>> Female: I apologize for the confusion.
At this time the call has begun.
You will be in listen only into the question and answer session.
The call is being recorded today.
If you have any objections you may disconnect.
At this time, you may begin.
[ Silence ]
>> Female: At this time, ma'am, you may begin.
>> Betsy Rodriguez: Before we start webinar,
I would like to remind you a few features that Live Meeting has
as well as other things
to remember during this presentation.
We will have not -- we will not use the [inaudible] feature
except for technical issues.
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If you have a question during the presentation,
please use the Q&A button located
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There type your question and press the ask button to send.
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Send them privately to me, Betsy Rodriguez.
For the convenience of all participants,
please make sure your phones or microphones remain on mute
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Your feedback is very important to us.
Please fill out the evaluation survey
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Select the file by checking the box, press down load and browse
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Upon receiving your evaluations you will receive complimentary
resources [inaudible] nutrition education resources.
So if you love food, or by any chance you're hungry today,
I honestly can say that this is the right webinar
for you at this time.
So today's webinar is brought to you
by the National Diabetes Education Program.
It's from Latinos [inaudible].
My name is Betsy Rodriguez, the [inaudible] director at CDCNVP,
and your host for this afternoon.
Our presenter today is Lorena Drago [phonetic].
Lorena is a registered dietician,
certified diabetes educator,
and Hispanic education specialist [inaudible]
private practice.
Ms. Drago also works as a consultant conducting lectures,
stress management workshop and diabetes patient education
for managed care organization, business and individual.
Ms. Drago discussed the role that nutrition plays in managing
and preventing diabetes, as well as focusing
on motivating clients for behavior change,
primarily in the Latino community.
So without further introductions,
I leave you with Ms. Lorena Drago; Lorena.
>> Lorena Drago: Thank you.
Thank you; and I will be happy to share this --
the next 45 minutes with all of you.
The objective of this webinar are to state three goals:
[inaudible] nutrition therapy for diabetes,
describe one component of the nutritional management
of diabetes, to describe
at least two nutrition interventions targeting
Hispanics or Latinos with diabetes.
I'm going to be using that term interchangeably throughout the
conference; and highlight the MDEP's nutrition
education materials.
[ Silence ]
Let me start with giving you a snapshot
of Hispanic demographics.
Based on the 2010 US Census survey,
we can see that the Hispanic population has grown almost 56%
in the United States.
The largest Hispanic groups
in the United States still remain Mexicans with 63%,
followed by Puerto Ricans, almost 10%,
and then we have other Hispanic subgroups.
And this is very important for those of you
who are counseling Hispanic patients to understand
that Hispanics come from many different locations,
and their health attitudes, their culture,
as well as their food preferences will vary
from one group to another.
The projection for 2020 is that almost --
there will be a almost 20% growth
in the Hispanic population.
When we look at diabetes and the racial and ethnic differences
in the prevalence of diabetes in these communities,
we see that 6% of non-Hispanic whites --
and this is based on 2010, have diabetes.
When we look at Hispanics,
the age adjusted rates were 9.3% of all Hispanics.
But as I was mentioning before, there is a difference
in the prevalence of diagnosed diabetes among different
Hispanic subgroups.
So we look here that if the highest prevalence will be
for Mexican Americans and also for Puerto Ricans.
And the ones that we have documented the least will be
for Cubans.
Now, what are the three goals of medical nutrition therapy
in diabetes management?
The three goals are to achieve
or maintain a blood glucose level in the normal range
and of course or close to that normal as long as it is safe
for the patient to do so.
A lipid and lipoprotein profile that reduces the risk
for vascular disease and then the blood pressure
to maintain the levels once again just like blood glucose
to be as close to normal as is safely possible.
And this is taken from the American Diabetes Association
Clinical Practice Guidelines in 2008, and it has remained
so even at the clinical guidelines of 2012.
Now, how effective -- when we talk about food, when we talk
about management of food and diabetes,
how effective is medical nutrition therapy?
Well, when we look at these studies
that have been conducted, there is a report of A1C
of roughly a decrease of 1% in type 1's and one
to two percent in type 2's.
And this is just with meal planning
and with meal modification that is specific
for the person with diabetes.
And this is excluding all types of medication.
So medical nutrition therapy it is very effective
in managing blood glucose.
