Diagnosis: Diabetes by STUDIO Gannett

Diabetes Diagnosis:

ONLINE MAGAZINE

Patti

LaBelle

Living Well EAT BETTER ON A BUDGET FULL-FIGURED & FEELING FIT PREDIABETES: ARE YOU AT RISK?

NOVEMBER 2017

Insulin injection tips One of the most important aspects of managing your diabetes is making sure you use proper technique when injecting your insulin. The right technique is every bit as important as the right dosage and choice of insulin. By following the proper injection technique, you can reduce the risk of lipohypertrophy—the fatty lumps that can develop under your skin and may interfere with your absorption of insulin. Here are some tips to help you start and maintain the right techniques so you can stay on top of your diabetes and focus on living a full and rewarding life. Remember to check with your healthcare professional to make sure you’re using the proper injection technique. Injection techniques may vary for adults and children.

1. Rotate injection sites. Never overuse any given injection site. Instead, vary each and every injection using the different recommended injection sites—the thicker portions of your buttocks, thighs, upper arms and abdomen. Space injections within a site approximately one finger apart from previous injections. Use a single injection site no more frequently than every four weeks. 2. Avoid injecting into lipohypertrophy. 3. Use the shortest needles available. (currently the 4 mm pen needle and 6 mm insulin syringe).* 4. Use a needle only one time.

Remember, with the right insulin injection technique you can manage your diabetes to live a wonderfully rich and full life. *Excluding safety syringes in the institutional setting. Reference Frid AH, Kreugel G, Grassi G, et al. New insulin delivery recommendations. Mayo Clin Proc. 2016;91(9):1231–1255.

Every day, you’re faced with challenges and make important decisions to overcome them. These decisions define a lifetime of healthy living with diabetes. Your determination and strength keep you going when things get tough and your relentless dedication is an inspiration to everyone around you. We’re proud to support your commitment to healthy living. Learn more about managing your diabetes at bd.com/InjectionTips 3 © 2017 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company. MC6850

Diabetes Diagnosis:

4 diagnosis DIABETES

EXERCISE SAFELY

Experts offer tips for shedding pounds without injury

WHATâ&#x20AC;&#x2122;S UP, DOC?

Get the skinny from your physician before hitting the gym

KETOGENIC DIET

Eating fewer carbs and more fat can be beneficial

DIETING DOLLARS

Shop healthy and lose weight, not money, with these tips

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6 8 10 12 14

STATS & FIGURES

Find out how this growing epidemic is affecting Americans

Contents NOVEMBER 2017

EDITORIAL DIRECTOR Jeanette Barrett-Stokes jbstokes@usatoday.com

16 20 24 28 30

CREATIVE DIRECTOR Jerald Council jcouncil@usatoday.com

SWEET REFRAIN

Patti LaBelle offers diabetes-friendly recipes worth singing about

MANAGING EDITOR Michelle Washington mjwashington@usatoday.com ISSUE EDITOR Tracy Scott Forson

DIRE DIFFERENCE

EDITORS Amy Sinatra Ayres Patricia Kime Sara Schwartz Debbie Williams

Type 2 patients face more complications than Type 1

DESIGNERS Amira Martin Miranda Pellicano Gina Toole Saunders Lisa M. Zilka

CALL TO ACTION

A prediabetes diagnosis may help put you on the road to prevention

CONTRIBUTING WRITERS Karen Asp, Regina Bediako, Scott Berman, Ana Connery, Peggy J. Noonan, Christine Romero, Suzanne Wright ADVERTISING VP, ADVERTISING Patrick Burke | (703) 854-5914 pburke@usatoday.com

CONVENIENT CARE

Pharmacists at CVS help diabetes patients manage their health

ACCOUNT DIRECTOR Justine Madden | (703) 854-5444 jmadden@usatoday.com FINANCE BILLING COORDINATOR Julie Marco

TELLING TATTOOS

This is a product of

Body art serves as alerts for diabetes patients and others

@usatodaymags

Without limiting the rights under copyright reserved herein, no part of this publication may be reproduced, stored in or reproduced in a retrieval system, or transmitted, in any form, or by means electronic, mechanical, photocopying, recording or otherwise without the written consent of USA TODAY. The editors and publisher are not responsible for any unsolicited materials. PUBLISHED IN THE USA

Diagnosis:

Diabetes OVERVIEW

Ann Albright of the national Centers for Disease Control and Prevention asserts that diabetes continues to be a growing epidemic.

