than in whites
    • Having had gestational diabetes or given birth to at least one baby weighing 9 pounds or more
    • High blood pressure
    • Cholesterol levels are not normal—HDL cholesterol is low, or triglycerides are high
  • How can you prevent or delay type 2 diabetes?
    • Be physically active for at least 30 minutes on most days.
    • Lose a small amount of weight. For example, losing 10 to 15 pounds is helpful for someone who weighs 200 pounds.
  • What are the ABCs of diabetes control?
    • A is for the A1C test. If you have diabetes, take the A1C blood test at least two times every year. This test measures how well a person's blood glucose level has been controlled over the past 3 months. People who have diabetes should aim for an A1C number that is below seven.
    • B is for blood pressure. High blood pressure makes your heart work too hard. It increases your risk for a heart attack, stroke, or damage to your kidneys and eyes. A person with diabetes should have a blood pressure below 130/80 mmHg.
    • C is for cholesterol. Keep cholesterol at normal levels. Bad cholesterol (LDL) can build up and clog your arteries. It can cause a heart attack. People with diabetes need to keep their LDL cholesterol below 100 mg/dL.
  • How does diabetes affect your body?
    • Diabetes can cause damage to the heart, brain, kidneys, and eyes. It can cause nerve damage, which reduces sensation in your feet. Diabetes may also affect blood flow in your legs and feet. This can lead to sores that don't heal and amputation. Good control of your blood glucose can prevent this damage.

Weekly Pledge

  • Say:
    You have learned a lot today about diabetes prevention and control. Now let's think about how you can apply what you have learned. Please think of one change you can make in your everyday life to prevent or control diabetes. This will be your pledge for the week.
  • Say:
    Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:
    • I will talk to my doctor about my risk for diabetes and see if I need to get my blood glucose level checked.
    • If I have diabetes, I will check my blood glucose levels as my doctor tells me.
    • I will compare food labels the next time I go to the store to help me choose packaged foods that are lower in sugar.
    • I will drink water with my lunch this week instead of regular sodas or other drinks with sugar.
  • Say:
    Write your pledge on the "Be Smart About Your Heart: Control the ABCs of Diabetes" handout. Keep this handout in a special place so you can review your pledges and keep your goals in mind.
  • Note: Allow 5 minutes for group members to think of a pledge.
  • Say:
    Would anyone like to share his or her pledge with the group?
  • Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.
  • (Optional) Say:
    Keeping a personal value in mind can help you reduce your risk for diabetes or control your diabetes if you already have it. Remember that a personal value is a quality that you consider important.
    Today, the value is joy. Joy can help you replace boredom, indifference, and depression with a positive outlook. As today's quote states, "Just don't give up trying to do what you really want to do. Where there is love and inspiration, I don't think you can go wrong." Joy can help you enjoy preparing foods the healthy way. Joy is contagious, and others may follow your example!
  • Ask:
    How could you use joy, or another value, to help you keep your pledge?
  • Note: Allow 3 minutes for group members to share their thoughts.
  • Say:
    We will discuss the results of your pledges next week. Don't forget to continue working on your pledges to be more physically active; to cut back on salt, sodium, saturated fat, trans fat, and cholesterol; and to reach and keep a healthy weight.

Closing

  • Say:
    Thank you for coming today. What did you think of today's session?
  • Note: Allow a moment for group members to respond.
  • Say:
    I am looking forward to seeing you at the next session. The next session will be about making heart healthy eating an everyday family reunion. Please continue to fill out your family health history.
  • Note: Think about today's session. What worked? What didn't work? Have you had changes in your own life as a result of today's session?

Handouts

What Is Diabetes?

Diabetes happens when the body does not make enough insulin or cannot use it well. This causes glucose to build up in the blood. As a result, the body does not function well.

Glucose - The stomach digests the food.

Insulin - The pancreas makes the insulin.

Know your body

  • The food we eat goes to the stomach, where it is digested. The food is turned into blood glucose in the body. Glucose is also called blood sugar. The body uses glucose for energy needed for daily life.
  • The blood takes the glucose to the cells where it is turned into energy. However, glucose cannot enter the cells alone: it needs help. Insulin helps the glucose enter the cells. Insulin is a hormone that is made in the pancreas.
  • If the body does not produce enough insulin, or if the cells cannot use the insulin well, then the glucose cannot enter the cells and builds up in the blood.
  • People who have high levels of glucose in their blood have prediabetes or diabetes.

Are You at Risk for Type 2 Diabetes?

Check the risk factors you have. The more risk factors you check, the higher your risk for developing type 2 diabetes. Only your health care provider can determine if you have diabetes. On your next visit, find out for sure.








