Duane Reade Diabetes Magazine by Lena Duffy

Diabetes handbook free copy

INSIDE: Your Guide to Better Living

YOUR CITY. YOUR DRUGSTORE.

Today, Duane Reade is one of the most recognized and respected pharmacies throughout metropolitan New York. DIABETES HANDBOOK Fall/Winter 2009

CONTENTS: 5 Diabetes Overview 7 what to expect Head to Toe 8 DIABETES: A Guide for Living Well & 10 Medications Over-the-Counter Next 11 Your Doctor Visit 13 coupon savings 16 Blood Glucose Levels

18 Feature: Healthy Eating 19 DiabetIC Recipes care 22 FooT Be Sweet to Your Feet Good for You

Glucose 23 Blood Self-Monitoring Chart

leading the way…

to Living better with diabetes According to a recent announcement by the New York State Health Department, 1.5 million New Yorkers have diabetes and it’s estimated that half a million more residents do not know they have the disease. This is an alarming statistic that demands attention. At Duane Reade, we’re committed to making a difference. Duane Reade has created this informative handbook to serve as an introduction and reference guide for diabetes care. Inside you’ll find valuable information and helpful tips to help you live a healthy life beyond your diagnosis. In addition, we’re promoting community awareness and support for those with diabetes. This includes: Conveniently located Duane Reade Medical Clinics, each with an on-site physician and, at select locations, a LabCorp diagnostic testing facility. Duane Reade HomeCare with free home delivery and a variety of products to meet your healthcare needs. Convenient Duane Reade pharmacies to fill your prescriptions both on-site and online.

editor: William J. Malave contributors: Rebecca Rabano Eileen Figure-Sandlin Sheryl Norman art direction: Hannah Smith © Copyright 2009 Seltzer Kaufmann Marketing, Inc., Bloomfield Hills, MI • All rights reserved. www.skmmarketing.com • Made in the U.S.A.

Trusted pharmacists equipped with the latest information on diabetes research, treatments and medications.

working together, we can help you become symptom free Reference for select articles in this handbook provided by The health information in this publication is meant only to complement the advice of healthcare professionals, and is not intended to take the place of professional medical care.

diabetes Overview Got diabetes? you’re not alone.

Almost 24 million Americans share this diagnosis, according to the Centers for Disease Control, and statistics show it’s on the rise. But there’s a wealth of information out there to help you live a long, healthy life. The more you know, the better you’ll be at making life work for you.

Let’s get started:

What is diabetes? It’s a disease that affects the insulin hormone production in your pancreas. Normally, your body breaks down the food you eat and changes it into glucose. Your pancreas then releases a hormone called insulin. Glucose + Insulin = Energy that fuels your body. But when you have diabetes, insulin is not generated or used properly. Consider the three main types of diabetes:

type 1 diabetes — is when the body stops making insulin. First signs usually appear in childhood and adolescence. type 2 diabetes — the most common type happens

why

when the body doesn’t make enough insulin or doesn’t use it properly, or both.

me?

You’re at a greater risk for Type 2 diabetes if you are: A person with a family history of diabetes Overweight or sedentary A woman who has had gestational diabetes Over age 45 Hispanic/Latino, African American, Pima or American Indian, or Asian/Pacific Islander

gestational diabetes — occurs during pregnancy. Women diagnosed with this form have a 20% to 50% risk of developing another type of diabetes in 10 years. If glucose levels are not managed properly in all three types of diabetes, the bloodstream can become flooded with glucose, which could lead to other serious complications.

WHAT ARE THE

SYMPTOMS OF DIABETES?

Unquenchable thirst

Unexplained weight loss

Persistent urination

Itchy, dry skin

Numbness or tingling in extremities

Continual infections Swollen, red, tender gums

Excessive hunger Consult your doctor with any concerns. If your physician Blurred vision suspects diabetes, a blood test Irritability can confirm the diagnosis and Wounds slow to heal identify the type of diabetes. Unusual fatigue

what to expect If you’re diagnosed with diabetes… Your mind may race with questions. Discover the answers and you’ll gain a sense of power, control and direction to develop a healthy mindset in managing this disease.

Take medication as directed by your doctor.

