PLUGGED INTO PREVENTION

September Issue

American Association of Diabetes Educators

Welcome to the September edition of Plugged into Prevention, the official newsletter of the AADE DPP!

SPOTLIGHT ON AADE's DPP TEAM:

There is always the potential for fear when facing a new challenge. However, participants of the National DPP at Williamson Medical Center (WMC) seem to have willpower and a ferocious drive to succeed! People who have prediabetes are headed down the road to type 2 diabetes. They are determined to turn their situation around for themselves with increased physical activity, nutritional education, group support, and modest weight loss, these WMC participants are determined to turn themselves around.

With a total combined weight loss of 354 pounds in just ten weeks, participants have accomplished more than they ever anticipated. Between the Williamson County Recreation Center tour, information sessions, cooking demonstrations at Whole Foods, and playing trivia on the "Four Keys to Eating Out," participants of the DPP are continually being educated in different settings and acquiring new skills to apply in everyday situations.

The National DPP is taught at WMC in Franklin, TN by Sarah Neil Webb, RD, LDN, CDE, and Maureen Chase, BSN, RN, CDE. This 175 licensed bed, community hospital, operating under the Nutritional Services Department, has been supporting diabetes self-management education (DSME) programs for diabetes and prediabetes in a group or one-on-one format for over ten years. Now implementing the National DPP, it currently supports 45 participants as they make the strides to prevent type 2 diabetes.

The program has given participants a genuine change of mindset. "Instead of 'I deserve this high fat meal,' I think, 'I deserve to be healthy,'" says an anonymous participant. You cannot make these changes overnight, but this unique prevention program allows participants to make progress over a year span and develop a healthy and active lifestyle.

"Everything goes in the food journal, good, bad or other. I actively problem solve and have a positive action plan. It is not perfect by any means, but I am making progress," comments another participant. Participants talk through problems and frustrations. They listen to the solutions of others who have dealt with similar concerns. Seeing each other stay with the program and face many of the same challenges keeps participants moving forward in the program.

With the intention of having the program reimbursable by employers and third party insurance companies, WMC Nutrition and Diabetes program accepts frequent community speaker requests and maintains a program of topics to provide annually to community businesses. The DPP Lifestyle Change Program will soon be added as an option for those interested community businesses, coordinated through marketing efforts with the community and physician liaisons.

WMC continues to build a positive atmosphere led by Sarah and Maureen. Participants will continue to move forward and obtain their 5-7% weight loss goal by the end of the program.

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PHYSICAL ACTIVITY:

There are many ways in which physical activity contributes to overall health. But did you ever stop to think about its specific importance to diabetes prevention?

Reduced to a simple level, prediabetes is thought of as circulating levels of glucose that are higher than normal but not so high as to be diagnostic of diabetes. Why is it that the levels of glucose are higher than normal? While dietary factors can contribute to their being an excessive amount of glucose to be used by the body, how efficient muscle cells are at taking the glucose out of circulation and converting it to energy is another very important factor.

Insulin resistance correlates with the increased risk of developing prediabetes and type 2 diabetes. But what does it mean to be insulin resistant? When insulin binds to receptors on the surface of muscle cells, the cells are then able to transport glucose from the circulation into the cell and converted into energy. And when liver cells bind insulin, they stop producing glucose to release into the blood and instead synthesis glycogen. So while diabetes is typically thought of as an inability of the body to produce sufficient insulin- you can see that in type 2 diabetes - muscle cells and liver cells also have important roles. If insulin resistance is causing muscle cells not to take glucose out of circulation; and is causing liver cells to produce and release even more glucose into circulation - it is easy to see how this would increase the demand on the pancreatic beta cells to produce more and more insulin.

And so - while insulin resistance does not cause type 2 diabetes, it sets the stage for the disease by placing a high demand on insulin-producing beta cells. The National Diabetes Information Clearing House (NDIC) states, "The good news is that if people learn they have insulin resistance early on, they can often prevent or delay diabetes by making changes to their lifestyle."

Studies show that exercise increases glucose uptake and utilization by muscles. Thus - not only does increasing physical activity increase caloric expenditure, it makes muscle cells more effective at reducing levels of circulating glucose.

Muscle-strengthening activities (MSAs) improves insulin sensitivity helping reduce the risk of diabetes, according to the National Center for Health Statistics of the Centers of Disease Control and Prevention (CDC). MSAs should be done at least two days a week to include all major muscle groups (legs, hips, back, chest, abdomen, shoulders, and arms). CDC recommends doing 8-12 repetitions of an activity (one set). Those individuals that perform two to three sets of MSAs will gain even more benefits.

Strengthening muscles can be done at home or in the gym. Below is a list of activities to try:

* Lifting weights

* Working with resistance bands

* Doing exercises that use your body weight for resistance (i.e.,pushups, sit ups)

* Heavy gardening (i.e., digging, shoveling)

* Yoga

*Follow the Mayo Clinic's do's and don'ts of weight training.