Symptoms of Diabetes

The symptoms of type 2 diabetes develop over time. Some people have symptoms, and others do not. Here are some symptoms of diabetes.

  • Feeling tired
  • Increased thirst
  • Frequent urination
  • Increased hunger
  • Unexplained weight loss
  • Sores that don't heal
  • Very dry skin
  • "Pins and needles" feeling in the feet
  • Blurry vision
  • Feeling irritable

Tender Care for Your Feet

Diabetes can cause nerve damage, which reduces sensation in your feet. Diabetes may also affect blood flow in your legs and feet, making it harder for cuts or sores to heal. Small injuries may become infected and can become very serious.

Daily care

  • Wash your feet in warm water every day. Dry them carefully, especially between your toes.
  • Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. If you cannot bend over or pull your feet up to check them, use a mirror, or ask someone else to check your feet.
  • If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes.
  • Smooth corns and calluses gently with an emery board or pumice stone. Do this after your bath or shower. Do not use a pocketknife or razor blade that can cut your skin.
  • Cut your toenails once a week after a bath.

Periodic foot exam

  • Remind the health care provider to check your feet at every visit.
  • Get a complete foot exam once a year. If you have problems with your feet, have the health provider check them every 3 to 6 months.

Footwear

  • Wear well-cushioned shoes and socks at all times. Do not go barefoot.
  • Change your socks every day, and make sure they are clean and soft.
  • Buy shoes that are roomy and allow your feet to "breathe."
  • Medicare provides coverage of special shoes for people with diabetes. Check with your doctor to see if you qualify.

Be Smart About Your Heart: Control the ABCs of Diabetes

Some people have prediabetes, which is when blood glucose levels are higher than normal, but not in the diabetes range. People with this condition can reduce the risk of developing diabetes by losing a small amount of weight and increasing their physical activity.

If you have diabetes, controlling your blood glucose levels will help prevent complications.

The ABCs of Diabetes

If you have diabetes, three key steps can help you lower your risk of heart attack and stroke. Follow these ABCs:

  • A is for the A1C test, which is short for hemoglobin A1C. This test measures your average blood glucose over the past 3 months. It lets you know if your blood glucose level is under control. Get this test at least twice a year.
    Number to aim for: below 7
  • B is for blood pressure. The higher your blood pressure, the harder your heart has to work. Get your blood pressure measured at every doctor's visit.
    Numbers to aim for: below 130/80 mmHg
  • C is for cholesterol. Maintain a normal cholesterol level. "Bad" cholesterol, or LDL, builds up and clogs your arteries. Get your LDL cholesterol tested at least once a year.
    Number to aim for: below 100 mg/dL

Be sure to ask your doctor:

  • What are my ABC numbers?
  • What should my ABC target numbers be?
  • What actions should I take to reach my ABC target numbers?


Read the Food Label for Sugar!

Food labels tell you what you need to know about choosing foods that are lower in calories and sugar. Here is a food label for 100% grape juice. The label provides lots of useful information

100% Grape Juice

Nutrition Facts
   
Serving Size 1 cup (8 fl oz)
Servings Per Container 8
Amount Per Serving Calories 150
Calories from Fat 0
Nutrient % Daily Value*
Total Fat 0g = 0%
Saturated Fat 0g = 0%
Trans Fat 0g
Cholesterol 0mg = 0%
Sodium 15mg = 1%
Potassium 170mg = 5%
Total Carbohydrate 37g = 12%
Dietary Fiber 0g = 0%
Sugars 32g
Protein 0g
Vitamin A 0%
Vitamin C 120%
Calcium 2%
Iron 2%

Amount Per Serving
The nutrient amounts provided on the label are for one serving. If you have more than one serving, you will get more calories and other nutrients. For example, if you drink two servings (2 cups) of grape juice, you will take in 300 calories and 64 grams of sugar.

Calories and Sugar
Here are the amounts of calories and sugar in one serving.

Serving Size and Number of Servings
The serving size is 1 cup. There are eight servings in this container.

Percent Daily Value
The Percent Daily Value helps you compare nutrient amounts in products. There is no Percent Daily Value for calories or sugar. Choose foods with the lowest amount of calories and sugar.

The Choice Is Yours—Compare!

Which one would you choose?

The unsweetened iced tea has fewer calories and no sugar. That makes the iced tea a better choice! Read food labels, and choose products to keep your heart strong.

100% Grape Juice
One cup of grape juice has 150 calories and 32 grams of sugar.

Nutrients % Daily Value*
Amount Per Serving Calories 150
Calories from Fat 0
Total Fat 0g = 0%
Saturated Fat 0g = 0%
Trans Fat 0g
Cholesterol 0mg = 0%
Sodium 15mg = 1%
Patassium 170mg = 5%
Total Carbohydrate 37g = 12%
Dietary Fiber 0g = 0%
Sugars 32g

Unsweetened Iced Tea
One cup of unsweetened iced tea has 5 calories and no sugar. You can learn a lot from a food label.

