Hello, welcome everyone. Thanks for being here. Welcome to our webinar LALA Solute community workers by the American Prevention Association of Diabetes, which is to prevent diabetes complications from the head to the toes. I'm Wendy Hernández and I'm a presenter today. And I want to share about through Dona International. And I am a certified counselor and also a certified educator, as well as a community health worker. And I've been involved with these. workers since I was a little girl as a service consultant. Well, as a community worker in many positions for over 20 years and as a lawyer of these interests and of the community and community health workers, not only in the state where I live in Illinois and also in the national arena. And with this I am going to give the floor to Betsy Rodríguez to tell us about information about herself. Good afternoon, I am Betsy Rodríguez and I am an advisor on these issues. I am a nurse and also a community worker. I have been working with these workers in Latin America and in the United States for more than 30 years. I have been involved in many worker projects of community health and where I have been a reviewed the materials and also at CWH to the skills that have to be learned. And I am also part of the diabetes help guide community to see the effectiveness of these workers in the prevention of diabetes, cardiovascular diseases and diabetes. And I've been working with a group federal level, the CWH of the Department of Labor, and we have a new version of the profile of community health workers. And I'll put the link in the chat box so have access. It is a pleasure and honor to be here working with Wendy and the friend. We have been working on these community health worker issues for many years in organizations and boards of directors. And it's good that you are here to see the role that these workers play in this management of diabetes and possible complications. Wendy, very good Betsy. I'm so grateful you said that because I'm also a co-founder of the National Society of Community Health Workers and vice president of this Association of the State of Illinois. So thank you Betsy. Let me see. I want to tell you that This is an accredited continuing education program and please I do not have any specific statement. Betsy says that these conclusions from the presentation are those of the authors. They do not necessarily represent the official position of the centers for control and prevention of The diseases. Thanks Betsy. Yes, on this slide are the objectives. Let's identify diabetes complications and their causes, the most common complications and also recognize the community resources related to the prevention of diabetes and related complications. This is what we want to learn today as a goal. And also checking in the last slide, today we are going to look at the role of community health workers in complications related to diabetes and the exact ones that we are going to talk about and also the resources to assist these community health workers, to assist them in their efforts of the prevention and avoidance of diabetes complications. Let's do a survey and please everyone participate. Our question is if you are a community health worker, What type of organization do you employ? A private community organization? One that is one organization founded federally or state or other type in the end? Please answer the question. And our results here. Thank you. The first is most are employed through organizations funded or funded at the state and federal level. The second by organizations of the community. And another later and there are also some in private organizations. Thank you. And here moving forward. Let's start with the basics and definition of type of diabetes. There is approximately 37.5 million Americans with diabetes and 96 with prediabetes. 96 million. That The glucose level is high but not high enough to be diagnosed with diabetes. The Diabetes is a disease in which the body cannot use insulin properly. Some people can manage glucose levels with diet and physical activity and others they need to take medications, capsules, insulin infections and nowadays we have many options of medication to treat type 2 diabetes precisely. And in this we see on the slide the type of diabetes. There are other types but these are the basics. Type 1 is where the pancreas does not produces insulin and requires monitoring the glucose level and managing this insulin level in the blood and levels. Type 2 diabetes is where there is about 90% of the population with diabetes. and 10 for type 1. The body here does not make or produce enough insulin or does not use it properly and it can be managed through diet and an active lifestyle. and medication that may include insulin. And seasonal diabetes that occurs during pregnancy when the person's body cannot produce the necessary insulin due to the effect of hormones in the body or the ability to use insulin. Well, let's focus here on type 2 diabetes and the prevention of complications associated with this type of type 2 diabetes. The progression of diabetes over time especially that which is not well managed and The glucose level is very high for a fairly long time. This can lead to complications such as losing sight, hearing, heart disease, kidney disease and also diabetes-related eye diseases. They are also the complications we are dealing with to focus today. Here we see that the risk factors associated with type 2 diabetes are high glucose levels over time, high blood pressure, not well managed cholesterol, overweight, obesity, not being active, stress and also smoking or use of tobacco. Prevent this and this can be impacted by the same types of activities that led to diabetes. We are going to talk in this webinar how we can as community health workers help prevention and provide