SOADI Frontline Training - CAMH - Nicotine Dependence Clinic

Spring 2010
SOADI Frontline Training
Southern Ontario Aboriginal Diabetes Initiative | 8 Clairmont St Thorold ON L2V 1R1

SOADI FRONTLINE TRAINING 2
The goal of the SOADI Frontline Training is to facilitate diabetes
education to frontline workers in the First Nations, Inuit, and Métis
communities across Southern Ontario. The 2009 National
Aboriginal Diabetes Association (NADA) annual conference’s theme
was “restoring balance.” An important component of wellness and
balance is missing from today’s mainstream diabetes education.
The SOADI Frontline Training is intended to focus on the
significance of balance and wellness in our individual lives. The
purpose is to give practical diabetes education, but also to highlight
the importance of leading by example—change, after all, starts from
within you.
The purpose of SOADI Frontline
Training is to emphasize the
importance of leading by
example. Change, after all,
starts from within you.
The information which is being shared is a collection of knowledge
from various sources including speakers, articles, teachings, and
other Aboriginal and diabetes organizations. The SOADI Frontline
Training is a living curriculum that will continuously evolve.
A huge thank you and appreciated acknowledgement to Marilyn
Junnila from Ka:nen Our Children Our Future and Alta Fenton for
all of their support. It is because of supporters like you that SOADI
is able to collaborate and enhance diabetes wellness education and
training. With the help of our partnership, SOADI’s five-day Diabetes
Wellness Training was able to implement the Ka:nen
MenoBimaadziwin, Taking care of Ourselves and Our Families resource
and facilitator’s manuals, while combining SOADIs resources. This
partnership continues to lay groundwork for SOADI’s diabetes
education element of the Diabetes Wellness Curriculum.
An overwhelming nya weh and acknowledgement to SOADI’s
grandmother Renee Thomas Hill and her insights of the teachings
of the 13 Moons to explain the concepts of health and well-being
needed, “focusing on the interconnectedness with the cycles of
nature, the Creator’s gifts and the spirits of the universe.”
(Haudenosaunee Runner, Spring 2002, p 6). This shared knowledge
will be the foundation of the diabetes wellness element of the
SOADI Diabetes Wellness Curriculum.
An exciting partnership with the Sexsmith Farm and their fantastic
9-week program Garden Babies is anticipated to begin in June. This
upcoming shared skills and knowledge of organic farming,
gathering, cultivating, preparation, and preserving will be influential
in the development of the Diabetes Wellness Curriculum.

SOADI FRONTLINE TRAINING 3
Table of Contents
Table of Contents ....................................................................................................................... 3
What is Diabetes? ....................................................................................................................... 5
Objectives ............................................................................................................................. 5
Background ........................................................................................................................... 5
Diagnosis .............................................................................................................................. 5
Types .................................................................................................................................... 6
Signs and Symptoms ............................................................................................................... 6
Prevention ............................................................................................................................. 7
Risk Factors ........................................................................................................................... 7
Diabetes Management ................................................................................................................ 8
Objectives ............................................................................................................................. 8
Adapting to Life with Diabetes .................................................................................................. 8
Cultural Context ..................................................................................................................... 9
How to Manage .................................................................................................................... 10
Keys to Health ...................................................................................................................... 12
Setting Goals ....................................................................................................................... 12
Complications .......................................................................................................................... 14
Objectives ........................................................................................................................... 14
Effects ................................................................................................................................. 14
Diabetes and Complication Prevention .................................................................................... 14
Nutrition................................................................................................................................... 16
Objectives ........................................................................................................................... 16
Canada’s Food Guide ............................................................................................................ 16
Understanding Food .............................................................................................................. 16
Healthy Plate ....................................................................................................................... 19
Healthy Snacking .................................................................................................................. 19
Physical Activity ....................................................................................................................... 21
Objectives ........................................................................................................................... 21
Understanding Physical Activity .............................................................................................. 21
Sedentary Lifestyle Risks ........................................................................................................ 21
Benefits ............................................................................................................................... 22
Three Types of Activity ........................................................................................................... 22
Active Living ........................................................................................................................ 23
Small Change, Big Difference! ................................................................................................ 23
Important Considerations ...................................................................................................... 24

SOADI FRONTLINE TRAINING 4
Proper Foot Care ...................................................................................................................... 25
Objectives ........................................................................................................................... 25
Diabetes’ Effects .................................................................................................................. 25
Assessment and Risk Screening .............................................................................................. 25
Reflexology .......................................................................................................................... 26
Chiropody ............................................................................................................................ 27
Preventing Foot Care Complications ....................................................................................... 27
SOADI Holistic Foot Care Program .......................................................................................... 28
Stress ....................................................................................................................................... 29
Objectives ........................................................................................................................... 29
Definition ............................................................................................................................ 29
Factors of Stress ................................................................................................................... 29
Symptoms of Diabetes-Related Stress ...................................................................................... 30
Tobacco Cessation ................................................................................................................... 32
Objectives ........................................................................................................................... 32
Traditional Use ..................................................................................................................... 32
Tobacco versus Nicotine ........................................................................................................ 32
Smoking and Diabetes ........................................................................................................... 33
SOADI’s Partnership with TEACH ............................................................................................ 34
Children, Youth, and Gestational Diabetes ............................................................................... 36
Objectives ........................................................................................................................... 36
Healthy Lifestyle ................................................................................................................... 36
Gestational Diabetes ............................................................................................................. 36
Active for Life ....................................................................................................................... 37
Youth at Risk ........................................................................................................................ 37
References ............................................................................................................................... 39
Disclaimer ........................................................................................................................... 41

SOADI FRONTLINE TRAINING 5
What is Diabetes?
Objectives
By the end of this training session, participants will:
• Understand how diabetes affects our bodies, minds, spirits, and
emotions.
• Understand how diabetes affects First Nations, Inuit, and Métis
communities.
Diabetes prevalence is three to
five times higher among
Aboriginal people than among
the general Canadian population.
Health Canada 2009
Background
When we eat, our bodies break down food into a sugar called
glucose. This sugar is our main source of fuel and travels to all
parts of our bodies through the blood.
Insulin, a hormone produced by the pancreas, helps the sugar
enter into our cells. Some sugar is left in our blood as a back-up
supply. This sugar is referred to as our blood sugar and the amount
can be measured by a simple test.
Figure 1 The pancreas is the
body’s insulin-production centre.
High blood sugar can result in one of two circumstances:
1. When our pancreases cannot produce enough insulin.
2. When our bodies do not use insulin properly.
If the body’s cells do not use enough sugar and too much is left in
the blood, the result is a chronic disease called diabetes mellitus
(or just diabetes).
Diagnosis
Diabetes is diagnosed by blood tests designed to check your bloodglucose
level. These tests fall into one of three categories:
• FBS—a fasting blood glucose.
• RBS—a random blood glucose.
• OGTT—an oral glucose tolerance test.
Figure 2 The blue circle has
been the universal symbol for
diabetes since 2006.

