Thumbs up.

I think we're all set.

All right.

So we're gonna get started.

Today we have Joan Hill with us to talk about diabetes.

Joan's a registered dietitian and certified diabetes educator with over 30 years of experience, which is amazing.

That's a long time in this field.

And she works with people who not only have diabetes but also pre-diabetic to help keep them away from that type 2 diabetes diagnosis.

So after Joan goes through her presentation today, I'll talk about the anthem diabetes resources, which I think is a very important piece to today's presentation.

So I'll go through those for you.

Some you might know about, it's always good to have just a reminder of things.

And then we do have our new nutrition program that we have here monthly that we're starting in December.

So I'll talk about that.

Just as a reminder, it's the session's being recorded for those that can't come live.

So if you ask a question, just if you can be loud about it, we don't have a mic to hand around today, but um Joan can repeat your question and then give the answer out.

Because I I think that's how we decided we were going to go.

Ask questions as as the presentation's happening, so it's fresh.

Um so without any further ado, I'm gonna turn it over to Jo.

Thank you.

Sure enough.

Thanks.

So hi everybody, thanks so much for coming.

Um I'm from the Boston area, and so it was a little bit of a ride.

Glad it was great weather.

I actually twisted my husband's arm to come with me today.

Um so that's Joe Hill, which is kind of interesting because we've been married for 42 years, and it's the first time I think he's ever seen me speak.

I don't know.

No.

Maybe one or two other times.

Anyway, um, my job is to help convey to you how serious diabetes is.

Um, but you know, when I think about the way that business works, sometimes the slides come and they are not necessarily answering the questions that you want to have answered.

So the way that I really like to open up the dialogue, and it really should be a dialogue, because as you said, I didn't get your name when you came in the room, but you said diabetes is a curse.

And um, what I'd like to share with you is that it doesn't need to be if you're actually engaged in the process of how to manage.

And I know it's become extremely complex over the last 30 years that I've been doing education.

I I tell this funny story that at one time it used to be we talked to patients about insulin and one pill.

And now I talk to patients about technology using insulin, devices that they never had to use before, as well as maybe 14 different classes of drugs that one potentially can use to try and help manage diabetes.

So, with that introduction, what I'd like to do is just take a minute and ask, why did you come and what question are you hoping that I may be able to answer for you before we leave today?

And because I'm over 60, I write it on the board because I suffer from CRS, can't remember stuff.

So I'm going to just take a few minutes to ask, is there any particular question that's pressing on your mind that you would like me to address?

And I don't know the answers to everything, but I will be able to direct you to some places that you can find out that answer.

Yes, in the back.

So the question is, is type 1 diabetes still two to 3% of the population?

It is.

So when I hear people talk about the differences of diabetes, which we're gonna address in just a minute, um, a lot of people think because type 1 diabetes may has to require insulin, they think it's the worst kind of diabetes, right?

And so when I think about addressing the issues of how to manage type 1 diabetes, it's definitely a smaller population.

And it is certainly an insulin requiring treatment.

Um, but when we think about the differences that we have now from when I first started, I'll I can address that a little bit later.

Any other questions that people want to make sure I answer?

So diabetes is diagnosed when you're greater than or equal to 126 fasting.

So if you're if you're concerned.

And what is reported is that it should be on two separate occasions.

So it's not just one.

And then some people ask sometimes, is it by finger stick?

Is it by continuous glucose monitor?

Or is it by venipuncture?

So when the doctor takes blood or the phlebotomist takes blood out of your arm, it is diagnostic from the arm, not a finger stick and not uh a continuous glucose monitor at this time.

Things may change.

So the question is how accurate is the A1C that you get on the glucose monitor?

The glucose monitor name nomenclature is called a GMI, which stands for glucose management indicator, and it is not an exact measurement.

So your A1C could be different than what your GMI is if you have a continuous glucose monitor.

And so for those of you that are in the room that don't know what the continuous glucose monitor is, it's a device where you stick a sensor on your arm and you have a receiver, which could be either the phone and the sensor talks to the phone by Bluetooth, or you have a receiver, depending upon if you're Medicare.

Medicare requires that you get a receiver, which is insane when we think about all the mechanical things that we have to carry around with us.

So I what I tell patients when I meet with them is I say it's still better than not knowing, and it can help you to create a conversation with your provider to say, you know, my GMI has gone up.

If if I'm not seeing my doctor for three months, because usually insurance only reimburses for an A1C once every three months, if you see it elevated, then you can think to yourself, so what are the things that I can do that might help me bring down my GMI or my A1C?

Yes.

So the question is how accurate is the A1C on the finger stick versus one that is venipuncture?

I will say it's not a hundred percent, and the reason for that is user interaction.

So you can have two medical assistants doing an A1C at the same time off the same finger, and possibly have two different numbers.

So again, if that's all that you have available, um, you know, sometimes insurance companies or physicians' practices will do that only because they want the information today in which to be able to help make a determination, a change to your treatment plan.

And so even the finger stick, even though it's not 100%, it's still better than not knowing at all.

Okay.