appropriate assistance and resources so that it can be managed, as well as pointing out physical activity, medication and proper diet or nutrition. What is most frequently reported about community health workers is that when they help people, that they help people access medical services, advocate for individual needs, teach people how to use these health and social services, help people manage chronic conditions and this is the biggest part of managing diabetes. And these complications of diabetes, community health workers can help people understand the diagnosis, the symptoms, the complications in their native language and at their level of understanding. And it's also a very genuine way that we do that we conduct ourselves and also in a current and culturally appropriate way and the way of self-care. This is unique about the type of work workers do of the health community, in helping the participants, that those who participate can manage diabetes and also these workers can visit people in your home and with appropriate community resources and can help when we talk to They depend on nutrition, physical activity, and how to manage the disease, and these factors help a lot against the complications of diabetes. The next slide. Let's go see Wendy in a case, in a study. This is a person of 58 years old African American who has diabetes. She weighs 293 pounds and has a sedentary lifestyle. Sheila also has poor eating habits and could be helped by healthy nutrition and She also has family who are overweight. Your A1 level is 9.5%. Your glucose when you are On an empty stomach it is 215 milligrams. She has exhibited possible diabetes complications because she has numbness and tingling in the legs. So this diabetes management thing could help you a lot. See the challenges Sheila is facing and trying to prevent complications and manage her diabetes. Please put in the chat box some of the variables that are getting from this study or what they think about this case. Yes, I'm looking here. Bad eating habits, low income, discrimination in health matters. Yes, the audience is giving us endless answers. Yes, lifestyle, culture, educational level, transportation, access to resources. Yes, also race and cost of health care. Yes, lack of health insurance. This may also be in the dynamics. Yeah, They are doing very well. No, that is, being overweight, having bad nutritional habits and also have a sedentary lifestyle, overweight, high A1C and glucose levels. Also missing of access to nutritional security and financial problems. So you have done very well in listing these variables. Now let's see possible solutions. Please enter your ideas in the chat box. I'm going to give you a couple of minutes and please let us know some of the possible solutions that you, through your work, can use with your patients. Nutrition, yes, a healthy snack, support groups, education and information, food banks, education programs, helping them apply for health insurance, group support, also nutrition and diabetes classes, help educate families, physical therapy, to meal or meal planning, meals, referring them to a dietician and connecting them, transportation bills, medical advice and many many things. Yes, yes, very good. Could Check out these health center options and also healthy, low-cost food options. cost and also ideas like walking as good exercise and encouraging starting slowly and gradually increase and also review your analysis and laboratory results to be able lower the A1C or glucose level and also connect people with nutrition assistance, food banks or these types of services and yes, thank you, we are going to put this also and the links. The eastern standard of care shows us in studies that these workers are very effective in helping to combat diabetes and cardiovascular factors. risk in communities in need and in health care systems to help navigate the system health and as you said, connect people with available services that you mentioned and community resources and provide outreach and education to community members in need and also the way we support people with diabetes in a unique, culturally appropriate way. And these healthcare workers community can help people prevent and delay complications for people diagnosed with diabetes and those who They can prevent it before being diagnosed. And what has been identified as most helpful for a person with diabetes is your help, community health workers and promote healthy behaviors, being active, eating well, preventing a sedentary lifestyle and helping people with diabetes. Let's talk about self-help programs and how to behave. And these workers can help to have better behaviors, to prevent or delay these complications, being active, taking medications and managing stress. So Betsy, looks like we have another poll. Yes that's how it is. And the question is, using the same survey process, tell us people with diabetes, do they have more Are people who do not have diabetes more likely to have a heart attack or stroke? True or false? A true, B, false. Please put your answer. The results are 1% saying this is true. Look, we're going to find out more about this on the next slide, but according to the Center for Disease Prevention and Control, yes, that's right. There is twice the incidence of having a heart attack or stroke than people who do not have diabetes. Okay, Betsy, go ahead. As we are learning from this survey, people are twice as likely to have a heart attack with diabetes. And this is a very serious heart disease and it is very prevalent in the United States. And this causes problems that affect the heart. And this can also cause problems with the coronary artery and also with the arterial veins. And these are the ones that transport oxygen in the blood and also form deposits in the artery that cause them to narrow and touch and