SOADI FRONTLINE TRAINING 6
Types
There are four main types of diabetes:
Prediabetes
Prediabetes occurs when blood-glucose levels are higher than
normal but not as high as are found in diabetic individuals. This
state is referred to as impaired glucose tolerance (IGT) or impaired
fasting glucose (IFG). Prediabetic individuals are at an increased
risk of developing diabetes but can reduce this risk by eating
healthily, exercising regularly, and maintaining a healthy body
weight.
Type 1
Type 1 diabetes occurs when the pancreas stops producing insulin.
It often occurs during childhood through young adulthood and the
person living with type 1 diabetes will require insulin injections for
the rest of his or her life. Type 1 diabetes used to be referred to as
juvenile diabetes.
Type 2
Type 2 is the most common type of diabetes and usually develops
during adulthood. It occurs when our insulin is not working
properly, or our pancreases don’t produce enough insulin.
Gestational
Gestational diabetes occurs during pregnancy and usually goes
away after the individual gives birth. Gestational diabetes affects up
to 18% of Aboriginal women and increases both the mother and
child’s risk of developing type 2 diabetes in the future.
While type 2 diabetes is
generally considered to be a
disease that affects adults, we
have seen an increase in
children as young as six
developing the disease.
Signs and Symptoms
There are several signs and symptoms that could indicate that a
person has developed diabetes:
• Unusual thirst.
• Extreme fatigue.
• Blurred vision.
• Frequent urination.
• Headaches.
• Cuts that won’t heal.
• Weight loss or gain.
• Tingling in hands, legs, and feet.
Figure 3 Headaches, fatigue, and
blurred vision can be signs of
diabetes.

SOADI FRONTLINE TRAINING 7
People suffering from these symptoms should consider a diabetes
test. They must also be aware that a person living with diabetes will
sometimes exhibit no symptoms at all.
Prevention
Since type 2 diabetes is often determined by lifestyle choices,
people can work to prevent it and/or its complications by being
more active and eating healthy balanced meals.
Being active for just 30 minutes
a day can reduce a person’s risk
of developing diabetes by 50%.
Risk Factors
There are several risk factors associated with the development of
type 2 diabetes about which we can do little or nothing. These
include:
• Being of Aboriginal ancestry.
• Being 40 years of age or older.
• Having family members with diabetes.
• Having had gestational diabetes.
• Giving birth to a large baby (>9lbs).
Fortunately, there are a number of modifiable risk factors that can
help reduce both our risk of developing type 2 diabetes, as well as
the complications that can result from the disease:
• Quit smoking.
• Work to lower high blood pressure.
• Lose weight, if overweight.
• Avoid abdominal obesity (pot belly).
• Reduce stress.
• Include sufficient fruits and vegetables in diet.
• Increase physical activity.
• Avoid alcohol consumption.
Figure 4 Losing weight is one way
to reduce the risk of developing
type 2 diabetes.
If we choose to disregard the necessary behavior modifications, we
increase our chances of developing type 2 diabetes and/or
complications. This is especially true if we compound issues.

SOADI FRONTLINE TRAINING 8
Diabetes Management
Objectives
By the end of this training session, participants will:
• Understand the stages individuals go through when they are
first diagnosed with diabetes.
• Be aware of the steps individuals must take in order to
effectively manage their diabetes.
Adapting to Life with Diabetes
A blood glucose test will determine if an individual has diabetes.
Being diagnosed with diabetes is not the end of the world but it is
an emotional experience and it may be difficult to accept.
There are five stages an individual will likely undergo on the path to
acceptance. These stages are commonly referred to as the five
stages of grief:
1. Shock or denial.
2. Anger and resentment.
3. Withdrawal and/or depression.
4. Bargaining.
5. Acceptance or adaption.
During this period, the newly diagnosed individual needs a
supportive environment. On the way to acceptance of the diagnosis,
he or she may start to consider making healthier lifestyle changes.
There are five different stages that bring about a lasting change in
behaviour:
1. Precontemplation—considering making a change at some point
in the future.
2. Contemplation—thinking about making a change in the next six
months.
3. Preparation—getting ready for a change in the immediate
future.
4. Action—making the change.
5. Maintenance—working to prevent undoing the change that he or
she has made.
Being diagnosed with diabetes
can be an opportunity to
make positive changes, live a
healthy life, and become an
example to others.
Precontemplation
Contemplation
Preparation
Action
Maintenance
Figure 5 Transtheoretical model

SOADI FRONTLINE TRAINING 9
Practically speaking, there are a number of steps that one must
take in order to make change. These must happen as part of the
stages involved in making the positive change:
1. Learn more about diabetes.
2. Express feelings.
3. Assess unhealthy behaviour and its effects.
4. Commit to change.
5. Control and remove.
6. Find community/organization support.
Cultural Context
The Aboriginal people’s traditional ways of living and strength are
effective tools to manage diabetes. Spiritually, we understand that
we are responsible for taking care of our physical bodies first.
Positive lifestyle choices can help our families, our communities,
and us.
The Medicine Wheel is a sacred circle of life’s
healing journey. It is a symbol of all creation:
• Four races.
• Four colours.
• Four seasons.
• Four directions.
• Four elements (earth, sky, water, and fire).
• Four medicines (cedar, sage, tobacco, and
sweetgrass).
The Medicine Wheel becomes more real and visible
when used to help create change and healing. It
brings life balance physically, emotionally, mentally,
and spiritually.
Figure 6 Diabetes Medicine Wheel to
Healing and Wellness (Peggy Monague,
SOADI)
Being diagnosed with diabetes can be very emotional for people.
Using the Diabetes Medicine Wheel to Healing and Wellness,
individuals can relate to and comply with management and control
of their diabetes, as well as visualize a path to healthy choices and
lifestyle changes.
Awareness
• Share a story and name the loss.
• Grieving cycle—shock, anger, depression, bargaining, and
acceptance through talking and listening.

SOADI FRONTLINE TRAINING 10
• Coming to terms with having diabetes and being truly honest.
Education
• New beginning and thoughts about living with diabetes.
• Learn about diabetes, its risk factors, its complications, and
how to manage and treat it.
• Seek support from family, friends, health care teams, and Elder.
Self-Help
• Understand diabetes. Begin and comply with treatment and
management.
• Depending on the individual, counselling may be necessary.
• Encouragement and support is essential.
Wholeness
• The individual comes to terms with and accepts their diagnosis
and adapts to living with diabetes in a positive way.
• Understand the true meaning of healing the mind, body, and
spirit.
Isolation
• Living with diabetes is not easy. It is difficult to follow a daily
regiment so at any time an individual can go into these feelings
of fear, anger, alienation, and loneliness.
The arrows in the Diabetes Medicine Wheel to Healing and
Wellness also serve an important function. They remind us that
when a person falls into a box, there is a way out with tools and
coping skills in place. With these supports in place, it’s easier for
the diabetic to start again or continue in the circle of life.
How to Manage
Diabetes is a serious, chronic disease for which there is no cure.
However, good diabetes management will prevent or delay the
onset of complications.
Working with the help of your family and friends, Elder, community,
and diabetes health-care team, you can gain control of your
diabetes. Always remember, you are the one in control and you are
the most important person on this team.
Good diabetes management requires special attention to food,
exercise, monitoring, and medication.
Figure 7 Diabetes Management Team

