New Beginnings A Discussion Guide for Living Well with Diabetes Based on Themes from the Film The Debilitator November 2005 A joint program of the Centers for Disease Control and Prevention and the National Institutes of Health. http://www.ndep.nih.gov New Beginnings: A Discussion Guide for Living Well with Diabetes Based on Themes from the Film The Debilitator 2005 Acknowledgments Many National Diabetes Education Program partners contributed to the develop­ ment of this guide. The following people formed a core writing and review team that helped research, write, and refne drafts of the manuscript and enlisted the involve­ ment of school personnel and parents in reviewing the guide. Their dedication and assistance were invaluable. Albert Einstein College of Medicine National Diabetes Janet O. Brown, RN, MSN, MPH Education Center for Substance Abuse Treatment Program Staff Clifton Mitchell CDC Division of Diabetes Translation Georgia Division of Public Health Jane Kelly, MD Magon M. Mbadugha, MS, RD, LD Sabrina Harper, MS Healing Our Village National Institutes of Health Lenore Coleman, PhD National Institute of Diabetes & Mississippi State Department of Health Digestive & Kidney Diseases Victor Sutton, MPPA Joanne Gallivan, MS, RD Morehouse School of Medicine In addition, the National Diabetes Elvan Catherine Daniels, MD Education Program would like to thank the following individuals, who reviewed National Urban League portions of this discussion guide: Sandra Goodridge, MS, MA Pamela Allweiss, MD, MPH Ohio Department of Health Quanza Brooks-Griffn, MPA Thomas Joyce, MA Ann Bullock, MD Kristina Ernst, RN, CDE The Links, Incorporated Portia Jackson, MPH Mary Clark, MEd Michelle Owens, PhD University of Illinois at Chicago Betsy Rodriguez, MSN, CDE Caswell Evans, DDS, MPH Dawn Satterfeld, PhD, MSN, CDE U.S. Department of Agriculture Gladys Gary Vaughn, PhD Disclaimer The Debilitator is an independently produced flm created by Millennium Filmworks. The flm is not an NDEP product, and as such, the NDEP does not have the rights to use, reproduce, or broadcast the flm. The NDEP is not responsible for the content of The Debilitator flm, and reference to this flm does not imply an endorsement of products developed by the organizations that funded and created this flm. Information on obtaining this flm is provided solely as a service for users of this NDEP discussion guide. It is possible to use this discussion guide without access to the flm. Contact Millennium Filmworks at http://www. millenniumflmworksinc.org for further information on obtaining the flm. Photographs in the discussion guide that are related to The Debilitator flm were provided by Millennium Filmworks, Inc. Contents Contents Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 How to Use This Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Session One. Overview: The Debilitator 13 Session Two. What’s Going On in the Family? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Session Three. Be Smart About Your Heart: Know Your ABCs . . . . . . . . . . . . . . . . . 23 Session Four. Every Day Is a New Beginning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Handout for Session Four: Emotional Stages of Change Session Five. Diabetes Detection: Could I Have Diabetes Right Now… and Not Know It? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Handout for Session Five: Diabetes Detection Initiative Risk Test Session Six. You Can Be Your Own Worst Enemy or Your Own Best Friend . . . . . . 45 Handout for Session Six: Home Exercise Session Seven. Emotional “Short Circuits” and “Brain Shutdown” . . . . . . . . . . . . . 53 Session Eight. Children and Family: How Can They Understand?. . . . . . . . . . . . . . . 59 Handout for Session Eight: Effects of Diabetes Session Nine. Fear of “the Needle” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Handout for Session Nine: Myths and Facts About Insulin Handout for Session Nine: What You Might “Know” About Diabetes: Myths and Facts Session Ten. Working with Your Doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Session Eleven. A Frightening Future: The Rise of Type 2 Diabetes in Youth. . . . . . .81 Handout for Session Eleven: Obesity Maps and Diabetes Maps Handout for Session Eleven: Eating Healthily, Moving More new Beginnings: A DisCussion guiDe for Living weLL with DiABetes Session Twelve. Spirituality as a Guide and Support . . . . . . . . . . . . . . . . . . . . . . . . . 89 Session Thirteen. What Are My Patients Thinking? A Session for Health Care Providers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Handout for Session Thirteen: The 5As Handout for Session Thirteen: Role-Playing Exercise Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Creating Your Own Panel Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107 References and Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 NDEP Publications Order Form 113 State-Based Programs to Reduce the Burden of Diabetes . . . . . . . . . . . . . . . . . . . . .119 introDuCtion Introduction A discussion facilitator is the person who takes the lead in guiding the discussion. This person could be a diabetes educator but doesn’t have to be. Experience acting as a group facilitator is helpful but not essential, because these sessions do not need to be held in a formal setting. They could be explored in a more informal and intimate setting, such as a family gathering. How to Use This Guide Frequently Asked Questions how to use this guiDe How to Use This Guide Welcome to this new discussion guide from the National Diabetes Education Program (NDEP). This guide was developed to expand on themes and educational oppor­ tunities brought out in The Debilitator, a public television docudrama developed by independent flm company Millennium Filmworks. This flm and discussion guide focus on an often overlooked aspect of diabetes—the impact that emo­ tions can have on how people give and receive infor­ mation about diabetes, whether they seek help, and, ultimately, what infuences them to take action to control or prevent diabetes. Our experience participating in pilot test screenings of the flm The Debilitator has told us that people want to talk about it afterward: about their personal experiences and the emotions that accompany living with diabetes. This guide is intended to help facili­ tate the discussion by providing stimulus questions, group and individual exercises, and role-playing experiences. The material in this discussion guide is divided into 13 modules to be used by facilitators in leading sessions on topics drawn from The Debilitator. This flm is about Calvin Dixon, an African American man with neglected diabetes who dreams that he dies of a heart attack. The dream prompts him to share his fears with his family and to accept their help in taking action to control his diabetes. The modules for the sessions, all formatted in the same manner, include background information, learning objectives, materials needed, suggestions for stimula­ tion questions, and points to bring out in the discussion. An estimated time is given, but only for the discussion. An additional 30 minutes is needed for watching the flm. Many modules contain classroom and homework exercises, and some include optional activities. You may choose among these activities based on the interests of the group, the amount of time that you have, and your expertise as a discussion leader. Some handouts for the sessions are included in this discussion guide kit and may new Beginnings: A DisCussion guiDe for Living weLL with DiABetes be photocopied for participants; others must be ordered from the NDEP ahead of time or downloaded from the Internet at http://www.ndep.nih.gov Each module is designed to stand alone. You can use any one of the modules if you are meeting with a group only once, or you can use the modules as a series if you are meeting several times with the same group. The overview session is designed to bring out facts about diabetes and to probe emotions evoked by viewing The Debilitator. The session is “scripted”; that is, it contains detailed notes on what you can say to the group to facili­ tate discussion. You may want to use that module if you are meeting on a one-time basis with a group and the participants don’t know each other. The other modules in the guide focus more closely on specifc scenes in the flm and can be used in a support group, in an edu­ cational meeting, or in any other group that is meeting more than once. Those modules assume that the group members have already met together at least once. They are not as heavily scripted as the overview session, but they all include points that we suggest you bring out dur­ ing the discussion. Key to Icons Used in This Guide 1. Play flm, or replay scene in flm. 2. Distribute/review handout(s). 3. Make sure the following points are brought out in the discussion.