Critical Condition The numbers tell a stark tale

1.5

s the seventh-leading cause of death in the U.S. and with a growing prevalence among young people, diabetes remains a major health concern, affecting millions and costing billions each year. Here are some facts and figures about the disease in America:

Million

Adults age 65 and older with diabetes

12 Million

Diabetes patients

30+ Million

Adults with prediabetes

Cost of diagnosed cases in 2012

People under age 20 with diabetes

84 $245 193 Million

Billion

Thousand

SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION, 2017 DATA; AMERICAN DIABETES ASSOCIATION, 2015 DATA

6 diagnosis DIABETES

CENTERS FOR DISEASE CONTROL AND PREVENTION

New cases annually

A type 1 diabetes diagnosis affects the entire family... But we are in this TOGETHER

The Children's Diabetes Foundation supports research and clinical care, while providing resources for people affected by diabetes

Help us support our type 1 heroes! LEARN MORE DONATE

www.ChildrensDiabetesFoundation.org

Diagnosis:

Diabetes FITNESS

Full-Figured Fitness Experts offer advice on safely slimming down B Y R E G I N A BE D I A KO

BE INFORMED Patients should establish pre- and post-exercise blood-glucose levels, set goals with an endocrinologist and monitor levels during workouts, says Monet Bland, a clinical exercise physiologist at the Joslin Diabetes Center. Keep a carbohydrate snack, like a fruit drink, nearby in case your blood sugar gets low, advises WebMD. com. 8 diagnosis DIABETES

KNOW YOUR BODY While it’s important to keep your doctor informed of your progress, you’ll also need to do some self-evaluation to determine when you’re ready for more strenuous activity. “Listen to your body and know when things aren’t challenging anymore,” says Bland. Then you can increase the intensity on your own or with a trainer.

PACE YOURSELF Slowly adjust to your new routine by only working out one day a week for a month. Then, “add on one more day per week. It’s very incremental — that’s the most important part of this whole process from inactivity to activity,” says Daniele Hargenrader, a personal trainer and diabetes coach in the Philadelphia area.

PUMP IT UP To build muscle, incorporate strength training early on with simple tools like resistance bands. “When you build muscle, you’re increasing your basal metabolic rate, which is going to allow you to burn more calories. It’ll also help with improving insulin sensitivity,” says Bland.

GO EASY If you’re carrying extra weight, you might have knee or back issues or other painful conditions. Try easing into activities like yoga or water aerobics that will be kind to your sensitive spots. Author and diabetes fitness expert, Sheri Colberg, suggests seated exercises or stationary cycling to reduce stress on the lower limb joints.

ADJUST If you’re taking insulin for diabetes, your doctor may need to adjust your treatment once you begin exercising regularly. Activity can increase its efficacy, inducing low blood sugar if you aren’t prepared, says Bland. “Adhere to the pre-exercise and post-exercise blood glucose goals as established by an endocrinologist.”

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Diagnosis:

Diabetes FITNESS

Consultation Checklist

Being well-informed will help you avoid the risks of working out BY PEGGY J. N OON AN

10 diagnosisDIABETES DIABETES 2 diagnosis

Your heart health Exercises you plan to do

When you exercise

Where you work out

TIP Be sure you’re drinking enough water to prevent sticky blood, which may make it more difficult for glucose to penetrate cells. Hydrate before, during and after exercise.

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f you’ve been diagnosed with Type 2 diabetes, it’s important to consult a doctor before starting any fitness regimen. A medical professional will be able to determine what precautions are necessary for a safe workout. Here’s a list of topics to discuss with your physician:

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Diagnosis:

Diabetes FOOD

The Ketogenic Diet Fats work for you, not against you, in low-carb plan

t may sound counterintuitive, but one of the best ways those with Type 2 diabetes can lose weight and lower their bloodglucose levels is to follow the ketogenic diet, rich in fat and low in carbs. “A ketogenic diet is a low-carb plan that switches the body from using carbohydrates for energy to using fat as a primary fuel source,” says Wendy Scinta, founder

diagnosisDIABETES DIABETES 212 diagnosis

and medical director of the Syracuse-based Medical Weight Loss of New York. The science is simple: When daily total carbohydrate intake is limited to 30 grams or less, triglycerides are broken down and ketones are released into the bloodstream to provide energy for the body and kickstart weight loss. Ketone bodies are released to regulate and use sugar in a more effective way.