So I know we've answered a few questions, and as we go along, there may be some other things that you're thinking about.

Um so what we're going to talk about is what is diabetes, and it's the body's incapable of making enough insulin or insulin that is received by the cells in the body so that it can help to lower the blood sugar.

Insulin is a hormone, it's produced, it's produced by the pancreas, and you either have it or you have not enough, or you have some, but it doesn't work, or you don't have any.

And so the differences in the nomenclature of do I have type one versus type two versus gestational versus pre-diabetes, it really is trying to identify the biological problem of what's happening in your body.

So if your pancreas makes enough insulin, but you have no receptor sites on your cells.

Receptor sites are thought to be comparable to a door.

If I don't have any doors for the insulin to get into my cell, then I have high blood sugars.

The sugar stays on the outside of the cell and continues to rise.

If I have no insulin on the opposite side of the door, then that's considered type 1 diabetes.

Years ago they used to call it juvenile versus adult onset.

So type 1 was considered juvenile because it showed up more frequently in children, but it actually can occur to anybody in their life cycle.

My youngest child I ever took care of was a three-month-old, type 1 diabetes.

My oldest adult that I ever took care of was 93 years old when she got diagnosed with type 1 diabetes.

Type 1 diabetes is an autoimmune disease where it destroys the pancreas' capabilities.

So similar to your being able to have chicken pox as a child, but um, and now I'm gonna forget the name of the itchy stuff.

You know, we have to get a vaccine.

Shingles as an adult, right?

So you can get a disease throughout the life cycle.

Type 2 diabetes used to be called a down onset because it occurred to more people that were of older age.

But lo and behold, it can also occur to children, occur in children.

So glucose has to enter the cell where we convert it to sugar, and we have means to which to measure that to see how high or how low you are.

And if you're unable to use the insulin that you're still making, that's called insulin resistance or type 2 diabetes.

So sometimes when I meet with patients, one of the things that we might actually do is we might actually measure do they still make insulin and whether or not it's effective.

And if you're insulin resistant, you actually might be producing more insulin because your body is trying to respond to high blood sugar, and so it makes more and more and more.

With people with type 1 diabetes, we can measure something called a C peptide, and that is the precursor to insulin.

And if you don't have any precursors, you don't have any insulin capability, right?

You have no ability to make insulin.

So type one, no insulin.

Type 2, insulin resistance.

Where did prediabetes come into play?

Anyone have any idea about when that started?

It started probably about 38 years ago when doctors in the research arena started to identify that patients were coming to them with complications related to diabetes, but blood sugars not at the diagnostic criteria.

So now we are concerned about why are people having complications, heart disease, high blood pressure, strokes, loss of eyesight, tingling and issues with their feet.

Um so what they decided to do was to change the number and lower the number to 70 to 100 is normal.

Anything over 100 is considered pre-diabetes.

And why do we want to push that issue?

The more people know, the more we can help them change.

And I know it's difficult to change one's behavior, and it's difficult to change one's community and surroundings, but if we know that we can prevent diabetes by understanding how it works, then we're able to make changes.

So I have a family, and what was interesting to me was a few years ago, I was out on a boat with my uncle, and my uncle and I were talking about diabetes, and my uncle shared with me that my grandfather, who I never knew because he was dead when I think he died when I was four, um, he shared with me that my grandfather had diabetes.

I didn't know what was in the family.

Type 2 diabetes occurs more frequently in families.

If you have one parent that has type 2 diabetes, you have a 50% chance of having type 2 diabetes.

If you have two parents, it's 75%.

So we have genes that set us up, we have the food culture, our activities that have changed over the years from when we were active out in the field versus now working behind a desk.

Um foods everywhere, right?

When we were kids, me, my husband and I, we didn't have food at gross at a gas stations, right?

We just went to the gas station.

Now you can go and get a meal at a gas station.

So when it comes to thinking about the risks of type 2 diabetes, if you have a family history of it, what are some other things?

Inactivity, excess weight.

A lot of people say to me, it's because I ate too much sugar.

And I'm going to say that that's not necessarily true.

But when I think about a sugar containing product versus another food that is grown in the ground, we can have equal amounts of carbohydrate, but a higher meal that has more simple sugar carbohydrate can cause a rise in the blood sugar faster than can maybe an apple.

And so when I think about what's coming, what holiday is coming, Thanksgiving.

I don't even want to count how many servings of carbohydrate are in the food that we're going to be eating on Thanksgiving, but that is where it is a challenge, right?

When you think about how do I modify and make my meal more palatable and enjoyable, enjoying my family and friends, but not causing blood sugars to go too high.

If losing weight can help you manage blood sugars better, what became a national study was the National Institutes of Health had something called the diabetes complication control trial.

That was for people with type 1 diabetes and showing that control matters, less complications from diabetes if blood sugar is in good control.

But for type 2, the NIH had a 10-year study where it was called the diabetes prevention program.

And I think you're going to hear a little bit more about the LORC program, which is that program.

It was a study that actually ended early because of the fact that they proved before the end of the study, right?

