NEWSLETTER
MY
Fall 2010 Volume 33
Getting Activated Dr. Edelman’s Corner
INSIDE The Artificial Pancreas Project Page 3
Vitamin D
What You Don’t Know About the Sunshine Vitamin Page 4
What You Should Eat When Dining Out Page 6
What is Your A1c Telling You? Page 7
Going the Distance for Diabetes Awareness Page 8
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have never met a person with diabetes who does not want to live a long and healthy life. However, people with diabetes who do not have perfect glucose control are often labeled as “non-compliant.” I see this all too often in the hospital among the medical students, residents, endocrine fellows, dietitians, CDEs and other faculty and staff. Once a person with diabetes is labeled as non-compliant in their medical record, healthcare professionals who read the record in preparation for a visit have already developed a preconceived notion that this person does not follow the rules. It is a common situation that is pervasive among healthcare professionals and has been proven difficult to change. So why is it that many people with diabetes have high A1c values? The reasons are diverse, ranging from emotional and physical barriers to uninformed caregivers. Frequently, there is limited
access to the best therapies currently available. Of the many variables that influence glucose control and the eventual development of diabetes complications, the “activation” of the person living with diabetes to take a more dedicated role in his or her care is the most critical. Activation basically means that the PWD has been educated, motivated and empowered to take control of their diabetes with a positive attitude. As we spoke about in our previous newsletter, Extreme Diabetes Makeover Getting Activated (continued on page 2)
Special Acknowledgements Medical Advisory Board Chair: Ingrid Kruse, DPM Veterans Affairs Medical Center Alain Baron, MD CEO, Elcelyx Therapeutics John Buse, MD, PhD University of North Carolina Jaime Davidson, MD Dallas, TX Mayer Davidson, MD Drew University Daniel Einhorn, MD Diabetes & Endocrine Associates Robert Henry, MD Veterans Affairs Medical Center Irl Hirsch, MD University of Washington
Board of Directors Steven V. Edelman, MD Founder and Director, TCOYD Sandra Bourdette Co-Founder and Executive Director, TCOYD S. Wayne Kay CEO, Response Biomedical Corp. Margery Perry Terrance H. Gregg President & CEO, DexCom, Inc. Daniel Spinazzola President, DRS International
Contributing Authors
Steven V. Edelman, MD Julia Baron Candis Morello, PharmD Sarah Bajorek, PharmD Candidate Roz Hodgins Howard Zisser, MD
TCOYD Team Steven V. Edelman, MD Founder and Director Sandra Bourdette Co-Founder and Executive Director Jill Yapo Director of Operations Michelle Day Director, Meeting Services Antonio Huerta Director, Latino Programs and Exhibit Services Roz Hodgins Director of Development Alice Howe Senior Manager, Web Development Julia Baron Public Relations and Outreach Associate Jennifer Braidwood Continuing Medical Education Associate Jimm Greer Administrative Assistant
MyTCOYD Newsletter Editor: Julia Baron Design: Hamilton Blake Associates, Inc. MyTCOYD Newsletter is offered as a paid subscription of Taking Control Of Your Diabetes. All material is reviewed by a medical advisory board. The information offered is not intended to constitute medical advice or function as a substitute for the services of a personal physician. On the contrary, in all matters involving your health, TCOYD urges you to consult your caregiver. ©2010 All rights reserved.