“The body uses carbohydrate storage first as energy,” explains Scinta. “When carbs are depleted, the body creates ketone bodies by breaking down fatty acids. By decreasing carbohydrates and running on ketone bodies as fuel, sugars (i.e., glucose) naturally stabilize.”

PLAN FOR SUCCESS “Being successful on a ketogenic diet is all about

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BY S UZAN N E W RI G H T

Diagnosis:

FOOD Diabetes

Bonus Benefits In addition to helping some patients reduce medication intake, ketogenic diets can:

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TRAVEL LIGHT Stick to your diet by carrying low-carb foods with you.

planning,” says Scinta. “You have to get the carbs out of the house — all the crackers, breads, pasta and processed junk must go. It is so much easier to reach for a carb than a protein or fat, so you have to prepare yourself to have proteins and fats readily available.” Scinta says a typical day’s intake includes a breakfast of bacon and eggs; a salad with lean protein and low-glycemic veggies like broccoli, onions and peppers, with a high-fat dressing such as blue cheese for lunch; and chicken wings with ranch dressing and a salad for dinner. Snacks can include deviled eggs, pepperoni and cheese. Fruits are generally out — especially in the twoweek induction phase, when you need to keep carbs at less than 20 grams a day. “Be prepared for carb withdrawal: headache, fatigue and malaise. Remind yourself

that it will pass,” Scinta says. Sloane Burwell of Phoenix was diagnosed with Type 2 diabetes 15 years ago. During a five-year period on a ketogenic diet, she shed 60 pounds and slashed her prescription medication intake a whopping 80 percent. “When I dropped the carbs, I could tell the difference in my (glucose) numbers within 72 hours,” she says. She admits the diet was difficult in the beginning, but she’s made dietary adaptations. “There’s no place on Earth that won’t serve you a hamburger on a lettuce ‘bun.’ I missed chips and salsa, so I substituted pork rinds for chips.” To satisfy her sweet tooth, Burwell eats chocolate-covered pumpkin seeds and saltedcaramel macaroons. Vodka and soda is her cocktail of choice. “I’m totally committed to ketos,” she says. “I’m the proof it works.”

Reduce food cravings

Spur greater weight loss compared with fat-restricted diets

Increase HDL (“good” cholesterol) levels

Lower glucose, insulin and triglyceride levels

Decrease inflammatory markers

Lower blood pressure and improve vascular flow — Suzanne Wright

13 3

Diagnosis:

Diabetes FOOD

Money vs. Menu

BY A N N E S CHAMBE RG

ure, vegetables and dried legumes don’t cost much, but more expensive healthconscious choices like salmon and nuts make frozen pizza seem like an irresistible bargain. Then there’s the up-charge for organic, grass-fed and cage-free foods. Calculating the price of nutritional virtue is complicated, with differing considerations for each individual and family. Susan Nitzke, pro-

2 diagnosis 14 diagnosisDIABETES DIABETES

fessor emeritus of nutritional sciences at the University of Wisconsin-Madison, recognizes that some foods esteemed by the health-conscious are more costly, “but there are some strategies that help.” To improve your diet without spending too much, start where you are and make just two or three changes that appeal to you, she says. “Don’t think you have to buy the most expensive foods to be healthy.” Something as simple

as skipping the soda at a restaurant and just getting water can make a difference. Farmers markets make it easy to bring home fresh produce, along with other locally produced items. “Don’t forget that onions, cabbage and sturdy greens like collards and kale will be more affordable than something like microarugula,” says Jennifer Casey, executive director of Milwaukee’s Fondy Food Center. Casey buys grassfed meat products at

the farmers market, “but we don’t buy a lot because it’s expensive. With a meal, the focus isn’t on meat. So, it might be a vegetable and bean stew” with no meat. To her, any added expense is worth it. We should all eat more fruits and vegetables, says Casey, who maintains the idea is to choose less processed food and eat lower on the food chain — a more plantbased diet — because it’s eco-friendly and less expensive.

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Eating better doesn’t have to break your budget

Diagnosis:

Diabetes

Sweet Refrain BY TRACY S COTT FORSON

lthough her motherâ&#x20AC;&#x2122;s legs were amputated at age 58 as a result of Type 2 diabetes, and an uncle and aunt each lost their sight to the disease, singer Patti LaBelle was still surprised 21 years ago when she was also diagnosed.

