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Diabetes in Hawaii:

Introduction


[Above image]: The United Nations blue circle symbol representing diabetes.

It is obvious to me that diabetes has become a clear problem in Hawaii mainly from the statistics I have read from the Department of Health, ADA, CDC, etc. Though I do care about this issue and I do find it to be very conspicuous, I have never taken any action nor look into the situation even more. Type 1 is Juvenille Diabetes which cannot be prevented. In other words, this type of diabetes is the one that is passed down due to heredity. Type 1 is when the cells are unable to produce insulin. It's obvious why type 1 is passed down. Type 2 is the type of diabetes that produces insulin fine, but do not allow glucose into the cells.. I think that focusing on type 2 diabetes will be much better though since that is the main problem of diabetes in Hawaii. Type 1 isn't much of a big deal since you can't really choose whether you are diagnosed with it or not. The only things I know are the facts, which is that over 100,000 people currently have diabetes and that diabetes is the 7th biggest killer in Hawaii. My overall goal of this project? Not necessarily to scare people, but to make sure that they know how big of a problem this is in Hawaii and why everyone should be aware of diabetes to avoid getting it. I have had a few relatives die from it, and they never knew it was coming until they finally were affected by it. All of these deaths were from type 2 diabetes, and it sort of scares me because they never knew what was coming. I hope this article makes you (the reader) more aware of diabetes.

Mrs. Y's comments on introduction

Jared-This is a good start. You've explained your connection to this topic and have given some background. I would like to make some suggestions regarding your writing above-could you come meet with me so we can go over this? To start with, I would suggest taking "you" out as this may not apply to every reader. Also, you say "everyone thinks this only happens to 'fat people'" which you then say is incorrect but then later say "Type 2 is the type for overweight/old people". This seems a contradiction. There are a few more things I would suggest changing but we can go over this together. Lastly, what are your overall goals with this project? To increase your awareness? To increase awareness in people in Hawaii? To do something more than increase awareness? I can brainstorm with you if you'd like. Excellent video & good graphics.




[Above video]: Great explanation on diabetes

Research


"'Silent disease' eating at Hawaii's health:

URL: http://www.honoluluadvertiser.com/article/20080907/NEWS01/809070304/-1/diabetes

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Summary: A man named Joe Otulau has been diagnosed with type 2 Diabetes. From what? If you read my introduction, then he clearly ate too much unhealthy food. As stated in the first paragraph of the article, "A smile spreads across Joe Otulau's face as he recites his food vices, most notably pork smothered in gravy with rice and macaroni salad on the side." It was clear that type 2 diabetes was inevitable if Otulau kept up with this diet.

Despite how much he eats, he wants to stop. "Eating all those kinds of things, I need help. Hawaiians, Tongans, Samoans, we have a problem with all of the food." It then states that he is not alone, for statistics show that 57% of adults in Hawaii are either overweight or obese (Department of Health). That's basically saying that if you take 2 average adults living in Hawaii, there is a high chance that one of them is obese or overweight.

"We live in a fast-food, super-size, sedentary society. Ten to 20 years ago we all walked home and ate home-cooked meals and were out in the yard playing," said Majken Mechling, head of the American Diabetes Association in Hawai'i.

"In Hawai'i, with both parents working and long commutes, we don't have the luxury of the home-cooked meals that we used to have. We don't have time to shop at produce markets, and the best foods aren't always the cheapest."

The two above quotes shows what change does. With this growing economy, I can definitely see why your average family does not have the sufficient amount of time to cook a wholesome meal for the whole family.

Now you may ask, "Presumably the 'silent disease' in the title of the article is referring to diabetes. How is diabetes considered a 'silent disease'?" Danette Wong Tomiyasu, chief of the state Health Department's Chronic Disease Management and Control Branch gives a great explanation:

"Until you notice you're having symptoms, people don't realize the lifestyle they're leading or things that they're doing are negatively impacting their health," she said. "People really, truly need to realize the severity of the problem is that it can lead to death. It affects the entire family."

