sadpp booklet draft

8/9/2019 SADPP Booklet Draft

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Lets get started!

Introduction

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My name is Kumar.

When I arrived a year ago with my wife, mother and 2younger children we were very excited to be in Canada and

to start a new life. We had heard great things about living in

Canada.

Even though Canada is a great place to live, the last year has

been tough for my family and I. I dealt with a lot of stresstrying to nd a job, a new home we could aord, manage our

nances and to improve my English language skills. I didnt

have time to go to the doctor but didnt worry because we

were really healthy back home in India.

One day my family and I were attending the temple and

there was a program where we could get our blood sugar

checked. So we decided to get tested. They told my mother

and I that we had to go visit our doctor and he now tells us

that I have prediabetes and she has diabetes. I have never

heard of these illnesses. I am getting really worried because

my family depends on me so I dont want to get sick and I

dont know how to care for my mother.

Is there anything we can do?

Of course!

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Introduction

Diabetes is increasing at an alarming rate and has become a

worldwide epidemic. What is more alarming is that many

people have diabetes or prediabetes and do not know! The

story of Kumar and his family is a typical one for many peopleespecially those who have migrated to a western country like

Canada. Research shows the rate of diabetes is higher in the

South Asian population than other ethnic group.

South Asian migrants are

four to six times more likely to develop diabe-tes and at a younger age!

You may already know a family member or a friend in your

community living with diabetes. But what exactly is

prediabetes? What causes it? How do you know when you

have it? Can you reverse prediabetes or diabetes?

The handbook and DVD provided in this resource care kit will

provide you with tools to help prevent prediabetes and

diabetes in your life or in the life of a loved one. If you already

have diabetes, this care kit will provide information on how

to improve your quality of life and avoid complications. The

focus will be on lifestyle changes such as healthy eating,

physical activity and managing stress.

To start, we need to go over some basic concepts and terms

so you have a better understanding of both conditions.

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What is Diabetes?

Diabetes develops when the body has a problem with ahormone called insulin. After you eat, you break food down

into sugar. An organ called the pancreas produces insulin.

Insulin helps to move that sugar from the blood to the cells

of the body. You can get diabetes if the pancreas cannot

make enough insulin, or if the bodys cells do not respond to

insulin. This causes the glucose to build up in the blood andcause damage to the body organs. There are three types of

diabetes: type 1, type 2 diabetes and gestational diabetes.

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Type 2

In Type 2 Diabetes, your pancreas

produces insulin, but cells dont

respond to insulins effect, causing

glucose to remain in your

bloodstream after you eat.

Insulin isnt

recognized

by the cell.

In Type 1 Diabetes, your pancreas

produces little if any insulin.

Without insulin to help move

glucose into your cells, glucose

remains in your bloodstream.

Type 1


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Introduction

W

hatisDiabetes?

What is Type 1 Diabetes?

This type occurs in 1 out of 10 people with diabetes. This is

mainly due to genetic reasons and other unknown factors.This happens when the pancreas makes none or very little of

insulin. When the blood glucose levels rise to a certain level,

you are diagnosed with type 1 diabetes. This type usually

occurs in children and younger adults. But it is also possible

for adults of any age to develop type 1 diabetes.

What is Type 2 Diabetes?

Type 2 diabetes is the most common type of diabetes. This

type occurs in 9 out 10 people living with diabetes. In type 2

diabetes, either the pancreas is not able to make enough

insulin or the body is not able to respond properly to insulinor both. This leads to high blood glucose levels.

What is Gestational Diabetes?

Gestational diabetes only occurs during pregnancy. This

occurs in 2-4% of pregnant women. This type of diabetesdevelops temporarily and goes away after giving birth. But

both mother and baby are at an increased risk of developing

diabetes in the future.

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What is Prediabetes?

Prediabetes is a condition when blood glucose levels arehigher than normal but not high enough to have Type 2

Diabetes. If you have prediabetes, you are also at a higher risk

of getting Type 2 Diabetes in the future. It can be caused by a

condition known as insulin resistance. Insulin resistance

occurs when the bodys cells can not use insulin properly and

glucose is not able to enter the cells. This leads to highamounts of glucose in the blood leading to Prediabetes or

Type 2 Diabetes. This is why it is important to detect

Prediabetes early so you can bring your blood glucose levels

back to normal and prevent getting Type 2 Diabetes.

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Introduction

W

hatisPrediabetes?

Do I have Diabetes or Prediabetes?

Symptoms

Diabetes can be a silent disease because you may not experi-

ence early signs or symptoms. Symptoms may go unnoticed

for years. You may have diabetes if you experience any of

these symptoms. However, it is best to go see your physician

and have your blood glucose level tested.

Excessive thirst or hunger

Frequent urination (passing urine from the body)

Unintentional weight loss or gain

Blurred vision

Cuts and bruises that are slow to heal

Tingling or numbness in your hands or feet

Just like with type 2 diabetes, you may have prediabetes for

years and not know it. Prediabetes does not generally cause

symptoms. That is why it is also important to be tested for

prediabetes if you think you are at risk. If there are symptoms,

they are similar to those of type 2 diabetes. Some peoplemay also get a condition called acanthosis nigricans where

there is darkening of the skin in certain areas (neck, armpits,

knees, knuckles).

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Diabetes

Normal

> 7 mmol/L

4 - 5.9 mmol/L

Normal

8 - 11 mmol/L

5 - 7.9 mmol/L

Prediabetes

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Blood Glucose

One way your physician will test to see if you have Type 2

Diabetes is to measure your blood glucose levels. The

physician will check your exact blood glucose values with the

following blood tests. Any one of these tests can conrm the

diagnosis of Type 2 Diabetes:

Fasting blood glucose (do not eat or drink anything for

at least 8 hours).

Random blood glucose (any time without fasting).

Oral glucose tolerance test (OGTT). Blood glucose

values taken after fasting for at least 8 hours and 2

hours after you have a sweet liquid drink.

The blood tests for Prediabetes are similar to those for Type 2

Diabetes. However, the physician will not ask for random

blood glucose values. The diagnosis of prediabetes will be

conrmed after taking fasting or OGTT blood glucose values

only. Blood glucose values are lower for Prediabetes as

compared to Type 2 Diabetes for both tests.

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hatisPrediabetes

Introduction

Why Should I Be Concerned?

Diabetes is a serious condition. If it is not detected early, itcan cause damage (complications) to several organs that

may not be obvious until it is too late. This can really aect

your quality of life.

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Macrovascular Microvascular

Diabetic Eye Disease

(retinopathy and cataracts)

Renal Disease

Stroke

Neuropathy

Foot problems

Peripheral Vascular

Disease

Heart Disease

and Hypertension


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Once you are diagnosed with Type 2 Diabetes, you cannot

reverse it.

However, if you can detect Prediabetes early,you can prevent or delay Type 2 Diabetes and

its complications.

Sometimes it may take up to ten years before someone with

prediabetes gets diagnosed with Type 2 Diabetes. But it is

important if you have Prediabetes to keep your bloodglucose in a normal range. Research shows that high blood

glucose levels during Prediabetes may still cause damage to

your body. One of the major complications that develops is

heart disease.

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WhatisPrediab

etes

Introductio

n

Am I At Risk?

There are many reasons as to why South Asians are at a

greater risk for prediabetes and type 2 diabetes. Some are

due to heredity (genes) like family history or ethnic

background. Others are due to lifestyle changes that can be

caused by coming to a new country (migration) like Canada.

Research has shown that once South Asians migrate to urban

areas (larger cities), their lifestyle becomes unhealthy. South

Asians adopt a more westernized diet that is more caloriedense (high in fat and sugar) and the level of physical activity

decreases. This can lead to weight gain. Too much weight

gain can lead to obesity.

Obesity is when too much of your body weight is fat. Having

too much body fat can lead to many health problems. But itis abdominal obesity(fat in the abdomen) that puts you at a

higher risk for getting insulin resistance, prediabetes and

type 2 diabetes (gure 5).

Research shows that South Asians are at a

higher risk of getting abdominal obesity whichcan be due to their genes but also to lifestylechanges.