16 diagnosis DIABETES

DEREK BLANKS PHOTOGRAPHY

Patti LaBelleâ&#x20AC;&#x2122;s latest cookbook offers diabetes-friendly desserts

friendly recipes in her latest cookbook, After passing out during a show in Desserts LaBelle: Soulful Sweets to Sing About, Albany, N.Y., the two-time Grammy Award released in April. There are dishes made winner was rushed to the hospital where the traditional way, and also those that use doctors immediately determined diabetes sugar substitutes, like stevia or Splenda. was the cause. Having watched the disease Desserts LaBelle, her fourth cookbook, was ravage her relatives, LaBelle quickly inspired in part by what the singer calls the realized she needed to take control of her Patti Pie Phenomenon (or PPP). In November health. 2015, just in time for the Thanksgiving She didn’t hesitate to make changes to holiday, fan James Wright Chanel her diet, which previously consisted of fried chicken, macaroni and cheese, sweet potato purchased a Patti LaBelle sweet potato pie from Walmart and gave it a glowing review, pies and other rich foods. complete with finger-licking and renditions “Had I thought about it before I was of LaBelle hits. The video went diagnosed, I would have started viral, garnering 20 million views. eating better then. I thought I “In 48 hours, every single one would not get it,” she explains. of those pies sold out,” she “When I was diagnosed, it made explains in the book. That’s sense because it was in my when she realized her sweets family.” were in high demand. It turns out, a family history LaBelle was already of the disease wasn’t LaBelle’s established as a cooking only risk factor. As an African –Patti LaBelle authority. She has multiple American older than 45, she was cookbooks, and a Cooking more susceptible than most to Channel show, Patti LaBelle’s Place, which Type 2 diabetes, according to the national returns to the air this month. So, her Centers for Disease Control and Prevention. culinary skills were no secret, but Wright Black women are the third-largest Chanel's viral video brought renewed demographic affected by the disease, interest in her recipes. following American Indian/Native Alaskan “It was a blessing. It was a surprise,” she women and men. says, noting that she keeps in touch with Without relying on a nutritionist, fan Wright Chanel, even inviting him to she challenged herself in the kitchen, perform with her onstage modifying recipes to make them healthier when she tours near and lessening the risk of becoming the next his hometown, and he's diabetes tragedy in her family. appeared on her cooking “I was smart enough to know what to show. make for myself to live,” says 73-yearIn addition to being more old LaBelle, whose trial and error in the mindful about her diet, kitchen eventually led to culinary success. LaBelle has incorporated “I make mac and cheese with wheat pasta. exercise into her routine, ... Instead of the fried, I’m going to have the regularly walking her Shih sautéed chicken or the baked chicken. I use Tzu around the block and hot peppers and lots of garlic, and my food using her pool. “I’m not a tastes just like fried chicken,” she adds. “I’ve The Desserts LaBelle swimmer, so I walk up and gotten away from really wanting all of that. cookbook includes recipes down the water,” she adds. I don’t think about the things I used to do.” from Patti LaBelle’s friends and relatives. $19.60, amazon.com However, she says she’s > LaBelle has shared some of her diabetes-

GRAND CENTRAL PUBLISHING

“I was smart enough to know what to make for myself to live.”

Patti Labelle

most active during her highenergy performances. “Onstage, I do a total workout. I’m pretty, pretty active up there,” she says. “Dancing, for me, that’s exercise. I have fun with it. I have diabetes, but diabetes doesn’t have me.” Realizing what an important part family history plays in the development of Type 2 diabetes, LaBelle says she’s making sure her family learns what’s necessary to avoid the disease. “We all have to do things to prevent this from happening,” says LaBelle, whose son/manager Zuri Edwards has also changed his eating habits since her diagnosis. “The best thing you can have is a support system.” Although her cravings for fried, fatty foods have waned, LaBelle says she still wants ice cream, chocolate and cheesecake occasionally. “I have alternatives that I go to,” she says. When her glucose levels are low, she may take the opportunity to indulge a little, but her desire to be healthy eclipses her sweet tooth. “I want to live,” she says. “I pray. Every morning when I get up, I say, ‘Thank God I woke up and now I’m on this day for 24 hours to do the better things for Patti LaBelle.’ Hopefully, I make good choices that day. Hopefully, I enhance my life and help someone else in their life and their journey. Thank God I’m here, and I can spread the word.” l 18 diagnosis DIABETES

AMY ROTH

Diagnosis:

Diabetes

Fresh Strawberry Pie Big, bold and beautiful, this scrumptious fruit pie is bursting with fresh berries. Stevia is the sweetener here, and a little goes a long way. The pie is especially good when local strawberries are in season, but it also does wonders with the supermarket variety, too. Frozen pie shells are thinner and less caloric than homemade and are a good option when counting your nutritional numbers. SERVES 10 1 9-inch frozen pie shell 1 tsp. unflavored gelatin powder 2 T. water 2 lbs. fresh strawberries, preferably small ones, hulled, about 6 cups 2 tsp. fresh lemon juice 2 tsp. (6 packets) powdered stevia extract 10 T. thawed frozen light whipped topping, for serving Bake the pie shell according to the package directions. Let the shell cool completely. Sprinkle the gelatin over the water in a small heatproof ramekin baking dish. Let stand until the gelatin softens, about five minutes. Slice the strawberries into halves or quarters, depending on their size. Process enough of the strawberries (about 1Â˝ cups) in a blender or food processor to make 1 cup puree. Transfer the puree to a bowl. Whisk in the lemon juice and stevia. Set the remaining sliced berries aside. Place the ramekin in a small skillet of simmering water (the water should come about halfway up the sides of the ramekin) and stir the gelatin mixture constantly until it is completely dissolved, about two minutes. (Or microwave the mixture on high power in 10-second intervals, stirring after each period until the mixture is completely dissolved, about 30 seconds total. Do not let the mixture boil.) Stir a few tablespoons of the puree into the dissolved gelatin. Whisk the gelatin mixture into the puree. Fold the remaining strawberries and the puree together in a large bowl. Heap the mixture in the baked pie shell. Refrigerate, uncovered, until the filling is chilled and set, at least one hour. (The pie can be refrigerated for up to eight hours.) Slice and top each piece with a tablespoon of the whipped topping. REPRINTED FROM DESSERTS LABELLE WITH PERMISSION FROM GRAND CENTRAL PUBLISHING

Diagnosis:

Diabetes UNFAIR COMPARISON

A Dire Difference

BY AN A CON N ERY

eens and young adults with Type 2 diabetes develop complications such as kidney, nerve and eye diseases — as well as some risk factors for heart disease — more often than their peers with Type 1 diabetes, according to a recent study published in the Journal of the American Medical Association (JAMA).

20 diagnosis diagnosisDIABETES DIABETES 2

While the development of these complications occurs in members of both groups, researchers at the University of Colorado in Aurora were surprised by how much more common they are in those with Type 2 diabetes. “In general they were three to five times higher than those with Type 1,” says Dana Dabelea, professor of epidemiology and pediatrics at the

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Diabetes complications are more common in Type 2 patients than Type 1

“It’s a very serious and challenging condition that we need to meet head-on. There really needs to be a push for advances in care of Type 2 diabetes in kids.”

— Elvira Isganaitis, Joslin Diabetes Center

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university and lead author of the study. There are several possible reasons for these differences, and Dabelea believes obesity, a condition that has increased in juveniles in recent decades, is a significant factor. More than 70 percent of the JAMA study participants with Type 2 diabetes had a high body mass index compared with just 14 percent of those with Type 1. Many factors — such as living in food deserts where access to healthier options is scarce — may

lead to poor eating habits in young Type 2 patients. Those external factors may also make it more difficult for these teens and young adults to adopt the lifestyle habits necessary to manage the disease and avoid additional complications, explains Elvira Isganaitis, a pediatric diabetes endocrinologist at Joslin Diabetes Center. “Type 2 diabetes disproportionately affects minorities, and on average, kids with Type 2 are more likely to come from households that suffer from poverty,” Isganaitis says. Nearly 45 percent of