can create plaque that causes the inside of the artery to not have good blood circulation. And this is arteriosclerosis or the hardening of the arteries. This causes poor blood circulation to the heart and It can cause a heart attack or stroke. The Center for Disease Control says that if you notice symptoms of a heart attack in yourself or someone else, symptoms must be taken into account. And this Center for Disease Control says that it can be discomfort or also nausea, vomiting, chest pain and also pain in both arms or shoulders and also not being able to breathe well and you have to act quickly and also feel weak or dizzy or about to faint. So we can help people identify these symptoms. Tell the person, for example, about having a clot or an embolism, Yes, ask them to smile and if they have any weakness or numbness in the face, leg or side of the body, if they have confusion, Ask the person to repeat a simple phrase and if it sounds strange, wait a while, but don't wait too long and call 911 immediately. And also if they have problems seeing with one or both eyes or feel dizzy or about to faint, call 911. As we talk about over time, high blood pressure can damage blood circulation, just like high glucose and also have high cholesterol or triglycerides. Also unfortunately none of these have symptoms and it is another of the reasons why it is very important for people with diabetes to have regular visits with their healthcare provider. And as you see here, other factors can increase heart problems, such as smoking, being overweight, being obese, being physically inactive, have a blood pressure plan high in trans fats, fats, cholesterol and salt. So this to mention a few. These community health workers can help patients or clients by explaining the importance of taking care of their heart. using these easy tips how to manage a proper weight and also rest and sleep well. As we talk over time, high glucose or pressure can damage heart and nerve endings. and people with diabetes may have to develop other cardiovascular disease conditions due to having high cholesterol and triglycerides, for example. And people in the community, health care workers, can help by promoting healthy eating, physical activity, taking prescribed medications, quit smoking and also remind people that lifestyle change can lower the risk of having these heart diseases and also to attend regular health care visits and self-manage with education and support the use of these services to manage this disease and to help them find resources locally. And you can also access the education locator of the American Diabetes Association and we will put these links or links in the chat box of program locators. Also, maybe we are hearing ourselves like a broken record or a scratched record repeating itself, but over time they can damage the veins or arteries of our body and produce chronic kidney disease or nepropathy and this, diabetes and high blood pressure are the main causes of kidney disease. So we can. It is important to maintain low glucose levels and blood pressure levels. Having any of these diseases increases the risk of having a stroke or heart attack. These are the filters, the kidneys to remove excess of these elevated substances and excrete serprin and feces. And if they are damaged, they cannot work effectively and long-term damage kidneys can lead to the use of dialysis or even a kidney transplant. The kidneys work or work hard to help the capillaries, so that diseases do not occur, there are no symptoms and until the entire Kidney function is failing and also the first symptom is fluid retention. Others are not being able to sleep, having a bad appetite, having stomach pain, weakness and difficulty concentrating. Wendy, could you help us? Yes of course. In this help of community health workers, we should encourage people to see their doctor regularly to have their status checked. blood pressure level and also send tests or laboratories to avoid diabetes complications. They can also encourage people to find healthy options. of nutrition and how to eat healthier, have foods low in sugar and salt and also be physically active, take your prescribed medication, stop smoking and drink water. We can also, many people do not have the resources to meet with a registered dietitian and You can help through resources or by locating offices throughout the county or locally that can provide these checkups at a low cost. And so are you. Your participation is vital to help educate people about drinking water instead of juice or soda and also how to take care of their kidneys so that your kidneys take care of you. And also encourage people to eat a healthy diet. And Betsy, go ahead, my friend. Yes, thank you, Wendy. About half of people with diabetes have damage to the nerve endings or neuropathy, which occurs mainly in the legs, feet and hands and is very common. We could probably guess the risks and possible complications. And a person with diabetes has high levels of glucose and all over a long time and have had diabetes for a long time. They have high risk. And the person with diabetes is obese or over 40 years old and has high blood pressure or high cholesterol. They have a higher risk. Damage to the nerve endings or neuropathy that causes tingling, numbness. And this can also lower the ability to feel the cold, hot, pain and it would be good not to feel it. But if someone cannot feel pain in their feet, they can hit or they may not realize that they have a blister or fungus or something that could damage their feet and become complicated, I couldn't do it. So because of poor circulation, which is an additional complication of diabetes, they can become infected or worsen and if this happens, it can result. in an amputation of a finger, foot or even part of the leg so that the infection or gangrene