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which measures the ratio of weight to height, while

you are at risk for Prediabetes or Type 2 Diabetes. It is

important to know what puts you at risk for Type 2 Diabetes

and Prediabetes so you are able to get tested and avoid long

term complications.

12 Waist circumferences for a) obese, and b) non-obese

a b


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Changeable Risk Factors

Being overweight

Having abdominal obesity

Lack of physical activity

Having Prediabetes

Unhealthy diet

High blood pressure

High cholesterol

Heart disease

Family history of diabetes

Ethnic background

Age

Personal history of diabetes

Giving birth to an overweight baby

Unchangeable Risk Factors

W

hatisPrediabetes

Introduction

Risk Factors

Here is a list of factors that can increase your risk of getting

Type 2 Diabetes. Some factors you are not able to change

such as family history or ethnic background. But other factors

you can certainly change like your lifestyle. By making some

changes to your weight, diet and level of activity, you can

prevent or reduce the risk of getting Type 2 Diabetes.

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You should get tested for Prediabetes if you are 40 years of

age or older even if you have no other risk factor. If you are

younger, you should get tested if you have any of the

following risk factors. This is especially true if you have

prediabetes as part of a condition called metabolic

syndrome.

Being 40 years of age or older

A close blood relative (parent or sibling) who has Type

2 Diabetes or heart disease

Having some complications related to Type 2 Diabetes

(nerve, eye or kidney problems)

Having heart disease

Having other conditions associated with

insulin resistance

Having high blood pressure

Having high cholesterol

History of having high blood sugars

Have history of gestational diabetes

Being in the high risk ethnic groups (South Asian)

Being overweight, especially around your abdomen

(abdominal obesity)

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Make sure to getyourself tested if you have

any of these symptoms.

Doctors orders.


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hatisPrediabetes

Introduction

What is Metabolic Syndrome?

Research shows that people who have insulin resistance andabdominal obesity increase their chances of getting

metabolic syndrome . Metabolic syndrome is a group of

conditions that increase the risk of getting prediabetes, type

2 diabetes and heart disease. Research has shown that South

Asian migrants are at a higher risk of getting metabolic

syndrome and at a younger age! An individual is diagnosed

with metabolic syndrome if they have three or more of these

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Hypertens

ion

>130/85mm

Hg

Abdominalobesity

Waist>40(males)

Waist>35(fem

ales)

HDL-C

holeste

rol

110mg/dL


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Can I Reverse Prediabetes?

Once you know you have prediabetes, the good news is thatyou can reverse it. You can do this by making some changesto your lifestyle. For example, if you are overweight and haveabdominal obesity, losing only 5-10 per cent of your bodyweight can reverse prediabetes. This means if you are at 200lbs, you only need to lose 10-20 lbs.

Research shows that having a healthier diet and

increasing physical activity together can have

the most impact in preventing or reversing

prediabetes.

This can be done by making your diet healthier (lower calo-

ries, lower fat intake and increase bre) and being moreactive (150 minutes of moderate physical activity per week).

The process of migration and settling into a new country alsoincreases the level of stress due to such strains as nding anew job or home. This can also increase the risk of type 2

diabetes so it is important to be able to manage stress inyour life. In the next 3 chapters, we will focus on how you canmake lifestyle changes to prevent prediabetes and type 2diabetes. These include a healthy diet, being active andmanaging stress.

Some other changes you can make include:

Stop smoking

Manage blood pressure

Manage high cholesterol

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T

rue

orFalse

Introduction

True orFalse?

If I eat too much sugar, I will get Type 2 Diabetes.

False! Risk factors for type 2 diabetes can be genetic factorssuch as ethnic background and having a close blood relativewith type 2 diabetes. Lifestyle factors like not beingphysically active and having an unhealthy diet also play arole. However, eating too much sugar can cause weight gainwhich can indirectly increase your risk for type 2 diabetes.

I dont have worry about type 2 diabetes now, I

will get it when I am old.

False!A risk factor for developing type 2 diabetes is being

over the age of 40. But diabetes can occur at any age. SouthAsians are at a higher risk of getting type 2 diabetes at ayounger age. It is the combination of risk factors (diet,activity, weight, and genes) that will determine when you willget diabetes, not just your age.

Diabetes is contagious and I can get it fromsomeone else.

False! You cannot get diabetes from being around otherpeople. Some research suggests that type 1 diabetes may betriggered by other factors such as a virus but only a

combination of genetic and lifestyle factors determine if youget type 2 diabetes.

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KumarsAction Plan

Now that I have prediabetes, I know I am at risk for gettingtype 2 diabetes and its complications such as heart disease. I

will make sure to manage my blood glucose levels. I will

focus on lifestyle changes such as losing some weight, eating

healthier, being more physically activity so I can reverse

prediabetes and prevent type 2 diabetes.

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Lets get started!

Healthy Eating

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My name is Geeta.

I am Kumars wife. My mother in law and I are in charge ofdoing all the cooking and the groceries at home. I am not

sure how I will cook at home now that Kumar has

prediabetes and his mother has diabetes.

We have been told we need to eat healthier but I am not sure

if everyone in the family will enjoy eating healthy foods. We

enjoy eating our South Asian foods so we dont want to give

them up.

I know prediabetes and diabetes raises your blood sugar so I

dont want to bring any sugar in the house. But I am not sure

which foods have sugar? I am nding planning daily meals

for everyone in the family a challenge.

How we can be healthy and

still maintain our traditional

way of eating?

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HealthyDiet

HealthyEa

ting

Healthy Diet

What is A Healthy Diet?

Whether you have prediabetes or diabetes, the important

thing to know is there is no special diet that needs to be

followed. In the case of Geeta and her family, they can still

enjoy their traditional South Asian foods and eat healthier.Eating healthy to prevent or manage diabetes is to have a

balanced diet. This includes eating the foods you enjoy but

watching serving sizes and following regular mealtimes. It

also includes adding a variety of foods into you diet to ensure

you are getting all the right amount of nutrients.

There are three main types of nutrients that provide you with

energy (calories). These are carbohydrate, protein and fats.

Other nutrients essential for good health are vitamins and

minerals. A great start to healthy eating and ensuring you are

getting the right amount of all these nutrients for good

health, is to follow Eating Well with Canadas Food Guide.

Following the food guide will help to ensure a variety of

foods in your diet. The guide is divided into four food groups:

Vegetables and Fruit

Grain Products

Meat and Alternatives

Milk and Alternatives

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Figure 9 - Recommended Daily Intake For Adults

19-50 Years

Food Groups

Grain

Vegetables

and Fruit

Milk andAlternatives

Meat and

Alternatives

Serving Per Food Group

Female FemaleMale Male

51+ Years

7-8

3 32 2

3 32 2

6 786-7

7 78-10

H

The number of servings for each food group dier depend-

ing on age and gender. This is because each of us require a

dierent amount of calories and nutrients. You can use the

chart below as a guide (see gure 9). It will show you howmany servings of each food group you need. A serving is a

specic amount of food usually measured in cups, ounces or

pieces. The number of servings may look like a lot. But the

size of each serving is small so the servings add up quickly.

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a

b

c

d

ef

g

h

i

j

k

l m n o

p

qrt

u

s

a. 1 cup low fat plain or flavoured yogurt

b. 1 cup low fat milk or fortified soy beverage

c. 1.5 oz low fat paneer cheese

d. 1/2 medium or 1/2 cup potato

e. 1 cup leafy vegetable (spinach, lettuce, mustard leaves, rapini)f. 1/2 yellow/green beans

g. 1/2 cup fresh, frozen or canned vegetables

(cauliflower, carrots, bitter melon, eggplant, okra)

h. 1/2 of a medium mango

i. 1 medium banana

j. 1/2 cup mixed berries

k. 1/2 cup cooked rice, bulgar, quinoa, or pastal. 1 slice (35 g) bread

m. 1/2 (35 g) whole grain pita

n. 1/2 (35 g) whole grain muffin

o. 1/4 (35 g) naan

p. 3/4 cup cooked or canned beans and lentils

or thick dahl

q. 1/4 cup seeds (eg. sesame, sunflower)

r. 2 eggs

s. 1/2 cup or 2.5 oz cooked chicken, beef, or fish

t. 3/4 cup tofu

u. 1/4 cup nuts (eg. almonds, walnuts)

Milkan

dAlter

natives

FruitsandVegetables

GrainProduc

ts

MeatandAlternatives

HealthyDiet

HealthyEa

ting

Here are some examples of common foods from each food

group. It also shows how much of each type of food you

need to make one serving. The key to ensuring you get all

the nutrients and calories in the right amounts is to watchyour servings.