SOADI FRONTLINE TRAINING 11
Food
Healthy eating is a vital part of diabetes management because it
helps people maintain healthy weights and can help delay the onset
of complications. Traditional foods such as wild meat, fish, plants,
and berries are positive additions to the person living with diabetes’
diet.
We are taught that food is medicine. It is therefore important to
nourish our bodies with the proper amounts. This helps us maintain
our spiritual, emotional, physical, and mental health. Healthy eating
includes:
Figure 8 Traditional foods like
berries are a great addition to a
person living with diabetes' diet.
• Three meals per day at around the same time every day.
• Meals served four to six hours apart with healthy snacks
between meals.
• Foods low in fat, salt, and sugar.
• High-fibre foods.
• Using Canada’s Food Guide to help make good food choices.
• Paying attention to portion sizes.
Exercise
Exercise plays an important role in effective diabetes management.
It helps blood flow for a stronger heart, builds strong bones and
muscles, helps us maintain a healthy weight, reduces stress, lowers
blood sugars, and lifts our spirits.
Finding an enjoyable activity is essential, as it should be something
that we do every day. It is also a good idea to exercise after meals.
Monitoring
Good blood-glucose levels decrease the risk of complications. It is
therefore important to:
• Test regularly, at different times of the day.
• Before meals, levels should be 4-7
• 2+ hours after a meal should be 4-7
• 1-2 hours after a meal should be 4-10
• Target ranges may differ for individuals. We are all unique.
• Record levels in a journal to see progress, trends, etc.
• Test if you are not feeling well or if you feel you are having a low
blood sugar reaction.
Taking responsibility and ensuring that we learn how to manage our
blood-glucose levels will help to delay or prevent the onset of
complications.
Figure 9 Keeping track of testing
allows us to view progress.

SOADI FRONTLINE TRAINING 12
Medication
Healthy food and exercise may not be enough to keep blood glucose
levels under control. When this happens, your doctor may
recommend you start on medication.
There are four different types of pills you could be prescribed:
1. Glyburide—makes the pancreas work harder to create more
insulin.
2. Metformin—helps the body use glucose better.
3. Gluconorm—stimulates the pancreas to secrete insulin when
needed.
4. Avandia—works to reduce insulin resistance, helping the body
to use insulin better.
Figure 10 Medication may be
necessary for effective diabetes
management.
Keys to Health
The keys to health are consistent for all people living with diabetes:
• Exercise regularly.
• Maintain a healthy weight.
• Maintain good control of blood sugars.
• Take medications/insulin as prescribed by your doctor.
• Eat a balanced diet.
• Get regular check-ups with your health-care team.
• Be happy, stress free, and take care of your spirit.
• Be smoke-free.
• Find your spiritual, mental, emotional, and physical balance.
Setting Goals
Goal-setting can help individuals make positive changes. To make
our goals less overwhelming, we must take small steps that we lay
out in an action plan.
Figure 11 Effective diabetes
management requires finding
balance in all aspects of one’s
life.
SMART Goals
Smart goals are:
• Specific—what is it that we want to do?
• Measurable—how will we know when we’ve achieved it?
• Achievable—how are we going to do this?
• Realistic—is this something that we can realistically achieve?
• Time-specific—how long will we allow ourselves to accomplish
this?

SOADI FRONTLINE TRAINING 13
When combined with defined tactics, SMART goals provide a
realistic benchmark and plan for individuals making change.
Making this plan solidifies the goals and makes the individual
setting the goal accountable for the outcome.
Example: Set one physical-activity goal and indicate three simple
tactics that will be used to accomplish each goal.
GOAL
To be able to bend down and touch toes within two weeks by
performing a series of stretches every day, both at home and in the
workplace.
TACTICS
Stretch each morning after waking up, before doing anything else.
Stretch at work on breaks and after lunch-hour workouts.
Stretch in the evening, even if I’m watching a TV program.
SPECIFIC
To increase flexibility enough to reach my toes
when I bend down, while keeping my legs straight.
Figure 12 The best way
to ensure that you
achieve your goals is to
make sure they are
achievable.
MEASUREABLE
Monitor distance reached each time,
and aim to reach further the next time.
ACHIEVABLE
Ask a friend to help me with new stretching
techniques.
REALISTIC
Ensure that I make progress each and every
time I stretch.
TIME-SPECIFIC
I will be able to achieve my goal in two
weeks.

SOADI FRONTLINE TRAINING 14
Complications
Objectives
By the end of this training session, participants will:
• Understand the complications resulting from diabetes.
• Realize complications’ impact on our minds, bodies, spirits,
and emotions.
• Identify methods of complication prevention.
Effects
Excessive blood glucose over a long period of
time can cause diabetes-related problems.
These complications can affect almost every
part of the body:
• Brain (stroke).
• Eyes (blindness).
• Nervous system.
• Circulatory system (high blood pressure).
• Obesity.
• Heart.
• Kidneys.
• Sexual dysfunction.
• Feet (amputation due to poor circulation).
Figure 13 Some of diabetes’ complications have serious
complications of their own.
Diabetes and Complication Prevention
White/North/Mental
Knowledge is power. It is important that we learn all that we can
about living and maintaining a healthy lifestyle. We should ask
questions, as well as attend workshops and conferences. We can
seek further knowledge from Elders and Traditional Healers.
Seeking answers empowers us.
• Learn all about diabetes and what to do to prevent it, as well as
its complications.
• Learn about healthy eating and being active.
• Learn how to maintain a healthy weight.
• Learn how to make healthy lifestyle choices.
Figure 14 Diabetes Prevention
Medicine Wheel

SOADI FRONTLINE TRAINING 15
Yellow/East/Spiritual
Do things that lift the spirit such as, attending and participating in
ceremonies, giving thanks to the Creator for what he has given us,
praying, drumming, singing, and dancing. By observing nature and
going on nature walks, we can keep in touch with the Creator.
• Connect to Mother Earth.
• Participate in traditional ceremonies and fests.
• Respect Elders and traditions.
• Eat healthy foods and be active.
• Accept body size and shape.
• Love yourself for who you are.
• Laugh and enjoy life.
Figure 15 Dancing and
giving thanks to the
Creator helps lift our
spirits.
Red/South/Emotional
Laugh, cry, and share what’s on your mind with someone you
respect and trust. Keeping a journal and singing also helps to
reduce stress.
• Take responsibility for your health and well-being.
• Participate in Healing Circles.
• Use healthy coping skills by talking and being active.
• Recognize that you are unique and a gift from the Creator.
• Feel good about your size and shape.
Figure 16 Keep laughing to
reduce stress.
Black/West/Physical
Take part in daily activity such as walking, dancing, skipping,
baseball, or hockey. Eat three balanced meals and healthy snacks
each day. Test blood sugars and make regular doctor visits. Take
medications and inject insulin as directed.
• Eat to nourish your body.
• Be active to keep your body strong.
• Maintain a healthy body weight by balancing healthy eating with
physical activity.
Figure 17 Take care of your
physical being to keep diabetes'
complications to a minimum.