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HEALTHY EATING:

Food labeling and nutritional content of a product are necessary for consumers to know. A food label allows for comparison of food products, acquire nutritional facts and help in selecting foods with ingredients they either want or need to avoid.

*The U.S. Food and Drug Administration (FDA) provides guidance to many of the questions consumers have regarding food labeling.

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RECIPE:

Lime- Infused Halibut with Ginger Relish

As a meaty fish, halibut stands up well to the sweet and spicy topping. This dish is perfect for a dinner party. Your guests will relish the flavors!

FISH

4 halibut fillets (4 ounces each), rinsed and patted dry

1 tablespoon fresh lime juice

2 teaspoons canola oil

� teaspoon coarsely ground black pepper

� teaspoon salt

RELISH

� cup chopped pickled ginger

1 medium jalapeno, seeded and finely chopped

2 tablespoons chopped fresh cilantro leaves

1 tablespoon finely chopped red onion

1 teaspoon canola oil

� teaspoon lime zest

1 tablespoon fresh lime juice

Canola oil cooking spray

1 lime, cut into 4 wedges (optional)

Place fish fillets in a 13 x 9- inch glass-baking pan. Whisk together 1 tablespoon lime juice, 2 teaspoons canola oil, black pepper, and salt in a small bow. Spoon evenly over fish and turn several times to coat evenly. Let stand 20 minutes in the refrigerator.
Meanwhile, combine relish ingredients in another small bowl.
Coat a grill pan with cooking spray; place over medium-high heat until hot. Remove fish from marinade, place on grill, and brush with any remaining marinade. Cook 5 minutes on each side or until opaque in the center and easily flaked with a fork. Place on a serving platter and squeeze lime wedges over all. Top with relish.

Calories	160	Cholesterol	35 mg
Calories from fat	55	Sodium	360 mg
Total fat	6.0 g	Total carbohydrates	2 g
Saturated fat	0.6 g	Dietary fiber	0 g
Trans fat	0.0 g	Sugars	1 g
		Protein	24 g

Exchanges per serving: 3 lean meat

Flavorful tip: For variation, serve the ginger relish on salmon, tuna, or mahi mahi fillets. The assertive flavors of the relish also balance nicely with grilled items, such as chicken or pork.

"The Heart-Smart Diabetes Kitchen: Fresh, Fast and Flavorful Recipes Made with Canola Oil" from the American Diabetes Association and CanolaInfo.org

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What would you like to learn about? Send your comments or suggestions to nblum@aadenet.org

NATIONAL DIABETES PREVENTION PROGRAM

National Diabetes Prevention Program is designed to bring to communities evidence-based lifestyle change programs for preventing type 2 diabetes.

About the AADE:

Founded in 1973, AADE is a multi-disciplinary professional membership organization dedicated to improving diabetes care through education. With more than 14,000 professional members including nurses, dietitians, pharmacists, and others, AADE has a far reaching network of practitioners involved in the daily treatment of diabetes patients. To learn more go to: www.diabeteseducator.org

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Be sure to continually look for updates regarding the National Diabetes Prevention Program on both the AADE and CDC websites:

AADE DPP Website: www.diabeteseducator.org/prevention

CDC Website: www.cdc.gov/diabetes/prevention/about.htm

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American Association of Diabetes Educators
200 W. Madison Street, Suite 800 | Chicago, Illinois 60606
Phone: 800/338.3633 | Fax: 312/424.2427
www.diabeteseducator.org
� 2013 American Association of Diabetes Educators

This newsletter was supported by the Cooperative Agreement number 1U58DP004519-01 from The Centers for Diabetes Control and Prevention. Its contents are solely the responsibility of AADE and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

AADE has recently launched a mobile app called Diabetes Goal Tracker to help people with prediabetes and diabetes set goals based on the AADE7 Self-Care Behaviors™, track their progress and achieve lifestyle and behavior change.

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This app has educational materials to help your participants:

Understand the effects and complications of diabetes, and why it's important to prevent its onset

Learn more about the AADE7 Self-Care Behaviors™, which are seven areas of lifestyle and behavior change. They are: healthy eating, being active, monitoring, taking medication, problem solving, reducing risks and healthy coping

Find ways to set realistic goals through concrete examples of some common barriers

Learning is a social experience. A unique feature of the app is the option for users to share completed goals with one another. This community-centered resource will help users find inspiration from others who have overcome their issues.

Participants can download this app for free through the iTunes Store (for the iPhone) or Google Play Store (for the Android). You can learn more about this app on our website: www.diabeteseducator.org/goaltracker

For more information or questions regarding the Diabetes Prevention Program, please contact AADE at

dpp@aadenet.org.

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