And there are probably a lot of people who say, oh, i know that theres diabetes; i know somebody who has diabetes; i know that in some people it can be really dangerous, in other people, they can manage it. So im a little confused. So what is the headline . What do we need to know about diabetes that is central to the issue . Well, the first thing, maria, is that diabetes is a Major Health Care problem around the world. This is not just in this country, it is everywhere. Hinojosa but its not something that you see, right . Isnt that one of the problems . I mean, you can be living with diabetes and be fine. Mmhmm. Actually, it is estimated that perhaps, for type 2 diabetes, which is the most common type of the disease ten times more frequent than type 1 diabetes, for instance people only have the disease for ten or 15 years without knowing that they have the condition until they manifest the first symptoms, which would be perhaps, like, frequent urination, increased thirst, fatigue, tiredness, infections that dont heal or dont get better very quickly. But theres a silent face. People may have the disease for years and years without really having any idea about the presence of the problem. And sometimes they know about the disease because they have already developed the complications of the disease. Hinojosa so if. If, for example, you start having some of these symptoms, are you saying that people just wont go to the doctor to deal with these symptoms, or they might go to the doctor but the doctor might not test them . Do you have to say, look, be sure that you test me for diabetes. Is that what. Or are we on the assumption that doctors will know to do this . Well, it is part of a routine exam nowadays to check the blood sugar. Its a blood test, and its part of the annual physical exam, for instance, for most people. Hinojosa so key here annual physical exam. Yes. Hinojosa thats something that you want people to just understand, that everybody really needs to be getting an annual physical. Absolutely, and this is not just to check for blood sugar, diabetes, its also for the blood pressure, for cholesterol, to check the weight, for instance, all these different conditions that we dont really pay a lot of attention to because we feel well. We dont realize that theres something going on, because we feel perfectly well. Hinojosa all right, well, let me. Lets, though, get back to the issue between type 1 and type 2 diabetes. Yeah, all right. So lets start from the very beginning. Diabetes is a disease that is characterized by high sugar concentration in the blood that we call glucose. Now, theres different ways to get to that high blood sugar. In type 1 diabetes, the problem is that the pancreas, which we have in the abdomen, does not produce enough insulin from the very beginning, and therefore, people need to take insulin injections. This is most common in children and adolescents, although nowadays, anyone with. Can have type 1 diabetes at any age. Hinojosa so youre born with it . Youre not born with it, but you have the genetic tendency to develop type 1 diabetes. Hinojosa okay. Now, most of these people are thin, they do not have Family History of diabetes thats sort of the norm and they, as i said before, need insulin from the very beginning. Now, type 2 diabetes, given that its also diabetes, is different. The pancreas may still be able to produce some insulin, particularly in the early stages of the disease. Another problem with type 2 diabetes is that the insulin that the body produces doesnt work very well. Thats what we call insulin resistance, meaning the body doesnt respond too well to insulin action so the blood sugars go up in the circulation and then people may be able to develop some complications. Type 2 diabetes is more common as we get older. Hinojosa but. But one of the major problems, maria, is that now were seeing type 2 in children and adolescents. Hinojosa thats what i was going to say. So now what were hearing is type 2 diabetes, were seeing it in kids. So what is happening with the fact that were now seeing type 2 diabetes, which we associated more with people kind of later in life. Right. Hinojosa . Whats happening that now kids are getting it . So in an easy way, what i always talk about is type 2 diabetes lets remember the number two, you know, type 2 has two problems. One is that the pancreas doesnt produce enough insulin, and that the insulin that the body produces doesnt work well. Now, for both conditions, theres two sources of problems. One is a genetic predisposition, which means that there is a tendency to develop the disease, because that comes from our history, from our family background, but its also, maria, related to our lifestyle. Thats the other element that plays a major role in type 2 diabetes. Hinojosa so were talking. As we become overweight, we dont exercise, we dont eat the way we should, all those factors contribute to that genetic tendency then to develop this very serious condition. Hinojosa and you are the director of the latino initiative. Yes. Hinojosa . Which means that within the latino community, specifically, and in broader senses, the African American community, the native american community. Yes. Hinojosa . We are seeing numbers that are spiking. Yes, more than in other populations, and the reason for that is the two elements that i just mentioned. The genetic predisposition and also the lifestyle issues that contribute to type 2 diabetes are more common in some of these racial and ethnic minorities. Hinojosa so for example, paint a picture of when you are in a Barrio Latino and youre just looking around, what is the picture that you see that is kind of raising flags for you . In some of these neighborhoods where theres more racial and ethnic minorities, its been well documented theres less access to healthy foods. Its part of a cost issue its a financial situation but its also a social issue. That sometimes, some of these markets are more appealing to some of these different groups and also for businesses. You know, they know that they can actually succeed more by providing some of these fast foods, et cetera, in some of these neighborhoods. So its really a big, big challenge. Hinojosa and the fast food issue for communities of color comes in because you have, lets say, working parents . Both of them might be working, and so then the easy thing to do is, ill