Depending on the type, this could mean oral medication, insulin injections or a combination of both. Many people with diabetes also need to take medications to manage their cholesterol and blood pressure.

pay close attention to your body’s warning signals to avoid complications. Test blood glucose levels as suggested by your doctor. Check your blood pressure regularly, scan your skin and gums daily to rule out redness, swelling or bleeding.

a support group can offer solutions and answers. It could even be helpful to partner with someone who can offer support, encouragement and guidance as you change old habits and grow into new healthy ones. modify your lifestyle for better health. Plan and avoid skipping meals, keeping a snack handy if mealtime is delayed. Get active so body systems function better and take medications regularly.

The BedWarmer™ by Battle Creek®

The Battle Creek® “Recipe for Comfort™” combines nightly use of a BedWarmer™ with light daily exercise. Working in conjunction to help maintain circulation for enhanced comfort and cell rejuvenation, this approach can provide proven results. Standard BedWarmer™ (Model 058) • Single temperature model heats the bed at a steady rate through the night. • Simple lighted On/Off switch makes it easy to see whether unit is On or Off. Deluxe BedWarmer™ (Model 358)

Sleep More

Soundly

to Wake Rested and

Rejuvenated

(Shown)

• Dual Temperature switch allows user to heat the unit quickly and then easily switch to low heat, to maintain warmth through the night. • Luxurious fleece cover adds an extra layer of comfort for users that prefer the BedWarmer™ on top of their sheet.

Gentle overnight warmth provides a clinically

proven method to ease the pain of arthritis, relax

Restless Leg Syndrome, warm legs and feet affected by Peripheral Artery Disease or diabetes.

head toe diabetes:

In the previous issue, we examined the impact of diabetes on the heart, eyes and healing. In this issue, Diabetes: Head to Toe will examine several more health implications and some proactive steps to help bring them under control.

a guide for living well

Whether you’ve been newly diagnosed with diabetes or have coped with the disease for quite some time, you probably know that the condition can impact virtually every aspect of your health. The good news is that diligent blood glucose control can often stave off many health complications for a very long time — if not forever.

Tummy trouble When people think of common diabetes complications, stomach problems don’t often come to mind. Yet both type 1 and type 2 diabetes are among the major causes of gastroparesis, or delayed gastric emptying. Diabetes can damage the vagus nerve, which controls the movement of food through the digestive tract, and can prevent the stomach muscles and intestines from working normally. When the movement of food slows down or stops, heartburn, nausea, vomiting, acid reflux, abdominal bloating or even blockage can result. Gastroparesis makes glucose control much more difficult because the stomach empties slowly or unpredictably. Weight gain, increased difficulty losing weight and depression could also be signs of hypothyroidism. Cushing’s Syndrome is a rare disorder that occurs due to an excessive amount of the hormone cortisol in the body. Symptoms can vary, but most people are more likely to have a

be afraid to seek professional counseling. “…don’t Talking to someone could save your life and open doors to a happy, healthy world for you. ” rounded face, increased fat around the neck and upper-body obesity. It can also be brought on by hormones taken for asthma, lupus, rheumatoid arthritis and other inflammatory diseases, as well as for immunosuppression therapy after organ transplants.

How to Take Control

In addition to these conditions, weight gain can be brought on by insulin therapy for type 2 diabetes, or certain antiseizure, antidepressant and antipsychotic medications.

Mental readiness ake lifestyle changes you M plan to continue, so weight loss is permanent.

Some steps to avoid these disorders are to regulate insulin levels tightly, eat six small meals a day, and substitute some liquid meals for solid foods. Watch closely for telling symptoms and report them to your doctor immediately. Your doctor may also recommend avoiding both high-fat foods (which slow digestion) and high-fiber foods (which are difficult to digest), and limiting your sodium intake. Finally, drugs like metoclopramide and erythromycin, which stimulate the stomach to empty more efficiently and control both nausea and vomiting, are also quite effective.

Reward success with non-food items like taking the day off from work or buying some stylish clothes.

Food and the feel good factor

rink at least eight glasses D of water a day.

Whether it’s dinner with the family, or a festive celebration, food helps to create a jovial, engaging atmosphere in which family and friends share good times. But for some, the comfort and security of food can create a painful struggle. Overeating and a number of other eating disorders can be attributed to — or even be the result of — anxiety, stress, low self-esteem or excessive alcohol use.