Reflection: Unfortunately, this article seems a bit disturbing, yet very informative. The stats given were shocking and when people for the CDC call type 2 diabetes the "silent disease", that denotes that a lot of people can get it without even knowing it. If it's really common in Hawaii, then change must be made. Like I said in the introduction, there are many organizations out there to fix diabetes (the biggest one is most likely the "American Diabetes Association"), but they are clearly not doing good enough/need more funding and/or support in order to fix this.

As for Joe Otulau, I don't know what the future holds for him. This article wasn't very old, so I doubt Otulau has made a full recovery, but I can only hope for the best.

Further questions:

1. Why do Hawaiians, Tongans, and Samoans specifically have this problem/why does he say that? Is it just because of their genetics? Do the majority of them like the plate lunches that Otulau likes?

2. Why would it be that we have stopped "playing in the yard" and stopped getting active? Is it because of things that have made us inactive, or is it because of the growing economy and we just don't have time?

Children facing adult-size health issues

URL: http://www.honoluluadvertiser.com/article/20080907/NEWS01/809070301/-1/diabetes

Summary: This article explains how children are getting type 2 diabetes more frequently in such a short time. "In a single generation's time, type 2 diabetes has become so prevalent in children it's no longer known by its traditional label of "adult-onset" diabetes." In other words, type 2 diabetes was something that most adults got and hardly any children.

Why does this matter? Take this quote into consideration: "The reason why it's very alarming is that we know there are many complications for diabetes including blindness, renal disease, cardio diseases and amputations, and the longer the duration the more likely these complications start to show up." The main reason why this is a huge issue is that children will suffer from all of these diseases early on in their life and will have to deal with them for a longer duration. Here's a frightening stat for you:

"The U.S. Centers for Disease Control and Prevention estimates that one in three American children born in 2000 will develop diabetes in their lifetime if current trends continue. In Hawai'i, it's closer to one in two because of the state's ethnic mix." I believe that "current trends" from 2000 are continuing.

The article goes on with family issues and nearly the same exact thing that I just summarized (how type 2 diabetes is bad for young children)

Here is a very good picture explaining physical activity/food nutrition of obese/overweight people (found at the bottom of this article):

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Further questions:

1. Why was type 2 diabetes only common for adults? I truly do not understand that. Were eating habits different back then for children? I don't see why the numbers of people with diabetes have raised exclusively for children.

2. When it says that children will suffer from diabetes earlier on in their lives, does this mean that children with type 2 diabetes already have it as severe as adults?

Diabetes Report (State Department of Health:

URL: http://hawaii.gov/health/family-child-health/chronic-disease/diabetes/pdf/diabetesreport.pdf

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Summary: First off, I would just like to say how convenient this report was. For one thing, I was able to download it as a .pdf file, thus being able to read it whether I had internet connection or not. Secondly, it focused on diabetes in Hawaii, which is the focus for my project. Now on topic:

Since this is the summary, I feel that it is necessary to go over ever single page of the article.

Page 1: What is this report for? Clearly to cover the issue of diabetes, but specifically what about it? "The 2004 Hawaii Diabetes Report is intended to provide partners and stakeholders with information on the prevalence of diabetes and its effects on the people of Hawaii. This report is a valuable resource for use in planning programs and initiatives targeting those people most impacted by the disease."

It gives a very good statistic that is clearly very important and significant (it was on the first page.) "It is estimated that approximately 100,000 people in Hawaii have diabetes and more than 900 people die every year of related complications, making it the seventh leading cause of death in the state. Diabetes is a serious, common, and costly disease, but by working together, we can create a healthier Hawaii. I invite you to join us in that effort." It lists acknowledgements and goes on to the next page.

