"Sometimes she'll have a light dinner of yogurt with fruit and nuts," said Carrillo. "If we go out to fast food places, I'll get her a hamburger and salad, not fries. And a diet soda."

Annamaria Carrillo is one of the approximately 13,000 Salinas residents diagnosed with diabetes. More than six percent of those diagnosed are, like the Carrillos, of Mexican descent.

To raise awareness about diabetes and how to manage it, the county Health Department implemented "Steps to a Healthier Salinas," a multimillion-dollar, federally-funded program to help Salinas residents eat less, exercise more and talk to their doctors about conditions like diabetes and obesity. Based on annual surveys conducted over the past three years, trends suggest that the Steps program has been succeeding.

The National Institutes of Health says 20 million people in the United States have diabetes, but a third of them don't know it.

People with Type 1 diabetes don't produce enough insulin, which their bodies need to convert food into energy. People with Type 2 diabetes have abnormally high levels of blood sugar because their bodies

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don't produce or use insulin.
This condition was once known as "adult-onset" diabetes, until doctors started diagnosing the condition in 3-year-olds.

Left unchecked, the disease can lead to blindness, heart disease, kidney failure, pregnancy complications, nerve damage and amputations.

"The real significant thing," said Chesney Hoagland-Fuchs, program coordinator of the Diabetes Education Center at Natividad Medical Center, "is that in the future, diabetes statistics will double for the general population, but will go up 150 percent in the Latino population."

Part of the problem is what Hoagland-Fuchs calls the "Latino paradox." Recently-arrived immigrants eat better and exercise more, she said. As they adapt to their new lives here, though, they lead less healthful lifestyles.

Another factor, she said, is the "thrifty gene" hypothesis, which suggests that some populations have genes that store fat as a way to survive in times of famine. When people from these groups adapt to the Western lifestyle, though, the gene doesn't turn off and keeps storing fat.

A study released in October by researchers at the county Health Department and the Stanford Prevention Research Center estimates that 64 percent of the 157,000 Salinas residents are of Hispanic descent.

Nora Carillo, whose mother was a diabetic, credits Hoagland-Fuchs with teaching her how to care for her daughter's condition. "She gave me literature, taught me about foods, how to check her blood sugar, how to administer the shots," she said. "I really appreciate everything she taught me."

More than 150 local groups, ranging from schools to taquerias to senior centers, are currently working with the Steps program.

One trend found in the survey — that more men diagnosed with diabetes are seeking medical advice for their condition — is particularly significant.

"That's huge," she said, crediting the Health Department's social marketing campaign with the results. "Men of all cultures hate to go to the doctor."

The survey data also show that the age at which women are being diagnosed with diabetes has been dropping steadily, while more men of Mexican descent are taking diabetes management classes.

Even in the program's final year, the Steps team is "still finding solutions that make sense," said David Lees, a health program coordinator with the county Health Department. He cited their partnership with Natividad's Diabetes Education Center, which is working toward accreditation from the American Diabetes Association.

Hoagland-Fuchs said that with the Steps funding, she plans to start monthly formal diabetes education classes in January in addition to regular support group meetings. She'll offer the four-hour courses to groups of 20 at a time, and expects to expand her staff gradually in response to the interest.

"As long as the demand's there, the talent's there," she said.

Nora Carrillo plans to attend one of Hoagland-Fuchs' classes with her daughter. Though she is not diabetic, Carrillo tries to watch what she eats as well. She tries to be more health-conscious, preparing low-salt meals for herself and her daughter, incorporating more fruits and vegetables into their diets, and watching their sugar intake.

"Sometimes, it's kind of hard." Carillo said if she has to choose between an orange and a slice of chocolate cake, she'd eat the latter.

"When the campaign started, we wanted community solutions," said Steps coordinator Lees. By teaming up with various local groups and organizations, the community has gained what he called "a heightened awareness of chronic disease and healthy lifestyles."

Though federal funding will end next year, Lees said the Steps team hopes that other groups will formally adopt the polices and practices they've begun. Steps won't end, he said, but will simply transition to another phase.

"There's definitely momentum right now," he said, "and the goal is to sustain that."

See www.stepstoahealthiersalinas.org learn more about the Steps to a Healthier Salinas program.

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