And it has also been shown to reduce LDL cholesterol 15
to 25 points, effective in reducing hypertension,
and the improvements of hypertension becomes apparent
in three to six months.
So medical nutrition therapy is an adjunct to medications,
exercise and other lifestyle modifications
for the person with diabetes.
I am going to share with you some
of the general medical nutrition therapy recommendations.
For 2008 those -- that was a review
of all the recommendations that exist today
and every year thereafter, including 2012,
there has been some modification.
So I'm going to be using both recommendations.
The recommendations for the primary prevention of diabetes;
so we know that not only do we have diagnosed cases
of diabetes, but we also have a large percentage of individuals
that might be in this pre-diabetes zone,
meaning that they are at risk of developing diabetes.
So the studies have shown that a moderate weight loss --
so we are talking about 7%, sometimes even up to 10%
of their body weight, might impact positively
on an individual's risk of preventing diabetes.
When it comes to different kinds of diets,
whether it's a low carbohydrate diet,
a low-fat calorie restricted, a Mediterranean,
and even a vegetarian diet, as long as the calories are kept
to sustain the person's body weight
or achieve the weight loss have been equally effectively.
Of course, adding physical activity
about 150 minutes per week,
also increasing dietary fiber 14 grams for every 1,000 calories.
And we're going to go into that a little bit more
so that you can visualize
when this recommendation is made what are we talking
about when we are suggesting
that individuals consume 14 grams of dietary fiber?
The consumption of whole grains is also very important.
At least half of the grains that are consumed by persons at risk
of developing diabetes --
and I should say almost every individual should come
from whole grain.
And to limit the intake of sugar-sweetened beverages,
and that has been a epidemic in the nation,
is the use of sugar-sweetened beverages.
And what we see is that there is a 26% greater risk
of developing diabetes
where individuals consumed sweetened --
sugar-sweetened beverages consistently.
Now, we just talked about the 14 grams of fiber
for every 1,000 calories.
So here we have some examples
of what foods contain soluble fiber.
So we have one and a half cup of oats, we have one cup
of cooked kidney beans, we have one cup of okra, an apple,
strawberries, and a cup of cooked broccoli.
All these foods contain soluble fibers.
But what I would like you to do right now, and we can go
to poll question number one, is from those foods
which one is highest in soluble fiber?
And if you could please --
[ Silence ]
Okay. We're going to be closing the polls
so make your selections.
[ Silence ]
Okay. The polls are closed now.
And I see that 43% selected kidney beans,
and oats was the second most popular.
So let's go back to the slides.
And we'll see that most of you were correct.
One cup of kidney beans has six grams of soluble fiber compared
to one and a half cups of cooked oats with three grams of fiber.
Nevertheless, all of these foods are healthy.
And when we think about needing 14 grams of fiber
for every 1,000 calories that we need --
so we're talking about 28 grams of soluble fiber
if a person consumes a 2,000-calorie diet.
So it would be easily met by a combination of fruit,
vegetables, as well as beans and peas.
The other recommendation was to include multigrains,
whole grains, et cetera.
What I wanted to show here is it is very difficult
to distinguish what is a whole grain and what is not.
In this example we have two crackers,
and most people will probably select the one on the right,
the multigrain cracker as a whole grain.
What happens is what you need to do as a healthcare professional,
as well as the consumer, is to look at the ingredient list.
And you will see that the first ingredient
on both is enriched flour, which is not multigrain.
What multigrain means is that at least five different grains
should be added to a product in order to be called multigrain.
But it doesn't mean that the product
in itself is a whole grain product.
So here at a glance when you want
to choose whole grain foods,
this is what you should be looking for when you're looking
at the ingredient list.
So the word whole should be -- should precede the grain,
and we're talking about whole wheat, whole corn or rice,
brown rice, and then some of the maybes might be wheat,
flour, semolina, et cetera.
They might or might not be whole grain.
And definitely when you see enriched wheat flour,
that is not whole grain.
So these are now the recommendations
for the management of diabetes.
We've looked at the prevention of diabetes
with the weight loss, including whole grain,
reduction of calories to meet that goal.
And now we're looking at the recommendations
for the management of diabetes.
Well, the research has shown
that about a 5% weight loss is associated with a decrease
of insulin resistance.
So, again, the message should be any kind
of weight loss is beneficial for persons with diabetes.
The other recommendation is to monitor carbohydrate intake,
foods with carbohydrates.