Nutrients % Daily Value*
Amount Per Serving Calories 5
Calories from Fat 0
Total Fat 0g = 0%
Saturated Fat 0g = 0%
Trans Fat 0g
Cholesterol 0mg = 0%
Sodium 0mg = 0%
Patassium 0mg = 0%
Total Carbohydrate 0g = 0%
Dietary Fiber 0g = 0%
Sugars 0g

* Percent Daily Values are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

Pam's Food Choices

Pam has offered to go grocery shopping for her mother, Ms. Diane, who is home sick with the flu. Ms. Diane also has diabetes.

Pam wants to buy foods that are lower in calories and sugar to help her mother. Look at the food labels. Help Pam select foods that are lower in sugar.

Which foods should Pam buy? Write the number of your choice for each pair in the space between the labels. Then write the number of grams of sugar saved by this choice.

  Food 1 Food 2
Nutrient Cooked Oatmeal Toastre Pastry
Serving Size 1/2 cup (41g dry) 1 pastry (52g)
Servings Per Container 13 8
Amount Per Serving Calories = 130
Calories from Fat 20
Calories = 180
Calories from Fat 45
Total Fat 2g = 3% 5g = 8%
Saturated Fat 0g = 0% 1.5g = 8%
Trans Fat 0g 1g
Cholesterol 0mg = 0% 0mg = 0%
Sodium 0mg = 0% 170mg = 7%
Total Carbohydrate 22g = 7% 31g = 10%
Dietary Fiber 4g = 16% 1g = 4%
Sugars 0g 16g
Protein 5g 2g
Vitamin A 0% 0%
Vitamin C 0% 0%
Calcium 0% 0%
Iron 0% 10%



  Food 3 Food 4
Nutrient Gelatin Sugar-Free Gelatin
Serving Size 1/4 cup 1/4 cup
Servings Per Container 8 8
Amount Per Serving Calories = 80
Calories from Fat 0
Calories = 10
Calories from Fat 0
Total Fat 0g = 0% 0g = 0%
Saturated Fat 0g = 0% 0g = 0%
Trans Fat 0g 0g
Cholesterol 0mg = 0% 0mg = 0%
Sodium 100mg = 4% 55mg = 2%
Total Carbohydrate 19g = 6% 0g = 0%
Dietary Fiber 0g = 0% 0g = 0%
Sugars 19g 0g
Protein 2g 1g
Vitamin A 0% 0%
Vitamin C 0% 0%
Calcium 0% 0%
Iron 0% 0%



  Food 5 Food 6
Nutrient Fat-Free, No-Sugar-Added Chocolate Ice Cream Chocolate Ice Cream
Serving Size 1/2 cup (66g) 1/2 cup (66g)
Servings Per Container 16 16
Amount Per Serving Calories = 80
Calories from Fat 0
Calories = 170
Calories from Fat 80
Total Fat 0g = 0% 9g = 14%
Saturated Fat 0g = 0% 6g = 30%
Trans Fat 0g 0g
Cholesterol 0mg = 0% 20mg = 7%
Sodium 50mg = 2% 40mg = 2%
Total Carbohydrate 19g = 6% 21g = 7%
Dietary Fiber 5g = 20% 1g = 4%
Sugars 4g 17g
Protein 3g 2g
Vitamin A 6% 4%
Vitamin C 0% 0%
Calcium 8% 6%
Iron 0% 4%



  Food 7 Food 8
Nutrient Diet Soda Regular Soda
Serving Size 1 can (12 fl oz) 1 can (12 fl oz)
Servings Per Container 1 1
Amount Per Serving Calories = 0
Calories from Fat 0
Calories = 140
Calories from Fat 0
Total Fat 0g = 0% 0g = 0%
Saturated Fat 0g = 0% 0g = 0%
Trans Fat 0g 0g
Cholesterol 0mg = 0% 0mg = 0%
Sodium 35mg = 1% 50mg = 2%
Total Carbohydrate 0g = 0% 39g = 13%
Dietary Fiber 0g = 0% 0g = 0%
Sugars 0g 39g
Protein 0g 0g
Vitamin A 0% 0%
Vitamin C 0% 0%
Calcium 0% 0%
Iron 0% 0%

Note: Percent Daily Values are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

Think Before You Drink: Hidden Sugar in Common Beverages

Try to guess the amount of sugar (in teaspoons) that is found in each drink.