At-risk Youth

Diabetes is on the rise in America’s kids New diagnoses of Types 1 and 2 diabetes in U.S. youth under age 20 surged from 2002 to 2012, according to a recent study funded by the National Institutes of Health and the national Centers for Disease Control and Prevention. The diagnosis of new cases of Type 2 diabetes linked to obesity increased about 5 percent each year from 2002 to 2012, the study found; while new cases of Type 1, the most common form for young people, went up about 2 percent every year. “We need to understand why the increase in rates of diabetes development varies so greatly and is so concentrated in specific racial and ethnic groups,” says Barbara Linder, senior adviser for childhood diabetes research at NIH. The study published in the New England Journal of Medicine showed higher rates of diabetes diagnoses among minorities. Type 2 diabetes rose by 8.5 percent in Asian Americans ages 10 to 19. Blacks that same age saw a 6.3 percent increase, followed by a 3.1 percent bump in Hispanics and whites at fewer than a 1 percent increase. Hispanics saw the biggest rate increase of Type 1 diabetes at 4.2 percent, followed by blacks at 2.2 percent and whites at 1.2 percent. Females, ages 10 to 19, saw a 6.2 percent increase in Type 2 diabetes, while males of the same age experienced a 3.7 percent increase. Across all age groups, Type 1 diabetes increased 2.2 percent in males and 1.4 percent in females. Experts says those who develop diabetes at a young age are at risk of developing complications from the disease earlier, shortening life expectancy. — Sean Rossman 21 3

Diagnosis:

the Type 2 participants in the JAMA study for Type 2 youth hasn’t caught up with lived in homes where incomes totaled less the increase in childhood obesity and than $25,000 annually, compared instances of the disease. with only 14 percent of Type 1 “Over the last 20 years or so, TYPE 2 patients, who tend to come from there’s been this massive influx DIABETES MAY PUT YOU more affluent backgrounds. With of treatments for adults. None of AT RISK FOR: less access to health insurance and the new treatments have been adequate medical care, “maybe approved for Type 2 in kids,” says there are delays in diagnosis Isganaitis, referring to a 2012 study or different management of published in the New England OBESITY complications in the two groups,” Journal of Medicine. “Kids with Type Isganaitis says. 2 diabetes are less likely to respond She also points out that the to the typical treatment. They biology of Type 1 and Type 2 progress much more quickly (than EYE DISEASE diabetes is different. Type 1, once Type 2 adults) to needing insulin. commonly referred to as juvenile It’s a very serious and challenging diabetes, is an autoimmune condition that we need to meet condition where insulin is not head-on. There really needs to be a HEART DISEASE produced by the body. It is usually push for advances in care of Type 2 discovered during the adolescent diabetes in kids.” years (but can show up at any Whether diagnosed with Type age), and is treated with insulin, 1 or Type 2 diabetes, glucose KIDNEY DISEASE administered either by injection and glycemic control is the best or by mechanical pumps. Type therapy, experts agree. When 2, when the body improperly combined with healthy habits processes insulin, was once considered and consistent weight control, the risk of an adult ailment. Research on treatments complications may shrink. l 22 diagnosis diagnosisDIABETES DIABETES 4

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Diabetes UNFAIR COMPARISON

Diagnosis:

Diabetes PREDIABETES

Preventive Measures As a precursor to Type 2, a prediabetes diagnosis may help you avoid the disease BY SCOTT B ERM AN

one in 10 of those people are aware of it, making prevention a challenge. Prediabetes is “a phase that people pass through on the way to diabetes,” says Edward Gregg, chief of the epidemiology and statistics branch in the CDC’s division of diabetes translation. It is a serious situation: As of 2015, diabetes was the seventh leading cause of death in the U.S., according to the American Diabetes Association (ADA).

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f you knew your habits were leading you toward sickness and disease, a life of daily needle pricks, strict dieting and prescribed medications, you’d probably make the changes necessary to keep that from happening. Nearly 34 percent of American adults are likely to progress to Type 2 diabetes, according to the national Centers for Disease Control and Prevention (CDC), but only about

24 diagnosis DIABETES

What is prediabetes?

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Broadcast journalist Joan Lunden, left, interviews Ann Albright, director of the CDC’s division of diabetes translation.

“Prediabetes generally has no symptoms, according to the Mayo Clinic. However, one sign that a person is at risk of Type 2 diabetes is “darkened skin” on the elbows, neck, armpits, knees and other areas. Those with Type 2 may notice “increased thirst, frequent urination, fatigue and blurred vision,” the Mayo Clinic points out, adding that if you note any of those things, you should see your doctor and be tested. Regardless of signs, given the CDC-estimated 84 million people who have prediabetes, just about everyone should take the quick self-test at doihaveprediabetes.org to determine their risk. If there

seems to be a risk, get “an ordinary fasting glucose or a hemoglobin blood test,” Gregg suggests. The self-test is an initiative of the CDC’s National Diabetes Prevention Program awareness campaign in conjunction with the American Medical Association, ADA and the Ad Council. The risk of developing Type 2 diabetes increases with age, Gregg points out, but research shows it’s increasingly affecting more than just adults. The number of teens diagnosed with prediabetes and diabetes is growing. For this age group, being overweight is the primary