And we will take a look at what those foods are.
So limit the saturated fats, less than 7% of total calories,
and we're going to see an example
of how you can take this recommendation
and put it into action.
And also to minimize the intake of trans fats.
And trans fats are those foods
that contain partially hydrogenated oil,
listed as one of the ingredients.
These are some examples of foods that are high in saturated fat.
It might be certain cuts of meat, chocolate and ice cream,
definitely one of my favorites, high saturated fat food.
And dairy products made with whole milk
and of course the usual culprits, butter,
lard or fat, et cetera.
So when we talk about what is that 7% of our calories
when we translate it into our budget, we are talking
about between 12 to 16 grams of fat per day.
That should be the budget for someone
that might be consuming an 1800-calorie diet,
which will be perhaps what the average American would
be eating.
Weight reduction plans might be somewhere between 1200
to 1400 calories, and the fat will be reduced.
So here we have some common foods, American cheese, cheddar,
et cetera, and what I would like to know is --
and we can go to poll question number two, from those foods
that are listed, which food has the highest amount
of saturated fats?
And you can make your selections now.
[ Silence ]
Okay. And make your selections, polls are closed.
So we have at one glass eight ounces of whole milk
as our winner, and an ounce
of American cheese as the runner-up.
Let's go back to the slides.
And for those of you
that selected American cheese you are correct.
Six grams of saturated fat for the most part,
and of course each gram might vary a bit;
and a glass of whole milk.
It's five grams of saturated fat.
So as you can see very easily, someone that is consuming one
to two glasses of milk -- let's say ten grams of fat,
and has a grilled sandwich with two or three slices
of American cheese, can really go over their daily budget.
So 12 to 16 grams of saturated fat per day really does not give
you a lot of wiggle room.
And many times many
of our patients are limiting their egg consumption
because of their cholesterol content --
and I'm referring to the yolk,
but you see that one egg including the yolk only has one
gram of saturated fat.
So when you're counseling you have to pay attention
to the consumption of other foods that others might not feel
that they need to limit from their diet and that
that might be because of their high cholesterol levels.
A diet that is high in saturated fat will increase
LDL cholesterol.
And that's one of the goals of diabetes management.
So pay attention to those foods in the diet.
Okay. So we talked about carbohydrates, and people talk
about a low carbohydrate diet, is it better
than a low-fat diet, better than a Mediterranean diet?
And the optimal mix
of macro-nutrients really mostly should come from carbs,
and again, we talked about fruits and vegetables, beans,
legumes in general, and whole grain.
That's where most
of the carbohydrates should be coming from.
The protein and the fat well most likely should come
from lean and also the good and the healthy fat.
So while saturated fat might need to be decreased,
there are other types of fats
that are considered to be healthy.
But above all, the total number of calories do matter regardless
of that macro-nutrient mix.
And the number of calories should be appropriate
for a person's age, height, weight, physical activity,
medication and their blood glucose levels.
So when we look at a meal, and we deconstruct that meal,
we see that the meal that you have on the left it's a mix
of carbohydrates, protein and fat.
And very seldom did we consume just one type of food.
And I want to focus, even though our foods come from carbs,
protein and fat, I want to focus on just one component
of the nutritional management of diabetes.
And that will be for today's lecture, the carbohydrates
in diabetes management.
And the reason that I want to focus on carbohydrate is
because carbohydrate in foods is what affects blood glucose
levels the most.
So that's the reason why that will be the choice.
So when we are talking about carbohydrates,
I want to use managing carbohydrates
as the primary strategy for achieving blood glucose control.
And the blood glucose levels it's a combination
of how much carbohydrates a person with diabetes eats,
how much available insulin they have,
and that determines their blood glucose levels.
So what is the minimum daily carbohydrate recommendations?
Is it 100, 130 or 150?
When we are talking about going low carb or having enough carbs
to sustain health, what would that look like?
And the answer is 130.
That's the American Diabetes Association recommendation.
Now, what is 130?
How many cups of rice can I eat for 130,
how much bread can one eat with 130?
Let me just give you an idea of what 130 looks
like in terms of food.
One cup of cooked rice, one cup,
will have 45 grams of carbohydrates.
And that's about a fifth worth.
So that means that if a person has two servings or two cups
of cooked rice, that will use 90 grams of the 130 grams
that are budgeted for the day.