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odifyingYourDiet

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Modifying Your Diet

Research has shown that in order to reverse prediabetes and

reduce your risk of type 2 diabetes, a healthy diet should

include lower calories, lower fat and higher ber. In this

section, we will provide you with tips on how to modify your

diet to make it healthier in order to prevent or reduce your

risk of type 2 diabetes. All while ensuring you are still able to

enjoy your favorite South Asian dishes. In this section you willlearn to:

How to control servings or amount of food you eat

What foods or ingredients can you add, reduce or

replace in your diet to make it healthier

Tips on how you can watch the amount of calories youeat daily to lose weight or prevent gaining weight

Highlight the importance of label reading when

grocery shopping

Tips on how to grocery shop on a tight budget

It is important to note that this handbook provides basicguidelines to diet modication and does not replace indi-

vidual dietary counseling as part of regular diabetes

education. Talk to a registered dietitian for more information

about individual meal planning.

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Watch Your Portions

Healthy Eating Plate Model

The key to ensuring you are getting all your nutrients in the

right amounts is to watch serving sizes. A typical South Asian

diet tends to include large meals during lunch and dinner. It

is built around rice or bread (roti) with only a small amount of

the healthy eating plate model as a guide. It will ensure you

are getting foods from all of the food groups and in the right

portions.

A typical meal should be served on an eight inch plate. It

should be divided into three parts:

vegetable curries or salad or both

A quarter of the plate has a meat or a meat alternative

A quarter of the plate has grains (either rice or roti but

not both!)

On the side of the plate, a glass of low fat milk or

yogurt and a fruit for dessert.

Balanced Plate Unbalanced Plate


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Handy Portion Guide

Another way to measure out portions on your plate, is to

follow the handy portion guide . This helps you plan theportions in your meal. It can also help to count the number of

servings you are having according to Canadas food guide.

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VEGETABLES

FATS

MEAT AND ALTERNATIVES

MILK AND ALTERNATIVES

FRUITS, GRAINS, AND STARCHES

Choose as much as youcan hold in both hands.

Choose an amount the size of your fist.

Choose an amount up to the size of the

palm of your hand and the thickness of

your little finger.

Limit fat to an amount the size of your thumb.

Drink up to 250 mL (8 oz) of low-fat milk

with a meal.


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Add, Reduce, or Replace?

This section will focus on paying attention to specic nutri-ents in your diet. Key nutrients play a role in managing

weight and to prevent or reduce the risk of type 2 diabetes

and its complications like heart disease. We will focus on

carbohydrates, added sugar, bre, the dierent type of fats

and salt in the diet and what you may need to add, reduce or

replace to make your diet healthier.

Choosing Healthy Carbohydrates

You need a certain amount of carbohydrate in your diet to

fuel your brain and give you energy. When you eat

carbohydrate containing foods, they are broken down into

glucose. It is important to eat 3 meals a day at regular

intervals to provide a constant supply of energy. But if you

eat too much carbohydrate at one meal, it can raise your

blood glucose level. Carbohydrate containing foods come

mainly from the following foods:

Fruit

Starchy vegetables

Grain products

Milk and milk alternatives

Beans and lentils

Sweetened foods and drinks


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odifyingYourDiet

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Research shows that South Asians have a

high carbohydrate intake coming from grainssuch as white rice or bread or sweetened foodsand drinks.

High carbohydrate intake from these sources can lead to

lower HDL levels and high blood triglycerides and can lead to

heart disease. You need to choose your carbohydrates

wisely. Whole grains, fruit and vegetables should be chosen

more often than sweet foods. Sweet foods include foods

such as South Asian desserts like jilabi or gulabjaman, snacks

(chocolate, cookies and candy), juices and sweetened soft

drinks. These foods to not have any added nutrients while

carbohydrates from other foods such as fruits and vegetables

that contain healthy carbohydrates according to each foodgroup.

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Fruits

MeatandAlternatives

MilkandAlternatives

Veget

ables

Grain

s

cookeddahl

orbeans

paneer

milk r

aitalass

i

flavouredorunflavouredsoybeverage

wintersquash

blackberry

blueberry mangogrape

corn

apple

sweetpotato peasparsnip

banana

chapatti,roti,ornaan

pulaoorupma

brownrice

dhokla

popcorn

bagel


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Can I Still Have Sugar?

Having diabetes does not mean you completely eliminate

sugar or your favourite desserts. If you have diabetes, are

physically active and maintain near normal blood glucose

values then the occasional sweet food is not going to harm

you.

Most people are getting a lot of added sugar in their diet.

This is sugar that is added on top of what naturally occurs in

foods. We should aim to get no more than 10% of our daily

calories from added sugar. So for the average adult, that is

only 12 teaspoons of sugar in the entire day! . Remember

that this also includes table sugar such as the sugar you add

to your tea or to South Asian desserts. Leave these foods for

special occasions or if you are going out to visit family andfriends. Shown below are common foods and how many

.

9.5

2.5 3.5 6 52.5

16.5 27.5 27.516.5 6.5

COLA

COOKIES APPLES GRAPES

LEMONADE MILKSHAKE


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Go for Fiber

As part of a healthy diet, Canadas food guide encourages us

to increase our ber intake. Foods like fresh fruits, vegetables,

whole grains, nuts, seeds and legumes have a lot of ber. The

recommended intake is 25-30 grams a day. This is great for

weight management, reducing blood glucose levels and

helps keep you regular.

One type of bre called soluble bre is especially important

in lowering LDL cholesterol and controlling blood glucose

levels. South Asian diet is full of soluble ber containing

foods such as okra, eggplant, green beans, beans and lentils

(rajma, chole and dahl), fruits and nuts.

Canadas food guide encourages us to make at least half of

our grain choices in a day as whole grains to increase intake

of ber, vitamins and minerals. Here are some tips on how

you can eat more whole grains:

Choose millet (bajra), sorghum (johar), ragi or whole

wheat our to make rotis or chapattisAdd wheat bran to wheat our to increase ber intake

Eat cracked wheat (dahlia)

Use nger millet (kurrakan) our to make pittus

Choose brown basmati rice, 100% whole grain bread or

rye bread

Pop your own low fat, unsalted popcorn for a snack

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Fats: The Good, The Bad, and The Ugly

Just like carbohydrates are important, we also need fats for

good health. But we need to make sure we get both the bad

and good fats in the right quantity. There are three dierent

types of fats:

Unsaturated fats: mono- and polyunsaturated

Saturated

Trans fats

Unsaturated Fats or Good Fats: These fats are liquid at room

temperature like oils such as olive and canola. These are best

for heart health as they decrease LDL (bad or unhealthy

cholesterol). Canadas food guide recommends to add 2 to 3

tablespoons of unsaturated fats daily. These include, cooking

oil, salad dressings, soft margarines and mayonnaise.

There are two types of polyunsaturated fats: omega-3 and

omega-6. Omega-3 is a nutrient that is protective against

heart disease and mainly found in fatty sh like salmon and

kingsh. If you are vegetarian, you can include plant sources

of omega-3 such as axseeds, walnuts, canola oil, walnuts,

tofu and soybeans.


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Saturated Fats or Bad Fat: These fats are more solid at room

temperature. They include ghee, butter, lard, hard

margarines, coconut oil and hidden sources (beef tallow,

ground meat, skin on meats, full fat dairy products).

Saturated fats are bad fats because if eaten in access, they

raise LDL cholesterol and are not good for heart health. So

the intake of this fat should be limited. You should get no

more than 10% of your calories or 2 tablespoons a day fromthese bad fats.

