SOADI Frontline Training - CAMH - Nicotine Dependence Clinic
SOADI Frontline Training - CAMH - Nicotine Dependence Clinic
SOADI Frontline Training - CAMH - Nicotine Dependence Clinic
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Spring 2010<br />
<strong>SOADI</strong> <strong>Frontline</strong> <strong>Training</strong><br />
Southern Ontario Aboriginal Diabetes Initiative | 8 Clairmont St Thorold ON L2V 1R1
<strong>SOADI</strong> FRONTLINE TRAINING 2<br />
The goal of the <strong>SOADI</strong> <strong>Frontline</strong> <strong>Training</strong> is to facilitate diabetes<br />
education to frontline workers in the First Nations, Inuit, and Métis<br />
communities across Southern Ontario. The 2009 National<br />
Aboriginal Diabetes Association (NADA) annual conference’s theme<br />
was “restoring balance.” An important component of wellness and<br />
balance is missing from today’s mainstream diabetes education.<br />
The <strong>SOADI</strong> <strong>Frontline</strong> <strong>Training</strong> is intended to focus on the<br />
significance of balance and wellness in our individual lives. The<br />
purpose is to give practical diabetes education, but also to highlight<br />
the importance of leading by example—change, after all, starts from<br />
within you.<br />
The purpose of <strong>SOADI</strong> <strong>Frontline</strong><br />
<strong>Training</strong> is to emphasize the<br />
importance of leading by<br />
example. Change, after all,<br />
starts from within you.<br />
The information which is being shared is a collection of knowledge<br />
from various sources including speakers, articles, teachings, and<br />
other Aboriginal and diabetes organizations. The <strong>SOADI</strong> <strong>Frontline</strong><br />
<strong>Training</strong> is a living curriculum that will continuously evolve.<br />
A huge thank you and appreciated acknowledgement to Marilyn<br />
Junnila from Ka:nen Our Children Our Future and Alta Fenton for<br />
all of their support. It is because of supporters like you that <strong>SOADI</strong><br />
is able to collaborate and enhance diabetes wellness education and<br />
training. With the help of our partnership, <strong>SOADI</strong>’s five-day Diabetes<br />
Wellness <strong>Training</strong> was able to implement the Ka:nen<br />
MenoBimaadziwin, Taking care of Ourselves and Our Families resource<br />
and facilitator’s manuals, while combining <strong>SOADI</strong>s resources. This<br />
partnership continues to lay groundwork for <strong>SOADI</strong>’s diabetes<br />
education element of the Diabetes Wellness Curriculum.<br />
An overwhelming nya weh and acknowledgement to <strong>SOADI</strong>’s<br />
grandmother Renee Thomas Hill and her insights of the teachings<br />
of the 13 Moons to explain the concepts of health and well-being<br />
needed, “focusing on the interconnectedness with the cycles of<br />
nature, the Creator’s gifts and the spirits of the universe.”<br />
(Haudenosaunee Runner, Spring 2002, p 6). This shared knowledge<br />
will be the foundation of the diabetes wellness element of the<br />
<strong>SOADI</strong> Diabetes Wellness Curriculum.<br />
An exciting partnership with the Sexsmith Farm and their fantastic<br />
9-week program Garden Babies is anticipated to begin in June. This<br />
upcoming shared skills and knowledge of organic farming,<br />
gathering, cultivating, preparation, and preserving will be influential<br />
in the development of the Diabetes Wellness Curriculum.
<strong>SOADI</strong> FRONTLINE TRAINING 3<br />
Table of Contents<br />
Table of Contents ....................................................................................................................... 3<br />
What is Diabetes? ....................................................................................................................... 5<br />
Objectives ............................................................................................................................. 5<br />
Background ........................................................................................................................... 5<br />
Diagnosis .............................................................................................................................. 5<br />
Types .................................................................................................................................... 6<br />
Signs and Symptoms ............................................................................................................... 6<br />
Prevention ............................................................................................................................. 7<br />
Risk Factors ........................................................................................................................... 7<br />
Diabetes Management ................................................................................................................ 8<br />
Objectives ............................................................................................................................. 8<br />
Adapting to Life with Diabetes .................................................................................................. 8<br />
Cultural Context ..................................................................................................................... 9<br />
How to Manage .................................................................................................................... 10<br />
Keys to Health ...................................................................................................................... 12<br />
Setting Goals ....................................................................................................................... 12<br />
Complications .......................................................................................................................... 14<br />
Objectives ........................................................................................................................... 14<br />
Effects ................................................................................................................................. 14<br />
Diabetes and Complication Prevention .................................................................................... 14<br />
Nutrition................................................................................................................................... 16<br />
Objectives ........................................................................................................................... 16<br />
Canada’s Food Guide ............................................................................................................ 16<br />
Understanding Food .............................................................................................................. 16<br />
Healthy Plate ....................................................................................................................... 19<br />
Healthy Snacking .................................................................................................................. 19<br />
Physical Activity ....................................................................................................................... 21<br />
Objectives ........................................................................................................................... 21<br />
Understanding Physical Activity .............................................................................................. 21<br />
Sedentary Lifestyle Risks ........................................................................................................ 21<br />
Benefits ............................................................................................................................... 22<br />
Three Types of Activity ........................................................................................................... 22<br />
Active Living ........................................................................................................................ 23<br />
Small Change, Big Difference! ................................................................................................ 23<br />
Important Considerations ...................................................................................................... 24
<strong>SOADI</strong> FRONTLINE TRAINING 4<br />
Proper Foot Care ...................................................................................................................... 25<br />
Objectives ........................................................................................................................... 25<br />
Diabetes’ Effects .................................................................................................................. 25<br />
Assessment and Risk Screening .............................................................................................. 25<br />
Reflexology .......................................................................................................................... 26<br />
Chiropody ............................................................................................................................ 27<br />
Preventing Foot Care Complications ....................................................................................... 27<br />
<strong>SOADI</strong> Holistic Foot Care Program .......................................................................................... 28<br />
Stress ....................................................................................................................................... 29<br />
Objectives ........................................................................................................................... 29<br />
Definition ............................................................................................................................ 29<br />
Factors of Stress ................................................................................................................... 29<br />
Symptoms of Diabetes-Related Stress ...................................................................................... 30<br />
Tobacco Cessation ................................................................................................................... 32<br />
Objectives ........................................................................................................................... 32<br />
Traditional Use ..................................................................................................................... 32<br />
Tobacco versus <strong>Nicotine</strong> ........................................................................................................ 32<br />
Smoking and Diabetes ........................................................................................................... 33<br />
<strong>SOADI</strong>’s Partnership with TEACH ............................................................................................ 34<br />
Children, Youth, and Gestational Diabetes ............................................................................... 36<br />
Objectives ........................................................................................................................... 36<br />
Healthy Lifestyle ................................................................................................................... 36<br />
Gestational Diabetes ............................................................................................................. 36<br />
Active for Life ....................................................................................................................... 37<br />
Youth at Risk ........................................................................................................................ 37<br />
References ............................................................................................................................... 39<br />
Disclaimer ........................................................................................................................... 41
<strong>SOADI</strong> FRONTLINE TRAINING 5<br />
What is Diabetes?<br />
Objectives<br />
By the end of this training session, participants will:<br />
• Understand how diabetes affects our bodies, minds, spirits, and<br />
emotions.<br />
• Understand how diabetes affects First Nations, Inuit, and Métis<br />
communities.<br />
Diabetes prevalence is three to<br />
five times higher among<br />
Aboriginal people than among<br />
the general Canadian population.<br />
Health Canada 2009<br />
Background<br />
When we eat, our bodies break down food into a sugar called<br />
glucose. This sugar is our main source of fuel and travels to all<br />
parts of our bodies through the blood.<br />
Insulin, a hormone produced by the pancreas, helps the sugar<br />
enter into our cells. Some sugar is left in our blood as a back-up<br />
supply. This sugar is referred to as our blood sugar and the amount<br />
can be measured by a simple test.<br />
Figure 1 The pancreas is the<br />
body’s insulin-production centre.<br />
High blood sugar can result in one of two circumstances:<br />
1. When our pancreases cannot produce enough insulin.<br />
2. When our bodies do not use insulin properly.<br />
If the body’s cells do not use enough sugar and too much is left in<br />
the blood, the result is a chronic disease called diabetes mellitus<br />
(or just diabetes).<br />
Diagnosis<br />
Diabetes is diagnosed by blood tests designed to check your bloodglucose<br />
level. These tests fall into one of three categories:<br />
• FBS—a fasting blood glucose.<br />
• RBS—a random blood glucose.<br />
• OGTT—an oral glucose tolerance test.<br />
Figure 2 The blue circle has<br />
been the universal symbol for<br />
diabetes since 2006.