Remember to keep up with regular physician checkups.

Monitor food intake and physical activity. Noting your progress will encourage you to keep going. Avoid tempting situations. Eat slowly to allow your brain to realize you’re full.

Think “active” Ride a bike or walk, when possible. Wash your car by hand.

If you think there may be an emotional and/or social obstacle in the way of you or a loved one obtaining and maintaining a healthy weight, don’t be afraid to seek professional counseling. Talking to someone could save your life and open doors to a happy, healthy world for you.

Get in extra exercise by taking the stairs or parking in the back of the lot.

The kidney connection

15-minute walk on your A lunch break is good for your body and can help clear your head.

Managing glucose levels effectively can also reap long-term benefits when it comes to keeping your

Walk the dog, instead of letting him out into the backyard.

continued ON page 15

medications

& over-the-counter If you’ve recently been diagnosed with diabetes, you might consider giving your medicine cabinet an extreme makeover. Create space for new prescriptions and treatment supplies by removing over-thecounter medications that contain sugar, alcohol, and eucalyptus — ingredients that can throw glucose levels off. Post a chart inside the cabinet door that lists your medications, dosages, your physician’s name and phone number. Then, keep a copy for your wallet and another for your workplace.

Rely on your Duane Reade pharmacist to help you understand all facets of diabetes. You’ll find highly qualified professionals within our pharmacies, medical clinics and HomeCare program who are committed to providing the guidance and support you’ll need throughout this lifestyle transition.

Cabinet contents: Oral medications and insulin

can manage your diabetes and get your glucose levels to target. Your doctor may prescribe a combination of these for your treatment plan. There are six categories of oral medication: Meglitinides prevent a rise in blood sugar levels by increasing the insulin amount produced in your body. Sulfonylureas lower blood glucose levels by increasing the amount of insulin produced in your body. Alpha-glucosidasE inhibitors block enzymes that help digest carbohydrates, slowing the rise in blood glucose. Biguanides improve the ability of your body to use insulin and prevent the liver from releasing stored glucose. Thiazolidinediones make insulin work more effectively and lower the amount of glucose released. DIPEPTIDYL PEPTIDASE IV (DPP-IV) INHIBITORS help your body make more insulin after a meal and also reduce how much blood glucose your body makes.

Insulin: There are four injectable forms of insulin

currently available. Each delivers the medication at different speeds. Physicians will often prescribe two or more types of insulin to reach blood glucose goals: Rapid-acting insulin works within 15 minutes, peaks at an hour, and remains in the bloodstream two to four hours. Regular-acting or SHORT-ACTING INSULIN begins to work 30 minutes after the injection, peaks two to three hours later, and stays in the bloodstream for three to six hours. Intermediate-acting INSULIN gets into the bloodstream within two to four hours, peaks four to 12 hours after the injection, and remains for 12 to 18 hours. Long-acting insulin kicks in six to 10 hours after the injection and stays in the bloodstream for 20 to 24 hours.

INCRETIN MIMETIC is a unique injectible medication that “mimics” the effects of hormones to help the body make more of its own insulin.

Other supplies could be…

Syringes and needles or insulin pen • rubbing alcohol swabs • insulin jet injector • insulin pump • blood glucose monitoring system: test strips, lancets and urine ketone test strips

Helpful hints

Your next doctor visit

Before Your next doctor visit

List your questions, including any on blood glucose patterns. Bring a calendar with symptoms documented, your blood glucose chart (see page 23) and any other necessary notes. Take your blood glucose monitor, a tape recorder, notebook and a pencil. Have a loved one also attend the appointment.

If you have diabetes, you may already know about your increased risk for high blood pressure and cardiovascular disease. Controlling your blood pressure is one of the most important things you can do to manage diabetes. Monitoring your blood pressure regularly at home is one of the best ways you can help your doctor help you.