Trans fats or Ugly Fat: This is the worst type of fat for heart

health since it raises LDL cholesterol and lowers HDL

cholesterol (good or healthy cholesterol). Trans fats are found

in fats (hard margarine), baked goods (pasteries and donuts),fried foods and fast food (chicken nuggets, sh sticks and

french fries) and packaged snacks (chips and cereal bars).

Also limit eating out because some restaurant dishes can

contain trans fats.

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Cooking With Oils At Home

We do not realize that when we cook that we are adding a lot

of fat to our dishes. Even if they are good unsaturated fats!

They all add the same number of calories. Fat can add up

quickly in the day if you are not watching! Next time you are

cooking, use proper teaspoon or tablespoon measures. That

way you can measure exactly how much fat you are adding

to your favorites curries rather than eyeing it. To help you, a

set of cooking measures are included with this resource carekit.

When cooking at home, try to use unsaturated fats such as

canola oil instead of saturated fats like ghee or coconut oil.

We get enough omega-6 in our diet mainly from our cooking

oils but omega-3 is a nutrient that is lacking in our diet. Anideal cooking oil would be one that is high in

monounsaturated, low in saturated fat, has more omega-3

fats and less omega-6 polyunsaturated fats.

Olive oil is a good choice as it has shown many health

benets, but can be expensive. It also has a low smoke pointand can burn easily so is good to use as a condiment. Since

oil sometimes is heated to high temperatures in traditional

South Asian cooking, it may be best to use another oil which

do not burn at high temperatures during cooking.

Canola, vegetable and safflower oils can be themost cost-effective and healthiest oil to use foreveryday cooking.


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Where is the Salt?

South Asian diets can be high in salt with foods such as

pickled products (achars), papadums, snack mixes, salt

containing tamarind pastes, packaged spice mixes and

pre-made curry sauces. Salt can raise your risk of high blood

pressure. Intake of salt should not be more than one

teaspoon of salt (2300 mg) a day. For those who already have

high blood pressure, they should limit their daily intake of

salt to 1500 mg. You can keep track of most of your daily salt

The great thing about South Asian cooking is that there are

salt. Tips for cutting down on salt while still maintaining

add spices, herbs

use fresh garlic, ginger

add lemon, lime juice, zest, vinegar

34

917

2

61

2111

7

75

159

1

77

148

1

COCONUT SAFFLOWERCANOLA OLIVE

SATURATED POLYUNSATURATED

linoleic acid (omega-6)

alpha-linoleic acid (omega-3)

oleic acid (omega-9)

MONOUNSATURATED


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Garlic

Cinnamon

Turmeric

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35

Research is now showing that certain spicesand herbs used in the South Asian diets mayhave health benefits .

Tumeric (haldi), cinnamon (dalchini), garlic and ginger all

heart disease. Keep in mind that research is ongoing so none

protectagainstheartdiseaseandcancer.

MaylowerbloodpressureandlowerLDLcholestero

l.

Maylowerbloodsu

garlevels.

Maylowerinflammation

(bod

ysr

esponsetoinjury,

irritation,orinfection),lo

werLD

Lcholesterolan

dhelpwithmotionsickness

.Mayfightinfections,lo

werinf

lammation,may

Ginger


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odifyingYourDiet

HealthyEa

ting

Tips for Weight Management

Managing your weight is important in order to preventweight gain and abdominal obesity. As mentioned in the

previous chapter, if you are overweight you only need to lose

a small amount (5-10 per cent) of your body weight to

reverse prediabetes or prevent type 2 diabetes. Here are

some tips to help you manage your weight.

Eat three small meals every day (breakfast, lunch and

dinner) instead of eating 2 large meals

Avoid sweetened drinks (energy drinks, juice, soft

drinks) which do not have a lot of nutrients. If eaten in

excess, sugar will lead to weight gain and will be

turned into fat by the body. Choose only unsweetened,

100% juices. Better yet, drink water, low fat milk or tea

Eat foods high in ber such as whole grains, fruits with

skin on, vegetables, legumes, nuts and seeds because

that will ensure you feel full longer and do not feel

hungry in between meals

Choose healthy snacks like vegetables (baby or raw cut

carrots), whole grain products (low fat popcorn),

unsalted nuts or seeds and low fat dairy (eg yogurt

topped with fresh fruit). Only have them if you are

hungry in between meals. Try to limit South Asian

snacks that are deep fried like samosas or pakoras or

South Asian snack mixes such as ganthia or chevra.

Try to limit eating out. Eating South Asian foods inrestaurants can be full of calories as most items are

high in fat or fried. Try to avoid fast food.

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Nutrition Labels at A Glance

Reading labels helps you understand how much of aparticular nutrient is present in the product you are about to

buy. How do you know which brand or product is better over

another? Nutrition labels can help to make an informed

choice when you are at the grocery store. Nutrition labels can

include:

Nutrition Facts Panel: This label explains the amount of

calories and nutrients per serving in that food.

Nutrition labels help you compare foods and pick the

healthier choice. For example, if you are comparing

breads at a grocery store, you may want to look at the

amount of ber in each serving to know which one has

more ber.

Ingredient List. This has ingredients listed from the

highest to the lowest amount according to the weight.

So if sugar or fat are the rst ingredients on a product,

it is likely not the healthiest choice!

Nutrition Claims: Statements such as high in bre, no

sugar added can help you choose healthier food

For more information on nutrition label reading, view the

nutrition labeling chapter in the DVD provided with this

handbook.


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odifyingYourDiet

HealthyEa

ting

Can Eating Healthy Be Expensive?

Research shows that low income neighborhoods have fewer

grocery stores with healthy foods. If they exist, they are

smaller and have less choice of fresh foods like fruit and

vegetables. Also, the cost of fresh and healthy foods is higher.

The number of fast food restaurants is also higher in

low-income areas. This has shown to lead to obesity in theseneighborhoods. For South Asian migrants living in these

neighborhoods, lack of access to healthy foods can increase

their risk of Type 2 Diabetes. So how can you eat healthier on

a tight budget? Follow a few key tips on the following page.

38

Nutrition Facts

Amount

Calories 113 g

Fat 1.6 g 2 %

0 %

0 %

21 %

8 %

0 %

0 %

0 %

25 %

6 %

Cholesterol 0 mg

Sodium 242 mg

Total Carbohydrate 23 g

Protein 3.5 g

Dietary Fibre 0 g

Calories from Fat 8 g

Sugars 3.5 g

% Daily Value

Serving Size 1 Slice (45g)

Saturated Fat 0 g

Vitamin A

Vitamin C

Calcium

Iron

+ Trans Fat 0 g

Nutrition Facts

Amount

Calories 120 g

Fat 1.5 g 2 %

0 %

0 %

8 %

7 %

20 %

0 %

0 %

4 %

8 %

Cholesterol 0 mg

Sodium 180 mg

Total Carbohydrate 21 g

Protein 5 g

Dietary Fibre 5 g

Calories from Fat 8 g

Sugars 2 g

% Daily Value

Serving Size 1 Slice (45g)

Saturated Fat 0.3 g

Vitamin A

Vitamin C

Calcium

Iron

+ Trans Fat 0 g

WhiteBread

WholeGrain

Bread

Start here Limit these nutrients

Get enough of these

nutrients

Check calories

Check guide to % DV5% or less is LOW

20% or more is HIGH


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39

Healthy Eating Tips

Plan your meals ahead: If you are going to be traveling

far to nd a grocery store with lower cost healthy

options, make a list for the next two weeks before you

go. That can save you time, money, gas or transit token.

Go canned or frozen: If you nd fresh food more expen-

sive, use canned or frozen vegetables. They are just as

healthy and cheaper.

Buy generic brands: Generic brand are cheaper and the

quality is the same

Cook from scratch: You will save money and eat healthy

by controlling what you add to your food

Buy in bulk: If items like potatoes or beans, are on sale,

buy them in large quantities. Or better yet, try to go to

a bulk food store. These products do not spoil easily

and will last you a long time. If meat or sh is on sale,

you can buy it in bulk and then freeze it in smaller

freezer bags. Or invite your friend (s) to buy in a group.