Page 2: This page is full of text that is part of the introduction. The first paragraph explains what diabetes is (refer to my introduction or on the diabetes report if you would like to know more). The 2nd paragraph explains statistics found from the Centers for Disease Control and Prevention (CDC). Example: 18.2 million people of all ages have diabetes in the United States. A third of those people (approx. 5.2 million) are unaware that they have been diagnosed with diabetes. 3rd and 4th paragraph talks about the risks of diabetes. After the 4th paragraph, it goes on talking about how examples of diabetes-related complications that could be prevented or reduced. 1st example (5th paragraph) is cardiovascular disease. "Adults with diabetes are two to four times more likely to die of heart disease and stroke, which together cause about 65% of deaths among people with diabetes. These deaths could be reduced by 30% with improved care to control blood pressure, blood glucose, and blood cholesterol levels." 2nd example is eye disease and blindness. (Self-explanatory: many people get diseases in the eye and become blind due to diabetes).

Page 3: Continuation of the examples of diabetes-related complications that could be prevented or reduced. They are all pretty much self-explanatory like eye disease and blindness, so here they are in order according to the report: Kidney disease, amputations, pregnancy complications, and flu- and pneumonia-related deaths.

Pages 4-5: These pages are basically acknowledgements of reports/surveys that have helped to collect statistics. The reports/surveys are: Hawaii Behavioral Risk Factor Surveillance Survey (BRFSS), mortality data from Hawaii vital statistics records averaged over three years (2000~2002), end-stage renal disease (ESRD) data
from the Transpacific Renal Network (ESRD Network 17) for 2002, and the Centers for Disease Control and Prevention’s (CDC) web publications.

Page 6-16: These pages are full of figures (graphs and bar charts/pie charts/ 25 figures included) that all show what data has been collected from each of the reports/surveys. Here are a few example of ones I found important:

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As you can see, all of these statistics are very thorough.

Reflection: The charts/statistics that were given in this report were pretty shocking, especially since this is mainly focused on Hawaii. I was totally unaware that a third of the population in the United States that have been diagnosed with diabetes were unaware that they are diagnosed with diabetes. It just makes me wonder that so many people in Punahou must have diabetes.

Further questions:

1. Is there an updated report on diabetes? This may only be four years old, but who knows how the statistics may have changed. It could've possibly drastically changed and the graphs that were presented may be outdated already.

2. Does the State Dept. of Health hold events in Hawaii for diabetes? Are they obligated toward research/funding for diabetes in Hawaii, or do they leave that job for the ADA?

American Diabetes Association:

URL: http://www.diabetes.org/home.jsp

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Summary: The American Diabetes Association is clearly an association that is there to help people out with diabetes, both directly and indirectly, and by that I mean that they can give one-on-one support or they can give tips/healthy recipes that you can find conveniently on the website. Despite all of the organizations that make a huge effort trying to aid people with diabetes, I have to say that this is the best organization out there. They seem to care the most about diabetes, trying to raise money, spending that money into research, etc. Were talking millions of dollars that they donate.

First off, there is a very nice article where you can find out more about diabetes, but if you read my summaries above, I'm absolutely sure that you know enough about diabetes already.

They have a section specifically for fitness, which clearly denotes that it explains how to stay fit in order to obviously avoid being diagnosed with diabetes.

They have a section for what you should eat. They have a very convenient "Ask the nutritionist" section, "My Food Advisor" (basically helps you create and maintain a healthy diet), etc.

They also have recipes under the nutrition section and a "recipe of the day." What's today's (October 26, 2008) recipe? Toast and Jam Treat. Here is an example of recipes on the American Diabetes Association website:

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Under it, it says that it is from a book published by the ADA (American Diabetes Association). This recipe is specifically for seniors, and the cookbook was filled with recipes specifically for seniors. As you can see, the ADA is very organized and is doing a good job at trying their best to maintain diabetes.

Reflection: Like I said, ADA has done a lot for people with diabetes. I just can't believe at how much they have done. Created cookbooks full with healthy foods to keep a healthy diet, giving tips of the day, hosting community programs and events, giving a very detailed background on diabetes, funding research and doing some research on diabetes itself, etc. I'm proud that ADA does all of this. I just wonder how there can be so many obese/overweight people in Hawaii when they can make their own foods with these recipes and become healthy, become fit, find out tips on curing diabetes, etc. I know it must be tough to get healthy, but with so much support, I find it so much easier than doing it alone.