SOADI FRONTLINE TRAINING 16
Nutrition
Objectives
By the end of this training session, participants will:
• Know about proper nutrition.
• Understand the special diets people living with diabetes should
follow.
Canada’s Food Guide
Canada’s Food Guide will help:
When you enter a grocery store
today, you see more highcalorie,
high-fat choices in three
minutes than our ancestors
saw in a lifetime.
David Sobel, MD
Director of Patient Education &
Health Promotion
Kaiser Permanente
• Meet your daily needs of vitamins, minerals, and other
nutrients.
• Reduce your risk of obesity, type 2 diabetes, heart disease, and
other chronic illness.
• Contribute to your overall health and vitality.
Canada’s Food Guide for First Nations, Inuit and Métis:
• Compliments Canada’s Food Guide.
• Based on current evidence
• Meets recommended nutrition intakes
• Promotes health and wellness while preventing chronic disease
• Includes both traditional and purchased foods
Understanding Food
Serving—a standardized way of measuring food. This measurement
differs depending on the kind of food. It is the amount
recommended by the Canada Food Guide, for example.
Portion—the actual amount of food we eat. It may be more or less
than a serving.
Figure 18 Our traditional foods can all
be part of a healthy diet.

SOADI FRONTLINE TRAINING 17
Fruit and Vegetables (Frozen, Fresh or Canned)
Fruits and vegetables are high in nutrients such as vitamins (e.g. A,
B, and C), minerals (e.g. potassium and magnesium), and fibre. In
addition, they are usually low in fat and calories.
In order to get the most nutrients, we should try to eat one dark
green and one orange vegetable each day. Also, we should choose
fruits and vegetables with little or no added fat, sugar (avoid heavy
syrups), or salt. Lastly, it’s best to eat vegetables and fruit more
often than drink their juices.
Children Teens Adults
2‐3 4‐8 9‐13 14‐18 Years 19‐50 Years 51+ Years
Girls and Boys Female Male Female Male Female Male
4 5 6 7 8 7‐8 8‐10 7 7
Table 1 Recommended Number of Fruit and Vegetable Servings per Day
Sample Servings
• ½ cup vegetables (dark green, orange, or other)
• ½ cup cooked or 1 cup raw leafy vegetables/wild plants
• ½ cup fruit or berries
• 1 piece fruit
• ½ cup 100% juice
Grain Products
Grain products provide fibre, vitamins, and iron. They are typically
low in fat. We should choose whole grain products as often as
possible, as well as those that are lower in fat, sugar, and salt.
Children Teens Adults
2‐3 4‐8 9‐13 14‐18 Years 19‐50 Years 51+ Years
Girls and Boys Female Male Female Male Female Male
3 4 6 6 7 6‐7 8 6 7
Table 2 Recommended Number of Grain Products Servings per Day
Sample Servings
• 1 slice bread
• 35 g bannock
• 30 g cold cereal
• ¾ cup hot cereal
• ½ cup cooked pasta
• ½ cup cooked rice (white, brown, or wild)

SOADI FRONTLINE TRAINING 18
Milk and Alternatives
Milk products provide calcium, vitamins A and D, protein,
phosphorus, and magnesium. We should try to drink two cups of
skim, 1%, or 2% milk each day. Soy beverages are an alternative
when we don’t drink milk.
Children Teens Adults
2‐3 4‐8 9‐13 14‐18 Years 19‐50 Years 51+ Years
Girls and Boys Female Male Female Male Female Male
2 2 3‐4 3‐4 3‐4 2 2 3 3
Table 3 Recommended Number of Milk & Alternatives Servings per Day
Sample Servings
• 1 cup milk/soy beverage
• ¾ cup yogurt
• 1.5 oz. cheese
Meat and Alternatives
Meat and alternatives provide protein, vitamin B, and zinc. We
should choose to eat:
• Meat alternatives such as beans, lentils, and tofu more often.
• At least two servings of fish each week.
• Lean meat and alternatives prepared with little or no added fat
or salt.
• Meat with visible fat trimmed.
• Poultry with skin removed.
• Roasted, baked, or poached meat with little or no fat.
• Wild game, which contains less fat than commercially-available
meat.
Children Teens Adults
2‐3 4‐8 9‐13 14‐18 Years 19‐50 Years 51+ Years
Girls and Boys Female Male Female Male Female Male
1 1 1‐2 2 3 2 3 2 3
Table 4 Recommended Number of Meat and Alternatives Servings per Day
Sample Servings
• ½ cup traditional meat or wild game
• ½ cup fish or shellfish
• ½ cup lean meat or poultry
• 2 eggs
• ½ cup cooked beans
• 2 tbsp peanut butter

SOADI FRONTLINE TRAINING 19
Healthy Plate
To create a healthy plate, take a medium-sized plate and fill:
• A half of the plate with vegetables and fruit.
• A quarter of the plate with starch foods.
• A quarter of the plate with protein foods.
Tips for Portion Control
• Eat within two hours of waking up to boost metabolism.
• Eat three balanced meals every day, with healthy snacks in
between.
• To prevent overeating, do not eat foods directly out of a bag or
a container. Place the desired portion on a plate or in a bowl
and put the bag or container away.
• Try not to eat in front of the TV or computer.
• Wait 20 minutes before a second helping to ensure hunger.
Stop eating when no longer hungry.
• Try sharing portions at restaurants; restaurant-sized portions
are often bigger than necessary to satisfy our hunger.
• Avoid “eyes are bigger than stomach” syndrome.
Figure 19 Healthy Plate
Healthy Snacking
Healthy snacking is good for us because it:
• Gives us energy to keep us balanced
throughout the day.
• Helps our minds focus and concentrate.
• Helps our body get all its nutrients.
• Helps us meet our daily food serving
requirements.
• Helps keep our blood sugars level.
• Prevents us from getting hungry in
between meals.
Tips for Healthy Snacking
• Have healthy snacks prepared; for
example, wash and cut fruits and Figure 20 The Five “White Gifts” (Jan Longboat)
vegetables when you purchase them.
• Create serving-sized snacks in bags or
containers so they’re ready to go.
• Try to buy only healthy snacks. Eat sugary and/or salty snacks
in moderation.