Use less meat: Try to use less meat which will save you

money and will be a healthier option. Try to eat meat-

less 2 days a week. Replace with meat alternatives likebeans and lentils, tofu or egg.


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T

rueorFalse?

HealthyEating

True orFalse?

I do not like healthy foods, they all taste bland.

False!Healthy foods do not necessarily all taste bland. It is howwe cook and what we add that determines the avor of our dishes.The great thing about South Asian cuisine is that it has a lot ofspices and herbs that add a lot of avor to dishes. So you cancontinue to cook the same traditional dishes at home but just

need to reduce amount of fat, salt and sugar you add.

Certain South Asian foods that I eat will preventor treat Type 2 Diabetes.

False! There is some scientic evidence to suggest that certain

South Asian foods like fenugreek (methi), bitter melon (kerala) andcinnamon (dalchini) can help lower blood glucose, the research isnot nal. So you can continue to enjoy these foods as part atraditional South Asian diet. But if you have Type 2 Diabetes, youstill need to take your medication and consult your health careprofessional to properly manage your condition.

I cant do my religious fasting if I have Type 2Diabetes.

False! South Asians come from diverse faiths. Those who arepracticing Muslims or Hindus may fast on certain occasions or oncertain parts of the year. It is possible to fast safely if you haveprediabetes or diabetes managed with diet and physical activityonly. If you are on multiple medication or on insulin consult withyour physician or fasting could be dangerous. For Muslims whofast during Ramadhan, there is a tendency to eat a lot of highcalorie foods such as sugary uids and fried foods (samosas andpakoras) after breaking fast. For those who have prediabetes ortype 2 diabetes, this intake may lead to high blood glucose levelsor weight gain. 40


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41

GeetasAction Plan

I now know how to modify my diet by adding variety fromEating Well with Canadas Food Guide and still keep my

traditional way of eating. I will watch my intake of foods with

added sugar like South Asian sweets. I will add more bre by

eating foods like whole grains, vegetables, beans and lentils. I

will measure the amount of fats I am adding to foods I cook

at home and read nutrition labels when I am at the grocery

store.


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Lets get started!

Physical Activity

3


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43

My name is Lakshmi.

I am Kumars mother. I have been told that I need to do moreexercise since I have diabetes. I am 65 years old and I think I

am too old to exercise. God has given me this disease and so

whatever happens will happen because God wants it to

happen.

I never did exercise back home in India and I was healthy. Istay home most of the day so how can I exercise?

I pray, take care of my

grandchildren and clean the

dishes so that is enoughexercise for me.


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ctivity

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hatisPhysical

Activity?

What is Physical Activity?

Why is Physical Activity Important?

Being physically active is the one of the most important

things you can do to prevent type 2 diabetes and its

complications like heart disease. The most dicult thing

about engaging in physical activity is getting started. This istrue for Lakshmi, she has never been physically active and

now feels she is too old to start. She needs to be motivated

to start and to know that physically activity can be done at

any age.

If you are already active, good for you! Unfortunately, most ofus are not being as active as we should.

A recent survey shows that 52 per cent of

Canadians are physically inactive.

This is especially true for South Asian migrants who have lowlevels of physical activity after arriving to a new country like

Canada. As a result, research has found that South Asians

have lower HDL cholesterol levels that may put them at risk

for poor heart health.

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45

The key is to remember is that any kind of activity is good for

you and being active has many health benets. The benets

are too great to ignore. It can help prevent many other

diseases such as:

Osteoporosis

Obesity especially abdominal obesity

Certain types of cancers

Depression

Prevent early death

These are just a few of the benets! As people age, they tend

to reduce the amount of physical activity they do. This can

lead to loss of muscle mass and increase risk of certain

diseases. There are many benets for the elderly to remain

active. These include:

Improving exibility

Helping with memory loss

Fall prevention

Building strong muscles, bones, and joints

Maintaining independence

Improving sleep quality

More energy

The elderly (age 65 and older) should select activities they

enjoy doing like taking their grandchildren for a walk or try

doing new activities like dancing, volunteering, yoga or

gardening. After all, aging does not mean you have to stop

having fun.


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hatisPhysical

Activity?

PhysicalA

ctivity

What is Physical Activity?

Physical activity is described as any body movement thatinvolves your bodys muscles and allows you to use up

energy. It is also important to remember that you do not

have to spend a lot of money buying expense exercise

equipment or getting a gym membership to be active. The

good news is that any activity that you do as part of your

daily life counts.

There are dierent types of physical activities. These can

include household activities such as sweeping the oor or

mowing the lawn or lifestyle activities such as carrying bags

of groceries home. Physical activity should include activities

that focus on:

Cardiovascular endurance (good for your heart and

lungs) like taking a brisk walk or running.

Muscle strength such as carrying groceries.

Body exibility such as stretching or doing yoga.

Daily physical activity should include all three types of

activities. If most of us are not engaged in enough physical

activity each day, how can we start to be more active?

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What Kind of Physical Activity

Should I Do?

When thinking of how much is enough, think of the FITT

principle. This principle stands for Frequency, Intensity,

Time and Type which must be considered for all activities

in order to gain health benets.

Frequency: How often should you engage in activity?

Intensity: How Hard?

Time: How long?

Type: What sort of activity?

Endurance Activities

There are three intensities of activity:

Light activity is dened as being able to talk and sing

while doing the activity. This can include light house-

work such as ironing and gardening.

Moderate activity is where you are able to talk, not sing

and may be slightly out of breath while doing the

activity. This can include a brisk walk or mowing the

lawn.

Vigorous activity is where you are not able to say more

than a few words without pausing for a breath. You

may also start to sweat. This can include hiking orswimming.


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PhysicalA

ctivity

Keep in mind that depending on your level of tness

sometimes even doing light activities can lead people to be

out of breath. So do the talk test next time you do any kind

of physical activity and if you are able to carry a lightconversation then you are at a moderate intensity. If you are

going breathless (hung and pung) and sweating then

you are doing a more vigorous type of activity.

The key to preventing prediabetes and Type 2 Diabetes, is to

engage in aerobic type of physical activities more often.Aerobic activities are those that use your larger muscles and

that you do for longer periods of time. Aerobic activities

strengthen your heart and lungs. These include activities of

moderate and vigorous intensity.

The recommendations are 150 minutes ofmoderate aerobic intensity exercise per

week.

Which may seem like a lot but you do not have to do it all at

once! This can be done for 30 minutes a day, 5 days a week.

Or if that is too much to start, you can break it up intosegments of 10 minutes each, 3 times a day. So for example

you can:

Walk briskly while going to work for 10 minutes

Heavy cleaning like washing windows or car for 10

minutesMow the lawn for 10 minutes

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Activity?


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The recommendations encourage vigorousaerobic intensity exercise for

20 minutes, 3 times a week .

If you are not able to do a lot of vigorous exercise, then you

can combine moderate and vigorous activities together in a

week. This can be done for a total of only 120 minutes per

week. So for example, you can:

Walk briskly for 30 minutes, 2 times a week

Cycle for 20 minutes, 3 times a week

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PhysicalA

ctivity

Brisk Walking

Walking is a low cost and easy exercise to incorporate in to

your daily life. Studies have shown that walking at a faster

pace or brisk walking helps control blood glucose, lower

triglycerides, weight and blood pressure . One study

showed that women who walked briskly for one hour a day

cut their risk of developing type 2 diabetes by half!

One way to motivate yourself is to use a pedometer. A

pedometer is a device that records the number of steps taken

when walking throughout the day. Just clip the device to

your waistband and watch your steps add up. The goal

should be 10,000 per day which for most people is

approximately 30 minutes of walking a day but do not feel

you have to achieve this right away . If you are beginner, youcan start with 10-15 minutes a day and gradually build up.

There is a pedometer included with this resource care kit.

50

W

hatisPhysical

Activity?

mem

mode

sr

Display MEMORY

SETRESET

MODE

Displays the number of steps

number of aerobic steps,

calorie, and distance.Displays the time and the

duration of aerobic walk.

Use this button to call up

the data of seven days.

Use this button to changetime, weight, and stride

distance when setting

the unit.