We have in a good study, we have a control group and we have the group that doesn't get the study parameters.

The control group got more diabetes than those that were participating in the intervention.

And so they had to stop it early because these guys went on to get diabetes and it wasn't ethically responsible.

So now the diabetes complicant uh diabetes uh prevention program is definitely been shown to be effective in preventing your developing diabetes.

So if you're in that pre-diabetes state, which I don't know, I can't tell by looking at you.

You don't have a PD on you.

Um it's definitely something worthwhile to look into.

So the doctor usually detects a high blood sugar.

They can do a urine test and see that you're spilling.

Oh, I'm sorry, I'm flipping the pages and not moving forward, sorry.

So the doctor can tell that you have diabetes by doing what we talked about before, the venipuncture.

I I will tell you in my history of managing people with diabetes, you know, sometimes people go to health fairs, and lo and behold, when they do the finger stick, the finger stick is 350.

I would, you know, get them to a doctor quickly, but I would say, I'm not sure, let's get you to the doctor.

Um you look at urine, urine cannot, it can tell you if you're spilling sugar.

So the way that I sort of describe this, your body doesn't like to have maple syrup for blood.

So what happens is you start to go to the bathroom more frequently so that you can rid yourself of the extra sugar.

And so that is the reason why it shows up in your urine.

Your body is saying, get rid of the sugar so I'm not going to be in trouble.

Everybody has a different renal threshold, which means my kidney might tolerate more sugar in my blood before I start to spill over into my urine, whereas your kidney might have a different tolerance level.

So it's not an exact science, but it definitely can tell you time to get the venipuncture if you're spilling urine, sugar in your urine.

So usually the doctor asks you to do a fasting blood sugar, which means nothing to eat, 10 to 12 hours before you go.

Because if you do drink something that has sugar in it, your blood sugar could be high, but that doesn't tell you what the fasting blood sugar is, and we already spoke that that should be 126.

And again, normal blood sugar for the non person, the person without diabetes is 70 to 100.

So what are some of the signs and symptoms of diabetes?

Excessive thirst.

So remember if your body's saying to it, I don't want to hold this sugar in my system, I'm going to go to the bathroom more frequently, so you become dehydrated.

So that's why you're drinking more.

Frequent urination, excessive hunger, weight loss.

Why do you lose weight when your blood sugar is high?

If you have enough insulin, the sugar's going to be stored.

But if you don't have any insulin, your body says, let's find some other food.

So you start to break down fat cells.

The fat cells actually help to produce some sugar to keep you alive.

Think about the folks that were in Germany in the concentration camps, right?

By the time they got out of the concentration camps, if they did, they had no fat on their body whatsoever.

And after you're finished with the fat cells, you'll start to break down protein or muscle mass.

You might have fatigue.

Well, why do you have fatigue?

Well, if you have no sugar to give you energy, you're going to be tired.

Changes in vision.

That isn't necessarily diabetic eye disease as much as it is changes in the fluid status in your body.

So if you think your your eyeballs are pretty much a uh full of fluid, if I'm dehydrated, it changes the shape of my eyeball.

And so I'd now I'm, you know, my vision is blurry.

Slow healing cuts and infections and persistent itching.

So the question is is there a correlation between eczema and diabetes?

And not that I'm aware of.

So you end up with high blood sugars.

Um when the baby is delivered and the placenta is gone, blood sugars usually return to normal.

So we have type one, type two, gestational, prediabetes, and then we have some other oddball diabetes that show up in very few and far between.

But most of all, doesn't matter what type you have, controlling what you eat, how much you exercise, and if necessary, medications to help lower the blood sugar so you lower the risk for any complications related to it.

That's the one thing I think has made my job easier is the growth of the internet.

But with good things come bad things.

Every five years I had to resit for the exam to become a specialist in teaching.

Does that mean that you can't learn from your neighbor who's had it for 20 years?

No.

But if you think about where do you get information and whether or not it's good information versus information that says things that might not be supported by science, I'd prefer that you use a reputable source.

So registered dietitian, I just learned you're going to be having the capability of meeting with an RD, that's great.

In the diabetes prevention trial, they used coaches, so they were trained on how to work around people learning about setting goals, and we're going to talk about that in a minute.

Thinking about, you know, the information that you get on the internet, whether it's scientifically based or not, I don't know how you are using those tools now, but there's definitely more support groups for people with diabetes, whether it's type one, type two, or people that are gestational.

So certainly utilizing those resources.

So let's talk about setting goals.

When I think about being diagnosed with any disease, whether it's diabetes or high blood pressure or high cholesterol.

I think to myself, what should I do?

Exercise.

Eat right, managing monitoring, taking your prescriptions and learning about it.

When you're setting a goal, whether it's around any of these parameters, it's it's critical for you to work on making sure that it's realistic.

Right.

So for all of you that are in the room, have you thought about a goal that you would like to set for managing?

What maybe one of your goals was to attend this session so you could learn a little more about what it's all about.

When setting a goal, we want to make sure that we set long-term and short-term goals.

We want to be able to make ourselves feel successful, so making them realistic.