SOADI FRONTLINE TRAINING 20
• Try to stay away from processed and packaged snacks.
• Keep healthy snacks nearby at work and home in order to
prevent eating unhealthy snacks.
• Read labels.
• Beware of marketing!
• “Now you can eat the whole bag without feeling guilty....”
• “No Trans Fat”
• “Made with Real Fruit”
• “All Natural”

SOADI FRONTLINE TRAINING 21
Physical Activity
Objectives
• By the end of this training session, participants will:
• Understand the physical activity needs for people living with
diabetes.
Understanding Physical Activity
Physical activity can be described as any bodily movement that
enhances health.
Exercise—a form of physical activity that is planned, structured,
repetitive, and performed with the clear goal of improving health or
fitness.
Fitness—the ability to carry out ordinary tasks without unjustified
fatigue, and with adequate energy to enjoy spare time, as well as
respond to emergencies. It includes a number of components
including cardio-respiratory endurance (aerobic power), skeletalmuscle
endurance, skeletal-muscle strength, skeletal-muscle power,
flexibility, balance, speed of movement, reaction time, and body
composition.
Figure 21 Physical activity can
take place in a traditional
aerobics class at the gym or
while pulling weeds from your
flower beds.
Sedentary Lifestyle Risks
Remember, any amount of exercise is better than none at all. An
inactive lifestyle is associated with many health risks including:
• Premature death.
• Heart disease.
• Obesity.
• High-blood pressure.
• Type 2 diabetes.
• Osteoporosis.
• Stroke.
• Depression.
• Colon cancer.
Figure 22 A sedentary
lifestyle could result in illness
or premature death.

SOADI FRONTLINE TRAINING 22
Benefits
In terms of type 2 diabetes prevention, the benefits of regular
exercise are extensive:
• Improved health and fitness which promotes continued
independent living in later life.
• Better posture and balance.
• Improved self-esteem and -confidence.
• Weight control.
• Stronger muscles and bones.
• Increased energy.
• Stress reduction and relaxation.
• Improved blood pressure control.
• Strengthens heart and improves circulation.
• Improved sleep patterns.
• Better moods and uplifting.
Figure 23 Regular exercise can
lower blood pressure.
There are additional benefits for those who have been diagnosed
with diabetes:
• Reduced blood-glucose levels.
• Improved circulation to arms and legs.
• Possible reduction in or stoppage of insulin medication.
• Reduced risk of complications.
Three Types of Activity
Endurance—strengthen heart, lungs, and circulatory system, which
increases energy levels. Examples include walking, yard and garden
work, cycling, skating, tennis, and dancing. These activities should
be performed four to seven days a week.
Flexibility—also known as stretching. These activities increase
range of motion and make movement easier by helping to relax
muscles and keeping joints mobile. Examples include gardening,
mopping the floor, bowling, yoga, curling, and dance. Perform these
types of activities four to seven days a week.
Strength—improves muscle and bone strength, improves posture,
and helps in the prevention of diseases like osteoporosis. These
activities involve using the muscles against some type of resistance.
Examples include lifting and carrying groceries, climbing stairs,
push-ups, and weight training. Perform these types of activities two
to four days a week.

SOADI FRONTLINE TRAINING 23
Active Living
Active living means integrating exercise into your everyday life
through common activities. This is especially important for those
who don’t have time for structured exercise or sports.
Many everyday activities can offer health benefits depending on the
length of time and energy spent while doing them. For example, 60
minutes of light activity is needed to be of benefit to your health
while 30 to 60 minutes of moderate or 20 to 30 minutes of vigorous
activity will provide comparable benefit.
Below are some common household activities as compared to
structured, recreational activities at light and moderate intensity.
Very Light Effort Light Effort Moderate Effort Vigorous Effort Maximum Effort
Strolling
Dusting
60 minutes 30‐60 Minutes 20‐30 Minutes
Light walking
Volleyball
Easy gardening
Stretching
Brisk walking
Biking
Raking leaves
Swimming
Dancing
Water aerobics
Range Needed to Stay Healthy
Aerobics
Jogging
Hockey
Basketball
Fast swimming
Fast dancing
Sprinting
Racing
Small Change, Big Difference!
Small changes in your day-to-day life can go a long way to making a
difference to your health:
• Take the stairs whenever possible. This includes at work, the
mall, hotels, or other large buildings. Avoid elevators and
escalators unless you have physical limitations that make them
necessary, or are pressed for time.
• Walk or bike instead of driving, if reasonable.
• Use work breaks wisely. Take a walk alone or invite co-workers
along. Lunch can be divided into 30 minutes for activity and 30
minutes to enjoy eating your lunch.
• Wake up and stretch! Stretch anytime, anywhere, even at work.
Decrease your risk of injury by increasing your flexibility!
• Drink about eight glasses of water per day to stay hydrated.
Sometimes when we think we are hungry, we are actually
thirsty! Drink water before, during, and after activity. Make
water your beverage of choice over pop and sweetened juices.

SOADI FRONTLINE TRAINING 24
Important Considerations
The most important thing that you can do before starting an
exercise routine or if you have any concerns about the status of
your health is to consult your physician.
Once you have determined that you will start exercising, keep the
following in mind:
• Wear comfortable shoes.
• Always wear some kind of medical information device like a
MedicAlert bracelet or necklace.
• Start slowly and then gradually increase duration or intensity
(one at a time, not both at same time).
• Pay close attention to blood-glucose levels before, during, and
many hours after activity.
• Drink water before, during and after activity.
• Always carry some form of fast-acting carbohydrate with you in
case you need to treat low blood glucose (hypoglycemia). This
could include glucose tablets or a candy, such as Lifesavers.
• If you decide to lift weights as part of your strength training, be
sure to consult with a qualified exercise specialist first.
• Stop exercising if you experience any type of pain (muscle pain,
chest pain, etc.).
• Do not exercise if you are ill or your diabetes management is
unstable.
• If you take insulin, it is best not to exercise when it is peaking.
Your blood glucose may drop during, immediately after, or
many hours after the activity is finished.
• Challenge yourself safely. For example, walking briskly can
increase the heart rate, cause light perspiration, and
comfortable shortness of breath. All of these conditions indicate
adequate intensity. The amount of time it takes one person to
reach these indicators can vary greatly from person to person.
Figure 24 Before starting an
exercise plan, be sure to visit
your doctor.

SOADI FRONTLINE TRAINING 25
Proper Foot Care
Objectives
By the end of this training session, participants will:
• Understand the principles of proper foot care.
• Understand the importance of our feet.
Diabetes’ Effects
Too much sugar in the blood causes cells to stick together and
become locked in the blood vessels causing blockages. These
blockages can then cause:
• Poor circulation—limits the blood flow carrying food and
oxygen from your heart to the rest of your body, especially your
feet. This affects the body’s ability to heal itself which ultimately
encourages infection. Because the body responds slower, it has
trouble getting healthy blood to the infected areas.
• Neuropathy—a condition resulting in the loss of sensation, or
nerve damage, due to decreased blood flow. The early stages of
neuropathy cause tingly feelings in the feet.
• Complications—kidney disease affects proteins that are
involved in wound-healing, and eye damage can make it difficult
to check for foot damage daily.
Your feet walk upon the earth
and through this, your spirit is
connected to the Universe.
Jenny Wallace
Cherokee, North Carolina
History of Reflexology
Assessment and Risk Screening
A person living with diabetes is at risk to develop foot complications
when he or she is not:
• Effectively managing diabetes.
• Controlling blood-sugar levels.
• Taking medication properly.
• Exercising.
• Being careful about what is put into the body.
A person is at high risk if he or she has a:
• History of foot ulcers—a wound that took two or more weeks to
heal.
• Loss of sensation—cannot feel monofilament test.