Press this button for more

than 1.5 seconds so that

the screen will change to

the setting display. Usethis Button to set time,

weight, and stride distance.

Press this Button for more

than 1.5 seconds to reset

the data of today to 0.

Use this button to reset time,weight, and stride distance to

the initial values when setting the unit.

Use this Button to repeat the display in the order of number of steps, number

of aerobic steps, calorie, and distance.


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Strength Activities

Resistance training should involve all major muscles in your

body. The goal for resistance training is a minimum of 20

minutes, 2 days a week.

Doing aerobic along with muscular strengthactivities (resistance training) like lifting

weights or other heavy objects like soup cans,

will have a greater impact on preventingprediabetes and type 2 diabetes.

For more assistance on how to do resistance training exer-

cises, refer to the DVD accompanied with this handbook.

Flexibility Activities

Flexibility activities help you to move more easily and keep

your muscle and joints healthy. This can include gentle

reaching, bending, and stretching of all your muscle groups.

It can be achieved by doing activities such as gardening,

mopping the oor, stretching exercises and yoga.


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Yoga

Yoga is a holistic approach for physical and spiritual wellbeing. Yoga exercises comprise of various body posture

(asanas), breathing techniques (pranayamas).

Research now shows that doing yoga can have many health

benets. Participating in yoga daily can help lower blood

glucose, LDL cholesterol, body weight, blood pressure and

more importantly reduce stress and help with your mood.Yoga is a great, low cost, low impact exercise that you can do

in the comfort of your own home. For more assistance and

demonstration of yoga exercises, refer to the DVD with this

handbook.

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W

hatisPhysical

Activity?

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VigorousAerobicIntensity

BicyclingBollywood or Bhangra dancing

Jogging or running

Swimming hard

Sports (basketball, cricket)

Shovelling snow

Gardening with a shovel

20minutes

3timesaweek

P

53

This table summarizes and provides examples of the various

intensities and types of physical activity you can do as part of

your daily lifestyle.

Vacuuming and mopping

Brisk walk

Stair climbing

Mowing the lawn

Leisurely swim

ModerateAerobic

Intensity

30minutes5daysaweekor

10minuteintervals,3timesaday

LightInte

nsity Playing with your childrenPraying (namaz or pooja)

Casual walking

Gardening

Ironing

Washing dishes

Body weight exercisesWeight training

Resistance exercises

Wall pushups

Half or full squats

Lunges

Heel Raises

Leg curls

Yoga

Stretching

Gardening

Mopping or vacuuming

MuscularStrengthandEndurance

Flexibility

20 minutes

2 times a week

2timesaweek


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55

I Am Not Used To Being

Active, What Should I Do?

Lets Get Started!

Here are some tips to help you on your way to an active

lifestyle and to ensure you are doing it safely. For more

information on how to engage in physical activity safely, referto the DVD accompanied with this handbook.

Consult your physician: The most important thing

before you start is to ask your physician which activities

are suited for your age and health. Stop activity

immediately and seek medical assistance if you get any

type of pain, chest discomfort, cold sweat, paleness,

extreme shortness of breath or dizziness, severe joint

or muscle pain, swelling or fainting while being active.

List activities you enjoy: The next step is to make a list

of the activities you enjoy doing and are able to do

comfortably.

Be realistic: You do not have to participate in physicalactivity for 2 hours in a day! Most people make

unrealistic goals and when they cannot achieve

them, they feel a sense of failure. So set small goals for

yourself.

Keep a log to remember: When you rst start out, keep

a log of how many minutes and times a week you are

being active. That will help you gradually increase theamount and intensity of activity you do.


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Tips To Increase Physical Activity

Here are some practical tips to help you start an active lifeand overcome some challenges you may face as a newcomer

to Canada:

Partner up with a friend: Being active will be more

enjoyable and motivating if you can be active with

someone else on a regular basis.Start up a womens club or program: If you do not feel

comfortable being active in public invite friends, play

music and do Bhangra or Bollywood dancing together.

You can do this in the comfort of your home.

Be active where you live: If you live in an apartment or

condominium, use the exercise facilities that are

provided and go on the bike or treadmill. You can also

walk the hallways of your apartment or condominium.

Take a walk: If you are elderly and stay at home, you

can take your grandchildren for a walk outside or if you

live near a temple, mosque or gudwara, walk everyday

for prayers

Be a role model: Get your family involved and do

activities that the entire family can enjoy. Take a hike

one weekend, go skating or take your children for a

long walk in your neighborhood.

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eingActive,WhatShouldIDo?


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57

True or False?

I do a lot of walking when I am at work, pray

(namaz or pooja) and do house work like

cleaning dishes. So I am doing enough

physical activity to prevent Type 2 Diabetes

False! These activities are examples of light physical activity,but they may not necessarily reduce your risk of Type 2

Diabetes. To prevent diabetes you need to do activities at a

higher intensity such as mowing the lawn, washing the car

with your hands or taking a brisk walk.

I am fasting for Ramadan so I cant be active

False! It is certainly safe to be active during Ramadan aslong as you are doing light to moderate intensity activities. It

is a good idea to be active in the morning and try not to any

vigorous activity like running or cleaning windows 1-2 hours

before breaking fast or Iftaar meal.

I cant be active during the winter monthsbecause I am not able to go out

False! You can be active all year around. You can still go outand take a walk in mild, cold weather if you use weather-

appropriate clothing. Wear a hat, since up to 40 percent of

your body heat is lost through your head and neck. If theweather is not too cold (less than 10 degrees Celsius) or if it is

slippery or snowy, choose an indoor activity. Try walking with

a friend in your home basement, go walking in a shopping

mall or climb stairs in your home.


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ctivity

LakshmisAction Plan

I now know that I can be active at any age, it can be fun andthat being active is actually good for managing my Type 2

Diabetes and to prevent complications. I will try to do more

yoga as that is what I enjoy and take my grandchildren out

for a walk when I can. I will also try some strength activities

by carrying grocery bags home or climbing the stairs at

home.

58

A

ctionPlan

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Lets get started!

Mental Health

4


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61

Immigrating is Hard.

Newcomers may face a lot stress when arriving to a new

country. For newcomers, sometimes this stress is there for at

least the rst two years.

For South Asian families the stress can be due to many

factors such not nding a proper job, trying to support an

extended family, living in low income housing, and not being

able to speak English. Many families may not realize they areunder ongoing stress and as a result, may not take proper

steps to manage it.

If stress is not addressed, it can aect your health in many

ways. One way is to aect your mental health.

So How Do You Cope?


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alth

Mental Health

What is Mental Health?

Mental health is about how your mind feels, how you think,

how you see the world around you. When your mental health

is good you feel good and you do not feel sad or worry about

every issue in your life. When you are stressed or feelanxious, it can aect your mental health. You may see

changes in your mood, in how you are around other people

or how you think.

When these changes in mood occur, we say people are

experiencing mental illness. Anyone can develop a mentalillness like depression or schizophrenia. Many things can

cause a mental illness such as traumatic event in your life,

your genes, chemical changes in your brain and also stress.

Mental illness is a problem that eects how you feel, think

and get along with other people.

Someone with a mental illness may say strange things,

isolate themselves from family or friends or hear or see things

that other people do not see. The focus of this handbook

will not be on all mental illnesses and how to treat them. If

you have a mental illness (depression, bipolar disorder,

schizophrenia), please seek help from a trained professional.

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63

What is Stress?

You are likely wondering, what does mental health have to

do with preventing type 2 diabetes? How you deal withstress can aect not only your mental but physical health as

well. Stress is a persons response to a situation he or she is

not able to control. We all feel stress in our daily lives. Not all

stress is bad. People deal with stress in dierent ways. Some

are able to cope with it well and others take on a lot of

tension. If the stress is not addressed, it can lead to healthproblems. When you start to get stressed, it leads your body

to a ght or ight response. This response is there so the

body can get ready to either physically ght or run away

from a stressful situation. This response is caused by

hormones such as adrenaline. This can aect you in a

physical, emotional or mental way:

Physical Responses:

Headache

Dry mouth

Heart begins to race

SweatingCold feet or hands

Mental or Emotional Responses:

Anger and frustration

Worry

Feeling helplessCant sleep well

Mind racing and not able to make decisions


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BRAIN

PANCREAS

FATANDS

UGAR

LEVELS

INSULIN

EPINEPHRINE

RELEASE OF HORMONES INSULIN RESISTANCE

METABOLIC SYNDROMETYPE 2 DIABETES

CORTISOL

T2DT2D

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65

Does Stress Cause Type 2 Diabetes?