So, what kind of goals would you like to think about setting?

They can be quantitative where they're measurable.

So I can say, I want my A1C to go from 7.4 to 7.

Or you can say a behavioral goal.

I want myself to exercise every Monday, Wednesday, and Friday at 2 o'clock.

Or maybe medical adherence.

So I want to remember to take my medication seven days out of seven, or maybe it's five days out of seven.

Qualitative goals are really behavioral.

So I want to spend more time enjoying life, doing more hobbies, relaxing, having lifestyle stressors.

Um can interfere with your managing your diabetes.

So what are some other kind of goals that you can think about setting?

Portion control.

Say it again.

Movement.

So maybe one of the goals is got nothing to do with your health.

Maybe goals have to do with managing other parts of your life.

So in thinking about the whole picture, you have to think about a vision, mission, goals, and action.

So your vision is living a longer and healthier life, wouldn't you say?

That would be mine.

My mission, why?

So that I can help people manage their lives.

I have two children.

By looking at the vision, it's multi-level, it's a broader tier.

Actually, I'm not feeling very well right now.

And I actually need to sit for a minute.

So here at the city through Anthem, we have a lot of different resources that are available to us.

Um that in looking at our aggregate data, we know they are not needing use for the people that need to be using them.

So for instance, um our diabetes population.

We have staff who are in type one.

We have staff who are in that pre-diabetic area.

We have ingestational.

And so for all of those areas, Anthem has a program here that can help us that we need to have people starting to realize, okay, this is happening.

What are my resources?

So diabetes, for instance, with the condition care program through Anthem, that has all of those groups.

It has others as well.

So you're talking about anyone that has asthma, chronic um pulmonary issues, COPD, heart conditions, high cholesterol and high blood pressure, low back pain, arthritis, any of those muscular skeletal.

They're groups for all of these areas.

And basically, okay, sorry.

Thank you.

So basically, what the condition care programs provide is access to a team.

It gives you a team that is your team that can help you with case management.

If it's maybe a new prescription, you have access to all right, what is this prescription?

Sometimes our doctors are busy and they're coming in and they're giving you a prescription and they're walking out of the room, and you're not really able to hear what all those pieces are.

You know, what are the um things that you need to be aware of?

You know, um, I think of you know, one with you know, a lot of that comes up a lot is you know, if I'm on this medication, you know, how does it affect my sleep?

Because a lot of the medications will, and we don't even think about that.

Um, using um, you know, like drinking alcohol, you know, we don't even think about those things, but some of these medications will affect that when it comes to um you know managing these um areas.

So it gives you that access to a pharmacist who can help answer your cra your questions.

That coaching that Joan talked about, that's what you're assigned.

You're assigned a coach through these conditioned care programs, and you're actually um able to connect with this team through the Anthem Um conditioned care program at any time.

So it's 24-7, you can call in the nurse line, they have access to your you know, your records through the condition care program, and it actually just gives you that support, so you just feel comforted.

Um the coordination between doctors and health care services.

This is a big frustration, and I hear it a lot.

People say, Well, you know, I got this diagnosis and I have to go see a specialist, but then I called and I can't seem to find someone who's taking new patients through the condition care program, they offer that service for you.

So they can help you find that specialist or a spe maybe it's not a specialist, maybe it's a specialized coach or service.

They can help maintain that relationship partnership with you.

Um individualized education and resources.

There's so much to the Anthem portal, um, the Sydney app, for instance, that we don't even realize is there unless we're in there all the time.

And so the condition care programs again will help point out the areas of education and resources that are available to you that can help you manage.

Um preventative care, again, you know, that's that's a big part of this.

It's helping you stay, for instance, if you're pre-diabetic, it's keeping you away from that type two diagnosis.

Um, it's helping you to lower those numbers um and move in the right direction versus um move to a number or a type one, for instance, who may not be managing well, who then has issues with um circulation, and then no, lo and behold, there's issues um with feet and you know, there's amputation and and things because lack of that um ability to um to circulate your blood through all of your extremities.

So that's something they'll help manage.

Um and then just self-management tips.

Oftentimes it's new and it's scary and we're overwhelmed by that diagnosis, and it has us, you know, just focus forward and not thinking about okay, how is this gonna impact my family?

How is this gonna impact me in my workplace?

Like, am I gonna need you know, a special um, you know um opportunity, you know, provided to me to help manage what I'm doing.

Maybe it's you know, um, I have to take some time off to go through testing, or um, you know, I have to come back and you know, I might have to go check my blood sugar during the day while I'm here at work if it's diabetes.

That is all stuff that this self-management component will help you to work through so that you don't get overwhelmed so it doesn't become a demon or you know, something that you feel is just um bigger than you're able or capable of of managing.

Um you really can do it.

Um, and I think the condition care programs help.

It's also a cost savings.

Um, they're gonna tell you where you can save money.

So, for instance, a big one with the insulin under diabetes is the insulin.

Where do I get the insulin?

Where do I get my pumps?

Where do I get my supplies?

They will help you to identify the cheapest option for you that's gonna be the least amount of stress on you as that person.