[ Silence ]
I will just summarize some of the recommendations
by the American Diabetes Association,
and I will just reiterate
that the fiber intake is very important.
When the fiber is increased in the diet, that can help
to manage hunger, and also soluble fiber can help
to manage cholesterol levels.
And very high fiber diet could even help
to manage blood glucose levels.
Some -- the diet should be a combination of fruits
and vegetables and whole grains, legumes
and low-fat milk and dairy products.
We also talked about the amount of carbohydrates
and how quickly those 130 grams might go in one day
when a person counts carbohydrates.
Another recommendation is the use of glycemic index
and load as an advantage.
And I'm not going to go into the definition or examples,
but I will just say that the glycemic index it's really how
quickly the blood glucose level rises, depending on the type
of carbohydrates that is consumed.
And foods that have sugar can be substituted
for other carbohydrates foods; even though they might not be
as nutritious, but they can be used.
Now, let me just give you a couple foods, some of the foods
that may contain carbohydrates, and some of them may not.
So let's go to poll question number three.
And there are six foods.
What I want you to do is select the food
that does not contain carbohydrates.
[ Silence ]
Okay. Let's close the polls.
Okay. So the first answer, chicken cutlets,
the most popular one, followed by spinach,
and sugar-free cookies.
Let's go back to the slides.
And I just want to show the foods that are now in red,
those are the foods that have carbohydrates.
Chicken cutlets was the correct answer;
unless the chicken cutlets is breaded or it has flour.
But just the chicken cutlets that is not a food
that contains carbohydrates.
Spinach might be a surprise for some of you
since it is a starchy and very nutritious vegetable.
Most non-starchy vegetables do have carbohydrates,
however the amount is very little.
I would say that when I compare one cup
of cooked rice having 45 grams of carbohydrates,
if I had one cup of cooked spinach the amount would be 10
grams of carbohydrates.
However, because there is so little amount of carbohydrates
in most vegetables and people do not consume a lot of vegetables
in one meal, that many meal recommendations advise not even
to count these vegetables at a source
of carbohydrates unless they're eating very large quantities.
And I just want to remind you
that sugar-free foods might be sugar-free
but they are not necessarily carbohydrate free.
Even though the sugar might not be an ingredient in that cookie
or cake, there is flour, and there might be fruit added to it
or milk, and all those three foods
that I just mentioned they have carbohydrates.
And that's very important to talk to people with diabetes
about because they might assume that once a product says,
sugar-free, it is equivalent to carbohydrate-free.
Now I'm moving to some nutrition interventions targeting Latinos
with diabetes.
I'm going to talk about traditional foods,
newly acquired from tradition, nutritional counseling based
on the food groups, and I'm going to share with you some
of the tools that I have used in practice that I have deemed
to be culturally appropriate teaching tools.
The first item will be the food differences by Hispanic groups.
As I was mentioning before, just as the prevalence
of diabetes is different among certain Hispanic groups,
so is the countries of origin and the food prices.
So our Mexican patients with diabetes came
from different parts of Mexico.
Depending on where they come from, their food habits
and preference foods will be different.
Individuals that live in the Caribbean parts of Mexico,
let's say in the Yucatan Peninsula, will have access
to different kinds of foods such as fish, compared to people
that are coming from the Northern part of Mexico,
especially the central part
in which goat might be a preferred meat.
Corn and beans, though, are two
of the staple carbohydrate sources.
They use seafood, poultry and pork depending on what part
of Mexico they come from.
And it is ubiquitous to use chili throughout Mexico.
Some places might prefer to have corn tortillas,
and some other places might prefer to have flour tortillas.
When we look at the countries from Central America,
I am just going to focus here on the staples.
As we saw in Mexico, corn and beans are the staples.
Those are two sources of carbohydrates.
Now, rice, beans and corn are staples in Central America.
Pork, chicken and beef are also used as the sources of protein.
And it is seasoned also with tomatoes and onions,
and chilies are not used as prevalently as in Mexico.
When we look at South America, it's a vast territory,
so it will be very difficult
to just summarize all the different foods
in South America.
And once again, the coastal regions will have a very
different food traditions and food cultures
as the inland part of the countries.
Going back again to the staples that are traditional
in South America, potatoes, corn and rice are staples.
