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Healthy Heart, Healthy Family: A Community Health Worker's Manual for the Filipino Community

Manual Contents

Session 7
Protect Your Heart: Prevent and Control Diabetes

Page Contents

Objectives

By the end of this session, group members will:

  • 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 (blood sugar) and what they mean
  • How to prevent and control diabetes
  • The amount of sugar in common beverages

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Materials and Supplies

To conduct this session, you will need:

  • “Healthy Heart, Healthy Family” manual and picture cards
  • Blackboard and chalk or several large pieces of paper, a marker, and tape
  • Prepare before the session:
  • (Optional) Note: Arrange for a health professional or a diabetes educator to come to the session to measure group members’ blood glucose levels.

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Handouts

Give each group member these handouts during this session:

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Introducing the Session

  1. Welcome
  2. Review of Last Week's Session
  3. About This 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, and diabetes.
      Q: What is the healthiest way to lose weight?
      A: Eat smaller portions of a variety of foods lower in fat and calories, and increase your physical activity.
      Q: How does the Nutrition Facts label help people who are trying to lose weight?
      A: The Nutrition Facts label tells you the serving size and the number of calories in a serving.
    • Say:
      At the end of 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.
  3. About This Session
    • 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.
    • Say:
      Lola Idad’s family often thought that these changes were impossible, but Lola always reminds them that “Sa taong walang takot, walang mataas na bakod.” “To a fearless person, no fence is too high.”
    • Say:
      In this session, Lola’s family will share the lessons they have learned through their experiences, to help us on our journey to heart health.

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Conducting the Session

  1. The Facts Don’t Lie
  2. What Is Diabetes?
    What is Prediabetes?
  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. Nutrition Facts Label Activity–Sugar
  10. Think Before You Drink–Hidden Sugar in Drinks Activity
  11. Pesang Isda (Fish Simmered With Ginger and Tomatoes) and Munggo Gisado (Sauteed Mung Beans) Recipe Activity
  1. The Facts Don’t Lie
    • Say:
      • Diabetes is a serious problem for Filipino families. It affects men, women, and children.
      • A study in San Diego County found that one out of every three Filipinas
        has diabetes.
      • More than half of the Filipinas with diabetes do not know they have diabetes.
      • Most Filipinas with diabetes (about 90 percent) are not obese (their BMIs are less than 30 kg/m2).
      • 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.
  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 blood glucose. Blood glucose is also called blood sugar.
    • Say:
      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 it 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 are not physically active.
      • Is usually treated with diet pills or, sometimes, insulin shots.
      • Can occur at any age, but is more common after age 40.
      • Is increasing among children, especially if they are overweight.
      • 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 blood 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 liquid 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.
  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 checkmark next to the risk factors that they have.
    • Say:
      Your chances of getting diabetes increase if you:
      • Are overweight, especially if you have extra weight around the waist.
      • Have a parent or sibling with diabetes.
      • Are Asian American, Native Hawaiian or other Pacific Islander, African American, Latino, or American Indian.
      • Have had gestational diabetes or have given birth to at least one baby weighing more than 9 pounds (4.1 kg).
      • 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, that is, a level of HDL (high-density lipoprotein) cholesterol (“good” cholesterol) of 35 mg/dL (milligrams per deciliter) or lower, or a triglyceride level of 250 mg/dL or higher.
      • Are not very active (participate in physical activity less than three times a week).
    • 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 (90.7 kg) would benefit from losing 10 to 15 pounds (4.5 to 6.8 kg).
    • (Optional) Give group members the “Take These Small Steps Now To Prevent Diabetes” handout. Review the handout with the group.
    • (Optional) Give group members the “Rose Learns About Preventing Diabetes” handout. Ask for three volunteers to read the role play. As the trainer, you can read the introduction.
      Note: Allow 5 minutes for discussion.
    • Ask the following questions:
      • What are some of the lessons we learned from this role play?
      • Is there any part of the play that you can use in your own life?
  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
      • Very dry skin
      • “Pins and needles” feeling in feet
      • Sores that don’t heal
      • 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.
    • Give group members the “Be Good to Your Heart: Know Your Blood Glucose Level!” handout.
    • 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:
        • Headache
        • Feeling shaky
        • Feeling anxious
        • Dizziness
        • 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 below 70 mg/dL, your health care provider may tell you to do one of the following:
        • Drink ½ cup of fruit juice.
        • Drink 1 cup of milk.
        • Take 2 to 3 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
      • Amputation of the feet or legs–Diabetes can cause nerve damage. The first sign of nerve damage is the loss of sensation in the feet or legs. If you have nerve disease, you may lose feeling or have tingling or pain in your toes, feet, or legs.
      • Kidney disease–With diabetes, the excess glucose in the blood damages the blood vessels inside the kidneys. Filipino Americans are four times more likely than Caucasians 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 Nutrition Facts labels to find foods that have less sugar.
    • Give group members the “Read the Nutrition Facts 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–mango nectar or unsweetened iced tea?
    • Say:
      The iced tea has less sugar. One cup of mango nectar has 50 grams of sugar, compared to 0 grams of sugar in 1 cup of unsweetened iced tea.
      Note: Unlike other nutrients, sugar does not have a Percent Daily Value on the Nutrition Facts label.
    • Say:
      Let’s try another activity. Mila needs our help.
    • Give group members the “Mila’s Food Choices” handout.
    • Say:
      First, I am going to read about Mila’s problem. Then we will use the Nutrition Facts labels to find some solutions.