They they want to take that away from you.

So, how do you get involved in condition care programs?

Anthem has two options.

Anthem.com, you can do it.

You know, if you're not a person that's gonna put an app on your phone, that is okay.

I completely understand that.

Um I think here at the city we have multi-generations, and some people don't want that app, and I respect that.

So know that you can do um Anthem.com and they'll help you through that platform to get into the contingent care program that you need.

Um, also the Sydney Health App is is the I think the easiest.

Um, you go in, there's a whole area in there on the conditioned care programs, there's the education pieces that conditioned care will help bring forward.

There's some self-care management things that are there as well.

So either of these options will get you into where you need to be.

And if you're looking, um, if you're struggling with either of these options, I'm here at the city as a resource.

Come on down, we'll pull up the app, we'll we'll do it together, and we'll get you into where you need to be so that you have what it is that you need.

So, LARC.

Um, Joan talked about it a little bit.

Um, through Anthem, we have access to LARC as a program.

It's a digital diabetes prevention coaching tool.

Um, you'll often hear LARC D PP is what it's referred to.

Um, it's a pre-diabetic focus tool.

So someone who is type one, this is not gonna be for you.

Um, this is that pre-diabetes management component.

Um, you must qualify.

So it's gonna have you go in and take a quick, it literally takes a minute.

You answer a few questions, and then it's gonna, you know, decide whether you are someone who is qualified for the program.

Um it's basically what it works on is the premise of weight loss, which then will obviously will lower numbers as Joan was talking about when you start to you know lower your weight loss and are doing the right things for your body, um, it will it will help with lowering your numbers.

Um participation in the program is part of the Anthem Healthcare plan.

So that's what's great.

It's free.

It's free to you.

Um there is um no limit to the amount of time.

So you can just continue to stay with this program until your numbers are within parameters, um, or as long as you qualify.

So as long as you can go in and answer those questions and qualify, you can stay with this program.

Um, and you know, the mobile app is free as well, which I think is great.

Um it as I said, it supports losing weight, eating healthier, increasing activity, sleeping better, which is a big one.

Sleep can throw so much off in an individual's body and how it manages the day-to-day.

So that's big.

And then managing stress, because we know that stress is is affects the body in ways we don't even realize it is oftentimes until until it's too late.

So LARK provides a wireless scale.

Um, they used to be, some of you might know of the LARC when it was attached to Weight Watchers.

It's no longer attached to Weight Waters, it's its own program.

So they provide a wireless scale that synks to the LARC app, so you're able to actually Are you okay?

All right, good.

Um, your your colors coming back.

Yes.

Um there's 24-7 support for this as well.

Um, some people, you know, just may um, you know, have more of an ability to work on a program like this in the evening hours.

Um, so they're pretty flexible there.

Um, you are provided a weight loss coach.

It's education on pre-diabetes and prevention.

So it that's what it's everything it's gonna educate is gonna help to keep you from that type two or that um that type one scenario.

Some type two patients will be entered into this program.

I've seen some that their numbers are just too high and they really need to be working with a different program that's monitored by a doctor.

Um, this they just they're at a point where their numbers are just too high and almost in that type one scenario.

Um there's the the mobile app as we talked about.

And what I love about this is it's customizable to where you're at.

So, how many times have we done those programs where they provide you a menu or they provide you an exercise routine and you're like, gosh, I don't like any of this.

I don't like the food on here, I don't eat this.

This exercise program doesn't work with my lifestyle.

I don't have time to do an hour workout here in the, you know, it just doesn't work.

What I love about LARC is they sit down, your coach sits down with you and says, What do you like for food?

What do you want in your diet?

How much time do you want to focus in on exercising to get started?

Because they know as a coach, we're we're trained to work with individuals to start out small and to create those changes.

So we're gonna go after those things and creating the goals as Joan was talking about.

We're gonna create these little goals that are then gonna build some excitement and some motivation for these individuals that are going to want them grabbing at those larger goals.

So that's what I love about this program.

I love the coaching mechanism and the way that they coach the individuals and stress management tools, which I think is fabulous.

There's a lot of things there that people can learn from.

So success with the program.

Members on average lost 4.2% of their body weight in 12 months.

And these are people who gave it their all.

They jumped in and they said, you know what, I need to create change for myself.

I need to be doing better, I need some sort of tool.

This is no cost to me, and it's here, it's in the palm of my hand.

I'm gonna give it what I got.

And they do.

Um, it's flexible, it's convenient, um, and it focuses, as I said, on those small changes, and there's no limit.

So, how to enroll in LARC, the Sydney app.

Um, if you go into the Sydney app, LARC can be found under the programs in the My Health dashboard.

So that's um where you'd find that.

Um, unfortunately, finding it on the desktop is not as easy, and that that we have found it and it's it's not user-friendly.

So I say to people, they really want you on the app because of the connectivity to the LARC app itself.

So which is right within, you know, you can you don't ever have to you just pull up your Sydney and your icons there to pull it up.

So that's what they're trying to approach.

