Diabetes Self-Management Blog

The first leg of my two-stop, cross-country trip went great. I led an all-day seminar for nurses called “New Solutions to Diabetes” in Lafayette, Louisiana. What an interesting place!

Lafayette is in the heart of Cajun and Creole country. A lot of French and a strong emphasis on music, fun, dancing, eating, and drinking — not necessarily in that order. We went to a Zydeco breakfast with a live band in a small town. Everyone was dancing and drinking, and it was 10 in the morning!

They also have high rates of diabetes and other health problems. I had downloaded an article from a local newspaper about Louisiana’s number one ranking in diabetes deaths. The article blamed people’s bad food habits for the problem. It also mentioned that Louisiana ranks first in the nation for kidney-disease deaths, fifth for cancer deaths, sixth for accidental deaths and deaths from Alzheimer disease, and ninth for deaths from strokes and heart disease.

I started by asking the nurses, could all this be due to obesity, lifestyle, or to eating Cajun cuisine? What had been left out of this “blame the victim” piece? I had researched and found out that Louisiana ranks 31st in the nation in per capita income. And they rank 49th in equality, behind only New York, meaning that they have more rich and poor and fewer people in the middle. Both poverty and inequality are independently associated with health problems.

Louisiana is also one of the most polluted states, although no rankings are kept. And pollution, as I have been reporting here, contributes to diabetes, obesity, and various illnesses. So it’s not all about the food.

In the morning, we talked about the social causes of illness — bad food, barriers to physical activity, stress, inequality, and isolation. The combination of stress and inactivity is especially dangerous. If you’re stressed, your cells become more insulin resistant and your blood glucose level goes up so your muscles will have fuel for running away or fighting. So you have to run or do something physical when you’re stressed. Most of the time we don’t, of course. We just worry.

As I’ve reported before, stress is not evenly distributed through society. Stress is a response to a threat. The less power you have and the harder your life is, the more threat there will be, so the more stress you will have. That may be a reason people with less money, less education, less social status, less self-confidence, and less social support have more diabetes.

What Did I Mean by “Solutions”?
The second part of the program was about “self-management support (SMS).” That means helping people help themselves. SMS is the way health professionals should work with people with diabetes, instead of giving orders. We talked about goal setting, action planning, and assertiveness.

After lunch, we talked about getting help — working with people as couples, families, support groups, and communities. I focused on “buddy systems,” also called “patient mentor programs.” That means connecting people with diabetes to help each other on an ongoing basis.

The last part was called “hot topics in diabetes.” It was about the issues we have been discussing in this forum — diet, weight, early insulin use, tight control, sleep, sex, and a couple of others.

Enjoying Louisiana
The day was a big hit — I got close to the best evaluations of my career. Hopefully, the word will get around and I’ll get more invitations.

But maybe the evaluations were so high because the lunch was so good. The event was hosted by the Petroleum Club. (Lafayette is full of “petroleum” places, because it was big in oil production for about 50 years. Not anymore, though.) The food was great, better than at any of the restaurants we ate at. The gumbo was full of oysters and hot, but not too hot.

The next day we went on a swamp tour and saw alligators, snakes, turtles, and birds. We went to a Cajun restaurant with live music and dancing and to a Cajun museum. Those guys really suffered — they have a story that’s as awful as anything else in American history. The “Acadians,” as they were then called, were kicked out of Canada by the British and sent all over the colonies, rejected and hated everywhere because they spoke French and were Catholics. Survivors (fewer than half of the original Acadians) gradually collected in the Louisiana swamps. They connected with Africans and Native Americans and made a new life.

I think the trauma they suffered back in the 1700’s is still affecting them. That’s why there is so much drinking and partying, because the threat of destruction is passed on through the generations, without anyone saying anything about it. It’s all stress, as it is for many other oppressed groups and individuals.

On to Alaska
Anyway, we made it back across the country, and in two days I leave for Fairbanks. I’m doing two workshops there. It’s supposed to be 20 degrees below zero there. I had Aisha with me in Lafayette, but will be on my own in Alaska. Wish me luck.

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Comments
  1. You wonder is past trauma is stored in the genome or epigenome.

    As for economic conditions it would be interesting to compare the Louisiana Acadians with the ones on north shore of New Brunswick to see if big better economics lead to better health.

    Bring your wool undies to Alaska. I wear my duofolds all year around in Calgary.

    Posted by CalgaryDiabetic |
  2. HI CD,

    IMO, most of this intergenerational trauma isn’t genetic at all. It’s just passed down through parental stress and the resulting behaviors that cause even more trauma.

    You asked about the “epigenome.” For readers who don’t know, “epigenetics” is the study of how genes relate to the environment. It turns out that genes are not little dictators, acting but not acted upon. They can be turned on or off, and their expression changed, by other genes and by environmental factors.

    What is “epigenetic” in diabetes is whether the “thrifty genes,” the ones that store fat and discourage physical exercise, are turned on or off. It seems to take two solid generations of food security and relatively low stress to turn those genes off. Hard lives or histories of trauma prevent that from happening for a lot of people.

    Posted by David Spero RN |
  3. Thanks for writing this article about my beloved home state of Louisiana. Let me tell you North Louisiana is completely different from South Louisiana. Please also remember lots of Louisianans are mixed with Haitian, and Spanish European ethnic groups too. Thus how the Creole population was made.

    The ELEPHANT in the room of this article is that Louisiana has a high African American population. As most diabetic professionals know diabetes is usually seen in higher numbers in the ethnic populations. As seen after the Katrina and Haitian distasters. Most ethnic populations do not have access to health care or are living below the poverty line. Yes, complexion will still make a difference in the South as to healthcare and available facilities.

    Being a state in the South, most of the facilities that you see progressive states don’t exist or recieve little funding. Thus valuable information does not get to the people that are truly in need. As you stated most people are trying to survive on very low incomes. to most people as long as your are walking and breathing you have passed the test for being healthy.

    Louisiana is still recovering from the loss of oil money that stopped in the 80’s. It still has a low educational rate. Most of the young population leave the state for a better opportunities. This is what I did. I would love to go back but I would have to find a new profession.

    I think some of the issues that need to be addressed in the Diabetic community is a SERIOUS outreach toward ethnic populations in poor states such as Louisiana. This could be done through the 110 HBCU’s that are still in existance.

    Thanks for the article but look a little deeper into the gumbo next time.

    Posted by Chrystal |

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