The ght or ight stress response gives the body strength

and energy to deal with the stress. Once the stress is gone,the body relaxes again. Chronic stress which is a type of

stress that is on-going and unavoidable like getting a divorce

or nancial worries. In the case of chronic stress, the body

does not relax. The chronic stress can eventually cause

damage to our body.

The release of hormones and changes the bodygoes through during stress increases yourblood sugar and fat levels in the blood. This canlead to abdominal obesity and metabolicsyndrome.

These can then increase your risk of getting type 2 diabetes.

Or sometimes people who are stressed may start to smoke,

eat poorly, and are not active which can also lead to type 2

diabetes. The key to reducing the risk of getting type 2

diabetes is to manage the chronic stresses in your life. For

most of us, this is not always an easy task!


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What is Your Stress Index?

are truly stressed. We are not always aware that we are under

recognize. This is because they may be so familiar, we do not

think they are related to stress. So how do you know if you

are under stress? Find your stress level by taking this quick

test.

66

W

hatisMentalH

ealth?

Do You Frequently? YES NO

1. Neglect your diet?

2. Try to do everything yourself?

3. Blow easily?

4. Seek unrealistic goals?

5. Make a big deal of everything?

6. Keep everything inside?

7. Race through the day?

8. Spend time complaining about the past?

9. Fail to get a break from nose and crowd?

10. Look to other people to make things happen?

11. Complain you are disorganized?

12. Act Rude?

13. Neglect Exercise?

14. Gossip?15. Put things off until later?

16. Have few supportive relationships?

17. Have difficulty making decisions?

18. Avoid people whose ideas are different

from your own?

19. Get too little rest?

20. Use sleeping pills and tranquilizers without

the doctors approval?21. Get angry when you are kept waiting?

22. Fail to build relaxation time into day?

23. Ignore stress symptoms?

24. Fail to see the humour in situations others

find funny?

25. Think there is only one right way to do

something?


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Now count up the number of "yes responses and see where

you are in terms of stress level. Check below to see what your

score means. If you have scored 16 or above, go back to the

stress index and take a look at some of the warning signs and

changes in habit. Then see if you are able to make changes to

your life to decrease the level of stress .

Score? Diagnosis

1 - 7 You handle the stress of daily life well. There are few

hassles in your life. Make sure, though, that you are

not trying so hard to avoid problems that you shy

away from challenges.

8 - 15 Youve got your life in fairly good control. Work on

choices and habits that could still be causing some

unnecessary stress in your life.

16 - 22 Youre approaching the danger zone. You may well

be suffering stress-related symptoms and yourrelationships could be strained. Think carefully about

choices youve made and take relaxation breaks

every day.

23 and Over Emergency! Take some time to re-think how you are

living, change your attitudes, and pay careful

attention to diet, exercise, and relaxation.


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Tips to Cope With Stress

How did you score on the Stress Index? If you are in the

danger or emergency zone, then here are some ways inwhich you can cope with stress. Everyone deals with stress

dierently. It is important to remember that there is no right

way to deal to with stress. You may decide to cope with it in

a spiritual, physical or emotional way. One way is through the

use of stress balls. Although the research does not prove that

the use of stress balls help to relieve stress, people do ndusing a stress ball relieves some tension. Stress balls are

included in this resource kit so go ahead and give one a try.

On the next page, you will nd some other tips to help you

relieve some stress and tension in your life.

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Coping with Stress

Socialize: Coming to a new country can be

overwhelming. Take the time to get involved in your

community and make friends.

Write to family and friends or pay a visit back home:

Keeping in touch with loved ones back home can make

you feel less lonely.

Be active: Participate in physical activity like doing

yoga or walking to relax and clear your mind

Volunteer or nd a hobby: Sometimes working with

others in the community or nding something you

enjoy doing gives you a feeling of satisfaction and it

will relieve your own stress.

Be spiritual: Focus on your spirituality like praying

(namaz or pooja). It can help you cope with stress

Look to Humor: Make jokes and laugh away the stress

Feel sad: Allow yourself to feel sad sometimes. It means

you acknowledge and recognize you are stressed

Take out time for you to relax: Take a break! Watch your

favorite South Asian drama or lm to take your mind

o the stress.

Get help to manage your money: There are many

expenses when you move to Canada. Start to manage

your nances and make a monthly budget so you do

not feel overwhelmed and frustrated when dealing

with expenses

Learn Canadian English: Not knowing the language canmake you feel alone. Although it may not be easy to

learn a new language at rst, it will get easier with time

and it is also a great way to make new friends


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What if I Do Not Deal with Stress?

If one does not deal with stress then he or she may start toexperience symptoms of low mood or depression. Everyone

experiences unhappiness and has feelings of sadness or

worthlessness. People may experience feelings of low mood

temporarily when things are not going well. Then they feel

better again. If the feelings of low mood last for a long time

and are not going away, then one may have depression.

Depression is not just about feeling blue or feeling down. It

is a mental illness that aects the entire body. It aects our

mood, thoughts and body. In South Asian culture and

language, depression is not well recognized. Some may

explain it as a worry or thinking too much or sinking of

the heart.

Research shows that South Asian newcomers

especially women and the elderly are at a

greater risk to experience depression.

There can be many challenges for people when dealing withdepression. There may be feelings of shame or disapproval

with talking about depression to others. They may not feel

comfortable opening up and talking about it. So they will not

take the step to get help. It is important to remember that

depression is a mental illness. It is just like any other illness

like diabetes or heart disease. There is nothing shamefulabout having depression.

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Checklist for Depression

Do you think you may be depressed? See below for symp-toms for depression. If you have 5 or more of these symp-

toms that are highlighted for 2 weeks or more, then you may

have depression. If you think you may have depression seek

advice from a trained professional. You should not use this

information to diagnose yourself or someone else.

Depression Checklist

Only see bad things about yourself

Feel unreasonable guilt

Feel like life is not worth living

Feel very sad all the time

Restless or irritable

Lose interest in activities that you enjoy

Cannot concentrate and make decisions

Feel like you are tired all the time

Sleep too much or too little

Eating less and losing weight or eatingtoo much and gaining weight


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Does Depression Cause Type 2 Diabetes?

Research shows that having depression maylead to Type 2 Diabetes.

Being depressed can lead to many lifestyle changes such as a

poor diet, lack of physical activity and smoking. These

lifestyle changes along with certain medications for

depression can lead to weight gain. All these can indirectly

increase the risk of getting type 2 diabetes. Also depression

may cause changes in the brain which may also lead to

development of type 2 diabetes. That is why it is important if

you think you may be depressed, to seek help from your

physician to lower your risk of getting type 2 diabetes.

Research also shows that those who already have type 2diabetes have a higher chance of being depressed. The risk

of having depression is even greater if individuals with type 2

diabetes have one or more diabetes related complications.

These complications can be eye or nerve damage. Those

living with undiagnosed diabetes or prediabetes do not

show higher rates of depression.

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True orFalse?

My doctor cant help me with my symptoms ofdepression, I can deal with it

False! Most of us have great coping strategies that we useto lift our spirits when we are down or have the blues. We

talk to a friend, go out to the movies or pray. But if symp-

toms of depression are not going away, you may need toseek help from a train professional like your physician. People

with depression have mental or physical symptoms that last

for several weeks or years. A trained professional can help

you feel better so you can live a normal life.

My stress wont lead to depression

False! Depression has many possible causes. Stress itself isnot bad. But chronic stress, if not managed well, can wear

you down and overwhelm you. So it is important to manage

stress before you have trouble coping. Otherwise, it can lead

you to have symptoms of depression.