“Prediabetes is higherthan-normal blood glucose, which increases the risk of developing Type 2 diabetes in the future,” explains Edward Gregg, chief of the epidemiology and statistics branch in the division of diabetes translation at the national Centers for Disease Control and Prevention. Risk factors, in order of prevalence, include obesity, high blood pressure, high cholesterol, physical inactivity, high blood glucose and smoking. Untreated prediabetes “often leads to Type 2 diabetes within five years,” according to the CDC’s 2017 National Diabetes Statistics Report. In turn, people with Type 2 diabetes are at risk of “heart attack, stroke, blindness, kidney failure and the loss of toes, feet or legs.” Patients are diagnosed with prediabetes as a result of either an ordinary fasting glucose or a hemoglobin blood test, says Gregg. He says that typically, “a concerned doctor will recognize that a patient has certain risk factors,” such as a family history of diabetes, lifestyle factors and hypertension. Gregg points out another risk factor: a history of gestational diabetes, which can happen during pregnancy and may resolve itself, but still indicates an increased risk for diabetes at a later point. — Scott Berman

Diagnosis:

Diabetes PREDIABETES

OBESITY

HIGH CHOLESTEROL

Risk Factors

HIGH BLOOD GLUCOSE

HIGH BLOOD PRESSURE

PHYSICAL INACTIVITY

risk factor, according to the ADA. Like with adults, teens can delay or prevent diabetes by losing weight, maintaining a healthy diet and staying active. Broad-based efforts at home, school and throughout communities — from mealtime to playtime — can be effective in raising awareness about childhood diabetes and getting real results. “Children of all ages need education, support and modeling of good health behaviors,” says Francine 4 26 diagnosis diagnosisDIABETES DIABETES

Kaufman, chief medical officer and vice president for global, medical, clinical and health affairs at Medtronic Diabetes. She explains that many schools, hospitals, parks and recreation centers and the Y have healthy lifestyle programs for all ages. Although the staggering number of those with prediabetes is a concern for all adults, Gregg says with the new programs and awareness efforts, “There’s a good chance to make a major difference.” l

Find a local lifestyle change program, approved by the national Centers for Disease Control and Prevention.

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SMOKING

What’s so natural in

SPLENDA NATURALS ®

Stevia SweetenerS?

Everything. SPLENDA® Naturals* Stevia Sweeteners are made from stevia and are 100% natural with nothing artifical. Plus, unlike other stevia sweeteners you may have tried, SPLENDA® Naturals has no bitter aftertaste! Our no-calorie SPLENDA® Naturals Stevia Sweetener Packet blend is now available in a convenient table top jar! Each teaspoon provides the same amount of sweetness as two teaspoons of sugar but with no calories. Sprinkle into your favorite beverage, on cereal, fresh fruit, and much more. TIP: If you have diabetes, you should not count the carbohydrates listed on the nutrition facts panel as they will not impact your blood sugar levels.

Homemade Chai Serves 3

INGREDIENTS 3 slices peeled fresh ginger 3 packets SPLENDA® Naturals Stevia Sweetener 12 black peppercorns 3 whole cloves 2 cardamom pods 1 cinnamon stick 2 cups water 2 Darjeeling tea bags ½ cup 2% reduced-fat milk DIRECTIONS Combine ginger, SPLENDA® Naturals, black peppercorns, whole cloves, cardamom pods, cinnamon stick, and water in a small saucepan. Bring to a boil. Add tea bags, cover and steep for 5 minutes. Remove spices and tea bags with a slotted spoon and discard. Add milk and cook over medium heat until thoroughly heated. Do not boil. Serve immediately. NUTRITION INFO Serving Size: 1 (~7 fl oz) drink Calories . . . . . . . . . . . . . . . . 30 Calories From Fat . . . . . . . . 10 Total Fat . . . . . . . . . . . . . . . . 1 g Saturated Fat. . . . . . . . . . . . 0.5 g Cholesterol . . . . . . . . . . . . . 5 mg Sodium . . . . . . . . . . . . . . . . 25 mg Total Carbs. . . . . . . . . . . . . . 6 g Dietary Fiber . . . . . . . . . . . . 0 g Sugars . . . . . . . . . . . . . . . . . 2 g Protein . . . . . . . . . . . . . . . . . 2 g