SOADI FRONTLINE TRAINING 26
• Loss of circulation—pulses found in foot, Doppler or manually,
history of lower-limb pain on exertion that is relieved with rest.
• Callus present on soles or toes of feet or an abnormal foot
shape (e.g. claw, hammer toes, bunion, obvious bony
prominence, Charcot's foot or joint).
A person living with diabetes may not be a good candidate for selfcare
if he or she:
• Is unable to see and reach the bottom of his or her feet.
• Does not have someone who has been taught to perform
appropriate foot care or an inspection.
• Wears poor-fitting footwear—shoes that are too narrow or short,
don’t have toe protection, have a rough or worn interior, or have
uneven wear on sole or heel.
• Has not received any foot care education before.
• Does not check feet often or ever.
• Does not report foot problems to health-care team.
• Does not take steps to reduce risk of injury.
Reflexology
Reflexology is a focused-pressure technique directed at the feet. It
is based on the premise that there are zones and reflexes on
different parts of the body which correspond to and relate to our
body parts, glands, and organs.
There are approximately 7200 nerve endings on the feet, and these
relate to various organs and glands within the body. A mirror image
of the body has been mapped on the feet and pressure applied on
specific reflex points on the feet can affect the corresponding part
of the body.
Benefits
• Reflexology treatments provide deep relaxation, which reduces
stress and tension that can aggravate diabetes.
• Enhances circulation—blood and lymph circulation improves,
blood supply to the cells is improved, and the release of toxins
from the body is increased.
• Stimulates pancreas and liver which helps in maintaining blood
sugar level and reduces blood sugar fluctuations.
Figure 25 Our ancestors used
reflexology as a part of their
healing, and we continue in their
footsteps.
Following a reflexology treatment it is important for the next few
days to drink plenty of water and rest whenever possible.

SOADI FRONTLINE TRAINING 27
Chiropody
Chiropodists specialize in foot care.
• Primary care—common foot conditions, foot infections, foot
deformities, orthotic requirements, and diagnosis of foot
disease and disorders.
• Diabetic foot assessments—checks the general health of the
feet which includes circulation and sensation.
SOADI Foot Care Clinic includes a screening and education on nail
care, ingrown toe nails, corns, callus, plantar warts, and skin
problems.
Preventing Foot Care Complications
Foot care professionals play a vital role in diabetes care:
• See a professional every six weeks.
• Do not cut your own toe nails.
• Do not remove your own corns or calluses.
• Wear proper footwear.
• Address any foot concerns immediately.
Controlling blood-glucose levels will help maintain healthy
feet:
• Eat regular balanced meals from each of the four food
groups.
• Drinking plenty of water.
• Take medications and insulin as prescribed.
• Control stress levels.
• Reduce sugar, salt, white flour, high-fat dairy, and lard.
• Family Doctor for HbA1C every three months.
• Check blood glucose regularly.
Possible
amputation.
Increased
risk of
infection.
Diabetes
Out of
Control:
Neuropathy
Healing
takes the
body longer.
Decreased
sensation in
the feet.
Increased
risk of
injury.
Figure 26 Foot care is extremely important for
people living with diabetes. Neglecting the feet can
ultimately lead to amputation.
Love your feet daily:
• Using a mirror, look at your feet closely every day.
• Wash your feet with lukewarm water and mild soap, dry them
(especially between toes), and moisturize then (but not between
toes) daily.
• Look for changes daily (e.g. blisters, bruisers, red areas, open
sores, etc.).

SOADI FRONTLINE TRAINING 28
SOADI Holistic Foot Care Program
Since February 2006 the SOADI Holistic Foot Care Program has
provided foot-care services to Aboriginal people affected by or at
risk of developing diabetes and its complications. We strive to
empower individuals through education, self-care resources,
professional assessment and referrals.
SOADI uses a holistic model and provides the following:
SOADI’s holistic model
supports a continuum of
seamless foot care services
based on education, screening,
care, treatment, support and
data collection. It strengthens
local community collaboration.
1. Holistic Foot Care Events
Outreach and Assessment Focus
2. Ongoing Foot Care Locations
Programs and Ongoing Self Care Focus
3. Individual Foot Care Subsidies
Access to include Home Visits; Ongoing Care and Support for
those who do not qualify for other funding sources.
4. Self Care and Prevention Resources
Self Care DVD, Gift Bag: Mirror and Diabetic Socks
All services are accessed through the local Diabetes Prevention
Coordinators or by calling the Head Office.

SOADI FRONTLINE TRAINING 29
Stress
Objectives
By the end of this training session, participants will:
• Acknowledge how stress can affect diabetes and our bodies.
• Recognize different types of activities to relieve stress.
Definition
Stress results from how we react to a situation emotionally,
physically, mentally, and/or spiritually. Everyone will react
differently. How the situation will affect us is dependent on our
attitude (positive or negative).
For example, when responding to a high blood-glucose reading, one
person may get upset. This can cause blood-glucose levels to
increase and puts the individual out of balance, both emotionally
and mentally. Another person may react differently and take the
steps necessary to lower blood-glucose levels by going for a walk.
This positive reaction decreases the individual’s stress and lowers
blood-glucose levels while also rebalancing him- or herself.
Factors of Stress
Stress is a normal part of life, and does not cause diabetes;
however, it can worsen the symptoms. Changes in our lives can be a
major source of stress. Our body reacts to these changes with
physical, emotional, spiritual, and mental responses. Being out of
balance in one of these areas can cause serious problems for
people with diabetes.
It’s stressful:
• To learn you have diabetes.
• Being told you have complications of diabetes.
• To monitor your health every day.
• Not being able to afford the medical supplies for proper
diabetes care.
• To inject insulin every day.
• To lose someone.

SOADI FRONTLINE TRAINING 30
We mustn’t let stress build up and rule our lives. We can never
underestimate the power to choose the way we react. We can
choose to maintain a positive frame of mind.
Start with positive self-talk:
• I can do it!
• I am open to new ways.
• I have control of my life.
Symptoms of Diabetes-Related Stress
Some signs of diabetes-related stress are:
• Blood-glucose increases.
• High blood pressure.
• Fatigue.
• High pulse rate.
• Dilated pupils.
• Shallow breathing.
• Sleep disruptions due to an inability to relax.
Prolonged stress can lead to:
• Feeling tired (“burnout”).
• Depression.
• Over- or under-eating.
• Illness and accidents.
• Headaches.
• Smoking and drinking.
• Muscle tension.
• Heart attacks.
Finding ways to relieve stress will be your own worthwhile personal
journey. A few ideas to reduce stress include:
• Good blood-glucose control.
• Drumming and singing.
• Eating healthy, balanced meals.
• Smudging with sweetgrass, sage, or cedar.
• Praying to the Creator or a higher power.
• Participating in healing circles.
• Meditation or yoga.
• Speaking to an Elder.
• Walking.