does not spread. So this can be a major cause of amputations. Wendy. Yes, thank you, Betsy. So this daily foot care is a good way to prevent complications. A person with diabetes should check their feet for any calluses, blisters or anything they see normal on their feet or cuts. They don't have to apply cream or wash the risk or go barefoot because they can get hurt. So encourage people with diabetes to wear slippers or socks inside the house so that they do not also wear tight shoes that rub and cause blisters or if they have trouble getting a pedicure or cutting their nails. what they can do with a doctor or an assistant who can help them cut these nails and not cut themselves any blister or any problem with your feet. Educate people how to cut their nails straight and without spikes and also take off their shoes and socks when having medical care so your healthcare provider can check your feet. Also that there is good blood circulation and Also encourage them to elevate their feet and move their toes so that blood can circulate throughout the day. be physically can help with blood circulation that are suitable such as walking or biking or swimming suitable and not so hard on the feet or punishing on the feet. And if there are problems, see your foot doctor or your family doctor and make sure there are no pain, tingling, lack of sensation, fungal infections, tingling, numbness, pain or blisters, any non-healing wounds or nails buried and make sure there is no infected callus or nail. May all of this help the people you attend to be aware and encourage them to ask for help. Thanks Betsy. Those were very good tips that Wendy shared with us. We are going to do another short survey to see what you think about hearing loss during diabetes. OK, again, hearing or hearing loss is twice as common in people with diabetes as people who don't have diabetes. Let's answer, A, true, B, false. Again, hearing loss is twice as common in people with diabetes as people who do not have diabetes. Let's see the results. I'm going to share with you what the Center for Disease Prevention and Control tells us in a moment. Okay, 83% of people, A, and 17% say no, it's false. Let me tell you something. According to the Centers for Disease Control and Prevention, it is twice as common, twice as common in people with diabetes. than people of the same age who do not have diabetes. And as we learn from these surveys, hearing loss is twice as common in people, in people with diabetes, as well as damage to vision, kidneys, and nerve endings. And, interestingly, even people with diabetes who They have such a high glucose level, but not so high that they are prediabetes, yet they have a higher incidence of hearing and vision loss. So it's good to keep these A1c, glucose and depression levels low. People with diabetes sometimes ask others to repeat themselves. what they have just been told, they have difficulty following conversations, they think that other people are babbling in crowded places, In restaurants with many people, they have difficulty turning up the volume on the television or radio and not listening to small children or people who speak at a low level. There are many ways that community health workers can help prevent this hearing loss. Many of these behaviors that can prevent diabetes can also help with hearing loss. Eat healthy, be active, take prescribed medications and stop using tobacco. And they can support people with diabetes to You can get these listening tests and also share these resources to have the listening test. Refer them to obtain this test. According to the Center for Disease Prevention and Control, loss of sight and blindness is also a cause that results from diabetes very commonly. Retinopathy is a common eye disease that can cause blindness in adults of working age. Diabetes, diabetes-related retinopathy also, when there is high blood pressure, can damage the veins and the light sensitivity in the back of the eye, the retina. Diabetes can also cause effects or affect both eyes. And anyone with diabetes can develop these types of vision-related diseases or retinopathy. And the longer you have diabetes, the more it can develop. Groups such as African Americans, Hispanics, indigenous people, and low-income groups may have a greater impact. And it is recommended to have an eye exam at least annually. And also if you see some points in the view. Wendy? Forward. Yes. We have talked previously about the many ways community health workers can help in prevention of diabetes complications. Being active, quitting smoking and taking tobacco products, good nutrition, maintaining blood sugar levels correct cholesterol and depression. But people who have low vision or eyesight can benefit from wearing special lenses or magnifying glasses and contacting to the optometrist or ophthalmologist and help them find local resources for measurement. And this can also be places where you don't see distortion, flashes, pain. They can also help people with diabetes by supporting them to talk to their doctors about getting an eyesight test. And through local resources for this. And you can help in this situation. Yeah? Let's see another case. Well, Roberto, Robert is 45 years old, white, and has type 2 diabetes. He wants to control his hypoglycemia and wants to drink a lot of soda to increase his glucose. He says he doesn't have time to eat well or exercise, but he's been feeling dizzy and even fainting. He thinks it's because he has low glucose. He fainted at home which he thought was given to this hypoglycemia. He doesn't have a way to measure, a meter to measure this level and he treats it by drinking soda to increase blood glucose. He works 12-hour shifts and says he doesn't have time to exercise or eat healthy. What do you think? Yes, he works a lot, it's an economic thing, he