For a special offer and to learn more about SPLENDA® Naturals Sweeteners visit: www.splendanaturals.com *For more information on how the SPLENDA® Brand does natural, visit www.splenda.com/naturals

Diagnosis:

Diabetes TREATMENT PROGRAMS

Convenient Care CVS helps fight diabetes with education, support

B Y K AREN ASP

iabetes isn’t a disease to take lightly. Consider this: As many as two in five individuals are expected to develop Type 2 diabetes in their lifetime, according to the national Centers for Disease Control and Prevention. It’s so prevalent that the American Diabetes Association estimates more than $1 of every $10 spent on health

28 diagnosisDIABETES DIABETES 2 diagnosis

care in the U.S. goes toward treatment for those with diabetes. To help patients better manage their disease, improve their health outcomes and lower their overall health care costs, CVS Health introduced its Transform Diabetes Care program early this year. The program provides in-person counseling and support, helping the patient adjust to

necessary lifestyle changes to manage the disease. However, you don’t have to be face to face to benefit. Program participants can connect to a glucometer and remotely share bloodsugar levels. “That enables the team to identify potential issues and intervene with one-on-one coaching,” says Troy Brennan, chief medical officer of CVS Health. CVS also makes

monitoring A1C (or blood glucose) levels easier with free checks at its more than 1,100 Minute Clinic locations across the U.S. To be eligible for this program, your employer or health plan must be a CVS Caremark pharmacy benefits management member. Most of the care takes place at CVS Health’s more than 9,500 pharmacies and at clinics.

CVS

The Transform Diabetes Care program allows in-person and remote monitoring of glucose levels by CVS pharmacists.

National University The School of Health and Human Services, in collaboration with the UCLA Geffen School of Medicine, offers an exciting opportunity for nurse practitioners to serve as primary care providers for an urban community in Los Angeles. An interprofessional healthcare team will travel to designated locations within the Watts/Willowbrook community to deliver care onsite. As part of an interdisciplinary team of clinicians, the nurse practitioners will monitor clinical trends using telehealth technologies to record and document patient ďŹ ndings. We are looking for dynamic bilingual nursing health professionals, who will assist this grant-funded project to shift the current paradigm in the delivery of health care, to implement this innovative start-up operation to launch a virtual nurse managed clinic. To be considered for this opportunity, please submit your resume to:

Gloria J McNeal, PhD, MSN, ACNS-BC, FAAN Dean, School of Health and Human Services (O) 858-309-3472 (C) 858-334-9560 gmcneal@nu.edu

We invite you to visit our website at www.nu.edu for a listing of open faculty and clinical positions

Diagnosis:

Diabetes LIFESTYLE

Artful Alerts New ink technology may put tattoos to good use

BY CHRIS TIN E ROM ERO

loy Macias wasn’t into the idea of wearing a medical alert bracelet, so when he found himself struggling to speak as a result of extremely low blood sugar — a condition that can lead to death if untreated — he decided to add to his collection of more than a dozen tattoos by getting new body art that informs others about his disease. “I wanted people to be aware that I’m a diabetic,” says the San Bernardino, Calif., father of seven. “If something happens, I can at least point (to the tattoo).” Not as taboo as they were in past decades, three out of every 10 Americans now has at least one tattoo, according to a 2016 Harris Poll. However, some physicians argue that the tattoos may be overlooked if they’re not standardized to help emergency responders locate them on patients. Currently, alert tattoos just help inform bystanders about another’s medical condition; but one day they may also help patients monitor their bodies.

30 diagnosis DIABETES

Massachusetts Institute of Technology and Harvard Medical School researchers recently worked on a project, dubbed DermalAbyss, which replaces traditional tattoo inks with biosensors that change color to reflect the body’s glucose levels. It would eliminate the need for tests that require finger pricking. “We imagine the future where the painful procedure is replaced with a tattoo, of which the color (changes) from pink to purple based on the glucose levels,” writes Katia Vega, an MIT Media Lab researcher, in a project overview. “Thus, the user could monitor the color changes and the need (for) insulin.” The inks have only been tested on pig skin so far, and researchers have no plans to pursue clinical trials or offer a product to consumers yet. If the technology becomes available, Macias is ready to try it. “I think that would be very helpful for everybody to have ... and check out their sugars all the time,” he says. “It would be awesome.”

ELOY MACIAS; JESSICA J. PAUL; MATTHEW EVANS

These tattoos aren’t just about artistic self-expression. They help patients alert others to their diabetes status.