Now, the Caribbean from Puerto Rico, Dominican Republic
and Cuba; rice and beans are staples but now I'm going
to add something else, which are starchy root vegetables,
which are also predominant in the diet.
So things such as cassava, taro, yams are also part
of the traditional meals.
And when counseling persons that are coming from the Caribbean,
it is very important to be aware that these are sources
of starch and carbohydrates.
I wanted to mention the globalization of food.
And that is because many times we assume
that when a person comes from any Latin American country
or region, that they're only eating their traditional foods.
And it's not the case anymore.
This is a McDonald's in Bogota, Colombia.
So many of the younger persons
from a particular country might already be exposed to some
of the same foods that we are exposed here.
This is a Kentucky Fried Chicken in Oaxaca, Mexico.
And here we have the places where Dunkin' Donuts has stores.
So we are not -- we should not assume that just
because someone's coming from Mexico, from Colombia,
and they're coming from another region
that they might not already be mixing traditional
with nontraditional foods.
And here we have McDonalds that is already ethnically correct,
with a selection of McPinto,
which is a combination of rice and beans.
So not only do we become, quote, unquote, Americanized,
but even a chain like McDonald's becomes also, should I say,
Guatemalized, and it even has fried plantains.
I am briefly going to go
over what the main points of the slides.
And as you can see on the left-hand side,
you have all the different food groups.
The column in the center it says, 'What you need to know,
meaning as the person that is teaching diabetes education,
that is bringing nutrition messages, to groups
and individuals of persons with diabetes or pre-diabetes.
And in the right-hand column is what your clients
or your patients need to know and do.
So if you're not familiar with Hispanics in general,
what you need to know in these category is
that Hispanics consume more beef than non-Hispanic Whites.
And what you need to share is to encourage the leaner cuts
of the different foods.
Where rice and beans is prevalent,
rice is much more prevalent on the plate [inaudible],
so it should be switched around.
Fruit is also added to shape and it's eaten and preserved
in juice, et cetera, and many times it is important
to differentiate real juice from juice drinks.
I also want to highlight that many times when we talk
about healthy oils, such as olive oil or canola oil,
that we need to emphasize to our patients
that oils even though they --
some of them might be very healthy,
they still have calories.
And that's every important for them to know.
They might think, 'Well, I'm just having olive oil.
I'm cooking with olive oil, therefore I can use as much
as I want because it's healthy.'
Very important to look at nutrition labels,
especially when they are using certain foods,
such as corn flour to cook with.
Choose healthier fats.
And again, I want to stress this that portions matter even
if the foods are healthy.
Somebody might be drinking an oat beverage or eating oatmeal
because they have heard that it's healthy.
But one cup is -- I mean, it might be healthy,
but not three and four cups.
And vegetables, encourage the use of vegetables
in stews and soups, et cetera.
I am going to share with you a program
that I spearheaded that I developed.
And it was -- it's a supermarket tour for Latinos with diabetes,
and how to make this program culturally competent.
In this particular program, I walked with a group of 10
to 12 individuals with diabetes,
and some of them had pre-diabetes, to teach them
about meal planning, reading food labels, et cetera.
It is very important that instead
of just providing information
that the program was culturally appropriate.
When we started in the produce section, many of the handouts
and food lists include starchy foods such as squashes
and sweet potatoes, et cetera.
So this might be a common list
of certain foods that are included.
However, translating this
into Spanish might not be culturally appropriate.
This is a picture of the actual supermarket
where I was conducting the tour, and as you can see,
the starchy vegetables that are here include things
such as cassava, it also includes taro,
different kinds of yam.
So when I had to culturally adapt the list,
I included things such as the pumpkin, as the cassava,
plantains, yams and the taro.
It is important to include in your handouts, even if they're
in Spanish, not just the foods
that are commonly traditionally listed, but the foods
that the group consumes.
And in here instead of just listing the breads
and the different types of breads, as you can see here,
there is one aisle with tortillas, another aisle
with tortillas, another aisle with tortillas,
and more carbohydrates in the form of corn flours
to make different products.
And of course from the floor all the way
to the ceiling, rice and beans.
So it is very important to once again --
and I am going to reiterate this,
that when you're creating a program for Latinos,
it's not just about translating the existing food list,
but to incorporate those foods that are traditionally sound
in the Hispanic groups that you're working with so
that they actually know what to do.