I am a religious person and I do pooja (prayers)especially when Im down. Being religious isthe best way to deal with depression

False!Having a belief system is a great way to cope with

daily life stresses and symptoms of feeling down. But to deal

with ongoing depression, people may also need to seek help

from others. It is important to understand that depression is

a medical condition. So getting help from a trained

professional like your physician so they are able to help you

cope.


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FamilyAction Plan

We have learned as a family that stress is a normal part of lifebut we need to manage chronic stress such as nancial

strains and ongoing family conict. If chronic stress is not

managed then it can put us at risk for mental illness like

depression or type 2 diabetes.

So we will try to manage our stress by being more active likegoing for walks and doing yoga, seek help to manage our

nances and try to relax by being more spiritual.

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Lets get started!

Appendix

5


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Glossary of Terms

Amputation: Surgical removal of one or more limbs from thebody.

Bipolar Disorder: Is a psychiatric mental illness that eects

how a persons brain functions. People experience shifts in

mood, behavior and how they function. These shifts can be

where the person is overly joyful or overexcited (manicepisode) and then extreme sadness or hopeless state

(depressive episode).

Body Mass Index: Body mass index is measured by calculat-

ing a persons weight to height ratio. Individuals are placed in

categories of normal weight, overweight or obese. The WorldHealth organization guidelines for normal BMI for South

Asians is set at lower values for healthy weight: 18.5 to 22.9

kg/m2

Cholesterol: Cholesterol is a soft waxy substance that is

mainly produced in an organ called the liver. You can also getsome cholesterol from your diet from foods such as egg yolks

and meats. It cholesterol travels around your blood in lipo-

proteins. There are two main lipoproteins: LDL which is the

bad cholesterol and HDL which is the good cholesterol.

High levels of cholesterol in the blood can increase risk of

heart disease.

High Density Lipoprotein (HDL) Cholesterol: HDL protects

your blood vessels from cholesterol build up and as a result is

protective against heart disease. It moves cholesterol away

from the blood vessels and cells of the body back to the liver

for removal from the body.


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Stress Ball: A small toy that is made of soft and exible

material. There are many types of stress balls and they do not

have to be in a shape of a ball. They can be used for stress

and muscle tension in your hand.

Stroke: Flow of blood to the brain is stopped to a small or

large area of the brain. This leads to sudden loss of brain

function and can cause brain damage. It can aect a number

of areas including the ability to read, write, remember, speak

or see.

Triglycerides: Triglyceride is a form of fat made by the body

from foods that you eat. It carries fat in your blood to cells

that need it. The triglyceride level is a laboratory test to

measure the amount of fat in your blood. Too much

triglyceride can increase the risk of heart disease.

Waist circumference: Waist circumference measures the size

of a persons waist. This provides information for the risk of

abdominal obesity. The World Health Organization Waist

circumference cut o values for South Asians is lower (men

below 90 cm and women below 80 cm)


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Organization and Contact Information Contd

Tamil Eelam Society of Canada

Provide settlement services, referrals to temporaryaccommodation for victims of domestic violence and new

arrivals. English as a Second Language (ESL) classes,

translation and interpretation, job search and resume

preparation and youth issues

www.tesoc.org

416-757-6043

Riverdale Immigrant Womens CentreCulturally specific counseling support services, assist

newcomers with settlement language training and employment

services, anti-violence assistance for women and children,

volunteer and student placement services

www.riwc.ca

416-465-6021


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Appendix

Assistance if You Are Feeling Stressed orExperiencing Signs of Depression

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Organization and Contact Information

Across Boundaries,

An Ethnoracial Mental Health Organization

Provides programs, social and recreational activities, support

groups, alternative and complementary therapies, art therapy,

creative expressions, community kitchen, individual and

family support

www.acrossboundaries.ca

416-787-3007

Canadian Mental Health Organization -

Rehabilitation Action Program

Programs to assist with employment, housing, early intervention

for youth, peer support, recreation services for people with

mental illnesses, stress reduction workshops and public

education campaigns for the communitywww.cmha.ca

416-289-6285

Mental Health Works

Accommodate employees experiencing mental disabilities such

as depression of anxiety in the workplace

www.mentalhealthworks.ca

416-977-5580

Community Resource Connections of Toronto

Individual and community support services. Assists adults who

are having difficulty in day to day living as a result of severe and

persistent mental health issues. The services are also culturally

specific. Also have Hostel Outreach Program which is a

community mental health program for homeless women and men

www.crct.ca

416-482-4103


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Here is more information if you of other organizations that

been published, that some of the contacts for these

organizations have changed. If so, visit www.211toronto.ca .

This sites list any of services in Toronto and the most recent

contact information. You can call 211 or 416-397-4636.

Help for Newcomers.


Settlement.org

Welcome to Ontario

www.settlement.org

Catholic Cross Cultural Services

www.cathcrosscultural.org

416-757-7010

Culture Link

www.culturelink.net

416-588-6288

You Are Here: Website for Youth

www.newyouth.ca

Toronto Social Housing Connections

www.housingconnections.ca

416-981-6111

Human Resources and Skills Development Training

www.poss.ca

Newcomer Resource Centre, Access Allianceaccessalliance.ca

416-693-8677

COSTI Immigration Services

www.costi.org

416-658-1600


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Appendix

Mental Health Organizations

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Centre for Addiction and Mental Health

www.camh.net

416-535-8501

Mood Disorders Association of Ontario

www.mooddisorders.on.ca

416-486-8046

Canadian Centre for Victims of Torture

www.ccvt.org

416-363-1066

Self Help Resources of Greater Toronto

www.selfhelp.on.ca

416-487-4355

Family Association for Mental Health Everywhere

www.fameforfamilies.com

416-207-5032

Family Outreach and Response Program

www.familymentalhealthrecovery.org

416-535-8501

Family Service Association of Toronto

www.fsatoronto.com

416-595-9618


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References

Several resources and peer reviewed journals played a keyrole in developing this handbook. For more detailed back-

ground information and references, refer to the research

report that guided the development of this handbook.

Chapter 1: Introduction

1. World Health Organization. Diabetes. Retrieved April 2,

2010 at http://www.who.int/diabetes/en/index.html

2. Abate, N. and Chandalia, M. (2007). Ethnicity, type 2

diabetes and migrant asian indians. Indian Journal of Medical

Research. 125, 251-258.

3. Misra, A and Ganda, O. (2007) Migration and its impact on

adiposity and type 2 diabetes. Nutrition. 23, 696-708.

4. Heart and Stroke Foundation. Diabetes and You: Manage

Your Lifestyle: Reduce Your Risk. Heart and Stroke Founda-tion. 1-13.

5. Canadian Diabetes Association. (2008). Prediabetes

prevention fact sheet. 1-2.

6. Misra, A, et al (2009). South asian diets and insulinresistance. British Journal of Nutrition. 101, 465-473.


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7. Misra, A and Khurana, L. (2009). The metabolic syndrome in

south asians: epidemiology, determinants and prevention.

Metabolic Syndrome and Related Disorders. 7(6): 497-514.

8. Eriksson, J. et al (1999). Prevention of type II diabetes in

subjects with impaired glucose tolerance: the Diabetes

Prevention Study (DPS) in Finland. Diabetologia. 42, 793-801.

9. Rai, M and Kishore, J. (2009). Myths about diabetes and its

treatment in North Indian population. International Journal

of Diabetes in Developing Countries. 29(3), 129-132.

Chapter 2: Healthy Eating

10. Health Canada. (2007). Eating Well with Canadas Food

Guide. Ottawa, Canada. Publications Health Canada.

11. Aga Khan Health Board UK. The Ismali nutrition centre

(n.d.). Retrieved April 2 at

http://www.theismaili.org/cms/519/Eating-for-health

12. Canadian Diabetes Association. (2005). Handy portion

guide. Beyond the Basics: Meal Planning for Healthy Eating,

Diabetes Prevention and Management.

13. Merchant, A et al (2007). Carbohydrate intake and HDL in

a multiethnic population. American Journal of Clinical

Nutrition. 85, 225-30.

14. EatRightOntario. (2010). Healthy carbohydrates for

diabetes. 1-3.

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