      Mila’s Food Choices

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

      Note: The correct answers to the questions are underlined. The sugar and calories saved by making the right choice are given below the choices.

      • Pan de Sal (Filipino roll) or a doughnut
        Choosing the pan de sal saves 14 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 90 calories.
      • Diet soda or regular soda
        Choosing diet soda saves 39 grams of sugar.
      • Bibingka (sweet rice cake) or cooked oatmeal
        Choosing the cooked oatmeal saves 44 grams of sugar.
  10. Think Before You Drink–Hidden Sugar in Drinks Activity
    Note: Prepare before the session.
    • Look at the box that appears below. Use drawings or empty cans or bottles to represent these drinks.
    • Prepare five separate displays for each of the five drinks.
    • Follow these instructions to prepare each display:
      • Cut a folder into two parts, folding 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 get the number of teaspoons, divide the grams of sugar on the food label by four.
    • Hide the displays until it is time to do the activity.
      Amount of Sugar in Drinks
      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 Mango nectar 12 ½ teaspoons (50 grams)
      8 ounces Energy drink 6 ¼ teaspoons (25 grams)
  11. 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 calories are in your favorite drink.
    • Give group members the “How Much Sugar and How Many Calories Are in Your Favorite Drink?” handout.
    • Say:
      Find your favorite drink on the list. Look to see how much sugar and how many 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 sugar or regular sodas.
  12. Pesang Isda (Fish Simmered With Ginger and Tomatoes) and Munggo Gisado (Sauteed Mung Beans) Recipe Activity
    • Say:
      With simple changes to traditional foods, Lola Idad and her family learned that heart healthy Filipino food tastes good.
    • Give group members the following recipe handouts: “Pesang Isda (Fish Simmered With Ginger and Tomatoes) Recipe” and “Munggo Gisado (Sauteed Mung Beans) Recipe.” Ask them to prepare one or more of them during the coming week. Tell them that using the recipes will give them a chance to practice some of the ideas from the session.
    • Ask:
      How are these recipes heart healthy?
    • Add the answers below if they are not mentioned:
      • The main dish is made with fish.
      • The side dish is made with vegetables, seafood, and lean meat.
      • The fish is simmered in water, not fried.
      • No fat is added to the fish and only a tablespoon of corn oil is added to the mung beans.
        • Additional flavoring with herbs and spices
        • Cooked and simmered slowly in moist heat
    • Say:
      Remember that foods lower in fat still contain calories. Check the portion size. If you eat these foods in large quantities, you may gain weight.

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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
    • Not being physically active
    • Being Latino, African American, American Indian, Asian American, or Native Hawaiian or other Pacific Islander (because diabetes occurs more often in people from these groups than in Caucasians)
    • Having had gestational diabetes or given birth to at least one baby weighing 9 pounds (4.1 kg) or more
    • High blood pressure
    • Cholesterol levels are not normal–HDL cholesterol is low, or triglyceride level is 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 (4.5 to 6.8 kg) is helpful for someone who weighs 200 pounds (90.7 kg).
  • 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.

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Lola's Life Lessons: A Time To Reflect

  • Say:
    Like many families, the de la Cruz family needs to make lifestyle changes. Lola Idad’s kids are busy with work and making sure that their children are safe and well educated. Lola encourages her family to stay on the heart healthy path to help prevent their risk for diabetes. She and the family learn to prepare heart healthy meals and plan time for the family to be more physically active.
  • Give each group member the “Lola’s Life Lessons: Session 7” handout. Ask a volunteer to read the handout.
  • Say:
    Please take a few moments to reflect on Lola’s advice and how this applies to your life. At the bottom of the handout, there is a space called “A Time To Reflect.” Use this section to record your thoughts and feelings about this week’s session. Remember, this is for you and no one else.

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Pledge for Life!

  • Give each group member the “Pledge for Life! Session 7” handout.
  • Say:
    Take the pledge for life with Lola Idad. She and her family have taken the pledge to lower their risk of getting diabetes. Take the step toward losing weight if overweight, eating healthy foods, getting regular physical activity, and keeping blood sugar within the normal range. Pledge to do one thing on this list during the coming week.
    Note: Give each group member 2 to 3 minutes to share.
  • Say:
    We will talk about how you did with your pledges at the next session. Remember to keep working on your pledges to be more active.
  • (Optional–if you can get a health professional to come to your session) Tell group members that a health professional will now check their blood sugar.

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 affair.
  • Note for Educator: Think about today’s session. What worked? What didn’t work? Have you made changes in your own life to prevent and control diabetes as a result of today’s session?

Go to Session 6

Go to Session 8


Information on this page is taken from the English print version of “Healthy Heart, Healthy Family: A Community Health Worker's Manual.” U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute, NIH Publication No. 08-3674, Originally Printed 1999, Revised May 2008.

Last Updated March 2012

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