Accuracy Counts… Trust Omron™

Place medications you’re taking (including over-the-counter drugs and vitamins) in a bag and bring this, along with your medication log. Make a copy of your list of physicians and their contact information — just in case medical tests will be forwarded — along with a copy of any medical emergency instructions and your contact person’s number.

during Your next doctor visit

Ask to record the session to retain vital information or take notes. Have your blood pressure and weight checked. Feet should be examined every time you see your doctor. A1C should be checked every three to six months, and cholesterol and microalbumin (for kidney function) annually.

after

Your next doctor visit

Call if your symptoms get worse, or if you have problems with your medicine. If you have had tests done, be sure to call the doctor’s office if you haven’t received the results when expected.

1 OFF

$ 00

Glucerna Shakes 6-Pack Bottles

5 OFF

$ 00

All Omron Blood Pressure Monitors ®

MANUFACTURER’S COUPON EXPIRES 12/31/09

SAVE 10 $

On your next purchase of one (1) 100 ct. Duane Reade™ TRUEtest™ Strips

Consumer: Present this coupon to the cashier at time of purchase. Coupon good for $10 off one (1) 100 ct. Duane Reade™ TRUEtest™ Strips purchase. One coupon per customer. Offer not good with any other offer. Retailer: When this coupon is used for this product, the transaction may not be submitted to Medicare, Medicaid or any private insurer as a claim. We will reimburse you the face value of this coupon plus 8¢ handling provided you and the customer have complied with the terms of this offer. Invoices proving purchases of sufficient stock to cover presented coupons must be shown on request. Any other application may constitute fraud. Coupon is void where prohibited, taxed or restricted. Consumer must pay any sales tax. Cash value is 1/20¢. Reproduction of this coupon is expressly prohibited. Mail to: Duane Reade™ TRUEtest™ Strips Offer, CMS Dept. #21292, 1 Fawcett Drive, Del Rio, TX 78840.

NICO-1479 06/09 Home Diagnostics, Inc. TRUEtest is a trademark of Home Diagnostics, Inc.

SAVE

with these valuable SAVINGS coupons

continued from page 9

Diabetes: Head to Toe kidneys healthy. Diabetes is the most common cause of kidney failure, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetic kidney disease can develop quite slowly over time as the kidneys’ ability to filter wastes becomes impaired. At first, the blood protein albumin begins leaking into the urine, which ultimately decreases the kidneys’ ability to filter wastes. As these wastes build up in the body, blood pressure usually also rises and kidney damage occurs. The NIDDK says it may take 15 to 25 years for

slow its progression. Also, high blood pressure can be a result of damage created by the diabetes or it can be the cause of diabetes. In addition, if kidney disease already exists, high blood pressure can accelerate its progress. The key is early detection and treatment. Happily, not every person with diabetes will develop kidney disease or kidney failure, and there are other things you can do to reduce your chances of developing either condition. Reducing the amount of protein in your diet may be beneficial, since excessive protein makes the kidneys work harder. Have your urine

…not every person “with diabetes will develop kidney disease or kidney failure, and there are other things you can do to reduce your chances of developing kidney problems.

”

kidney failure to occur — and then the only options for survival are regular kidney dialysis or a kidney transplant. Fortunately, the risk of ever developing kidney disease decreases in people who have lived with diabetes for more than 25 years without any signs of kidney failure. High blood pressure is a major factor in developing kidney problems in people with diabetes, so controlling it with medication, like ACE inhibitors or angiotensin receptor blockers, can help

checked for protein and blood (a sign that you’re excreting protein) regularly. Monitor your blood pressure closely using a home monitoring kit (be sure to have it calibrated by your physician for greatest accuracy). And consider replacing animal protein with soy protein, since some studies have suggested soy may have a beneficial effect on both the kidneys and the cardiovascular system. Of course, before you embark on any of these treatments, be sure to consult your primary doctor first. ■

Blood glucose levels

1 2 It’s important to log results. The results can guide you as you plan meals, exercise and take medications. It can also indicate if your treatment plan is working or needs adjustment.

3 4 16

You can stay powered up and live a vibrant life beyond diabetes if you manage your blood sugar — or glucose levels. Use the following strategy to reduce, or even free yourself of symptoms altogether.

Empower yourself with information

Start with your doctor and ask questions. Follow up with research at your local library, or online from reputable and official sources. You’ll find these websites helpful: www.diabetes.org (American Diabetes Association - ADA) www.cdc.gov/diabetes (Centers for Disease Control and Prevention) www.niddk.nih.gov or call 301-496-3583 (National Institute of Diabetes and Digestive and Kidney Diseases) Take advantage of support groups through your local hospital or library.