just go by and pick up those hamburgers or that Fried Chicken or whatever, because. Not because youre a bad parent, but because youve got a lot on your plate and youre thinking, you know, time, and youre thinking money . Oh, well, its an easy thing. I mean, if you want to eat, you know, fast food is really available, its affordable, its tasty, its filling. So it really has a lot of advantages for the working families, for people that dont have a lot of time to prepare the foods, et cetera. So we have moved away somehow from our traditions, also, maria, in the sense that. Hinojosa well, thats what i was going to bring up. We used to cook at home, and you know, that was sort of the natural thing to do. But now were so busy, we have to do a lot of different things, and fast food has come to our lives to sort of solve some of the challenges that we have. Of course, we are paying a huge price for that type of decision. Hinojosa isnt it true, also, that for newer immigrants, when you come to this country and you have a little bit of extra money, then going to a fast food place is like. Its a step up. Youre right. Hinojosa is there that kind of situation where you have immigrant parents who are like, well, this is what people eat in the United States of america, and my child is an american. Im going to feed them fast food. Right. There is what is called acculturation, and acculturation is related to the adoption of the lifestyle in any country that we go to if we live there. And its been well documented that, for people in the first five years when they come to this country, they tend to adopt some of these lifestyle issues. So as you said, people tend to eat fast foods, they become more sedentary as well, because people may be able to buy a car now. So they dont exercise, they dont walk, they dont ride their bikes anymore, and people tend to gain some weight. If you think about it, the immigrants are usually healthy, young people that come and work in this country, but in the first five years their Health Status usually changes. They become more overweight, they have more risk for diabetes, high blood pressure, high cholesterol, and after five years, their risk of diseases is a lot higher than what it was when they were in their country. Hinojosa this is just. I mean, youre from mexico. Is there a part of you that just wishes that you could just kind of stand there with a big sign that says, if you go into the United States, beware, because what youre going to eat in the United States and the lifestyle you are now going to engage in could make you sicker. It is true. Thats sort of the norm. Now, at the same time, because lets be fair, you also have choices, because you can always make good decisions. You may decide to exercise, you may decide to go for foods that are healthier, and this concept that always the. The better foods are more expensive, you know, is not absolutely true all the time. One of the things that we do in our program, for instance, is to teach people that within a limited budget, you can always make better choices, and you can always even if you dont have a lot of money go for better foods, for those that have less saturated fat, trans fats, you know, healthier meals in general. Hinojosa but do you feel that you are. You know, when you look at our communities, our immigrant communities, our communities of color where there is such a bombardment of, you know, again, fast food, notsuchhealthy food, easily accessible, and here you are trying to say, wait, dont make that decision; dont buy that fast food; think about taking the 45 minutes for cooking a meal for your family, really in the end, you have a huge battle that youre confronting. Oh, its a big battle. Its a huge battle, maria, because theres so many messages that are delivered every second to the population about not eating the right things, not exercising, because were concentrating on other things. Hinojosa i talk about it with my kids all the time. Our values, you know, are gone, and we have to rescue those. We have to go back to very basic principles about living in family, doing things together, being more physically active. We dont need a lot of the outside messages and values that the society wants us to acquire, and if we go back to some of those simple ways of living, we could have healthier and better lives. Hinojosa so the conversation about diabetes, and particularly, type 2 diabetes, is one that is of concern to a lot of people. Even pbs Public Television has started talking specifically to young people to hear their stories and to kind of get their stories out. So were going to take a listen to one particular story. Lets take a listen. I would say that i am intelligent, funny, i would say that i am very determined. I am artistic. Im a hopeless romantic. Im an independent person, and i have type 2 diabetes. I told her the news and she said, im sorry. this serious look was on her face. I said, dont worry, im going to do what i have to do to benefit myself. she said, i feel so bad for you. Whyd it have to be your health . when i found out i had diabetes, i was very shocked. I thought that was something that only older people got. I was 12 years old. I thought i was like, the only person that got it at such a young age. I didnt know anybody else who had had it. I thought that everything was going to be downhill from there. I thought i wasnt probably going to get past my 30s. I said, stop apologizing; this isnt taking over my life, just one part of the many that i will overcome in this fight. diabetes is only a problem if you dont take care of it. I just ate healthier and became more active. I joined basketball. I like playing basketball because it just keeps you on your toes and its a very fastpaced game. I dont like playing with girls. When i play against guys, its more of a challenge and it gives me more like. More motivation to walk onto the court and be like, okay, i need to beat him. I started college three months ago. I love college. I love how i have a lot of responsibility, because it makes me feel like more of an adult. One of the dining halls is just a buffet, so when i go to eat, its sort of like a little kid in a candy store. Like, i can have anything that i want. In the beginning, it was hard, because i was like, ooh, they have pasta and they have chicken and they have hamburgers and then they have a salad bar and they