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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