<strong>SOADI</strong> FRONTLINE TRAINING 6<br />
Types<br />
There are four main types of diabetes:<br />
Prediabetes<br />
Prediabetes occurs when blood-glucose levels are higher than<br />
normal but not as high as are found in diabetic individuals. This<br />
state is referred to as impaired glucose tolerance (IGT) or impaired<br />
fasting glucose (IFG). Prediabetic individuals are at an increased<br />
risk of developing diabetes but can reduce this risk by eating<br />
healthily, exercising regularly, and maintaining a healthy body<br />
weight.<br />
Type 1<br />
Type 1 diabetes occurs when the pancreas stops producing insulin.<br />
It often occurs during childhood through young adulthood and the<br />
person living with type 1 diabetes will require insulin injections for<br />
the rest of his or her life. Type 1 diabetes used to be referred to as<br />
juvenile diabetes.<br />
Type 2<br />
Type 2 is the most common type of diabetes and usually develops<br />
during adulthood. It occurs when our insulin is not working<br />
properly, or our pancreases don’t produce enough insulin.<br />
Gestational<br />
Gestational diabetes occurs during pregnancy and usually goes<br />
away after the individual gives birth. Gestational diabetes affects up<br />
to 18% of Aboriginal women and increases both the mother and<br />
child’s risk of developing type 2 diabetes in the future.<br />
While type 2 diabetes is<br />
generally considered to be a<br />
disease that affects adults, we<br />
have seen an increase in<br />
children as young as six<br />
developing the disease.<br />
Signs and Symptoms<br />
There are several signs and symptoms that could indicate that a<br />
person has developed diabetes:<br />
• Unusual thirst.<br />
• Extreme fatigue.<br />
• Blurred vision.<br />
• Frequent urination.<br />
• Headaches.<br />
• Cuts that won’t heal.<br />
• Weight loss or gain.<br />
• Tingling in hands, legs, and feet.<br />
Figure 3 Headaches, fatigue, and<br />
blurred vision can be signs of<br />
diabetes.
<strong>SOADI</strong> FRONTLINE TRAINING 7<br />
People suffering from these symptoms should consider a diabetes<br />
test. They must also be aware that a person living with diabetes will<br />
sometimes exhibit no symptoms at all.<br />
Prevention<br />
Since type 2 diabetes is often determined by lifestyle choices,<br />
people can work to prevent it and/or its complications by being<br />
more active and eating healthy balanced meals.<br />
Being active for just 30 minutes<br />
a day can reduce a person’s risk<br />
of developing diabetes by 50%.<br />
Risk Factors<br />
There are several risk factors associated with the development of<br />
type 2 diabetes about which we can do little or nothing. These<br />
include:<br />
• Being of Aboriginal ancestry.<br />
• Being 40 years of age or older.<br />
• Having family members with diabetes.<br />
• Having had gestational diabetes.<br />
• Giving birth to a large baby (>9lbs).<br />
Fortunately, there are a number of modifiable risk factors that can<br />
help reduce both our risk of developing type 2 diabetes, as well as<br />
the complications that can result from the disease:<br />
• Quit smoking.<br />
• Work to lower high blood pressure.<br />
• Lose weight, if overweight.<br />
• Avoid abdominal obesity (pot belly).<br />
• Reduce stress.<br />
• Include sufficient fruits and vegetables in diet.<br />
• Increase physical activity.<br />
• Avoid alcohol consumption.<br />
Figure 4 Losing weight is one way<br />
to reduce the risk of developing<br />
type 2 diabetes.<br />
If we choose to disregard the necessary behavior modifications, we<br />
increase our chances of developing type 2 diabetes and/or<br />
complications. This is especially true if we compound issues.
<strong>SOADI</strong> FRONTLINE TRAINING 8<br />
Diabetes Management<br />
Objectives<br />
By the end of this training session, participants will:<br />
• Understand the stages individuals go through when they are<br />
first diagnosed with diabetes.<br />
• Be aware of the steps individuals must take in order to<br />
effectively manage their diabetes.<br />
Adapting to Life with Diabetes<br />
A blood glucose test will determine if an individual has diabetes.<br />
Being diagnosed with diabetes is not the end of the world but it is<br />
an emotional experience and it may be difficult to accept.<br />
There are five stages an individual will likely undergo on the path to<br />
acceptance. These stages are commonly referred to as the five<br />
stages of grief:<br />
1. Shock or denial.<br />
2. Anger and resentment.<br />
3. Withdrawal and/or depression.<br />
4. Bargaining.<br />
5. Acceptance or adaption.<br />
During this period, the newly diagnosed individual needs a<br />
supportive environment. On the way to acceptance of the diagnosis,<br />
he or she may start to consider making healthier lifestyle changes.<br />
There are five different stages that bring about a lasting change in<br />
behaviour:<br />
1. Precontemplation—considering making a change at some point<br />
in the future.<br />
2. Contemplation—thinking about making a change in the next six<br />
months.<br />
3. Preparation—getting ready for a change in the immediate<br />
future.<br />
4. Action—making the change.<br />
5. Maintenance—working to prevent undoing the change that he or<br />
she has made.<br />
Being diagnosed with diabetes<br />
can be an opportunity to<br />
make positive changes, live a<br />
healthy life, and become an<br />
example to others.<br />
Precontemplation<br />
Contemplation<br />
Preparation<br />
Action<br />
Maintenance<br />
Figure 5 Transtheoretical model
<strong>SOADI</strong> FRONTLINE TRAINING 9<br />
Practically speaking, there are a number of steps that one must<br />
take in order to make change. These must happen as part of the<br />
stages involved in making the positive change:<br />
1. Learn more about diabetes.<br />
2. Express feelings.<br />
3. Assess unhealthy behaviour and its effects.<br />
4. Commit to change.<br />
5. Control and remove.<br />
6. Find community/organization support.<br />
Cultural Context<br />
The Aboriginal people’s traditional ways of living and strength are<br />
effective tools to manage diabetes. Spiritually, we understand that<br />
we are responsible for taking care of our physical bodies first.<br />
Positive lifestyle choices can help our families, our communities,<br />
and us.<br />
The Medicine Wheel is a sacred circle of life’s<br />
healing journey. It is a symbol of all creation:<br />
• Four races.<br />
• Four colours.<br />
• Four seasons.<br />
• Four directions.<br />
• Four elements (earth, sky, water, and fire).<br />
• Four medicines (cedar, sage, tobacco, and<br />
sweetgrass).<br />
The Medicine Wheel becomes more real and visible<br />
when used to help create change and healing. It<br />
brings life balance physically, emotionally, mentally,<br />
and spiritually.<br />
Figure 6 Diabetes Medicine Wheel to<br />
Healing and Wellness (Peggy Monague,<br />
<strong>SOADI</strong>)<br />
Being diagnosed with diabetes can be very emotional for people.<br />
Using the Diabetes Medicine Wheel to Healing and Wellness,<br />
individuals can relate to and comply with management and control<br />
of their diabetes, as well as visualize a path to healthy choices and<br />
lifestyle changes.<br />
Awareness<br />
• Share a story and name the loss.<br />
• Grieving cycle—shock, anger, depression, bargaining, and<br />
acceptance through talking and listening.