SOADI FRONTLINE TRAINING 31
• Dancing at a pow wow.
• Joining a support group.
• Reading.
• Learning to say no (setting boundaries).
• Positive self-talk.
• Live one day at a time.
• Humour—laugh often. Laughter is one of the best medicines for
relieving stress. It lowers your blood pressure, your heart rate
becomes more regular, and stress decreases.
It is important to remember to enjoy life and embrace it for what it
is—a wonderful, but at times a stressful, journey.

SOADI FRONTLINE TRAINING 32
Commercial Tobacco Cessation
Objectives
By the end of this training session, participants will:
• Understand the differences between traditional and modern
tobacco.
• Realize how these differences affect people living with diabetes.
Traditional Use
Tobacco has many traditional uses:
• Prayer.
• Ceremonies.
• Offering.
• To Creator.
• To each other (peoples).
• To our “brothers and sisters, grandmother, grandfather”
• Animals/creatures.
• Sun/moon.
• Creation.
Tobacco and Nicotine
Tobacco is a plant or medicine that contains nicotine. Nicotine is
not known to lead to any diseases such as chronic obstructive
pulmonary disease (COPD) or cancer. It is the 4,000 other
chemicals in cigarette smoke that contributes to these diseases.
Nicotine is one of the major addictive components in tobacco.
Figure 27 Tobacco is a
medicine given by the Creator
that has been exploited and
abused.
Carcinogens and Tobacco
A carcinogen is a cancer-causing substance or agent. There are a
minimum of sixteen carcinogens in unburned tobacco but more
than sixty carcinogens in cigarette smoke. Some commercial
tobacco companies market their cigarettes as “natural” or
“organic.” It is important to know that all cigarettes contain cancercausing
agents, regardless of where they are made.
Figure 28 Our original instruction.

SOADI FRONTLINE TRAINING 33
Smoking Youth
Why are so many Aboriginal youth smoking?
• Consider:
• Culture (Aboriginal and non-Aboriginal).
• Community, family, nation.
• Media, advertising.
• Economic benefits of tobacco.
• Accessibility of tobacco; acceptance as a norm.
• Boredom, isolation, loneliness.
• Concurrent disorders (depression, substance abuse).
• Peer pressure.
• Or are they trying to replace something? (SOADI Grandmother,
Renee Thomas Hill)
Figure 29 Tobaccowise (Cancer
Care Ontario, Aboriginal Tobacco
Program)
Impact of Tobacco
What are the potential impacts (positive and negative) of
manufactured tobacco on a person, their family, their community,
etc.?
The impacts of commercial tobacco use include:
• Cigarette smoking at an early age may be a factor contributing
to the high prevalence of cardiovascular disease amongst
Aboriginal youth in Canada (Retnakaran et al. 2005)
• The use of commercial tobacco products kills 16,000 Aboriginal
people in Ontario every year (Aboriginal Cancer Care Unit
2008). That means approximately two Aboriginal people die
every hour of every day due to commercial tobacco use in
Ontario alone!
Smoking and Diabetes
Did you know?
• Cigarette smoking increases the risk of type 2 diabetes for all
people (Foy et al., 2005; Houston et al., 2006; Carlsson et al.,
2004; Sairenchi et al., 2004).
• Some research suggests a linear relationship between diabetes
and number of cigarettes smoked (Will et al., 2001; Houston et
al., 2006); however, other studies have not found this link
(Sairenchi et al., 2004; Rimm et al., 1995).
• Pregnant women who smoke may also be at an increased risk of
developing gestational diabetes (England et al., 2004).

SOADI FRONTLINE TRAINING 34
• Smoking aggravates insulin resistance. This means that the
body is producing insulin but can’t use it properly. The degree
of insulin resistance is positively correlated with tobacco
consumption, and the more a person smokes, the more severe
their insulin resistance can be (Targher et al., 1997; Eliasson et
al., 1997). The good news is that the effect of smoking on
insulin absorption is reversed after only one week of not
smoking (Becker et al, 2006).
The combination of smoking and diabetes appears to heighten the
development of macrovascular complications (Yudkin, 1993)
including nephropathy, neuropathy (although not consistently
(Mehler et al., 1998)), and retinopathy.
Cigarette smoking increases mortality rates among individuals with
diabetes (Sherman, 2005; Al-Delaimy et al., 2001); however,
quitting smoking for 10+ years will eliminate the increased
mortality rates associated with smoking (Al-Delaimy et al., 2002).
Smoking cessation programs for people living with diabetes should
be individualized and implemented with a focus on specific
cognitive, behavioural, and pharmacological therapies that control
weight and prevent depression (Sherman, 2005). Treatment options
should include brief counselling, use of individual or group
counselling and pharmacotherapy (Haire-Joshu et al. 1999).
Some adverse effects of smoking are reversible:
• 24 hours—risk of heart attack and stroke drop.
• Three days—breathing is easier.
• Two weeks—coughing improves.
• One year—risk of coronary artery disease is reduced by 20-
50%.
• Five years—risk of stroke normalizes.
• 15 years—risk of dying equal to that of a non-smoker.
It’s worth quitting and it’s not as hard as you might think!
Figure 30 It's never too late
to quit smoking and it's
always worth it.
SOADI’s Partnership with TEACH
TEACH is a project geared toward training health-care professionals
in the public, private, and non-profit sectors who provide
counselling services to people who use tobacco.

SOADI FRONTLINE TRAINING 35
The program is designed to enhance knowledge and skills in the
delivery of intensive tobacco cessation interventions.

SOADI FRONTLINE TRAINING 36
Children, Youth, and Gestational Diabetes
Objectives
By the end of this training session, participants will:
• Apply knowledge of what diabetes is, and how it is affecting our
seven generations.
• Understand what we can do about the affects of diabetes on our
seven generations.
Healthy Lifestyle
It’s much easier to grow up physically active and eating good
healthy foods as a way of life than it is to change later. However,
change is possible with support and a positive attitude.
• Choose a balanced meal plan.
• Eat more, fibre, fruits, vegetables, and fish.
• Eat in moderation.
• Drink plenty of water.
• Be physically active, get involved in sports, and recreational
activities.
• Get your family involved, go for walks after dinner, or play
catch.
• Go outside with your friends, play hockey, or go skating.
• Walk off anger, frustration and depression.
Gestational Diabetes
Gestational Diabetes affects up to 3% of the general population and
up to 18% of Aboriginal women. Finding out you have gestational
diabetes can be very stressful.
Fortunately, there are many well-informed health professionals to
help answer your questions and guide you through this very
important time in your life.
Between 24 and 28 weeks into your pregnancy, your midwife or
doctor will send you to be screened for gestational diabetes.