This is, again, another picture of --
and many of you might not know of what this is,
but it's called cremes, which is the sour cream equivalent,
which is widely used in Central America.
So we have avocado.
We needed to include that.
So a list of traditional fats
for the American population may include mayo, cream cheese,
sour cream, salad dressing and oils.
But then what happens is look at this picture.
Again, this is pork skin.
So there is this giant display of pork skin.
Now, if a person with diabetes that consumes pork skin,
how are they going to be able to manage the pork skin
and still manage their diabetes?
So the -- my fat list included cremes, included pork rind,
and included avocadoes, again, to make it culturally acceptable
to an individual so that they know how to fit that pork rind
in their -- in their meal plan.
These are some carbohydrate teaching tools for Latinos
and other populations that I work with at the supermarket.
And many of them were not literate
in Spanish or in English.
So what I did was at the end
of the supermarket I just created a visual tool.
And my goal was for them to identify the foods
that had carbohydrates.
So it was a mixture of just pictures that I copied
and pasted from Google, and --
but it includes things such as cassava, as plantains,
and different -- and of course tortillas
that are ubiquitous in the person's diet.
And then I wanted to show them the foods
that did not have any carbohydrates,
so that they could relate
to that concept during our first visit to the supermarket.
And again I included things such as chicharrone,
which means pork back fat.
And I also included the cremes, which are the jar that you see
at the right-hand side, right above the avocado.
The other part of the --
at the end of our presentation I wanted to make it real.
We go to these carbohydrates, protein
and foods and we eat food.
So what I did was I showed them a meal
that had many different types of carbohydrate.
And most of the patients came from El Salvador,
so I wanted to create a visual that brought the foods
that they are familiar with, the foods that they like to eat.
And as you can see here, we have fufusa [phonetic],
which is made out of corn.
We have cassava, fried plantains.
We have pork, we had an empanada, which is a patty.
And we have two different kinds of tamal,
one made out of chicken, and the other one out of corn.
So what I did was I asked them first,
'Which of these foods have carbohydrates?'
And I had them just point at the food or just call it out loud.
And then I told them how much carbohydrate was
in all the foods that they have selected.
And I asked them, 'Well, if you have a 50-gram budget
for this meal, you clearly have gone over.
So what would you do to bring it to a 50-gram budget,
or you can change it to 75.'
And then I had the individual say, 'Well,
I guess I'm not going to have the pupusa,' or, 'I'm not going
to have the tamal,' or, 'I'm going to eliminate.'
So this way they were able to think
about what they would do at home.
It was not just about the numbers,
but it was about meal planning with real foods.
We also looked at before and after.
This is the plate method.
And we said, 'Well, you still can eat your rice and beans,
but instead of having two scoops or two cups, maybe have one
and then increase the amount of vegetables.'
We also looked about adding more vegetable into a meal
like arroz con pollo, less vegetables, more vegetables.
We looked about food preparation, and we looked
about plantains, deep-fried or oven-fried.
And how do we teach portion control,
we looked at the spoon method, how many spoons can I have
of this food in order to be balanced?
And you see comparisons that people were familiar with.
One ounce of cheese doesn't mean much.
However, when I told them that one ounce of cheese looks
like a tile of domino, especially Puerto Ricans
that love to play dominos, at least here in New York,
they knew exactly what one ounce looked like.
So you see, not just the light bulb and other things,
but things that are meaningful to the culture.
So what questions should you ask?
This is really my little point questions that I have used
and that is, 'Tell me about the top 20 foods
that you buy in your house.
If I went to your house right now, what would be
in your pantry, what would be in your kitchen?'
I asked them, 'What would a Mexican, Colombian, Venezuelan,
what would be in your shopping cart,
and some of the other questions that are --
that are listed there.
So the take-home message is,
Hispanics comprise the largest minority in the United States.
They're a very diverse group.
The good preferences vary widely amongst the different
Hispanic regions.
So you'd better ask, 'What are your top 20 favorite foods?'
Medical nutrition therapy, the three goals are
to manage blood glucose levels,
minimize cardiovascular disease and hypertension.
The energy balance should be good quality wholesome food
in the appropriate quantity.
And use culturally appropriate teaching tools.
And we looked at carbohydrates as one tool to manage diabetes,
not the only one, but one that we use today.
I also want to very quickly share with you some
of my favorite resources, because they are colorful
and they are beautiful.