have like, an ice cream machine and they have everything. Ive gotten a lot better with choosing what i eat and portion sizes, so ive learned how to control what i eat and not just get. Have like a freeforall. Eating healthier and just exercising, i lost a lot of weight and it was really encouraging. Diabetes does not define who i am. When i look in the mirror, i see somebody who is very strongwilled, and i see somebody who knows what they want in life and isnt going to let anybody stop them. So when people say theyre sorry, tell them dont worry you just need their support because the ball is in your court. Hinojosa misty anaya, thank you so much for joining us on the show thank you for having me. Hinojosa its great to have you. So youre 12 years old, right, youre growing up. Yes. Hinojosa . And everything is fine youre feeling fine. Hinojosa and then suddenly, what . You end up going to the doctor . Was it a. Well, one of my rel. One of my younger siblings was diagnosed with hypoglycemia, and then. So we had a sugar kit in the house, and then we went to dinner one night we went to a buffet and then we came back and my face was so red and i just wanted to go to sleep. And my mom said, no, somethings wrong with you. So we had a sugar kit in the house from my sibling, and then she checked my sugar and it was 356. Hinojosa oh, my god yeah, so. Hinojosa what. How is it that your family kind of knew to check your sugar . Because my younger sibling. Hinojosa they thought that maybe, perhaps, there was something there . Yes, and also, a whole bunch of like, all of my other relatives, pretty much, everybody has diabetes. Hinojosa so at that moment, when. Do you then go to the doctor . Mmhmm. Hinojosa right. And the doctor says to you. Youre 12 years old and the doctor says, misty, you have diabetes. Mmhmm. Hinojosa what went on for you at that moment . I was really scared. I was nervous, because i knew. One of my other relatives, she didnt take care of her diabetes and she had a lot of complications, and so i was scared. I was thinking that i wasnt going to live. Like, i had my whole life planned out ive always been like that and i just thought that my life was going to be shortened and that i wasnt going to. Yeah. Hinojosa so the first thing you heard is, you are a person with diabetes. My live is going to be shorter than everybody elses. Mmhmm. Hinojosa okay, dr. Caballero reality check. For a 12yearold, that kind of response of, oh, my god; ive got this illness, im 12, im not going to make it. Well, its a very natural thought. The good news, however, is that nowadays, if you control diabetes even if you start very early in age as misty did you have a very Good Opportunity to really have a very normal life and prevent complications. But. Hinojosa but there is a sense out there that its. Of course, of course, because actually, diabetes has been associated with a reduction in life span for many people, because diabetes can lead to complications. But every time that we talk about it, it is not just diabetes per se, its uncontrolled diabetes. Yes. Hinojosa okay, so what did the doctors to say to you . Then suddenly, at what point, misty, did you say, okay, ive got an illness. Mmhmm. Hinojosa . But if i listen to my doctors and all of the experts. Mmhmm. Hinojosa . They tell me that i can really control this. Mmhmm. Hinojosa and they said what to you, in terms of changing your lifestyle . They said one thing i had to change was my nutrition, because i was. When i was diagnosed with diabetes, i was very overweight well, not very, but i was overweight for my age and they told me to cut out all the soda and juice that i was drinking, stop eating a lot of fatty and greasy foods. And i changed. In the first week i lost six pounds just from cutting out soda and changing my nutrition, so. Hinojosa okay, so let me ask you something, misty. Mmhmm. Hinojosa a typical. Because ive seen kids in our barrios in our neighborhoods. Mmhmm, mmhmm. Hinojosa . And it just does a number on me when i see them at 8 00 in the morning and theyve got a can of whatever soda. Mmhmm. Hinojossometimes its actualu know, the most sugariest of the sugariest. Mmhmm. Hinojosa . And theyre eating some, you know, potato chips or something or another, and this is breakfast. Tell me what, lets say, breakfast or lunch. When i was younger, i usually ate cereal before i went to school. It wasnt that. But it was, like you said, in those. In like, especially latino communities, theres a lot of bodegas and Corner Stores everywhere and they sell chips, ice cream, juice, sodas, all junk food. Hinojosa and kids love that stuff. Mmhmm. Hinojosa so when you were told, misty, you need to just get rid of all that stuff, did you just think, well, thats impossible; thats what i eat ill never survive if i dont eat that stuff. laughing i was. Because i didnt know what else to do, so like, even when like, my mom went food shopping, because there was five kids, she just bought like, chips and stuff. And so i started eating a lot more fruit cups, and i would be like, the only one on my school bus. Hinojosa how has it changed you . What has it done to you . Because a lot of people say sometimes, when you get a certain illness or diagnosis, it changes you as a person not just in terms of your health, but as a person. So what has it done for you . Its definitely made me more responsible and ive matured a lot faster and its also made me appreciate life more. Hinojosa and what would you say is the biggest thing that youve had to change . So its about what you eat . What other things, like your life . I would say its. Its made me. Everything that i do, i have to watch to make sure im managing my diabetes well. So even if its before playing a sports game i have to make sure my sugars okay, when i go to social events especially now like, im in college, theres a bunch of social events. I have to make sure that i make smart decisions. If i go somewhere, i always have to make sure i have my sugar kit on me in case it drops, and juice. Like, if. Everything that i have to do, i have to think about, is my sugar going to be okay . Hinojosa but do you think its a burden, or youre just like. Im used to it now. Its not so much of a. Its not a hassle. You know, diabetes isnt my life. Hinojosa when kids in the hood, lets just say. Mmhmm. Hinojosa is there a lot of teasing thats going on around the iss