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Getting Activated (continued from page 1)
(XDM) will soon be available to millions of people around the globe to view online. TCOYD’s XDM program successfully addresses how to help people with out of control diabetes to become active in their own healthcare. Trust me, it’s not rocket science. For our first XDM program we accepted seven individuals living with diabetes who have extremely poor control of their condition (A1c values mostly between 9% and 11%, indicating an average blood glucose value of more than 250mg/dl). Over a 5-month period, they greatly improved their control and completely changed their attitudes about living a normal and proactive life with diabetes. TCOYD helped provide them with a dream team of diabetes specialists including myself; Dietitian Janice Baker, RD, CDE; Nurse educator Angela Norton, RN, CDE; Exercise physiologist, Larry Verity, PhD, FACSM; and Clinical psychologist Bill Polonsky, PhD, CDE. We gave them the attention they needed, gained their trust and addressed their emotional and physical barriers. This occurred only after we were able to truly connect with the group and develop a meaningful understanding of the issues that were preventing them from living successfully with their diabetes. There is no question that we helped to activate these individuals who were generally disheartened with the dayto-day frustrations of this chronic condition and all of the demands put forth by our professional community. I have always wondered how well physicians
would do when asked to prick their fingers and test their glucose three to four times per day, follow a consistent and rigid diet, exercise each day with consistent duration and intensity, take medications regularly including insulin injections and deal with the requirements to see multiple care professionals throughout the year as part of their diabetes treatment. What does it take to activate someone living with diabetes? It takes understanding, sincerity, knowledge and the ability to empathize with individuals in regard to what it is like to live with diabetes on a day-to-day basis. It also takes a conscious shift in attitude from categorizing someone living with diabetes who has poor control as non-compliant, to regarding them as not being active in their own condition. The answer to improving care in this country is, in part, developing new drugs and devices, but also changing the attitudes of caregivers toward their patients with diabetes by encouraging them to become activated in their own self-management, while addressing their individual physical and emotional fears, needs and concerns. This takes time and is a multidisciplinary approach. We must allow for these vital requirements within our new healthcare policies to take action. As patients and healthcare providers, let’s work together to improve lives and ultimately change the face of diabetes in this country.
Steven Edelman, MD Founder and Director Taking Control Of Your Diabetes
Closing the Loop Artificial Pancreas Project From the Desk of Dr. Howard Zisser, MD
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ntil there is a true cure for type 1 diabetes, the artificial pancreas represents the best prospect to minimize rapid and dramatic swings in blood glucose concentrations, further minimizing the short term risks associated with hypoglycemia (low blood sugar) or the long term risks associated with hyperglycemia (high blood sugar). As early as 1959, Professor E. Perry McCullagh, an endocrinologist at the Cleveland Clinic, demonstrated the concept of an implantable artificial endocrine pancreas. The closed-loop regulatory system, which consisted of a glucose monitoring device, transmitter and insulin syringe, was looked upon as the future treatment device for diabetes. All that was needed were the tools. This concept of automated control of glucose became a reality in the mid-1970s as researchers in Canada and Japan developed systems that automated glucose control. The system worked well and is still being used today to answer research questions. The main drawback to this system is that it requires continuous access to the vascular system, which is impossible to maintain due to risks of clotting and infection. This field of investigation remained quiet for the next several decades. Meanwhile, insulinpumping technology developed into an approved method of delivering insulin in a novel fashion that mimics the natural delivery of insulin in the body. The two remaining pieces to the puzzle
were a reliable way to continuously measure glucose and a brain or processor to make automated decisions for insulin delivery. The first generation of continuous glucose monitors, which can report glucose concentrations every 1 or 5 minutes, were approved for use about 5 years ago. Subsequent generations of these devices have improved in performance and accuracy. Once we were shown that using these devices could reduce both hypo and hyperglycemia at the same time, researchers and funding agencies became interested in combining these devices into systems using control strategies (the brains of the operation) that had historically been used to carefully control chemical reactions or refinery plants.
Did You Know? The Juvenile Diabetes Research Foundation (JDRF) was instrumental in establishing and funding a consortium of researchers around the world to tackle this problem. Please check JDRF.org for a research site near you.
Howard Zisser, MD, is the Director of Clinical Research and Diabetes Technology at Sansum Diabetes Research Institute where he conducts clinical trials on new and innovative therapies for type 1, type 2 and gestational diabetes. He currently manages trials investigating the JDRF funded Artificial Pancreas Project, the safety and efficacy of inhaled insulin, and implantable insulin pumps and implantable glucose sensors. Additionally, Dr. Zisser is Adjunct Professor, Department of Chemical Engineering, University of California, Santa Barbara.
There are many hurdles to conquer in order to reach the finish line specifically making an automated insulin delivery system. First, one has to build a system. We have accomplished this at UCSB/Sansum by building our Artificial Pancreas System, which includes pumps from Insulet, Roche and Animas and also includes glucose sensors from DexCom and Abbott. This modular system allows researchers around the world use the tools that they need and �drop in� any brain or controller that they want to test in order to tackle this problem without having to re-invent the wheel. Closing the Loop (continued on page 5)
Taking Control Of Your Diabetes
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Ask Your Pharmacist
Good Day Sunshine!
