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Presented by Janice S. Wong R.N CDE -2007

Now I am a Certified Diabetes Educator and teach diabetes patients how to live with this disease…but from a slightly different perspective because I, too, have to walk the walk…I know how my patients feel…because I have felt that way too. Nothing they tell me surprises me, and they tell me a lot. The one thing that will help you is to take classes, learn about diabetes, it affects everyone differently.

To live with this disease, you must understand a little how the body works. Your body needs energy, and we get our energy from food. We eat meat, fish, chicken, eggs (protein) rice, noodles, bread, (starch) vegetables, fruits, dairy products…these foods are digested into glucose our energy fuel.

Founded in 1973, the American Association of Diabetes Educators is a multidisciplinary professional membership organization of healthcare professionals dedicated to integrating successful self-management as a key outcome in the care of people with diabetes and related conditions.

Our Mission - Driving professional practice to promote healthy living through self-management of diabetes and related conditions.
Our Vision - Successful self-management for all people with diabetes and related conditions.

Research - AADE advances and promotes evidence-based diabetes self-management education and practice.

Driving Practice - AADE sets the scope and direction for the practice of diabetes education.
Professional Development - AADE provides opportunities for its members and the broader healthcare community to advance their skills and career goals.
Integration - AADE will advance diabetes education as central to quality diabetes care and prevention.
Advocacy - AADE advocates for public policy to improve access to services, supplies and care for those with diabetes or for those at risk for diabetes and related conditions.
Membership - AADE continues to enhance the effective and efficient operation of its member-driven organization.

Rice is one food almost all of us Asian Americans eat. It is pure starch and gets digested into glucose rather quickly and raises our blood sugar pretty high. A piece of bread = 15 grams of carbohydrate…1/3 of a cup of cooked rice = 15 grams of carbohydrate. So if you eat 1 cup of cooked rice …it is like you are eating 3 pieces of bread. Don’t frown, you’ll do as we all do…you will accommodate…cut back a little on the rice…use a smaller bowl, or increase your walking after you eat your big bowl of rice.

Use smaller dishes and bowls, eat slowly, enjoy your food. Your stomach is really only as large as your fist, we stretch it out by eating more than we need and by eating too fast. If you feel like snacking have a drink of water first, most of us are a little dehydrated, not really hungry, but if you must have a snack a piece of fruit like an apple is good for you, gives you fiber and lets you chew,

To get glucose into our cells….you need insulin. If you do not make enough Insulin or your cells are not receptive to your insulin….then glucose stays in your blood stream, and your cells will not get the fuel it needs and soon you will be tired. Also high blood glucose levels causes damage to your body internally. That is the danger of this disease…you cannot see the damage, and the damage cannot be undone.

Let me explain it this way. If you made a snow ball and rolled in the snow, pretty soon you would have a very large snow ball…that is what is happening to you internally. Everytime your blood sugar levels are elevated your snowball is getting bigger…that is how the internal damage happens , your internal snowball gets bigger and bigger. Pretty soon what started as a small snow ball is now a snowman inside your body , affecting every part of your body (complications). High blood sugars causes damage to your eyes, your nervous system, your kidneys, and makes us more susceptible to cardiovascular problems and strokes. It also can cut your lifespan down, and the golden years you were looking forward to will not be golden.

One of the first things you must learn to do is called "Self Monitoring" your glucose levels….using a glucose monitor…by putting a drop of your blood on a strip and having the monitor read your glucose level, then putting the results down in a log book so your Doctor or CDE can see if a pattern is developing…highs and lows, so adjustments can be made if you are on medicines. Most people start out doing this as directed…then taper off . But this is the only way to see how well controlled your blood sugars are on a daily basis. Your blood sugar goal depending on your age will be set up by your health care team, everyone is different. Another blood test that will be done every 3 months is a Hemoglobin A1c, this tells us what your average blood sugar has been for 3 months. Anything over 7 needs tightening up.