<strong>SOADI</strong> FRONTLINE TRAINING 10<br />
• Coming to terms with having diabetes and being truly honest.<br />
Education<br />
• New beginning and thoughts about living with diabetes.<br />
• Learn about diabetes, its risk factors, its complications, and<br />
how to manage and treat it.<br />
• Seek support from family, friends, health care teams, and Elder.<br />
Self-Help<br />
• Understand diabetes. Begin and comply with treatment and<br />
management.<br />
• Depending on the individual, counselling may be necessary.<br />
• Encouragement and support is essential.<br />
Wholeness<br />
• The individual comes to terms with and accepts their diagnosis<br />
and adapts to living with diabetes in a positive way.<br />
• Understand the true meaning of healing the mind, body, and<br />
spirit.<br />
Isolation<br />
• Living with diabetes is not easy. It is difficult to follow a daily<br />
regiment so at any time an individual can go into these feelings<br />
of fear, anger, alienation, and loneliness.<br />
The arrows in the Diabetes Medicine Wheel to Healing and<br />
Wellness also serve an important function. They remind us that<br />
when a person falls into a box, there is a way out with tools and<br />
coping skills in place. With these supports in place, it’s easier for<br />
the diabetic to start again or continue in the circle of life.<br />
How to Manage<br />
Diabetes is a serious, chronic disease for which there is no cure.<br />
However, good diabetes management will prevent or delay the<br />
onset of complications.<br />
Working with the help of your family and friends, Elder, community,<br />
and diabetes health-care team, you can gain control of your<br />
diabetes. Always remember, you are the one in control and you are<br />
the most important person on this team.<br />
Good diabetes management requires special attention to food,<br />
exercise, monitoring, and medication.<br />
Figure 7 Diabetes Management Team
<strong>SOADI</strong> FRONTLINE TRAINING 11<br />
Food<br />
Healthy eating is a vital part of diabetes management because it<br />
helps people maintain healthy weights and can help delay the onset<br />
of complications. Traditional foods such as wild meat, fish, plants,<br />
and berries are positive additions to the person living with diabetes’<br />
diet.<br />
We are taught that food is medicine. It is therefore important to<br />
nourish our bodies with the proper amounts. This helps us maintain<br />
our spiritual, emotional, physical, and mental health. Healthy eating<br />
includes:<br />
Figure 8 Traditional foods like<br />
berries are a great addition to a<br />
person living with diabetes' diet.<br />
• Three meals per day at around the same time every day.<br />
• Meals served four to six hours apart with healthy snacks<br />
between meals.<br />
• Foods low in fat, salt, and sugar.<br />
• High-fibre foods.<br />
• Using Canada’s Food Guide to help make good food choices.<br />
• Paying attention to portion sizes.<br />
Exercise<br />
Exercise plays an important role in effective diabetes management.<br />
It helps blood flow for a stronger heart, builds strong bones and<br />
muscles, helps us maintain a healthy weight, reduces stress, lowers<br />
blood sugars, and lifts our spirits.<br />
Finding an enjoyable activity is essential, as it should be something<br />
that we do every day. It is also a good idea to exercise after meals.<br />
Monitoring<br />
Good blood-glucose levels decrease the risk of complications. It is<br />
therefore important to:<br />
• Test regularly, at different times of the day.<br />
• Before meals, levels should be 4-7<br />
• 2+ hours after a meal should be 4-7<br />
• 1-2 hours after a meal should be 4-10<br />
• Target ranges may differ for individuals. We are all unique.<br />
• Record levels in a journal to see progress, trends, etc.<br />
• Test if you are not feeling well or if you feel you are having a low<br />
blood sugar reaction.<br />
Taking responsibility and ensuring that we learn how to manage our<br />
blood-glucose levels will help to delay or prevent the onset of<br />
complications.<br />
Figure 9 Keeping track of testing<br />
allows us to view progress.
<strong>SOADI</strong> FRONTLINE TRAINING 12<br />
Medication<br />
Healthy food and exercise may not be enough to keep blood glucose<br />
levels under control. When this happens, your doctor may<br />
recommend you start on medication.<br />
There are four different types of pills you could be prescribed:<br />
1. Glyburide—makes the pancreas work harder to create more<br />
insulin.<br />
2. Metformin—helps the body use glucose better.<br />
3. Gluconorm—stimulates the pancreas to secrete insulin when<br />
needed.<br />
4. Avandia—works to reduce insulin resistance, helping the body<br />
to use insulin better.<br />
Figure 10 Medication may be<br />
necessary for effective diabetes<br />
management.<br />
Keys to Health<br />
The keys to health are consistent for all people living with diabetes:<br />
• Exercise regularly.<br />
• Maintain a healthy weight.<br />
• Maintain good control of blood sugars.<br />
• Take medications/insulin as prescribed by your doctor.<br />
• Eat a balanced diet.<br />
• Get regular check-ups with your health-care team.<br />
• Be happy, stress free, and take care of your spirit.<br />
• Be smoke-free.<br />
• Find your spiritual, mental, emotional, and physical balance.<br />
Setting Goals<br />
Goal-setting can help individuals make positive changes. To make<br />
our goals less overwhelming, we must take small steps that we lay<br />
out in an action plan.<br />
Figure 11 Effective diabetes<br />
management requires finding<br />
balance in all aspects of one’s<br />
life.<br />
SMART Goals<br />
Smart goals are:<br />
• Specific—what is it that we want to do?<br />
• Measurable—how will we know when we’ve achieved it?<br />
• Achievable—how are we going to do this?<br />
• Realistic—is this something that we can realistically achieve?<br />
• Time-specific—how long will we allow ourselves to accomplish<br />
this?
<strong>SOADI</strong> FRONTLINE TRAINING 13<br />
When combined with defined tactics, SMART goals provide a<br />
realistic benchmark and plan for individuals making change.<br />
Making this plan solidifies the goals and makes the individual<br />
setting the goal accountable for the outcome.<br />
Example: Set one physical-activity goal and indicate three simple<br />
tactics that will be used to accomplish each goal.<br />
GOAL<br />
To be able to bend down and touch toes within two weeks by<br />
performing a series of stretches every day, both at home and in the<br />
workplace.<br />
TACTICS<br />
Stretch each morning after waking up, before doing anything else.<br />
Stretch at work on breaks and after lunch-hour workouts.<br />
Stretch in the evening, even if I’m watching a TV program.<br />
SPECIFIC<br />
To increase flexibility enough to reach my toes<br />
when I bend down, while keeping my legs straight.<br />
Figure 12 The best way<br />
to ensure that you<br />
achieve your goals is to<br />
make sure they are<br />
achievable.<br />
MEASUREABLE<br />
Monitor distance reached each time,<br />
and aim to reach further the next time.<br />
ACHIEVABLE<br />
Ask a friend to help me with new stretching<br />
techniques.<br />
REALISTIC<br />
Ensure that I make progress each and every<br />
time I stretch.<br />
TIME-SPECIFIC<br />
I will be able to achieve my goal in two<br />
weeks.
<strong>SOADI</strong> FRONTLINE TRAINING 14<br />
Complications<br />
Objectives<br />
By the end of this training session, participants will:<br />
• Understand the complications resulting from diabetes.<br />
• Realize complications’ impact on our minds, bodies, spirits,<br />
and emotions.<br />
• Identify methods of complication prevention.<br />
Effects<br />
Excessive blood glucose over a long period of<br />
time can cause diabetes-related problems.<br />
These complications can affect almost every<br />
part of the body:<br />
• Brain (stroke).<br />
• Eyes (blindness).<br />
• Nervous system.<br />
• Circulatory system (high blood pressure).<br />
• Obesity.<br />
• Heart.<br />
• Kidneys.<br />
• Sexual dysfunction.<br />
• Feet (amputation due to poor circulation).<br />
Figure 13 Some of diabetes’ complications have serious<br />
complications of their own.<br />
Diabetes and Complication Prevention<br />
White/North/Mental<br />
Knowledge is power. It is important that we learn all that we can<br />
about living and maintaining a healthy lifestyle. We should ask<br />
questions, as well as attend workshops and conferences. We can<br />
seek further knowledge from Elders and Traditional Healers.<br />
Seeking answers empowers us.<br />
• Learn all about diabetes and what to do to prevent it, as well as<br />
its complications.<br />
• Learn about healthy eating and being active.<br />
• Learn how to maintain a healthy weight.<br />
• Learn how to make healthy lifestyle choices.<br />
Figure 14 Diabetes Prevention<br />
Medicine Wheel
<strong>SOADI</strong> FRONTLINE TRAINING 15<br />
Yellow/East/Spiritual<br />
Do things that lift the spirit such as, attending and participating in<br />
ceremonies, giving thanks to the Creator for what he has given us,<br />
praying, drumming, singing, and dancing. By observing nature and<br />
going on nature walks, we can keep in touch with the Creator.<br />
• Connect to Mother Earth.<br />
• Participate in traditional ceremonies and fests.<br />
• Respect Elders and traditions.<br />
• Eat healthy foods and be active.<br />
• Accept body size and shape.<br />
• Love yourself for who you are.<br />
• Laugh and enjoy life.<br />
Figure 15 Dancing and<br />
giving thanks to the<br />
Creator helps lift our<br />
spirits.<br />
Red/South/Emotional<br />
Laugh, cry, and share what’s on your mind with someone you<br />
respect and trust. Keeping a journal and singing also helps to<br />
reduce stress.<br />
• Take responsibility for your health and well-being.<br />
• Participate in Healing Circles.<br />
• Use healthy coping skills by talking and being active.<br />
• Recognize that you are unique and a gift from the Creator.<br />
• Feel good about your size and shape.<br />
Figure 16 Keep laughing to<br />
reduce stress.<br />
Black/West/Physical<br />
Take part in daily activity such as walking, dancing, skipping,<br />
baseball, or hockey. Eat three balanced meals and healthy snacks<br />
each day. Test blood sugars and make regular doctor visits. Take<br />
medications and inject insulin as directed.<br />
• Eat to nourish your body.<br />
• Be active to keep your body strong.<br />
• Maintain a healthy body weight by balancing healthy eating with<br />
physical activity.<br />
Figure 17 Take care of your<br />
physical being to keep diabetes'<br />
complications to a minimum.