Further questions:

1. How much attention does Hawaii get from the ADA? It's a huge problem in Hawaii and it doesn't seem to be getting much better, so I'm guessing not.

2. The ADA seem to do a sufficient job of preventing/helping diabetes. Are there any other organizations out there that do a lot/the equivalent amount that the ADA does?

3. Looking at Jeff's video on his wiki (http://www.youtube.com/watch?v=adHdKIGH9Ro), how does the ADA diet harm you? That seems to be really odd, especially since it was made clearly to help diabetes. I can see how there can be no change, but how is he so sure? I didn't bother watching the video, so there is probably a lot of research behind his reasoning.

4. Linking to my third question, how is he so sure that his diet that he recommends is so helpful? Why doesn't the ADA do research on his diet and find flaws in it?

Diabetes mellitus - Wikipedia

URL: http://en.wikipedia.org/wiki/Diabetes

Summary: It looks like desperation when someone has to go to Wikipedia to get information on a problem that is so widespread/serious. Surprisingly enough, it gave really clear information. In fact, I found out a lot on the background of diabetes (both type 1 and type 2). It goes over a lot though, to the point where it's overwhelming. I only read the first few paragraphs because 1. It got repetitive at that point and 2. the rest was all of this scientific research that could be biased/subjective and things that were unnecessary to go into (a bit like the figures that were given in the 2004 Diabetes Report done by the State Department of Health). Not to mention that it was very confusing. The first few paragraphs were clearly objective and to the point.

Reflection: Why wasn't this summary as thorough as all of the other ones? I felt that this didn't really require a summary since the summary for this would've been nearly the same exact thing as the introduction. I felt as if I were just citing/annotating this Wikipedia article when I was writing the summary.

Further questions:

1. Who edits these pages? I know anyone is able to, but some parts of the article really go into detail. Do experts in diabetes edit it, or are they just false information/information taken from other websites (which are most likely annotated on the article)?

Interview


Majken Mechling

I was planning on interviewing Majken Mechling, but she was unavailable at the time that we schedule our appointment due to planning of World Diabetes Day the following day of our interview. I got to speak with one of her co-workers named Merle. She thoroughly answered one my questions, but that was it. I am not able to make the November 17 deadline, but I will try to fit in an interview with Majken once I get the chance. Here is Majken's information:

Workplace: American Diabetes Associatio, Hawaii Market, 1500 South Beretania Street, Suite #111, Honolulu, Hawaii, 96826

Title: Executive director of American Diabetes Association Hawaii office

Questions

1. What got you into diabetes? In other words, why did you choose to be the executive director?
2. Being the executive director of ADA Hawaii, you must deal with a lot of diabetics. Do you think that a fix to this problem is possible with all the current support, or do we need more people stepping up and helping?
3. In your opinion, do you think diabetics are currently getting enough support?
4. I was looking for a more up-to-date diabetes report from the State Dept. of Health, but was not able to find one. Why is that? Was there a diabetes report before the 2004 report? If so, when was it released?
5. Does the State Dept. of Health fund any of the diabetes events happening in Hawaii, or is that your job?
6. Are there any other diabetes associations in Hawaii that are trying to help like ADA? If so, what are the names of these associations?
7. Are there any events coming up that I could attend in order to become more knowledgeable about diabetes?
8. Do you think that parents are at fault for overfeeding their children, or is this a small problem?
9. Do you think we should include in our school's curriculum the consequences of overeating?
10. Is there anything I can do to help spread the word or help the cause of diabetes?
Merle's response: There is a fund-raising event by the ADA called "School Walk", where you get your school to donate money toward ADA to help fund diabetes research. It is a very fun event for the whole school and it helps spread the word!

