Each week, Editorial and Opinion Editor Jeanne Mariani-Belding hosts The Hot Seat, our opinion-page blog that brings in elected leaders and people in the news and lets you ask the questions during a live online chat.

On The Hot Seat last week was Majken Mechling, executive director of the American Diabetes Association's Hawai'i office.

Here is an excerpt from that Hot Seat session. To see the full conversation, go to The Hot Seat blog at www.honoluluadvertiser.com/opinion and click on "The Hot Seat." (Names of questioners are screen names given during our online chat.)

Harry: Why is Hawai'i's rate of diabetes higher than elsewhere? What are you doing to fix that?

Majken Mechling: Hawai'i has a disproportionately higher rate of diabetes due to our ethnic mix here in the Islands. Hawaiians, Pacific Islanders and the Asian communities have a higher rate of diabetes.

Tina: What can we do to prevent diabetes? If it's genetic, what are your chances of developing diabetes?

Mechling: There are so many simple things that can be done to impact diabetes, particularly type 2 diabetes. People are predisposed based on genetics; however, there are environmental factors as well. Even if someone is predisposed by ethnicity, family history, etc., they can do things to prevent it or at a minimum to prolong when they actually get diabetes and how they live with it.

Simple changes in behavior, knowing what we are eating, portion control of foods, eating more fruits and veggies, and of course simple exercise, like walking. Walking 10,000 steps a day can really have an impact when put together with a sensible diet.

Joe: Why does diabetes usually strike certain groups in our population? I don't mean childhood diabetes but diabetes in later life? Seems like here in Hawai'i we all eat pretty much the same types of food.

Mechling: Diabetes strikes certain ethnic groups for lots of reasons. If we look just at our food intake, we can really start to appreciate that traditional foods in the Pacific Rim really consisted of more fruits and veggies, with less intake of meats and fatty products. We have quickly westernized the diet of lots of ethnic groups in our community. As a society in general we have a tendency to eat lots of processed foods, lots of fast foods, and lots of food in general, super-sizing a good portion of what we put in our systems while at the same time we are becoming more and more sedentary — in our cars, in the elevators, in front of the TV and computer. Twenty years ago we were eating mostly home-cooked meals, walking everywhere and playing outside. Our world has changed and unfortunately that has impacted on our health. We need to eat more colorful foods, fruits and veggies, and walk, walk, walk.

Paul: My grandfather has diabetes and he is supposed to stay away from certain foods, but he just loves the high-fat, salty foods. Sometimes he will sneak a snack at night or when no one is around. What can we do to help him eat better without discouraging him too much?

Mechling: This is a great question, and so many people have asked this and have the same issues at home. We are all very set in our ways as humans and it is so hard to change some of our behaviors, especially as we get older and feel like "why not," I deserve to eat what I want when I want.

If your grandfather lives with you and he really is resisting the change, sometimes we have to do what our parents would have done with us and that is not have those foods available for him to sneak at night. It sounds harsh, but really, the goal is to keep your grandfather around and to have him healthy so he can enjoy the family and you him. Try putting lots of fresh fruits, whatever kinds he likes in places that have easy access for him, the front of the fridge so when he reaches in the things that he should eat for snacks, cut veggies, with a good dip, fruits, etc, are there and ready to go.

Don't forbid the things he likes — just have them as special treats, or have them for him earlier in the day so if he is going to eat them no matter what, at least you can get him out and about so he can walk some of it off.

We tell people it's OK to have your favorite foods — just know you are going to have to exercise more to compensate for it.

Bryan: I am African-American. The Advertiser stories did not really address my risk factors. Could you help? I am 45. I try to exercise, but not regularly. I guess my point is this: What are the risks factors for middle-aged, African-American men?

Mechling: Yes, unfortunately the African-American community is a high-risk group as well. The things that I mentioned with the Pacific Islanders applies to the African-American community as well.

Your risk factors are: Your age, your ethnicity, the fact that you aren't exercising with regularity, and family history. If I were you, I would go get a simple blood test and start walking!

Punini: Is any effort being made to educate mothers about the dangers of overfeeding and to include in our schools curriculum the consequences of overeating? It's the later suffering that should be the motivation, don't you think?

Mechling: We must educate our children while they are in the decision-making years so that they start at an early age to understand and to work toward a healthy lifestyle.

The American Diabetes Association has a program called "Diabetes and You." This is a fourth- and fifth-grade program that is taught by retired school teachers and brings diabetes information to the children.

It is free to all schools in Hawai'i and brings information not only to the children but provides a parent night as well, and then we have a School Walk component that gets everyone up and moving. The more we bring this program to the schools, the more educated our young people will be.