SOADI FRONTLINE TRAINING 37
Gestational diabetes is generally managed by diet and exercise and
goes away after the baby is born. Some women require insulin to
control this type of diabetes.
Good nutrition is the cornerstone to a healthy pregnancy. Weight
gain should be slow and gradual. Smaller, more frequent, healthy
meals and snacks will help. Walking after meals will also help keep
blood sugars under better control.
Active for Life
Some ways for young people to include daily activity in their life,
which can include the whole family and their friends are:
• Walking.
• Dancing.
• Rollerblading.
• Bicycling.
• Running.
• Berry picking.
• Swimming.
• Skating.
• Tennis.
• Skiing.
• Lacrosse.
• Canoeing.
• Spending time outdoors during all the seasons.
• Most importantly, have fun and enjoy whatever activity you do!
Youth at Risk
Some risk factors are:
• Having a family member with diabetes puts youth and children
at a higher risk.
• Children born to a mother with gestational diabetes are at
greater risk.
The number of Aboriginal children and youth developing type 2
diabetes in our communities is rising. The good news is that it’s
preventable!
Ways children and our youth can prevent type 2 diabetes:
• Increase physical activity.

SOADI FRONTLINE TRAINING 38
• Maintain a healthy weight.
• Choose healthy snacks.
• Eat balanced meals.
• Limit screen time.

SOADI FRONTLINE TRAINING 39
References
2008 Physical Activity Guidelines for Americans. (2008). Washington: U.S.
Department of Health and Human Services.
Al-Delaimy, W. K., Manson, J. E., Solomon, C. G., Kawachi, I., Stampfer, M.
J., & Hu, F. B. (2002). moking and risk of coronary heart disease among
women With type 2 diabetes mellitus. Arch Intern Med , 162(3):273-279.
Becker, R. H., Sha, S., Frick, A. D., & Fountaine, R. J. (2006). The effect of
smoking cessation and subsequent resumption on absorption of inhaled
insulin. Diabetes Care , 29(2):277-82.
Cancer Care Ontario. (2008). Commercial Tobacco. Retrieved May 11,
2009, from http://www.tobaccowise.com/commercial_tobacco
Carlsson, S., Midthjell, K., & Grill, V. (2004). Smoking is associated with an
increased risk of type 2 diabetes but a decreased risk of autoimmune
diabetes in adults: an 11-year follow-up of incidence of diabetes in the
Nord-Trondelag study. Diabetologia , 47(11):1953-1956.
Eliasson, B., Attvall, S., Taskinen, M., & Smith, U. (1997). Smoking
cessation improves insulin sensitivity in healthy middle-aged men. European
Journal of Clinical Investigation , 27(5):450-6.
England, L. J., Levine, R. J., Qian, C., Soule, L. M., Schisterman, E. F., Yu,
K. F., et al. (2004). Glucose tolerance and risk of gestational diabetes
mellitus in nulliparous women who smoke during pregnancy. Am J
Epidemiol , 160:1205-1213.
Foy, C. G., Bell, R. A., Farmer, D. F., Goff, D. C., & Wagenknecht, L. E.
(2005). Smoking and incidence of diabetes among US adults: findings from
the Insulin Resistance Atherosclerosis Study. Diabetes Care , 28(10):2501-
2507.
Haire-Joshu, D., Glasgow, R., & Tibbs, T. (1999). Technical scientific review
on prevention and cessation of smoking among persons with diabetes:
American Diabetes Association clinical practice recommendations. Diabetes
Care , 22(11):1887-1898.
Handbook for Canada's Physical Activty Guide to Healthy Active Living. Public
Health Agency of Canada.
Houston, T. K., Person, S. D., Pletcher, M. J., Liu, K., Iribarren, C., & Kiefe,
C. I. (2006). Active and passive smoking and development of glucose
intolerance among young adults in a prospective cohort: CARDIA study.
BMJ , 332(7549):1064-1069.

SOADI FRONTLINE TRAINING 40
International Diabetes Federation. (n.d.). Retrieved March 30, 2010, from
Diabetes Blue Circle Symbol: http://www.diabetesbluecircle.org/
Mehler, P. S., Barrett, W. J., Biggerstaff, S. L., & Schrier, R. W. (1998).
Smoking as a risk factor for nephropathy in non-insulin-dependent
diabetics. Journal of General Internal Medicine , 13(12):842-845.
MenoBimaadziwin - Taking Care of Ourselves and Our Families. (2009).
Thunder Bay: Ka:nen.
Pathway to Wellness: A Handbook for People Living with Diabetes. (2009).
Winnipeg: National Aboriginal Diabetes Association.
Renakaran, R., Hanley, A. J., Connelly, P. W., Harris, S. B., & Zinman, B.
(2005). Cigarette smoking and cardiovascular risk factors among
Aboriginal Canadian youths. Canadian Medical Association Journal , 173(8),
885-889.
Rimm, E. B., Chan, J., Stampfer, M. J., Colditz, G. A., & Willett, W. C.
(1995). Prospective study of cigarette smoking, alcohol use, and the risk of
diabetes in men, professor of epidemiology and nutrition. BMJ , 310:555-
559.
Sairenchi, T., Iso, H., & Nishimura, A. (2004). Cigarette smoking and risk
of type 2 diabetes mellitus among middle-aged and elderly Japanese men
and women. Am J Epidemiol , 160(2):158-162.
Sherman, J. J. (2005). The impact of smoking and quitting smoking on
patients with diabetes. Diabetes Spectrum , 18(4):202-208.
Targher, G., Alberiche, M., Zenere, M. B., Bonadonna, R. C., Muggeo, M., &
Bonora, E. (1997). Cigarette smoking and insulin resistance in patients
with noninsulin-dependent diabetes mellitus. Journal of Clinical
Endocrinology & Metabolism , 82(11):3619-3624.
Will, J. C., Galuska, D. A., & Ford, E. S. (2001). Cigarette smoking and
diabetes mellitus: evidence of a positive association from a large
prospective cohort study. Int J Epidemiol , 30(3):540-546.

SOADI FRONTLINE TRAINING 41
Disclaimer
Southern Ontario Aboriginal Diabetes Initiative (SOADI) is a nonprofit
organization that is funded by the Ontario Ministry of Health
and Long-term Care. The funding provides financial assistance for
the development, and enhancement of culturally appropriate
programs and services focusing on diabetes wellness and
awareness of healthy diabetes education, prevention and
management in Aboriginal communities, both on and off-reserve.
All information in this resource has been provided by SOADI and
has been developed with the best of care for those intended to be
trained and living with diabetes. It can nevertheless not be assumed
that any and all mistakes are completely excluded. By supplying
this information, SOADI does not assume nor provide any form of
guarantee. SOADI is not responsible for any possible incorrect
information supplied. SOADI recommends that you consult your
doctor or health care professional before pursuing any new diet or
exercise regime.
Any part of this publication may be reproduced. When it was
developed, it was intended to be shared with all communities. No
permission is required from SOADI however; SOADI does not take
responsibility should any changes be made to the content.
Please visit www.soadi.ca for regional Diabetes Prevention
Coordinator contact information.