World Diabetes Day


Official website: http://www.worlddiabetesday.org/

When: November 14th

What: To spread awareness of the spreading problem of diabetes.

In Hawaii: The day of our scheduled interview with Majken Mechling, there was an event for celebrating World Diabetes Day in Tamarind Park. I was planning on going there to find out more on diabetes and to take some pictures along with possibly getting an interview, but when I got there at 2:30, their mini-expo was already closed.

The ADA "Risk Test"


Merle gave me a very informational handout. It was full of ways you can test yourself to see whether you may be diagnosed with diabetes. Here are some examples:

"At-risk weight chart"

If your height is the same or more than the corresponding weight, you may be at risk for for diabetes

Height (in feet and inches without shoes)
Weight (in pounds without clothing)
4' 10"
129
4' 11"
133
5' 0"
138
5' 1"
143
5' 2"
147
5' 3"
152
5' 4"
157
5' 5"
162
5' 6"
167
5' 7"
172
5' 8"
177
5' 9"
182
5' 10"
188
5' 11"
193
6' 0"
199
6' 1"
204
6' 2"
210
6' 3"
216
6' 4"
221



"Find out if you are at risk for having diabetes now" test

"Find out if you are at risk for having diabetes now. Write in the points next to each statement that is true for you. IF a statement is not true, put a zero. Then add your total score." - ADA

I am a woman who has had a baby weighing more than nine pounds at birth
1
I have a sister or brother with diabetes
1
I have a parent with diabetes
1
My weight is equal to or above that listed in the chart (the "chart" is referring to the chart above)
5
I am under 65 years of age and I get little or no exercise
5
I am between 45 and 64 years of age
5
I am 65 years or older
9

If you scored 3-9 points:

"You are probably at low risk for having diabetes now. But don't just forget about it. Keep your risk low by losing weight if you are overweight, being active most days, and eating low fat meals that include vegetables, fruits and whole grain foods." - ADA

If you scored 10 or more points:

"You are at high risk for having diabetes. Only your health care provider can tell you if you have diabetes. At your next office visit, find out for sure." - ADA

Comments from Ms. Y:
Jared-"Wow" is my first response! Your wiki so clearly demonstrates your engagement in this project and the learning that is taking place. I liked reading your summaries and relfections as I could see your learning progress. Initially you thought that organiations in Hawaii may not be doing so much since this is such a problem here. But later after research, you discovered that the ADA is doing a lot, but there is still work to be done. You also raise some good questions (about race, diet, behavior, etc). I would be happy to discuss this with you a bit more if you feel like you're not really getting answers to these questions. I know you already attempted two different means of contacting experts. Are you still planning on asking your questions of someone? I think you told me "yes" but I can't remember when. Also, let me know if you want to brainstorm ideas for your Action Plan. So far, outstanding work!



Action Plan


For my action plan, I created a brief iMovie that gives a background on diabetes, focusing on type 2 diabetes in Hawaii. With this iMovie, I plan to not only spread the word of diabetes to many people varying in different age groups, but to also make people aware that they may never know when they have diabetes or not. I was hoping to help out the organizations that have done so much to spread the word and try to make people aware of type 2 diabetes.

Here is the iMovie I created:



Final Comments:
Jared- Overall you have done a fantastic job with this project. You have really taken the initiative to learn and go beyond the minimum. At each step of the way you challenged yourself to take the learning further. The information you have included on your wiki is interesting, diverse, and relevant. As for your Action Plan, it is still a little unclear what you might do with your iMovie. Who will you share it with? How will it be used by others to get the word out? Will you give a copy to the Diabetes association you worked with? Did you want me to share with other teachers? Your iMovie is fun to watch with your graphics and little touches. You also did a nice job with the organization of information in your iMovie. You followed a logical progression from your goals, introduction, explanation, consequences, and how one might avoid and get more information. The explanation part was a bit confusing (re: insulin, gates, etc.) but otherwise, the rest was clear and to the point. Nice job, Jared. You should be proud of your efforts and product!