So the desktop version is really not um user-friendly enough that I would promote it to anybody.

So and then lastly, we have um nutrition counseling.

It's something here at the city.

And looking at the aggregate data, this is an issue for this for the city.

Um diabetes is something that's prevalent.

We have a lot of it.

Um, we have a lot of concerns with it for the lack of management.

So this is something where we're gonna do everything and anything we can from the wellness side to help bring resources and opportunity to employees.

So hence the reason why we're working with Jaclyn Fedor, who some of you have met at past um presentations.

She's um with Nutrition Counseling of New England.

She, I think has really just she's taken a liking to a lot of the employees here, the conversations she's had already.

She just really believes that there's change that can be made here at the city.

Um, and she what I love about it is she's just very realistic, as Joan was talking about in breaking those goals down, like being realistic about it.

Um, so the way this will work is she's on site once a month for one-on-one visits.

She will have space here in the HR conference room, but she can also do Zooms during those times.

So if you're not at this location and want to work with Jaclyn, you can actually just schedule right through the app and just make a note that it would be Zoom from your location, and she'll send you a Zoom link and you can do it from wherever it is that you work if you don't work here at City Hall.

Um, or you could come here as well, but um we're trying to break down any and all barriers with this program.

So you can use the QR code.

There is also um a flyer here.

Um we're gonna add this to the employee um website under the wellness page, so you'll have access to this ongoing.

We have the first one is December 3rd, and we've actually uploaded if you look at Jacqueline's calendarly, um, there's actually four more months that we've added after that.

So we're we're moving forward with the schedule.

There is, I believe, one appointment available for the December 3rd time that she'll be here on site, and she'll be here from nine to four.

Um, and their um 30-minute visits that she has scheduled.

So there's staff that are really jumping on board with this, and I'm happy to see that.

So all right, and then lastly, walking spree.

This is the wellness portal that we just brought on board here at the city.

It's free to all employees here at the city, and you have every employee has access to one plus one on the portal.

So if you wanted to maybe have your spouse join you, if maybe it's um an adult child who you know is struggling and could you know benefit from this, they have access to everything that's within this walking portal.

Right now, we're within a fun little challenge that we're doing.

Um, the fall into fitness was our our first little um challenge.

Um I think we have 57 staff who engaged, which was good.

It was higher than I thought for the first challenge.

Um we do have a fun one coming up for December, which is maintain, don't gain over the holidays, which I think is gonna elevate our engagement a little bit higher because of the focus of that.

Um so many of us sort of go into the holidays with a little bit of a fear around um the weight gain and all of the treats and things that we have that are in our path.

Um step tracking, it's that's really what the premise is.

It's it's got you moving.

You know, you're if you have a wearable connected, you're you're getting notifications of of your you know updates, it's encouraging you to move if you haven't moved in a while.

So it's really fun.

It's citywide.

So there's people on there from all programs here at the city, which is great.

Um, it builds a community, which is really what wellness is trying to do here at the city is build a culture of wellness where we have that community, where we can get together and do walks and have a large group of people come where it's acceptable, you know, to do these sort of things within the work culture, um, which it's it's not always you know that way for for some companies.

So we're working on that.

Um demand workouts and resources.

This is another one.

Um, Les Mills is the program that they work with.

So anyone who's ever done a Les Mills workout, um they're great.

Um, they're free.

You have them right there, the access.

And it's not just the physical fitness, like hardcore workout things with weights and um, you know, jumping around.

This is you know, your yogas and your, you know, um your Pilates and your deep breathing mindfulness activities.

It's all on there and it's free to you as employees and your plus one.

Um and then the prizes are great for the employees, um, which I think is hopefully something that will engage more people as we go.

Um, because those um will eventually move from the concept that they're at right now, um, which is um gift cards to a website, they're gonna actually move to um amounts that you'll use within a gift card component on that platform for a number of different um gift cards.

So for like Whole Foods or Home Depot or Lowe's, those sort of things.

Target, all of those things will end up in the transition be a part of the prize component.

So I'm I'm looking forward to that.

So um to get started with walking spree, it's super easy.

Walking spree app, you download that, um, enter the the company code, which is City of Nashua.

It has to be just like that, caps um on the city in Nashua.

Um, if not, you'll end up with an issue.

Um follow the prompts to connect your smartphone or your wearable device.

What I love about it is you know, you don't have to have um a wearable device, you can use your phone to track your steps as well.

We always usually have those with us, so it's working for employees.

So ending you know the presentation, I I just want people to know that there is a lot here that is available to you that I I want to encourage people to be using.

Um it's here, it's free.

We need to use these things to help change our culture, to help bring people more resources and more opportunity.

Um any questions on these things while I pull back up the other presentation.

Questions?

And I'm sorry, I was not sure.

So I started out a little just because you did good.

Right back to where you were just switched to uh vision, vision.

Great.

Great.

It's a good thing I don't embarrass easily.

Stuff happens, right?

I will tell you.

It's been an interesting journey.

Um anyway, so when you think about your mission in vision, it's sort of the broader picture as to what you see.