Monitor glucose levels daily…

according to your treatment plan and get A1C tests as ordered by your physician. Blood glucose targets recommended by the ADA are 70-130 mg/dl before meals and less than 180 mg/dl two hours after the start of a meal. A free blood glucose chart is available on page 23 of this handbook, or online at www.diabetes.org/uedocuments/ ChooseGuide.pdf. Blood glucose can be checked on a daily basis by a meter that measures levels with a prick of your finger. Clean the area beforehand as residue on your finger can throw off a reading. Researchers are fast at work on a variety of noninvasive monitoring devices that track blood glucose, such as ultrasound and wireless sensor chips that transmit data to a cell phone. For more information on monitors, visit the Food and Drug Administration’s “Glucose meters and diabetes management” online section by clicking on it as you visit www.fda.gov/diabetes/glucose.html. The A1C test is done at your doctor’s office and indicates your average two- to three-month blood glucose level. A result of 7% or more may require changes in treatment.

Get a physical every year…

and take diabetes medications as per your doctor’s recommendations.

Plan meals in advance…

and be physically active for 30 minutes every day. Consistency is key. Eat meals consistently, using the same portions of proteins, carbs and healthy fats (see page 18 for more on nutrition).

feature: healthy eating

healthy habits

Managing mealtime with diabetes doesnâ&#x20AC;&#x2122;t mean food has to be boring. It just means that meals should be nutritionally balanced, with consistent portions, and eaten at about the same time each day. The National Diabetes Information Clearinghouse has a website to help you create meal plans using foods you love. Visit http://diabetes. niddk.nih.gov/dm/pubs/ eating_ez/index.htm. Discover more useful information about nutrition, lifestyle, prevention and more at www.diabetes.org.

With action comes a routine, and with a routine comes “success in meeting your goal of leading a healthier life. ”

1 2

3 4 5 6

Weigh in with your doctor

Are you within your recommended weight range? If not, ask the doctor about a plan to combat diabetes and shed pounds.

Figure out meals before they happen

Prepare and freeze entrees for when you don’t have time to cook. Make wise food choices by selecting lean meats, whole grains, fruits and vegetables, and non-fat dairy products.

Go light on sugar, salt and fat

Read food labels; stay away from processed foods and choose oils like canola and olive oil over solids like margarine, shortening and butter.

Quench your thirst with water

Water has no calories, is low in sodium and contains no fat or cholesterol, all benefits for a person with diabetes. And you won’t find caffeine in water. Most people need an average of eight to 12 cups (eight ounces per cup) of water a day.

be physically active for 30 minutes daily

Not only will you improve your mood, sharpen your thinking, tone up your body and get rid of stress, but you’ll also help the insulin work better by lowering your blood glucose, cholesterol and blood pressure. To vary your routine, pick an activity your whole family can enjoy, like swimming or biking. Before starting any physical activity, consult your physician.

Take notes

Keeping notes on when and what you eat and drink will help you get into healthier mealtime habits. At least at first, try to keep a log of your glucose levels before and after meals and workouts, keep track of your mood and energy level throughout the day, and jot down what exercise you did and for how long.

Making changes will require patience. For some, these changes may seem overwhelming; for others only a few changes are necessary, but by developing a plan, you’ll be able to take action. With action comes a routine, and with a routine comes success in meeting your goal of leading a healthier life.

Tropical breakfast shake Makes 4 Servings

1 fresh papaya, mango and/or pineapple, — seeds removed 2 tsp fresh lemon juice 1 /4 tsp ground allspice, divided 3 /4 cup orange juice 2 tsp honey 1 cup low-fat buttermilk 4 ice cubes

In a blender, puree the fruit, lemon juice, 1/8 teaspoon allspice and half of the orange juice. Add honey, buttermilk, remaining orange juice and ice cubes. Blend until smooth. Pour the shake into glasses and sprinkle remaining allspice on top. Garnish with additional fruit if desired. more recipes on page 20

Good for you

DIABETic Recipes FiestA CHICKEN CUCUMBER Salad

Makes 6 Servings

glazed salmon

21/2 cups shredded cooked chicken breast 1 /2 cup chopped cilantro 1 /4 cup chopped cucumber 1 /4 cup chopped red onion 2 tbsp sweet pickle relish 1 /2 cup light mayonnaise 1 long cucumber, cut into thin slices lengthwise soy & flax seed tortilla strips, optional

Combine first six ingredients together in a large bowl. Refrigerate. Pack salad into a 21/2" diameter cup or mini cake mold and invert onto plate. Wrap one slice of cucumber around each chicken salad serving. Garnish with tortilla strips if desired.