works too much, overwork, need a diabetes class, what are the barriers? Not taking the time to plan healthy food or exercise, feeling lonely, unable to get time off work, he drinks a lot of soft drinks, has low self-esteem, does not have adequate information, has a lot of stress, does not accept that he may have diabetes, poverty, lack of family support, no meal planning, no access to healthy food, all of this. All this plays part or a very important role. And no one is, they're not being lame to say that. And this, for example, of drinking soda to level out the low glucose level, on the contrary, this is not a good solution. So a person with diabetes who doesn't get a glucose check or measurement is trying to manage someone who can't see well without glasses. So not having a meter, this is all correct. And now we are going to talk about possible solutions. If you can put in the chat box, please, your ideas for possible solutions to help Robert. Very good. Let's see. Help from community health workers, seeing a doctor or health provider, planning meals, exercise, walk, talk to someone about nutrition, change the way you eat, educate yourself, manage your time better, connect you with resources, adjust your work or work hours, advocate for yourself, do self-help, see, have reviews. And the list is very long. And also help you with information and service resources. This is a very important role for you. I do not have nothing to add. You have given very good solutions to combat Robert's problem. So we continue. Here we have this to inform you about hypo or hyperglycemia. And also share resources on how to obtain a glucose meter. And this, all the kind of help that the workers of the community health can give you or guide you. And also educate him on healthy snacks. And in having weekly or daily physical activity. Also the use of water instead of unsweetened drinks. And give you advice on increasing this water intake. And encourage him to schedule medical appointments. And also talk about options for him to enroll in a virtual diabetes support program. To manage diabetes. I think Robert has a lot of hope, especially, and if one of you passes him on or refers him to other resources. Yes, Betsy. We are already an entire movement acting. And we are going to have and have a lot of impact on the community. Here, to summarize, we're going to, we've spent a lot of time talking about the risks, the risk factors, fighting the complications of diabetes. And as you have learned, there are many common risk issues for people with diabetes. But by focusing on healthier behaviors, combat these risks at the same time. And it is also a common theme in the way we can help people. Manage this disease or delay these complications. And managing the pressure level, heat levels, combating the use of tobacco. And steps to help you or people get healthy. This is free information that can be obtained online for Focus on healthy behaviors to combat and manage diabetes. Control it. And there's also a worksheet to help keep you on track with your goals. Yes, this is very good. Also encourage them to exercise for 30 minutes, 3 times a week, etc. This is a platform for you to ask questions. At this time you can put them in the chat box. Yes. We have some questions here, Betsy. A person, or the question is, can nerve damage Suppose nervous determination to someone who does not have diabetes? Damage to nerve endings can also occur in people who do not have diabetes. I would say that people with diabetes are at much greater risk. higher because they have problems with blood circulation and hardening of the veins or circulation routes, but it does not mean that any other person, even without diabetes, who had circulation problems, for example, or low circulation, could not have them. In other words, there are people who have prediabetes and have not been diagnosed with diabetes and may have high blood pressure or high cholesterol and this causes deposits in the arteries and veins that can prevent flow or blood circulation. So think about people who have obesity problems. Maybe you don't have diabetes, but maybe you have prediabetes or not. Not every obese person has to end up with diabetes and not every obese person has to have prediabetes, but obesity itself can cause many of these. problems because it is the way that perhaps reflects the way of eating or nutrition and can result in these levels reaching higher proportions. Yes, and affect the circulatory system. Another question, how does diabetes affect oral health, especially the gums? Yes, it is another possible complication that we did not talk about, but the same. When glucose levels are high in the bloodstream, it creates the perfect environment for bacteria. grow or reproduce and it is the same thing that can cause our teeth to be damaged in the end. So this gum disease is another complication possible for people with diabetes. And this is going back to what we've already talked about, the importance of helping people manage or control your illness or before having it preventively. So everything can affect and it is something that the community person, community health worker can help by providing resources, information in the language that people can understand and to be able to attract change to the people we are involved with and assist. So making people spend their time to your care. It has been a pleasure, my friend, at times, working with you. And with this we conclude our presentation. Thanks for being here. Make sure you visit our online pages and have a good day and all the links and links that we gave you. Thanks to the American Diabetes Association. Thank you so much.

webinar

community health workers

diabetes complications

diabetes prevention

risk factors

complication management

prevention strategies

education

resources