CNHSA strives to help those with diabetes and prediabetes

Every year, the American Diabetes Association uses the month of November to bring awareness to diabetes and its effect on our lives.

Millions of Americans are at risk for or have diabetes. The statistics hit even harder for Native Americans. According to the U.S. Department of Health and Human Services (HHS), Native Americans are nearly three times more likely than non-Hispanic white adults to be diagnosed with diabetes.

There is no simple answer to what diabetes is. In its most basic form, diabetes is a chronic disease caused by the pancreas’ inability to produce enough insulin to meet the body’s needs.

There are two kinds of diabetes, type 1 and type 2. With type 1 diabetes, the pancreas doesn’t make insulin. Type 1 diabetes is less common, with only 5-10% of people with diabetes having this form. It can start at any age but is often first diagnosed during childhood or teen years.

Type 2 diabetes can develop at any age but is more common in people older than 40.

Carol Ayers says she was diagnosed with type 2 diabetes at around 58. She’s spent the last 20 years learning how to control it. “I think the secret is keeping track of your blood glucose level; most people with diabetes don’t do that often enough,” said Ayers.

Ayers uses a constant glucose monitor (CGM). A CGM is a device that monitors your glucose levels 24 hours a day, so she must do fewer finger sticks to draw blood and check her glucose. “I think it’s the biggest thing, and it’s a modern miracle for me. I think if more people with diabetes had CGMS, we would get better compliance,” said Ayers.

CGMs will monitor trends in your glucose level and tell you when you need to check your blood glucose levels manually.

Knowing your glucose levels allows you to make better decisions on what you eat. Eating poorly and not controlling your diabetes can cause various health problems such as heart disease, nerve damage, kidney, foot, eye, gum and other dental problems.

Ayers has firsthand experience with the problems diabetes can cause. Her mother had three strokes and a heart attack which Ayers says was due to controlling her diabetes poorly.

Ayers herself has neuropathy. Neuropathy is nerve damage caused by diabetes. Over time, high blood glucose levels and high levels of fats, such as triglycerides, in the blood from diabetes can damage your nerves.

Damage caused by neuropathy can lead to a loss of feeling in the part of the body with the damage. “I know people that have stepped on a piece of glass and didn’t know it and nearly lost their whole foot over it,” said Ayers.

Lee Ann Sherrill, RN, CDE with the Choctaw Nation, reinforces the seriousness of diabetes, “It affects the nerves of the whole body, can cause a heart attack, stroke, blindness, person to be on dialysis or lead to amputation,” she said.

It doesn’t have to be like that, though. Diabetes and prediabetes can both be diagnosed with an A1C test. A higher A1C means your body isn’t controlling your blood sugar as well as it should. A normal A1C level is below 5.7%, a level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. The good news is that high A1C numbers can be brought down.

And if you have prediabetes, it doesn’t automatically mean you will develop type 2 diabetes. Some people with prediabetes can bring their A1C numbers to normal range.

According to the American Diabetes Association (ADA), you can lower your A1C and risk of type 2 diabetes by losing 5% to7% of your body weight, or 14 pounds if you weigh 200 pounds, and exercising moderately for 30 minutes daily. You don’t have to run a marathon to see results. This activity can be taking a walk every day with the dog or even chair exercises if you’re elderly. “It’s small choices, small steps every day that help to control diabetes,” said Sherrill.

Sherrill says you can start with 10-minute increments for people who never exercise. Do those three times a day, working up to your 30 minutes of physical activity. If all you can do is 10 minutes three times a day, Sherrill says don’t stop; something is better than nothing.

Nutrition is also a big part of controlling diabetes. Pick foods that are high in fiber and low in fat and sugar. Build a plate that includes a balance of vegetables, protein, and carbohydrates. Drink water instead of sweetened drinks.

Controlling diabetes is a multi-pronged approach. Many people can get their diabetes under control with diet and exercise. For others medication may be required.

Ayers stresses that medicine is not a cure, “You just can’t expect medicine to cover it; it’s like putting a Band-Aid over a dirty wound. You’re not attacking the problem itself, which is nutrition. It sounds very simplistic, but it is so complex,” she said.

When faced with bad nutritional choices, Ayers asks herself a question, “I just think of it as poison. I say to myself, would I pick up this bottle of poison and drink it if I knew it was poison,” she said.

Gradually switching to smaller portions is also a good way to reduce calories.

Ayers said that’s not always easy to do. “You’d like to eat with family and friends, but everywhere we go, everybody’s eating frybread, and they’re having sweet tea,” said Ayers.

According to Ayers, the social aspect is hard, but asking herself if she “wants that poison” helps.

Stopping diabetes before it becomes a problem is the best first step. In 2013 the Choctaw Nation started the Diabetes Prevention Program to help people at risk of diabetes. The one-year program is geared towards those with prediabetes or an A1C between 5.7% and 6.4%.

The program is designed around a group of people, or cohorts, that can work toward a common goal and support each other in lowering their A1C, body weight and increasing physical activity.

“Throughout the one-year program, each session is designed to build on the other and reinforce prevention through the year,” said Sherrill.

The program starts by discussing what type 2 diabetes is and why you want to prevent it. Then moves into counting fat grams, incorporating physical activity and even touches on some of the mental health aspects of prediabetes and diabetes.

For the first 16 weeks, cohorts meet once a week, either virtually or in person, then move into a monthly meeting.

“The first six months is the core part that gives us the tools to work with. Then the second six months are maintenance cohorts to help maintain this healthy lifestyle and reinforce the tools needed to continue to live a healthy lifestyle,” said Sherrill.

Education is important for those diagnosed with diabetes to keep some common misconceptions at bay. Mary Ayn Tullier, RN, a Lifestyle Coach with the Choctaw Nation Diabetes Prevention Program, says she often hears misconceptions concerning diabetes. One of those is that the medication will take care of it.

“That’s a really big misconception because it can still affect their organs, their body systems…even though they’re on medication, it’s not going to handle the whole cure of it,” said Tullier.

Ayers has also seen this with other people with diabetes: “Some people think they can take some insulin and then go to eat that big piece of pie. That’s not what they should be doing; they should be eating better,” said Ayres.

Sherrill adds, “A lot of times we hear, well, I have a family history of diabetes. Mom, dad, grandma, aunts and uncles, they all have diabetes, so I’m just going to get it. It’s inevitable that I will have it in my lifetime,” she said.

Sherrill says this isn’t true. “We know now, with the Diabetes Prevention Program, that it can be delayed or prevented. And the longer it’s delayed in a person’s lifetime, the less complications they’re likely to develop,” said Sherrill.

For more information visit the Diabetes Prevention Program webpage.