<strong>SOADI</strong> FRONTLINE TRAINING 16<br />
Nutrition<br />
Objectives<br />
By the end of this training session, participants will:<br />
• Know about proper nutrition.<br />
• Understand the special diets people living with diabetes should<br />
follow.<br />
Canada’s Food Guide<br />
Canada’s Food Guide will help:<br />
When you enter a grocery store<br />
today, you see more highcalorie,<br />
high-fat choices in three<br />
minutes than our ancestors<br />
saw in a lifetime.<br />
David Sobel, MD<br />
Director of Patient Education &<br />
Health Promotion<br />
Kaiser Permanente<br />
• Meet your daily needs of vitamins, minerals, and other<br />
nutrients.<br />
• Reduce your risk of obesity, type 2 diabetes, heart disease, and<br />
other chronic illness.<br />
• Contribute to your overall health and vitality.<br />
Canada’s Food Guide for First Nations, Inuit and Métis:<br />
• Compliments Canada’s Food Guide.<br />
• Based on current evidence<br />
• Meets recommended nutrition intakes<br />
• Promotes health and wellness while preventing chronic disease<br />
• Includes both traditional and purchased foods<br />
Understanding Food<br />
Serving—a standardized way of measuring food. This measurement<br />
differs depending on the kind of food. It is the amount<br />
recommended by the Canada Food Guide, for example.<br />
Portion—the actual amount of food we eat. It may be more or less<br />
than a serving.<br />
Figure 18 Our traditional foods can all<br />
be part of a healthy diet.
<strong>SOADI</strong> FRONTLINE TRAINING 17<br />
Fruit and Vegetables (Frozen, Fresh or Canned)<br />
Fruits and vegetables are high in nutrients such as vitamins (e.g. A,<br />
B, and C), minerals (e.g. potassium and magnesium), and fibre. In<br />
addition, they are usually low in fat and calories.<br />
In order to get the most nutrients, we should try to eat one dark<br />
green and one orange vegetable each day. Also, we should choose<br />
fruits and vegetables with little or no added fat, sugar (avoid heavy<br />
syrups), or salt. Lastly, it’s best to eat vegetables and fruit more<br />
often than drink their juices.<br />
Children Teens Adults<br />
2‐3 4‐8 9‐13 14‐18 Years 19‐50 Years 51+ Years<br />
Girls and Boys Female Male Female Male Female Male<br />
4 5 6 7 8 7‐8 8‐10 7 7<br />
Table 1 Recommended Number of Fruit and Vegetable Servings per Day<br />
Sample Servings<br />
• ½ cup vegetables (dark green, orange, or other)<br />
• ½ cup cooked or 1 cup raw leafy vegetables/wild plants<br />
• ½ cup fruit or berries<br />
• 1 piece fruit<br />
• ½ cup 100% juice<br />
Grain Products<br />
Grain products provide fibre, vitamins, and iron. They are typically<br />
low in fat. We should choose whole grain products as often as<br />
possible, as well as those that are lower in fat, sugar, and salt.<br />
Children Teens Adults<br />
2‐3 4‐8 9‐13 14‐18 Years 19‐50 Years 51+ Years<br />
Girls and Boys Female Male Female Male Female Male<br />
3 4 6 6 7 6‐7 8 6 7<br />
Table 2 Recommended Number of Grain Products Servings per Day<br />
Sample Servings<br />
• 1 slice bread<br />
• 35 g bannock<br />
• 30 g cold cereal<br />
• ¾ cup hot cereal<br />
• ½ cup cooked pasta<br />
• ½ cup cooked rice (white, brown, or wild)
<strong>SOADI</strong> FRONTLINE TRAINING 18<br />
Milk and Alternatives<br />
Milk products provide calcium, vitamins A and D, protein,<br />
phosphorus, and magnesium. We should try to drink two cups of<br />
skim, 1%, or 2% milk each day. Soy beverages are an alternative<br />
when we don’t drink milk.<br />
Children Teens Adults<br />
2‐3 4‐8 9‐13 14‐18 Years 19‐50 Years 51+ Years<br />
Girls and Boys Female Male Female Male Female Male<br />
2 2 3‐4 3‐4 3‐4 2 2 3 3<br />
Table 3 Recommended Number of Milk & Alternatives Servings per Day<br />
Sample Servings<br />
• 1 cup milk/soy beverage<br />
• ¾ cup yogurt<br />
• 1.5 oz. cheese<br />
Meat and Alternatives<br />
Meat and alternatives provide protein, vitamin B, and zinc. We<br />
should choose to eat:<br />
• Meat alternatives such as beans, lentils, and tofu more often.<br />
• At least two servings of fish each week.<br />
• Lean meat and alternatives prepared with little or no added fat<br />
or salt.<br />
• Meat with visible fat trimmed.<br />
• Poultry with skin removed.<br />
• Roasted, baked, or poached meat with little or no fat.<br />
• Wild game, which contains less fat than commercially-available<br />
meat.<br />
Children Teens Adults<br />
2‐3 4‐8 9‐13 14‐18 Years 19‐50 Years 51+ Years<br />
Girls and Boys Female Male Female Male Female Male<br />
1 1 1‐2 2 3 2 3 2 3<br />
Table 4 Recommended Number of Meat and Alternatives Servings per Day<br />
Sample Servings<br />
• ½ cup traditional meat or wild game<br />
• ½ cup fish or shellfish<br />
• ½ cup lean meat or poultry<br />
• 2 eggs<br />
• ½ cup cooked beans<br />
• 2 tbsp peanut butter
<strong>SOADI</strong> FRONTLINE TRAINING 19<br />
Healthy Plate<br />
To create a healthy plate, take a medium-sized plate and fill:<br />
• A half of the plate with vegetables and fruit.<br />
• A quarter of the plate with starch foods.<br />
• A quarter of the plate with protein foods.<br />
Tips for Portion Control<br />
• Eat within two hours of waking up to boost metabolism.<br />
• Eat three balanced meals every day, with healthy snacks in<br />
between.<br />
• To prevent overeating, do not eat foods directly out of a bag or<br />
a container. Place the desired portion on a plate or in a bowl<br />
and put the bag or container away.<br />
• Try not to eat in front of the TV or computer.<br />
• Wait 20 minutes before a second helping to ensure hunger.<br />
Stop eating when no longer hungry.<br />
• Try sharing portions at restaurants; restaurant-sized portions<br />
are often bigger than necessary to satisfy our hunger.<br />
• Avoid “eyes are bigger than stomach” syndrome.<br />
Figure 19 Healthy Plate<br />
Healthy Snacking<br />
Healthy snacking is good for us because it:<br />
• Gives us energy to keep us balanced<br />
throughout the day.<br />
• Helps our minds focus and concentrate.<br />
• Helps our body get all its nutrients.<br />
• Helps us meet our daily food serving<br />
requirements.<br />
• Helps keep our blood sugars level.<br />
• Prevents us from getting hungry in<br />
between meals.<br />
Tips for Healthy Snacking<br />
• Have healthy snacks prepared; for<br />
example, wash and cut fruits and Figure 20 The Five “White Gifts” (Jan Longboat)<br />
vegetables when you purchase them.<br />
• Create serving-sized snacks in bags or<br />
containers so they’re ready to go.<br />
• Try to buy only healthy snacks. Eat sugary and/or salty snacks<br />
in moderation.