So one I'm uh mother of two adult children.

One vision that I have is that my kids don't have to take care of me, right?

That I want to be healthy as long as I can, and hopefully they won't I won't burden them.

That's my vision.

So your vision may be different.

Um it's the broadest tier, and when you think about where you want to be overall, think as big as you can, and um don't limit yourself.

And it doesn't have to be diabetes related, right?

So many of you may be thinking of you know, but I don't know.

For me, it's retirement.

What would my vision be for my retirement?

To be well enough to travel to all the different places in the world that I have not seen.

That would be a good vision, right?

What about you all in thinking about your own mission and vision?

Do you have a big one?

Is it to get a promotion at this job that you're working at?

Is it to get more free time in your life?

Retirement for some just about there, right around the corner.

So you want to be able to look at your mission, but in order to be able to accomplish that, you really have to drill down to wrong direction.

What those specific goals are that would get you to the end, right?

So for me, if I'm talking about retirement, it might be I have to have a better understanding about what my finances are going to be because they'll be a little bit different, right?

So maybe it's I'm gonna get a class, I'm going to go to the class that's offered at the senior center, because it's not going to cost me any money.

Um when you're thinking about goals, their outcomes or objectives that you're honing in on and hoping to accomplish.

So what are the actions?

How do you accomplish those goals?

You think about three specific steps that you can do to accomplish them and write them down.

When when goals are written down, you actually become committed to those goals.

So if you just talk about them and don't put them anywhere, so you can write the goals and put it, save it in your notes pad on your phone, or you can write them on stickies and put them on the walls in your office, or you can oh, sorry.

Okay, no problem.

Okie doke.

Thank you.

Um as specific as you can be in writing your goals, the more you'll be able to accomplish them.

So you can't just say, well, I want to retire one day.

You have to be able to be more specific about I'm going to retire February 3rd, and before I do that, I need to attend that class so that I'll have my finances in order.

So how do you accomplish those?

Write them down, consider the criteria that you can thinking about the criteria.

There's an acronym that's used that's called SMART, and it describes your goals and what you want that to look like.

And so SMART S stands for specific individual goals that you want to accomplish.

It's your goal and it has to do with numbers and make sure you state them.

So for instance, I'm writing a goal about I want to lose weight.

That really is a global one rather than specific.

I would like to lose 15 pounds by five months from now.

That's a very specific goal.

But it doesn't actually get you to the end as much as it is.

So how will I accomplish my specific goal of losing 15 pounds?

Um what you want to be able to do is continue to drill down and make it be measurable.

So I'll tell you my goal when I was trying to lose weight was to eat less chocolate.

We all know dark chocolate is good for us, right?

Antioxidants, flavonoids, helps us with inflammation.

But if you eat too much and you add that up over the year, well, so my goal was to go from three squares, which is one ounce, to one square, right?

And that would accomplish the goal of helping me to lose weight.

So being specific, I'm going to eat one square a day instead of three, right?

And the purpose of the goal is to help hold you accountable and make sure that you're measurable.

It has to do with numbers, setting your points and um knowing that you've accomplished it.

So you can use a check sheet to say I accomplished that goal today, I accomplished that goal.

Maybe the goal in all reality, I wasn't really trying to get from three to one immediately.

My goal was to go from three to two for a couple of weeks, see how that felt, break that habit, and then go from two to one.

So are you are you feeling better?

Do you do you know that um by accomplishing that, you then all of a sudden you can see the scale start to go down?

Is the goal attainable?

Setting yourself up for failure.

I I like to use this comparison.

Um it's black or white, right?

Oh, if I say that I'm gonna do this and I don't accomplish it, what's that gonna say to your internal self?

Oh, you're a loser.

You couldn't do it.

What's the matter with you?

It should be so easy.

But if you say, if I have a gray matter in between, right, instead of being black and white, that's why making it small, achievable goals, you'll feel more self-efficacy, and you'll say pat myself on the back, you did a great job.

Look at where you were you where you are now.

So making a huge step in setting goals.

So when you all came, you were looking for some answers to some questions.

Were you thinking that you were going to walk out of here setting a goal?

Guess what?

I'm gonna ask you to set a goal.

But I want it to be relevant back to your diabetes if you have diabetes or pre-diabetes, or maybe you're dealing with a family member who has diabetes and you want to be here to support to support what is it that I could do to help them?

Um it's very easy for you to say I want my A1C to be lower, but really, what would it take in order for my A1C to be lower?

Take my medicine five days out of seven, even though we know seven is the best, right?

That's the the most attainable, but maybe for you right now, five days out of the week is better than saying seven because you can't accomplish it for seven, don't set your goal up for uh being self-defeating.

When you think about relevancy, it's also being responsible, make sure that you're safe when you're pursuing your goals.

Um, how did I do in setting my goal for this morning by not having an event while I was talking to you?

My goal was to not have an event when I was talking to you, and I did.

So what can I learn from if I am not successful at my goal?

Is guess what?

I have to change the goal.

So what could I have done differently that would have led me to not having an event while I was talking to you?