Asians, especially those from Far Eastern nations like China, Korea and Japan, are acutely susceptible to Type 2 diabetes, the most common form of the disease . . They develop it at far lower weights than people of other races . . . they are 60 percent more likely to get the disease than whites . . . peril is compounded by recent immigrants' sudden collision with American culture. Many of them left places where factory and field work was strenuous, televisions were rare and advertising was limited. They may speak little English and have poor access to medical care.
Click HERE for more info.

If you are overweight, just a little weight loss will make you feel better. So sending you to a dietitian to help you is a good idea. If you have a large abdominal girth (beer belly) I call it a buddy..and when you sit down if buddy takes over your lap…you need to lose your buddy. Exercise helps tone your muscles and this helps making your cells receptive more to the insulin you make….so walk a little more…this is one of the first things I tell patients…if possible increase your activity…but if you have medical conditions that limits your activity…we can figure out something to help you after your M.D.'s OK you doing some physical activity.

I am 64 years mature and I lift small weights daily starting with 6 lbs doing 4 reps of 25 bicep curls and 2 sets of overhead lifts and switching to a 25 lbs weights doing 2 sets of 25 overhead lifts. Since I have a bad back, I can’t run… if I can do can most people. My 80 yrs mature patients use water bottles half filled with water to do their bicep curls.

An estimated 800,000 adult New Yorkers - more than one in every eight - now have diabetes . . . New York, perhaps more than any other big city, harbors all the ingredients for a continued epidemic . . large numbers of the poor and obese . . it has a growing population of . . Asians, who can develop it at much lower weights than people of other races . . . It is a city of immigrants . . an aging population, a food supply spiked with sugars and fats, and a culture that promotes overeating and discourages exercise.
Click HERE for more info.

Diabetes once diagnosed belongs to you. You are the adult, you get to make your decisions. If you want to learn more how to live with this disease without the complications you will. I tell the wife, husband or significant other not to nag, you are not his or her mother or father. You will change your relationship if you nag, remember how you felt when your MOM nagged at you. Just don’t buy junk food. Buy fruits, vegetable he or she likes, buy fat free yogurt, sugar free puddings if he or she has to have sweets. Go for walks…don’t eat late dinners. All those calories will be stored as fat if not used, and how much exercise do you do after 7 P.M?

If you drink a little wine, make sure you have food in your stomach, might cause your blood sugars to go down(hypoglycemia)) if you are on diabetes meds. A lttle wine is not a 12 oz glass. If you smoke….well smoking is not good for your diabetes and costs too much…get a nicotine patch, save your money and buy yourself a gift at the end of the year.

Notice I didn’t say old…for some people old means can’t do…and we all can do some exercise. I have some patients doing wall push ups, I do these as it is easier than getting down on the floor. For those of you younger without medical problems that limit your activity, brisk walking is the best ….then a little light weight training. For those of you who are young and able…go to the gym 3X a week and continue brisk walking.

Diabetes Symposium at the Joslin Diabetes Center—April 2005
East Meets West—NY Times by Marc Santora- 2006
National Diabetes Fact Sheet-2005
American Diabetes Association
Diabetes and related Complications, 2nd Edition by M.K. Ansari, PHD
Rapid Reference for Nurses…Nutrition by Nancie Herbold and Sari Edelstein--2007

Some of the things you must do when you have diabetes is get a yearly vision checkup with an Ophthalmologist, see your MD with Log Book in hand every 3 months, get Dental checkups every 6 months, see a Podiatrist if you have thick toe nails that need trimming, numbness in your feet, and attend free diabetes classes when able.

There is no cure for diabetes…herbal meds, folk lore meds only will take money out of your pocket, and will not help you. If someone offers a cure…keep your money. This is just a brief overlay on diabetes in the Asian American community. In order to help control diabetes you must first learn what it is and how it affects your body.

Will continue in the next session where I will go over blood sugar goals for different ages, cholesterol, triglycerides, high blood pressure, vision and nutrition and more about complications.

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