They're in English and they're in Spanish.
And these are tailored specifically
for people with diabetes.
And the latest edition contains new and revised recipes,
things like a Spanish omelet, beef stew,
red Caribbean snapper, et cetera.
So these delicious recipes could be yours through this tribute
and to have in your clinic in your place of business;
because people want to share them.
Then these are recipe cards that you can share,
that you can keep, that you can keep handy,
and that you can even give as a gift
for simple activities that you can have.
So this is set one.
This is set two.
And I would say that you also have --
there's something else, you have posters.
You have posters that you can use in your waiting area,
that you can utilize if you're having a health fair,
if you're putting anything up.
I think they're colorful and look
at those mouth-watering pictures.
And last but not least, these are sample ads.
So if you're communicating, you're sending newsletters,
if you are -- anything that is printed,
you can just utilize them, use them and print them.
So I am going to now very quickly turn
over the presentation to Betsy Rodriguez, and she's going
to explain how you can order these colorful and delicious
and practical materials.
>> Betsy Rodriguez: Thank you, Lorena.
For more information or to order materials,
please call our number, 1-800 --
1-888-693-6337, or you can visit our website [inaudible].
You can also send me an email at bjr6@cdc.gov.
This is one.
Don't forget to complete your evaluation, please.
We invite you to use the resources on our website
at www.yourdiabetesinfo.org.
Here you will find information for people with diabetes,
at least for diabetes, healthcare professionals,
business, school and community organizations.
When you put -- when you are in our website under the second
on diabetes topics, you can select there, recipes,
and you will find all the information from [inaudible].
It's more than 40 slides.
All of them are together, all of these resources
that Lorena just showed to you all.
Thank you for participating in this webinar.
The National Diabetes Education Program is a partnership
of the Central Disease Control and Prevention
and the National Institute of Health and with more
than 200 public and private partners.
Our goal is to [inaudible] of course by diabetes.
And now let's move very quick to the Q&A section.
Lorena, so I'm giving you the mike
so you can answer questions right now.
>> Lorena Drago: Okay.
>> Female: Thank you.
At this time if you would like to ask a question
over the phone, please touch star one at this time.
Once again, to ask a question over the phone, press star one.
One moment.
[ Silence ]
>> Female: The first question we have comes from Amy,
and your line is open.
>> Amy: Hello.
Early on you mentioned
about limiting sugar-sweetened beverages.
I was just wanting to point out that it seems
like many sodas are actually sweetened
with high-fructose corn syrup, and I was wondering
if you wanted to talk about the effects of that as well,
and is that something that we should also let clients know
they should be limiting?
>> Lorena Drago: Yes.
Thank you, Amy, for your question.
The issue, of course is
of high-fructose corn syrup having a different effect
than just regular sugar is -- has been highly publicized
and it's controversial.
I don't know enough about the subject
of high-fructose corn syrup for me
to feel comfortable speaking about it.
However, what I do know is that increasing the consumption
of beverages that increases the amount of calorie consumption
and also replaces other healthy foods is not a positive way
to manage diabetes or even just for a healthy person overall.
So I really want to be very careful
because our society really wants to look for just one bad guy.
So if we eliminate high-fructose corn syrup, then it is okay
if we utilize other sources of added sugars.
And whether there might be some documentation, some evidence
that it might be harmful then I also do not want
to give the message that once a soda
or a beverage doesn't have high-fructose
that then it can be consumed [inaudible].
So I would say refrain from using it,
whether it's high fructose or not.
>> Amy: Thank you.
>> Female: And once again, if you would
like to ask a question, please press star one.
[ Silence ]
>> Female: The next question we have comes from Florence.
Your line's open.
>> Florence: [Speaks Spanish].
>> Female: [Speaks Spanish].
I'm going to repeat the question for those of you
that did not understand.
She wanted to ask the question in Spanish.
She wanted to know if there was a Spanish speaking educator
in Arkansas.
The American Association
of Diabetes Educators has a directory that can be utilized
to identify and also to locate different educators
and the languages that they speak
in different parts of the country.
>> Lorena Drago: Yes.
In the ADA website -- ADA website there's a map.
It says, 'Find an educator.'
You go to their website you will be able
to access what are the health educators in your area
in what is the language they speak.
>> Florence: Okay.
Well, thank you very much.