Vitamin D and Diabetes By Candis M. Morello, Pharm D, CDE, FCSHP and Sarah A. Bajorek, PharmD Candidate 2011
Vitamin D is a hot topic in diabetes research right now, and not just because of the recent sunny, warm weather. Research suggests that vitamin D, or “the sunshine vitamin,” may play a role in regulating insulin secretion, managing blood pressure and creating a better lipid profile. In fact, higher levels of vitamin D may decrease the risk of developing certain diseases, such as diabetes or heart disease. Interested yet? Read on to learn more about this innovative research in the field of diabetes.
Candis M. Morello, Pharm D, CDE, FCSHP, Associate Professor of Clinical Pharmacy at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences and Clinical Pharmacist at VASDHS Sarah A. Bajorek, PharmD Candidate 2011 at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences
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What is Vitamin D?
metabolic syndrome and diabetes. The exact way vitamin D affects itamin D is a fat-soluble vitamin, diabetes is not known. However with two types: the naturally current research suggests vitamin D occurring cholecalciferol (vitamin D3) and the synthetic ergocalciferol may act on the pancreas to increase insulin synthesis and secretion, which (vitamin D2). We get vitamin D3 correlates with lower blood glucose from the sun and vitamin D2 from levels. Studies have found that higher foods. When sunlight or ultraviolet levels of vitamin D are associated with radiation hits the skin, cholesterol better glucose tolerance as well. is converted to vitamin D3, while Furthermore, vitamin D may vitamin D2 is synthesized from also play a role in regulating systems plants. Regardless of the source of vitamin D, its activation in the body involved in blood pressure and cholesterol, resulting in lower blood pressure is dependent on normal liver and and cholesterol levels. In addition, a kidney function, therefore people with liver or kidney problems may be recent review article evaluated studies looking at the role of vitamin D in susceptible to low vitamin D levels. cardiovascular disease, diabetes Vitamin D is an important regulator of calcium and phosphorus mellitus and metabolic syndrome. absorption from the gastrointestinal High levels of vitamin D decreased the risk of having cardiovascular tract and calcium re-absorption in disease by 33%, type 2 diabetes melthe kidneys. The action of vitamin D results in higher levels of calcium litus by 55% and metabolic syndrome by 51% compared to lower levels of in the blood, which increases bone vitamin D. Further studies are needed growth and maintains bone health. Without enough vitamin D, the body to determine if this relationship is cannot absorb dietary calcium. Since causal and to identify the optimal dose calcium is necessary for bone health, of vitamin D supplementation. Currently, the American Diabetes low calcium results in weak bones Association (ADA) does not recomand increases the risk of developing mend vitamin D supplementation in osteoporosis. patients with diabetes without underlying deficiency. Vitamin D deficiency How is Vitamin D Associated can be determined by a blood test. with Diabetes? Studies suggest that vitamin D deficiency may be associated with Very few foods naturally hyperglycemia (high glucose), insulin contain vitamin D. The best resistance, high blood pressure, sources include: obesity and abnormal lipid profile, Oily fish (salmon, Egg yolks also known as “metabolic syndrome.” Orange juice* tuna, mackerel) People with metabolic syndrome are Milk* Beef liver at higher risk for developing diabetes. Cereals* Cheese Studies suggest a possible relation* Fortified with vitamin D ship between low levels of vitamin D,
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Did You Know? Suggested Daily Doses of Vitamin D
However, high intake of vitamin D can raise blood levels of calcium, which can cause changes in mental Vitamin D can be acquired status and heart rhythms. Early from sun exposure, diet or supplesymptoms of excessive vitamin D mentation. Most people obtain intake are nausea, vomiting, constitheir vitamin D needs through sun exposure. Five to 30 minutes of sun pation, weakness and weight loss. exposure on the arms, legs and back Since vitamin D is fat soluble, excessive amounts of it may be stored during peak hours (10 am to 3 pm) in fatty tissue for longer periods of at least twice weekly can generate all the vitamin D we need. However, time, increasing the risk of toxicity. People with sensitivities to the skin’s ability to produce vitamin vitamin D or its analogues should D is diminished with age (65 years not take vitamin D. Since vitamin and older), skin pigmentation (darker pigmentation require longer D increases blood calcium levels, it should be used cautiously in sun exposure) and sunscreen use. patients taking cardiac glycosides The recommended dietary (e.g. digoxin) or thiazide diuretics allowance for vitamin D has not been established. The recommended (e.g hydrochlorothiazide or HCTZ). In addition, people with a history of adequate intake (RAI) may not be high blood calcium, calcium-containenough in persons with osteoporoing kidney stones or malabsorption sis risk factors or low exposure to syndrome should not take vitamin sunlight. See Table 1 for the RAI for vitamin D supplementation. A vitamin D. As always, talk to your physician D supplement can be taken without before starting any new medications or supplements. regard to meals. Since the Federal Food and Drug Administration does not regulate supplements, be sure to The Bottom Line People with diabetes may be choose one with a “USP” certified seal on the bottle, which means the at an increased risk for low levels manufacturer followed standards of of vitamin D, possibly predisposthe US Pharmacopoeia. Vitamin D ing them to glucose intolerance, high blood pressure and abnormal is also used in higher doses for the prevention and treatment of osteo- lipid profiles. Ask your primary care porosis since it increases absorption provider to test your vitamin D levels of dietary calcium. For adults 50 years or older the recommended Table 1: Recommended Adequate dose is 800-1000 IU daily. Intake (RAI) for Vitamin D
Possible Adverse Effects of Vitamin D: How Much Is Too Much?