Kelly: I am Native Hawaiian. Isn't it true that fighting diabetes is more than just diet? That is too simplistic. I have seen this disease go through my family, and not all of them were lazy or overweight. Let's get real.

Mechling: Absolutely, you are so right on! Diabetes is certainly more than just diet. There are so many people who are thin who have diabetes; being overweight is not the determining factor.

Being overweight is just one of many risk factors. Age, ethnicity, lack of exercise and pure genetics are all part of the formula to the luck of the draw on diabetes.

In your case, obviously genetics has played a factor in diabetes and the impact it has had on your family.

What we do know is that eating a sensible diet, exercising regularly, and losing just five percent to 10 percent of your weight can really have an impact on preventing diabetes, prolonging diabetes, or managing diabetes.

The fact of the matter is some people, no matter how well they take care of themselves, will indeed still get diabetes. The difference can be, if you are taking good care of yourself and have an overall healthy lifestyle when and if you do get diagnosed, you will have a better change of success when it comes to managing the disease.

Diabetes knows no boundaries, and unfortunately, the Pacific Island community is seeing that every day amongst so many families.

My message to people is get and stay as healthy as you can, and know that your diet and exercise absolutely has an impact on diabetes regardless of when you are diagnosed.

So many people I talk to say 'I am going to get it anyway, all my family had it so why not just ignore it' or 'Do what I want and eat what I want.' Coming from a family that had diabetes and its complications like you obviously have, you know that no one wants to suffer the complications of this disease, especially the complications that can be prevented.

I say to these people you don't have to die from the diagnosis of diabetes, but if you ignore it, you will die from the complications.

Jo: I'm not very familiar with diabetes. I'm wondering why it can result in amputation?

Mechling: Great question and unfortunately a very real one for so many people.

Diabetes is a silent killer. As I mentioned earlier, it is not often the actual diagnosis of the disease that kills people but rather the complications.

While I am not a physician, so I will not give you the technically correct and medical terminology, I can tell you that diabetes affects the nerves in our body, and circulation is one of the first places that you will see diabetes hit as a complication. Most people start out with tingling in the extremities both hands and feet, then it starts to move along the limbs.

This is an unfortunate complication and a very real one. Diabetes is the leading cause of non-accidental amputation making it a serious complication.

This is why diet and exercise are so important for people who have diabetes, keeping blood sugar levels as steady and within range as possible prevents these levels from constantly moving up and down which results in the nerve and circulatory damage which results in amputation.

Jason: Can you tell us what part of the country has the highest number of diabetes cases? And in Hawai'i, what communities have the highest rates? Just curious. I would think you need to know this to have outreach, no?

Mechling: Unfortunately Hawai'i is up there with the higher rates of diabetes due to our ethnic mix. There are what we call hot spots throughout the country that show a disproportionately higher rate of diabetes than other places and most of the communities usually have a high rate of certain ethnic groups like African-Americans, Native Americans and Latinos, and in our case Pacific Islanders and Asian-Americans.

In Hawai'i, the highest rate of diabetes falls within the Hawaiian community and Pacific Rim communities. Then we are looking at the Asian communities, especially the Filipino community.

Yes, it is important to know this especially as we do outreach.

One of our current outreach programs at the American Diabetes Association is our Diabetes Sundays program, which is trying to reach those who have not been diagnosed but are at risk for diabetes, to try and reach out to these folks before they get diagnosed.

The program comes right to the church community during the service to connect spiritual and physical health. We have speakers from the community who live and work in that community talking about diabetes followed by an awareness health fair right on the premises of the church.

This program is partially funded by HMSA and we would gladly come out to any church in the community anywhere in the state!

Lan: Is there any indication when or if you will get diabetes? I guess what I'm asking is if you went to the doctor, would they be able to tell you that you have onset diabetes? Or is it something that you just wake up with?

Mechling: A great question and such a simple answer, yet for some reason we don't seem to ask the doctor to test us.

The answer is yes, the doctor can easily tell with a simple blood test if you have diabetes, or if you are pre-diabetic. They can tell best on several risk factors whether or not you are going to be at risk.

So we say to everyone who is overweight, over 45, sedentary, has a parent or sibling who has diabetes or who comes from the high-risk ethnic groups, which in our community is pretty much everyone: Get tested, ask your doctor to test you, go to a local community health fair and get tested, go to the pharmacy and ask when the next screening is going to be held or look for ProjectVision, which is a mobile eye screening, totally free exam that is on the road in Hawai'i. This is a 90-second digital photo of your eye that is done for free and can screen for early detection of diabetes, high blood pressure, glaucoma and more.

We can't say it enough to people — know the risk factors and get tested!

Reach Jeanne Mariani-Belding at jmbelding@honoluluadvertiser.com.