<strong>SOADI</strong> FRONTLINE TRAINING 20<br />
• Try to stay away from processed and packaged snacks.<br />
• Keep healthy snacks nearby at work and home in order to<br />
prevent eating unhealthy snacks.<br />
• Read labels.<br />
• Beware of marketing!<br />
• “Now you can eat the whole bag without feeling guilty....”<br />
• “No Trans Fat”<br />
• “Made with Real Fruit”<br />
• “All Natural”
<strong>SOADI</strong> FRONTLINE TRAINING 21<br />
Physical Activity<br />
Objectives<br />
• By the end of this training session, participants will:<br />
• Understand the physical activity needs for people living with<br />
diabetes.<br />
Understanding Physical Activity<br />
Physical activity can be described as any bodily movement that<br />
enhances health.<br />
Exercise—a form of physical activity that is planned, structured,<br />
repetitive, and performed with the clear goal of improving health or<br />
fitness.<br />
Fitness—the ability to carry out ordinary tasks without unjustified<br />
fatigue, and with adequate energy to enjoy spare time, as well as<br />
respond to emergencies. It includes a number of components<br />
including cardio-respiratory endurance (aerobic power), skeletalmuscle<br />
endurance, skeletal-muscle strength, skeletal-muscle power,<br />
flexibility, balance, speed of movement, reaction time, and body<br />
composition.<br />
Figure 21 Physical activity can<br />
take place in a traditional<br />
aerobics class at the gym or<br />
while pulling weeds from your<br />
flower beds.<br />
Sedentary Lifestyle Risks<br />
Remember, any amount of exercise is better than none at all. An<br />
inactive lifestyle is associated with many health risks including:<br />
• Premature death.<br />
• Heart disease.<br />
• Obesity.<br />
• High-blood pressure.<br />
• Type 2 diabetes.<br />
• Osteoporosis.<br />
• Stroke.<br />
• Depression.<br />
• Colon cancer.<br />
Figure 22 A sedentary<br />
lifestyle could result in illness<br />
or premature death.
<strong>SOADI</strong> FRONTLINE TRAINING 22<br />
Benefits<br />
In terms of type 2 diabetes prevention, the benefits of regular<br />
exercise are extensive:<br />
• Improved health and fitness which promotes continued<br />
independent living in later life.<br />
• Better posture and balance.<br />
• Improved self-esteem and -confidence.<br />
• Weight control.<br />
• Stronger muscles and bones.<br />
• Increased energy.<br />
• Stress reduction and relaxation.<br />
• Improved blood pressure control.<br />
• Strengthens heart and improves circulation.<br />
• Improved sleep patterns.<br />
• Better moods and uplifting.<br />
Figure 23 Regular exercise can<br />
lower blood pressure.<br />
There are additional benefits for those who have been diagnosed<br />
with diabetes:<br />
• Reduced blood-glucose levels.<br />
• Improved circulation to arms and legs.<br />
• Possible reduction in or stoppage of insulin medication.<br />
• Reduced risk of complications.<br />
Three Types of Activity<br />
Endurance—strengthen heart, lungs, and circulatory system, which<br />
increases energy levels. Examples include walking, yard and garden<br />
work, cycling, skating, tennis, and dancing. These activities should<br />
be performed four to seven days a week.<br />
Flexibility—also known as stretching. These activities increase<br />
range of motion and make movement easier by helping to relax<br />
muscles and keeping joints mobile. Examples include gardening,<br />
mopping the floor, bowling, yoga, curling, and dance. Perform these<br />
types of activities four to seven days a week.<br />
Strength—improves muscle and bone strength, improves posture,<br />
and helps in the prevention of diseases like osteoporosis. These<br />
activities involve using the muscles against some type of resistance.<br />
Examples include lifting and carrying groceries, climbing stairs,<br />
push-ups, and weight training. Perform these types of activities two<br />
to four days a week.
<strong>SOADI</strong> FRONTLINE TRAINING 23<br />
Active Living<br />
Active living means integrating exercise into your everyday life<br />
through common activities. This is especially important for those<br />
who don’t have time for structured exercise or sports.<br />
Many everyday activities can offer health benefits depending on the<br />
length of time and energy spent while doing them. For example, 60<br />
minutes of light activity is needed to be of benefit to your health<br />
while 30 to 60 minutes of moderate or 20 to 30 minutes of vigorous<br />
activity will provide comparable benefit.<br />
Below are some common household activities as compared to<br />
structured, recreational activities at light and moderate intensity.<br />
Very Light Effort Light Effort Moderate Effort Vigorous Effort Maximum Effort<br />
Strolling<br />
Dusting<br />
60 minutes 30‐60 Minutes 20‐30 Minutes<br />
Light walking<br />
Volleyball<br />
Easy gardening<br />
Stretching<br />
Brisk walking<br />
Biking<br />
Raking leaves<br />
Swimming<br />
Dancing<br />
Water aerobics<br />
Range Needed to Stay Healthy<br />
Aerobics<br />
Jogging<br />
Hockey<br />
Basketball<br />
Fast swimming<br />
Fast dancing<br />
Sprinting<br />
Racing<br />
Small Change, Big Difference!<br />
Small changes in your day-to-day life can go a long way to making a<br />
difference to your health:<br />
• Take the stairs whenever possible. This includes at work, the<br />
mall, hotels, or other large buildings. Avoid elevators and<br />
escalators unless you have physical limitations that make them<br />
necessary, or are pressed for time.<br />
• Walk or bike instead of driving, if reasonable.<br />
• Use work breaks wisely. Take a walk alone or invite co-workers<br />
along. Lunch can be divided into 30 minutes for activity and 30<br />
minutes to enjoy eating your lunch.<br />
• Wake up and stretch! Stretch anytime, anywhere, even at work.<br />
Decrease your risk of injury by increasing your flexibility!<br />
• Drink about eight glasses of water per day to stay hydrated.<br />
Sometimes when we think we are hungry, we are actually<br />
thirsty! Drink water before, during, and after activity. Make<br />
water your beverage of choice over pop and sweetened juices.
<strong>SOADI</strong> FRONTLINE TRAINING 24<br />
Important Considerations<br />
The most important thing that you can do before starting an<br />
exercise routine or if you have any concerns about the status of<br />
your health is to consult your physician.<br />
Once you have determined that you will start exercising, keep the<br />
following in mind:<br />
• Wear comfortable shoes.<br />
• Always wear some kind of medical information device like a<br />
MedicAlert bracelet or necklace.<br />
• Start slowly and then gradually increase duration or intensity<br />
(one at a time, not both at same time).<br />
• Pay close attention to blood-glucose levels before, during, and<br />
many hours after activity.<br />
• Drink water before, during and after activity.<br />
• Always carry some form of fast-acting carbohydrate with you in<br />
case you need to treat low blood glucose (hypoglycemia). This<br />
could include glucose tablets or a candy, such as Lifesavers.<br />
• If you decide to lift weights as part of your strength training, be<br />
sure to consult with a qualified exercise specialist first.<br />
• Stop exercising if you experience any type of pain (muscle pain,<br />
chest pain, etc.).<br />
• Do not exercise if you are ill or your diabetes management is<br />
unstable.<br />
• If you take insulin, it is best not to exercise when it is peaking.<br />
Your blood glucose may drop during, immediately after, or<br />
many hours after the activity is finished.<br />
• Challenge yourself safely. For example, walking briskly can<br />
increase the heart rate, cause light perspiration, and<br />
comfortable shortness of breath. All of these conditions indicate<br />
adequate intensity. The amount of time it takes one person to<br />
reach these indicators can vary greatly from person to person.<br />
Figure 24 Before starting an<br />
exercise plan, be sure to visit<br />
your doctor.
<strong>SOADI</strong> FRONTLINE TRAINING 25<br />
Proper Foot Care<br />
Objectives<br />
By the end of this training session, participants will:<br />
• Understand the principles of proper foot care.<br />
• Understand the importance of our feet.<br />
Diabetes’ Effects<br />
Too much sugar in the blood causes cells to stick together and<br />
become locked in the blood vessels causing blockages. These<br />
blockages can then cause:<br />
• Poor circulation—limits the blood flow carrying food and<br />
oxygen from your heart to the rest of your body, especially your<br />
feet. This affects the body’s ability to heal itself which ultimately<br />
encourages infection. Because the body responds slower, it has<br />
trouble getting healthy blood to the infected areas.<br />
• Neuropathy—a condition resulting in the loss of sensation, or<br />
nerve damage, due to decreased blood flow. The early stages of<br />
neuropathy cause tingly feelings in the feet.<br />
• Complications—kidney disease affects proteins that are<br />
involved in wound-healing, and eye damage can make it difficult<br />
to check for foot damage daily.<br />
Your feet walk upon the earth<br />
and through this, your spirit is<br />
connected to the Universe.<br />
Jenny Wallace<br />
Cherokee, North Carolina<br />
History of Reflexology<br />
Assessment and Risk Screening<br />
A person living with diabetes is at risk to develop foot complications<br />
when he or she is not:<br />
• Effectively managing diabetes.<br />
• Controlling blood-sugar levels.<br />
• Taking medication properly.<br />
• Exercising.<br />
• Being careful about what is put into the body.<br />
A person is at high risk if he or she has a:<br />
• History of foot ulcers—a wound that took two or more weeks to<br />
heal.<br />
• Loss of sensation—cannot feel monofilament test.