/4 cup low-sodium soy sauce 1 tbsp fresh ginger root, peeled and chopped 1 tbsp honey 1 tbsp fresh lemon juice 1 garlic clove, crushed

a large plastic zip-top bag, add marinade. Seal bag, pushing out the air and turn to blend. Refrigerate for six to 24 hours. Remove salmon and put remaining marinade in a bowl. Spray a pan with nonstick spray and cook the salmon over medium heat for five minutes. Turn and brush with marinade. Cook salmon five more minutes until opaque in the center.

1 lb salmon fillet, skinless

Makes 4 Servings

continued from page 19

For marinade: In a bowl, whisk together first five ingredients, until honey is dissolved. Place salmon in

peanut butter chocolate brownies

Preheat oven to 350Ë&#x161;F. Whisk the peanut butter, water, oil, egg and egg white in a bowl until well mixed. Stir in the 1 /4 cup creamy peanut half package of cake mix butter until the combination is thick. 1 tbsp water Spray the bottom of an 1 tbsp vegetable oil 8" x 8" pan with cooking 1 large egg spray. Press batter evenly 1 egg white 9 oz Devilâ&#x20AC;&#x2122;s Food cake mix, into the pan. Bake for approximately 15 minutes. with pudding (reserve half for future use) Remove from oven, let cool, then cut evenly.

Makes 16 Brownies

Talk to your pharmacist or healthcare provider today about Humalog® KwikPen,™ and for more information, go to KwikPen.com. Humalog is also available by prescription in the original Humalog Prefilled Pen. Humalog® is a registered trademark of Eli Lilly and Company and is available by prescription only. Humalog® KwikPen™ is a trademark of Eli Lilly and Company and is available by prescription only.

foot care

Be SWEET to your feet from extremes of hot and cold — and never walk barefoot. Finally, don’t cross your legs for long periods of time and don’t smoke, since both can reduce circulation.

Because people with diabetes…

often have nerve damage and lose sensation in their feet, it is important to be proactive about preventing further problems. Do this by checking your feet every day. Look for cuts and blisters — don’t try to clear them up yourself, instead, see a doctor right away. Use a mirror to check the soles of your feet, or have someone do it for you. Also, wash your feet every day and dry them carefully, especially between the toes. Inspect your shoes for foreign objects, protect your feet

Take further steps to maintain healthy feet by improving the circulation in your feet and legs by making daily exercise a habit. Poor circulation can impair the healing of injuries and lead to dryness and swelling. The best way to improve circulation is by walking. Start slowly, being careful not to overdo it, and check with your physician who may be able to recommend specific exercises and the right shoes to meet your specific needs. To prevent painful peeling and cracking, avoid very hot showers and baths. Apply lotion after you bathe to seal in moisture and drink lots of water to further help keep skin hydrated.

Give your feet the Comfort and Protection they need with

SensiFoot Diabetic Sock Comfort and Protection in every step.

™

Knee Crew

Mini-Crew

Rev. 08/09

Blood Glucose self-monitoring chart week of:

breakfast

lunch

Blood Sugar

evening

Blood Sugar

PRE POST Medication PRE POST Medication PRE POST Medication

E exercise

ill/stressed

Bedtime

UK urine ketones test, record result

Comments:

fri

Comments:

sun

Blood Sugar

Comments: example: L low blood sugar episode

sat

thu wed tue mon

Medication

dinner

Comments:

1 2

Copy blank chart to use week by week. Write the type and amount of insulin dose or oral diabetes dose each time you take it.

3 4

Fill in your blood sugar results in the “Pre” and “Post” spaces. Use the “Comments” section to record different events that happen during the day.