I should have had breakfast.

My story was we went to the doctors this morning, everybody had fasting blood work.

I had to have fasting blood work this morning, which meant no eating.

We had to get here in time.

I didn't eat.

Make it be responsible.

How about time-oriented?

When you see yourself having a beginning and an end, right?

If it if you say, I'm not, I'm gonna lose weight, but you don't say I'm gonna lose this amount of weight by this amount of time, you're not being uh realistic.

And by writing it down, it definitely holds you to being accountable.

Using your words and telling somebody that you're going to do it is also a way to make sure that it works.

So SMART goals are you're meant to establish them, evaluate them, and reevaluate.

If it isn't working, then reevaluate.

Don't be self-defeatist, just say, you know what I tried didn't work.

And maybe I can tool retool that and make that a little more attainable.

So I'm sorry that I had that little event uh lessons learned.

I will have food next time.

And I know that we went through a lot.

We've got a lot of information related to the resources that are available to you.

Um have any other questions come up in your mind in regards to how do I manage my prediabetes, diabetes type two or type one?

And I'll be happy to answer those questions.

So the question is where should you be after eating?

I will say globally, most doctors would say under 180 is a good range, but everybody is an individual.

If you are dealing with gestational diabetes, it would be a different range.

If you're dealing with, for instance, a lot of times, so if you have type 2 diabetes and you don't have any other medical issues or concerns, under 180 would be a good range.

How long?

Two hours after eating is what's recommended for the measurement.

Because two hours is when your blood sugar will be the highest after ingestion of any carbohydrate.

That's when it's thought that the carbohydrate is at the highest mark.

But some people that are, you know, really interested in extreme tight control for pregnancy, extreme tight control is critical because we want the fetus to develop normally.

And so it would be different.

It might be that it would be a higher level.

I deal with a lot of patients that have dementia that are living in assisted living, that have no capability of having anybody give them insulin because assisted living is no injections.

Right?

So if you can't get insulin, then is it realistic to think that their blood sugar is going to be 180?

It might be we're looking for 200.

Um if you're a person that's dealing with another disease, maybe you have cancer.

Is it realistic to think 180?

Such tight control?

No, it wouldn't be.

So I tell people that they should be having this conversation with their doctor and say, given what you know about my medical history, what would you say I should be at?

But globally, we say 182 hours after the meal.

Yes, question in the back.

So the sure.

So the question is what are the statistics related to if I had gestational diabetes, will I develop type 2 diabetes?

It's 5%.

And what we used to say is it didn't affect the child, but now actually we know that children of mothers that had gestational diabetes are likely to also develop diabetes.

Because of the nutritional changes that occur due to the placenta and insulin resistance, there's um some thought that children develop more fat deposits in a gestational pregnancy, which leads to you, it's not necessarily that it's fat per se, but the fat cell is a live entity, and it produces a chemical called a cytokine, and that causes inflammation, and inflammation leads to insulin not being responded to the way that it should, and it's insulin resistance.

So it's the fat cells in our body.

Um that's why losing weight decreases insulin resistance and inflammation.

And so then go ahead.

Yes.

Yes.

Two.

Yeah.

If if you're a parent that had type 1 diabetes, I think the statistics are 3% if you're a woman, you have a 3% likelihood to have a child with type 1.

If you're a man, it's 7%.

I don't think those statistics have changed.

And I I will just say one uh commentary related to medications.

Um in the diabetes prevention program, this big long study, they put patients on metformin, which is a medicine to help lower blood sugar, and they put them through just a lifestyle intervention.

And the people on the medication still developed type 2 diabetes, but not as at a higher rate as some of the other medicines that they used.

The people that were lifestyle intervention, it was 58% of the people did not go on to develop type 2 diabetes.

It was a very, very effective intervention.

And it's a minuscule of weight loss.

You know, sometimes people, when they think about being a heavier person, they think I have to lose a million pounds, and really it's only 5% of your body weight will result in insulin lowering your insulin resistance and insulin um stimulating your capacity to respond to insulin better.

Great.

Well, I appreciate your uh my understanding understanding my little hiatus and uh glad we were able to help.

Happy holidays.

How many how many carbohydrates in the turkey did it?

We actually we did an activity once um in a prior life and we reworked the Thanksgiving and it was not good.

Um but anyway, I want to thank you all because I know we're over time and thank Joan and thank the TV station for recording and sticking with us.

And I think in developing these goals, if you are someone who is struggling, one of the things that you could do is look at these conditioned care programs, look at LARC, and just start to get into these programs that can help you.

That can be an easy goal and it's free.

It's not going to cost you anything.

It's going to be a little bit of your time, but it's one action that you can put into place today to help with you know your management.

And the condition care program, you know what I love about it is it connects, they can see your medical records and they can connect back with your doctors.

So that your doctors are going to know.

Because I think that partnership when you're managing a disease is critical to help keep you managed and living that lifestyle that you can live where a disease is not a demon that you know is in your back pocket all the time.

So without any further ado, that's that's it for today.

Um and I do appreciate everyone's extended time today.

So thank you.