<strong>SOADI</strong> FRONTLINE TRAINING 26<br />
• Loss of circulation—pulses found in foot, Doppler or manually,<br />
history of lower-limb pain on exertion that is relieved with rest.<br />
• Callus present on soles or toes of feet or an abnormal foot<br />
shape (e.g. claw, hammer toes, bunion, obvious bony<br />
prominence, Charcot's foot or joint).<br />
A person living with diabetes may not be a good candidate for selfcare<br />
if he or she:<br />
• Is unable to see and reach the bottom of his or her feet.<br />
• Does not have someone who has been taught to perform<br />
appropriate foot care or an inspection.<br />
• Wears poor-fitting footwear—shoes that are too narrow or short,<br />
don’t have toe protection, have a rough or worn interior, or have<br />
uneven wear on sole or heel.<br />
• Has not received any foot care education before.<br />
• Does not check feet often or ever.<br />
• Does not report foot problems to health-care team.<br />
• Does not take steps to reduce risk of injury.<br />
Reflexology<br />
Reflexology is a focused-pressure technique directed at the feet. It<br />
is based on the premise that there are zones and reflexes on<br />
different parts of the body which correspond to and relate to our<br />
body parts, glands, and organs.<br />
There are approximately 7200 nerve endings on the feet, and these<br />
relate to various organs and glands within the body. A mirror image<br />
of the body has been mapped on the feet and pressure applied on<br />
specific reflex points on the feet can affect the corresponding part<br />
of the body.<br />
Benefits<br />
• Reflexology treatments provide deep relaxation, which reduces<br />
stress and tension that can aggravate diabetes.<br />
• Enhances circulation—blood and lymph circulation improves,<br />
blood supply to the cells is improved, and the release of toxins<br />
from the body is increased.<br />
• Stimulates pancreas and liver which helps in maintaining blood<br />
sugar level and reduces blood sugar fluctuations.<br />
Figure 25 Our ancestors used<br />
reflexology as a part of their<br />
healing, and we continue in their<br />
footsteps.<br />
Following a reflexology treatment it is important for the next few<br />
days to drink plenty of water and rest whenever possible.
<strong>SOADI</strong> FRONTLINE TRAINING 27<br />
Chiropody<br />
Chiropodists specialize in foot care.<br />
• Primary care—common foot conditions, foot infections, foot<br />
deformities, orthotic requirements, and diagnosis of foot<br />
disease and disorders.<br />
• Diabetic foot assessments—checks the general health of the<br />
feet which includes circulation and sensation.<br />
<strong>SOADI</strong> Foot Care <strong>Clinic</strong> includes a screening and education on nail<br />
care, ingrown toe nails, corns, callus, plantar warts, and skin<br />
problems.<br />
Preventing Foot Care Complications<br />
Foot care professionals play a vital role in diabetes care:<br />
• See a professional every six weeks.<br />
• Do not cut your own toe nails.<br />
• Do not remove your own corns or calluses.<br />
• Wear proper footwear.<br />
• Address any foot concerns immediately.<br />
Controlling blood-glucose levels will help maintain healthy<br />
feet:<br />
• Eat regular balanced meals from each of the four food<br />
groups.<br />
• Drinking plenty of water.<br />
• Take medications and insulin as prescribed.<br />
• Control stress levels.<br />
• Reduce sugar, salt, white flour, high-fat dairy, and lard.<br />
• Family Doctor for HbA1C every three months.<br />
• Check blood glucose regularly.<br />
Possible<br />
amputation.<br />
Increased<br />
risk of<br />
infection.<br />
Diabetes<br />
Out of<br />
Control:<br />
Neuropathy<br />
Healing<br />
takes the<br />
body longer.<br />
Decreased<br />
sensation in<br />
the feet.<br />
Increased<br />
risk of<br />
injury.<br />
Figure 26 Foot care is extremely important for<br />
people living with diabetes. Neglecting the feet can<br />
ultimately lead to amputation.<br />
Love your feet daily:<br />
• Using a mirror, look at your feet closely every day.<br />
• Wash your feet with lukewarm water and mild soap, dry them<br />
(especially between toes), and moisturize then (but not between<br />
toes) daily.<br />
• Look for changes daily (e.g. blisters, bruisers, red areas, open<br />
sores, etc.).
<strong>SOADI</strong> FRONTLINE TRAINING 28<br />
<strong>SOADI</strong> Holistic Foot Care Program<br />
Since February 2006 the <strong>SOADI</strong> Holistic Foot Care Program has<br />
provided foot-care services to Aboriginal people affected by or at<br />
risk of developing diabetes and its complications. We strive to<br />
empower individuals through education, self-care resources,<br />
professional assessment and referrals.<br />
<strong>SOADI</strong> uses a holistic model and provides the following:<br />
<strong>SOADI</strong>’s holistic model<br />
supports a continuum of<br />
seamless foot care services<br />
based on education, screening,<br />
care, treatment, support and<br />
data collection. It strengthens<br />
local community collaboration.<br />
1. Holistic Foot Care Events<br />
Outreach and Assessment Focus<br />
2. Ongoing Foot Care Locations<br />
Programs and Ongoing Self Care Focus<br />
3. Individual Foot Care Subsidies<br />
Access to include Home Visits; Ongoing Care and Support for<br />
those who do not qualify for other funding sources.<br />
4. Self Care and Prevention Resources<br />
Self Care DVD, Gift Bag: Mirror and Diabetic Socks<br />
All services are accessed through the local Diabetes Prevention<br />
Coordinators or by calling the Head Office.
<strong>SOADI</strong> FRONTLINE TRAINING 29<br />
Stress<br />
Objectives<br />
By the end of this training session, participants will:<br />
• Acknowledge how stress can affect diabetes and our bodies.<br />
• Recognize different types of activities to relieve stress.<br />
Definition<br />
Stress results from how we react to a situation emotionally,<br />
physically, mentally, and/or spiritually. Everyone will react<br />
differently. How the situation will affect us is dependent on our<br />
attitude (positive or negative).<br />
For example, when responding to a high blood-glucose reading, one<br />
person may get upset. This can cause blood-glucose levels to<br />
increase and puts the individual out of balance, both emotionally<br />
and mentally. Another person may react differently and take the<br />
steps necessary to lower blood-glucose levels by going for a walk.<br />
This positive reaction decreases the individual’s stress and lowers<br />
blood-glucose levels while also rebalancing him- or herself.<br />
Factors of Stress<br />
Stress is a normal part of life, and does not cause diabetes;<br />
however, it can worsen the symptoms. Changes in our lives can be a<br />
major source of stress. Our body reacts to these changes with<br />
physical, emotional, spiritual, and mental responses. Being out of<br />
balance in one of these areas can cause serious problems for<br />
people with diabetes.<br />
It’s stressful:<br />
• To learn you have diabetes.<br />
• Being told you have complications of diabetes.<br />
• To monitor your health every day.<br />
• Not being able to afford the medical supplies for proper<br />
diabetes care.<br />
• To inject insulin every day.<br />
• To lose someone.
<strong>SOADI</strong> FRONTLINE TRAINING 30<br />
We mustn’t let stress build up and rule our lives. We can never<br />
underestimate the power to choose the way we react. We can<br />
choose to maintain a positive frame of mind.<br />
Start with positive self-talk:<br />
• I can do it!<br />
• I am open to new ways.<br />
• I have control of my life.<br />
Symptoms of Diabetes-Related Stress<br />
Some signs of diabetes-related stress are:<br />
• Blood-glucose increases.<br />
• High blood pressure.<br />
• Fatigue.<br />
• High pulse rate.<br />
• Dilated pupils.<br />
• Shallow breathing.<br />
• Sleep disruptions due to an inability to relax.<br />
Prolonged stress can lead to:<br />
• Feeling tired (“burnout”).<br />
• Depression.<br />
• Over- or under-eating.<br />
• Illness and accidents.<br />
• Headaches.<br />
• Smoking and drinking.<br />
• Muscle tension.<br />
• Heart attacks.<br />
Finding ways to relieve stress will be your own worthwhile personal<br />
journey. A few ideas to reduce stress include:<br />
• Good blood-glucose control.<br />
• Drumming and singing.<br />
• Eating healthy, balanced meals.<br />
• Smudging with sweetgrass, sage, or cedar.<br />
• Praying to the Creator or a higher power.<br />
• Participating in healing circles.<br />
• Meditation or yoga.<br />
• Speaking to an Elder.<br />
• Walking.