>> Lorena Drago: [Speaks Spanish].
>> Florence: [Speaks Spanish].
>> Lorena Drago: Si.
>> Florence: Okay.
>> Lorena Drago: Well, thank you very much, okay?
>> Female: And once again that's to ask a question star one.
The next question comes from Patricia.
Your line's open.
>> Patricia: Yes, thank you.
Is the PowerPoint that you use
in this presentation available to the audience?
>> Female: [Inaudible].
>> Patricia: Hello.
>> Lorena Drago: Yes.
The presentation is -- it's going to be archived.
Actually, the whole webinar is going to be archived,
and the presentation will be archived as the PDF.
So that means that people will not be able
to make any observations to the presentation,
because our speaker -- if this is
about proprietary information of the speaker.
>> Patricia: Okay.
So how will we be able to access that?
>> Lorena Drago: As soon
as we finish this email I'll be sending an email
to all the webinar participants, sending the evaluation form,
and sending some other information including how
to access the archive webinar.
>> Patricia: Thank you.
>> Female: The next question we have comes from Lisa.
Your line's open.
[ Silence ]
>> Lisa: I got my question answered.
Thank you.
>> Female: Thank you.
The next question then comes from Jean.
Your line's open.
>> Jean: Hello?
>> Lorena Drago: Hello?
>> Jean: Yes.
This is Beverly Atlanta.
I'm calling from Indianapolis.
And I'm all -- I see a lot of Hispanic patients,
and they always have a question about eating carrots.
I know there are some vegetables that are starch vegetables
that I haven't met [inaudible] about carrots.
I just tell them I don't know about carrots.
How is that as far as eating a starch vegetable.
Is that true or not?
>> Lorena Drago: It's -- that's a very good question.
Thank you for asking it.
Yes. I think overall patients feel that they stay away
from carrots and also beets
because they feel they're high in sugar.
And I just want to say that they are not included
as a starchy vegetable.
They are included as a non-starchy vegetable,
which means that half a cup of cooked carrots and half a cup
of cooked beets on average would have approximately five grams
of carbohydrates.
So sweetness should not be the measure
for the amount of carbohydrates.
Things that are not sweet like a slice of bread or a cup of rice,
will have much more carbohydrates
than carrots and beets.
So you should encourage your patients to consume carrots
and beets as one of their vegetables of choice.
But I think that giving them those numbers can really
help them.
And just to let them know that don't guide themselves just
by how sweet a food might be,
because that does not determine the amount of carbohydrate.
>> Jean: Okay, thank you.
[ Silence ]
>> Female: Showing no further questions.
[ Silence ]
>> Betsy Rodriguez: Okay.
So being no further questions, I thank all of you
for your participation.
>> Female: Apologize.
We did have someone come in.
>> Betsy Rodriguez: Okay.
>> Rita Diskenzy: Rita Diskenzy [phonetic].
Could you -- could you repeat the instructions
for the evaluations?
How do fill out the evaluations?
>> Betsy Rodriguez: Rita, I will be sending an email
with the evaluation form and you can...
>> Rita Diskenzy: Oh, okay.
>> Betsy Rodriguez: ...talk to me by -- to my email.
>> Rita Diskenzy: Oh, okay, I'm sorry.
I thought I [inaudible] into the system.
Thank you.
>> Betsy Rodriguez: And also you can go to the system
as we speak right now to the three-page outcome.
You download -- you click on that icon,
and then from there you can download the evaluation.
>> Rita Diskenzy: Oh, okay.
But anyway, it was an excellent presentation.
Thank you.
>> Betsy Rodriguez: Thank you.
It is in the three-page icon call handouts,
but on the upper right portion of your screen.
Select the file by checking the box, press download and browse
to the location on your computer.
Then select the destination folder and click okay.
Or you can wait until I sent those to all of you.
>> Rita Diskenzy: Okay, thank you.
>> Female: No further questions.
>> Betsy Rodriguez: Well, thank you very much.
Muchas gracias for being on our webinar.
I'm hoping that this webinar was informative,
and you learned what to deal --
how to deal with the Latino population and diabetes.
I want to thank Lorena Drago for being our speaker for today.
And I want for all of you to give her this round of applause.
So thank you very much, Lorena, and thanks to everybody.
>> Lorena Drago: Thank you.
>> Female: Thank you for your participation.
You may disconnect at this time.