Write your answers on the "My Guess" line.
Drink Teaspoons of Sugar
My Guess
Teaspoons of Sugar
True Amount
Powdered drink with sugar Tsp. Tsp.
Diet soda Tsp. Tsp.
Grape juice Tsp. Tsp.
Regular soda Tsp. Tsp.
Lemonade Tsp. Tsp.
How Much Sugar and Calories Are in Your Favorite Drink?
Drink (12-ounce serving) Grams of Sugar Approximate Number of Teaspoons of Sugar Calories
Bottled Water 0 grams 0 teaspoons 0
Cola 41 grams 10 1/4 teaspoons 150
Diet Cola 0 grams 0 teaspoons 0
Root Beer 46 grams 11 1/2 teaspoons 170
Orange Soda 52 grams 13 teaspoons 210
Powdered Drink Mix With Sugar 36 grams 9 teaspoons 145
Sugar-Free Drink Mix 0 grams 0 teaspoons 0
Lemonade 25 grams 6 1/4 teaspoons 105
Sugar-Free Lemonade 0 grams 0 teaspoons 0
Grape Juice 32 grams 8 teaspoons 150
Orange Juice 20 grams 5 teaspoons 105
Fruit Punch 46 grams 11 1/2 teaspoons 195
Sports Drink 8 1/2 grams 2 teaspoons 75
Sweet Tea 33 grams 8 1/2 teaspoons 120
Unsweetened Tea 0 grams 0 teaspoons 0

Staying Healthy With Diabetes: Real-Life Stories

What can you do?

Scene 1: Harris Family Reunion

Saturday is the Harris family reunion. Many relatives will bring lots of tasty foods and desserts such as cakes, ice cream, and pies. Harold has not been to a potluck meal since his doctor told him he has diabetes. He has worked hard to make changes in his eating habits. Now, Harold wonders what he and his wife Faith should bring to the family reunion and what foods he should eat while he's there.

Scene 2: Connie's New Shoes

Connie bought a new pair of shoes a week ago. She wore them 2 days in a row because her feet felt fine. When she took off her shoes at the end of the second day, however, Connie noticed some red spots on both of her feet and blisters on the big toe of her right foot. She wonders what she needs to do about the red spots and blisters on her feet. Connie is concerned that she did not feel the sores on her feet. She also worries that her diabetes is not under control.

Scene 3: What's Wrong With Angela?

First visit: Angela and her cousin, Dawn, go shopping together on a Saturday afternoon. Angela has to stop frequently to use the restroom during the shopping trip, so Dawn, who is a community health worker, asks her if anything is wrong. Angela says she has been feeling tired and thirsty lately and she has been urinating often. Even though she is physically active, Angela wonders if she could have diabetes. She asks Dawn what she should do.

Second visit: When Angela talks to her cousin again, she tells Dawn that she went to the doctor. The doctor confirmed that Angela has diabetes. Angela is afraid.

Soul Food Makeover: Strawberry and Pineapple Delight Recipe

2 cups boiling water
1 package sugar-free, low-calorie strawberry gelatin
½ teaspoon cinnamon
1 large can (20 ounces) pineapple chunks in fruit juice, not drained
1 can (11 ounces) mandarin orange segments in fruit juice, drained
16 large ice cubes

  1. Pour boiling water in a large bowl. Add the gelatin and cinnamon to the water. Stir for at least 2 minutes, making sure the gelatin is completely dissolved.
  2. Drain pineapple chunks and save the juice. Add ice (or cold water) to the leftover juice to measure 1 ½ cups. Add gelatin. Stir until ice is completely melted.
  3. Refrigerate about 45 minutes or until gelatin is slightly thickened (consistency of an unbeaten egg white).
  4. Reserve ¼ cup each of the pineapple and orange. Add the remaining pineapple and orange segments to thickened gelatin. Pour into a 1½-quart serving bowl.
  5. Refrigerate 4 hours or until firm. Garnish with the reserved pineapple and orange segments.

Makes: 12 servings
Serving size: ½ cup

Each serving provides:
Calories: 40
Total fat: 0 g
Saturated fat: 0 g
Trans fat: 0 g
Cholesterol: 0 g
Sodium: 23 g
Total carbohydrate: 10 g
Dietary fiber: 1 g
Sugars: 9 g
Protein: 1 g
Potassium: 94 mg

The Makeover

Previously, the Harris family ate high-calorie desserts made with a lot of added sugar. This tasty recipe is low in sugar because it uses sugar-free gelatin as well as pineapple and mandarin oranges canned in fruit juice instead of heavy syrup. The cinnamon in the recipe provides the extra flavor without the added sugar. Try this delicious, low-fat dessert for your next social gathering.


Go To SESSION 6 Go To SESSION 8

Last Updated December 2010

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