<strong>SOADI</strong> FRONTLINE TRAINING 31<br />
• Dancing at a pow wow.<br />
• Joining a support group.<br />
• Reading.<br />
• Learning to say no (setting boundaries).<br />
• Positive self-talk.<br />
• Live one day at a time.<br />
• Humour—laugh often. Laughter is one of the best medicines for<br />
relieving stress. It lowers your blood pressure, your heart rate<br />
becomes more regular, and stress decreases.<br />
It is important to remember to enjoy life and embrace it for what it<br />
is—a wonderful, but at times a stressful, journey.
<strong>SOADI</strong> FRONTLINE TRAINING 32<br />
Commercial Tobacco Cessation<br />
Objectives<br />
By the end of this training session, participants will:<br />
• Understand the differences between traditional and modern<br />
tobacco.<br />
• Realize how these differences affect people living with diabetes.<br />
Traditional Use<br />
Tobacco has many traditional uses:<br />
• Prayer.<br />
• Ceremonies.<br />
• Offering.<br />
• To Creator.<br />
• To each other (peoples).<br />
• To our “brothers and sisters, grandmother, grandfather”<br />
• Animals/creatures.<br />
• Sun/moon.<br />
• Creation.<br />
Tobacco and <strong>Nicotine</strong><br />
Tobacco is a plant or medicine that contains nicotine. <strong>Nicotine</strong> is<br />
not known to lead to any diseases such as chronic obstructive<br />
pulmonary disease (COPD) or cancer. It is the 4,000 other<br />
chemicals in cigarette smoke that contributes to these diseases.<br />
<strong>Nicotine</strong> is one of the major addictive components in tobacco.<br />
Figure 27 Tobacco is a<br />
medicine given by the Creator<br />
that has been exploited and<br />
abused.<br />
Carcinogens and Tobacco<br />
A carcinogen is a cancer-causing substance or agent. There are a<br />
minimum of sixteen carcinogens in unburned tobacco but more<br />
than sixty carcinogens in cigarette smoke. Some commercial<br />
tobacco companies market their cigarettes as “natural” or<br />
“organic.” It is important to know that all cigarettes contain cancercausing<br />
agents, regardless of where they are made.<br />
Figure 28 Our original instruction.
<strong>SOADI</strong> FRONTLINE TRAINING 33<br />
Smoking Youth<br />
Why are so many Aboriginal youth smoking?<br />
• Consider:<br />
• Culture (Aboriginal and non-Aboriginal).<br />
• Community, family, nation.<br />
• Media, advertising.<br />
• Economic benefits of tobacco.<br />
• Accessibility of tobacco; acceptance as a norm.<br />
• Boredom, isolation, loneliness.<br />
• Concurrent disorders (depression, substance abuse).<br />
• Peer pressure.<br />
• Or are they trying to replace something? (<strong>SOADI</strong> Grandmother,<br />
Renee Thomas Hill)<br />
Figure 29 Tobaccowise (Cancer<br />
Care Ontario, Aboriginal Tobacco<br />
Program)<br />
Impact of Tobacco<br />
What are the potential impacts (positive and negative) of<br />
manufactured tobacco on a person, their family, their community,<br />
etc.?<br />
The impacts of commercial tobacco use include:<br />
• Cigarette smoking at an early age may be a factor contributing<br />
to the high prevalence of cardiovascular disease amongst<br />
Aboriginal youth in Canada (Retnakaran et al. 2005)<br />
• The use of commercial tobacco products kills 16,000 Aboriginal<br />
people in Ontario every year (Aboriginal Cancer Care Unit<br />
2008). That means approximately two Aboriginal people die<br />
every hour of every day due to commercial tobacco use in<br />
Ontario alone!<br />
Smoking and Diabetes<br />
Did you know?<br />
• Cigarette smoking increases the risk of type 2 diabetes for all<br />
people (Foy et al., 2005; Houston et al., 2006; Carlsson et al.,<br />
2004; Sairenchi et al., 2004).<br />
• Some research suggests a linear relationship between diabetes<br />
and number of cigarettes smoked (Will et al., 2001; Houston et<br />
al., 2006); however, other studies have not found this link<br />
(Sairenchi et al., 2004; Rimm et al., 1995).<br />
• Pregnant women who smoke may also be at an increased risk of<br />
developing gestational diabetes (England et al., 2004).
<strong>SOADI</strong> FRONTLINE TRAINING 34<br />
• Smoking aggravates insulin resistance. This means that the<br />
body is producing insulin but can’t use it properly. The degree<br />
of insulin resistance is positively correlated with tobacco<br />
consumption, and the more a person smokes, the more severe<br />
their insulin resistance can be (Targher et al., 1997; Eliasson et<br />
al., 1997). The good news is that the effect of smoking on<br />
insulin absorption is reversed after only one week of not<br />
smoking (Becker et al, 2006).<br />
The combination of smoking and diabetes appears to heighten the<br />
development of macrovascular complications (Yudkin, 1993)<br />
including nephropathy, neuropathy (although not consistently<br />
(Mehler et al., 1998)), and retinopathy.<br />
Cigarette smoking increases mortality rates among individuals with<br />
diabetes (Sherman, 2005; Al-Delaimy et al., 2001); however,<br />
quitting smoking for 10+ years will eliminate the increased<br />
mortality rates associated with smoking (Al-Delaimy et al., 2002).<br />
Smoking cessation programs for people living with diabetes should<br />
be individualized and implemented with a focus on specific<br />
cognitive, behavioural, and pharmacological therapies that control<br />
weight and prevent depression (Sherman, 2005). Treatment options<br />
should include brief counselling, use of individual or group<br />
counselling and pharmacotherapy (Haire-Joshu et al. 1999).<br />
Some adverse effects of smoking are reversible:<br />
• 24 hours—risk of heart attack and stroke drop.<br />
• Three days—breathing is easier.<br />
• Two weeks—coughing improves.<br />
• One year—risk of coronary artery disease is reduced by 20-<br />
50%.<br />
• Five years—risk of stroke normalizes.<br />
• 15 years—risk of dying equal to that of a non-smoker.<br />
It’s worth quitting and it’s not as hard as you might think!<br />
Figure 30 It's never too late<br />
to quit smoking and it's<br />
always worth it.<br />
<strong>SOADI</strong>’s Partnership with TEACH<br />
TEACH is a project geared toward training health-care professionals<br />
in the public, private, and non-profit sectors who provide<br />
counselling services to people who use tobacco.
<strong>SOADI</strong> FRONTLINE TRAINING 35<br />
The program is designed to enhance knowledge and skills in the<br />
delivery of intensive tobacco cessation interventions.
<strong>SOADI</strong> FRONTLINE TRAINING 36<br />
Children, Youth, and Gestational Diabetes<br />
Objectives<br />
By the end of this training session, participants will:<br />
• Apply knowledge of what diabetes is, and how it is affecting our<br />
seven generations.<br />
• Understand what we can do about the affects of diabetes on our<br />
seven generations.<br />
Healthy Lifestyle<br />
It’s much easier to grow up physically active and eating good<br />
healthy foods as a way of life than it is to change later. However,<br />
change is possible with support and a positive attitude.<br />
• Choose a balanced meal plan.<br />
• Eat more, fibre, fruits, vegetables, and fish.<br />
• Eat in moderation.<br />
• Drink plenty of water.<br />
• Be physically active, get involved in sports, and recreational<br />
activities.<br />
• Get your family involved, go for walks after dinner, or play<br />
catch.<br />
• Go outside with your friends, play hockey, or go skating.<br />
• Walk off anger, frustration and depression.<br />
Gestational Diabetes<br />
Gestational Diabetes affects up to 3% of the general population and<br />
up to 18% of Aboriginal women. Finding out you have gestational<br />
diabetes can be very stressful.<br />
Fortunately, there are many well-informed health professionals to<br />
help answer your questions and guide you through this very<br />
important time in your life.<br />
Between 24 and 28 weeks into your pregnancy, your midwife or<br />
doctor will send you to be screened for gestational diabetes.
<strong>SOADI</strong> FRONTLINE TRAINING 37<br />
Gestational diabetes is generally managed by diet and exercise and<br />
goes away after the baby is born. Some women require insulin to<br />
control this type of diabetes.<br />
Good nutrition is the cornerstone to a healthy pregnancy. Weight<br />
gain should be slow and gradual. Smaller, more frequent, healthy<br />
meals and snacks will help. Walking after meals will also help keep<br />
blood sugars under better control.<br />
Active for Life<br />
Some ways for young people to include daily activity in their life,<br />
which can include the whole family and their friends are:<br />
• Walking.<br />
• Dancing.<br />
• Rollerblading.<br />
• Bicycling.<br />
• Running.<br />
• Berry picking.<br />
• Swimming.<br />
• Skating.<br />
• Tennis.<br />
• Skiing.<br />
• Lacrosse.<br />
• Canoeing.<br />
• Spending time outdoors during all the seasons.<br />
• Most importantly, have fun and enjoy whatever activity you do!<br />
Youth at Risk<br />
Some risk factors are:<br />
• Having a family member with diabetes puts youth and children<br />
at a higher risk.<br />
• Children born to a mother with gestational diabetes are at<br />
greater risk.<br />
The number of Aboriginal children and youth developing type 2<br />
diabetes in our communities is rising. The good news is that it’s<br />
preventable!<br />
Ways children and our youth can prevent type 2 diabetes:<br />
• Increase physical activity.
<strong>SOADI</strong> FRONTLINE TRAINING 38<br />
• Maintain a healthy weight.<br />
• Choose healthy snacks.<br />
• Eat balanced meals.<br />
• Limit screen time.
<strong>SOADI</strong> FRONTLINE TRAINING 39<br />
References<br />
2008 Physical Activity Guidelines for Americans. (2008). Washington: U.S.<br />
Department of Health and Human Services.<br />
Al-Delaimy, W. K., Manson, J. E., Solomon, C. G., Kawachi, I., Stampfer, M.<br />
J., & Hu, F. B. (2002). moking and risk of coronary heart disease among<br />
women With type 2 diabetes mellitus. Arch Intern Med , 162(3):273-279.<br />
Becker, R. H., Sha, S., Frick, A. D., & Fountaine, R. J. (2006). The effect of<br />
smoking cessation and subsequent resumption on absorption of inhaled<br />
insulin. Diabetes Care , 29(2):277-82.<br />
Cancer Care Ontario. (2008). Commercial Tobacco. Retrieved May 11,<br />
2009, from http://www.tobaccowise.com/commercial_tobacco<br />
Carlsson, S., Midthjell, K., & Grill, V. (2004). Smoking is associated with an<br />
increased risk of type 2 diabetes but a decreased risk of autoimmune<br />
diabetes in adults: an 11-year follow-up of incidence of diabetes in the<br />
Nord-Trondelag study. Diabetologia , 47(11):1953-1956.<br />
Eliasson, B., Attvall, S., Taskinen, M., & Smith, U. (1997). Smoking<br />
cessation improves insulin sensitivity in healthy middle-aged men. European<br />
Journal of <strong>Clinic</strong>al Investigation , 27(5):450-6.<br />
England, L. J., Levine, R. J., Qian, C., Soule, L. M., Schisterman, E. F., Yu,<br />
K. F., et al. (2004). Glucose tolerance and risk of gestational diabetes<br />
mellitus in nulliparous women who smoke during pregnancy. Am J<br />
Epidemiol , 160:1205-1213.<br />
Foy, C. G., Bell, R. A., Farmer, D. F., Goff, D. C., & Wagenknecht, L. E.<br />
(2005). Smoking and incidence of diabetes among US adults: findings from<br />
the Insulin Resistance Atherosclerosis Study. Diabetes Care , 28(10):2501-<br />
2507.<br />
Haire-Joshu, D., Glasgow, R., & Tibbs, T. (1999). Technical scientific review<br />
on prevention and cessation of smoking among persons with diabetes:<br />
American Diabetes Association clinical practice recommendations. Diabetes<br />
Care , 22(11):1887-1898.<br />
Handbook for Canada's Physical Activty Guide to Healthy Active Living. Public<br />
Health Agency of Canada.<br />
Houston, T. K., Person, S. D., Pletcher, M. J., Liu, K., Iribarren, C., & Kiefe,<br />
C. I. (2006). Active and passive smoking and development of glucose<br />
intolerance among young adults in a prospective cohort: CARDIA study.<br />
BMJ , 332(7549):1064-1069.
<strong>SOADI</strong> FRONTLINE TRAINING 40<br />
International Diabetes Federation. (n.d.). Retrieved March 30, 2010, from<br />
Diabetes Blue Circle Symbol: http://www.diabetesbluecircle.org/<br />
Mehler, P. S., Barrett, W. J., Biggerstaff, S. L., & Schrier, R. W. (1998).<br />
Smoking as a risk factor for nephropathy in non-insulin-dependent<br />
diabetics. Journal of General Internal Medicine , 13(12):842-845.<br />
MenoBimaadziwin - Taking Care of Ourselves and Our Families. (2009).<br />
Thunder Bay: Ka:nen.<br />
Pathway to Wellness: A Handbook for People Living with Diabetes. (2009).<br />
Winnipeg: National Aboriginal Diabetes Association.<br />
Renakaran, R., Hanley, A. J., Connelly, P. W., Harris, S. B., & Zinman, B.<br />
(2005). Cigarette smoking and cardiovascular risk factors among<br />
Aboriginal Canadian youths. Canadian Medical Association Journal , 173(8),<br />
885-889.<br />
Rimm, E. B., Chan, J., Stampfer, M. J., Colditz, G. A., & Willett, W. C.<br />
(1995). Prospective study of cigarette smoking, alcohol use, and the risk of<br />
diabetes in men, professor of epidemiology and nutrition. BMJ , 310:555-<br />
559.<br />
Sairenchi, T., Iso, H., & Nishimura, A. (2004). Cigarette smoking and risk<br />
of type 2 diabetes mellitus among middle-aged and elderly Japanese men<br />
and women. Am J Epidemiol , 160(2):158-162.<br />
Sherman, J. J. (2005). The impact of smoking and quitting smoking on<br />
patients with diabetes. Diabetes Spectrum , 18(4):202-208.<br />
Targher, G., Alberiche, M., Zenere, M. B., Bonadonna, R. C., Muggeo, M., &<br />
Bonora, E. (1997). Cigarette smoking and insulin resistance in patients<br />
with noninsulin-dependent diabetes mellitus. Journal of <strong>Clinic</strong>al<br />
Endocrinology & Metabolism , 82(11):3619-3624.<br />
Will, J. C., Galuska, D. A., & Ford, E. S. (2001). Cigarette smoking and<br />
diabetes mellitus: evidence of a positive association from a large<br />
prospective cohort study. Int J Epidemiol , 30(3):540-546.
<strong>SOADI</strong> FRONTLINE TRAINING 41<br />
Disclaimer<br />
Southern Ontario Aboriginal Diabetes Initiative (<strong>SOADI</strong>) is a nonprofit<br />
organization that is funded by the Ontario Ministry of Health<br />
and Long-term Care. The funding provides financial assistance for<br />
the development, and enhancement of culturally appropriate<br />
programs and services focusing on diabetes wellness and<br />
awareness of healthy diabetes education, prevention and<br />
management in Aboriginal communities, both on and off-reserve.<br />
All information in this resource has been provided by <strong>SOADI</strong> and<br />
has been developed with the best of care for those intended to be<br />
trained and living with diabetes. It can nevertheless not be assumed<br />
that any and all mistakes are completely excluded. By supplying<br />
this information, <strong>SOADI</strong> does not assume nor provide any form of<br />
guarantee. <strong>SOADI</strong> is not responsible for any possible incorrect<br />
information supplied. <strong>SOADI</strong> recommends that you consult your<br />
doctor or health care professional before pursuing any new diet or<br />
exercise regime.<br />
Any part of this publication may be reproduced. When it was<br />
developed, it was intended to be shared with all communities. No<br />
permission is required from <strong>SOADI</strong> however; <strong>SOADI</strong> does not take<br />
responsibility should any changes be made to the content.<br />
Please visit www.soadi.ca for regional Diabetes Prevention<br />
Coordinator contact information.