Vitamin D is usually well tolerated at the recommended doses.
Age RAI 0-50 years 200 IU* 51-70 years 400 IU 71+ years 600 IU *IU, International Units
A serum vitamin D level of less than 15 ng/mL is considered inadequate for bone and overall health.
to see if supplementation is right for you. More studies are needed to determine the exact relationship between vitamin D supplementation and diabetes in people without vitamin D deficiency. Either way, head outdoors and enjoy small doses of sunshine to start boosting your vitamin D levels!
Closing the Loop (continued from page 3) Another hurdle is obtaining regulatory approval to conduct these trials. The JDRF has worked closely with the investigators and the FDA to make this hurdle as small as possible. Clinical studies are ongoing at all of the consortium’s research sites. The main limitation in the current systems is not the brains, but the time lags associated with current sensors and pumps. This makes the whole system sluggish. Future work will include novel delivery methods for faster insulin action (spreading agents, monomeric, intradermal, intraperitoneal and inhaled insulins) and improvement in sensor accuracy. The first product will probably not be a fully functioning closedloop system. It will be a step-wise approach starting with advanced hypoglycemia predictions, which will temporarily suspend insulin delivery then moving on to meal and exercise detection and then to overnight control and finally to full control.
Taking Control Of Your Diabetes
5
LivingWell
restaurant,” says Erica Bohm, M.S., who serves as the Vice President and Director of Strategic Programs at Healthy Dining. Over the years, the database and locales of Healthy Dining Finder have grown significantly. Restaurant By Julia Baron chains such as McDonald’s, Panda Express and Chili’s are represented, as well as local establishments who n the United States, dining out has become a staple of our want to participate in the program. culture. With the hustle and bustle of juggling family, work, Menu items with up to 750 calories, extracurricular activities and everything else that life throws 25 grams of fat, 8 grams of saturated our way, it is becoming increasingly difficult to prepare fats and 2000 mg. of sodium are healthful meals on a daily basis. highlighted on the website under each restaurant’s page. Some people On average, Americans dine out getting nutritionally when eating at are surprised by the choices and why approximately four to five times per restaurants. Both Esther and Anita they are among the healthier week. Whether it is breakfast, lunch decided to join forces to address this categories. or dinner, these meals can add up ever-growing problem. They began “There are so many people who in calories, fats, saturated fats and approaching restaurants and offering identify healthy foods by certain buzz sodium content. Many people find to identify healthy dishes on their words, such as ‘fresh’ or ‘organic.’ themselves fighting weight gain, menus and the caloric, fat and satuHowever, even items such as salads high cholesterol, heart complicarated fat contents involved. sometimes contain a lot of dressing or tions, diabetes and more and are This initial idea rapidly grew cheese and may have unexpectedly high wishing that they had healthier into 19 editions of the Healthy levels of calories, fat, saturated fat or menu options when it comes to Dining books for major Southern sodium,” says Bohm. eating out. For those living with California regions. Additionally, in For people living with diabetes, diabetes it can be especially demand- 2007, the organization launched its healthy dining choices can be espeing when trying to choose restauwebsite, HealthyDiningFinder.com. cially difficult to determine. Certain rants with healthy alternatives. This The website encompasses various menu items, such as foods high in is the basis for the Healthy Dining restaurants from fast food establishfats and carbohydrates, are typiProgram and the HealthyDiningments to family restaurants and cally labeled “no-no’s,” as are foods Finder.com website. includes several dishes from each reshigh in caloric value. Knowing Started by Anita Jones-Mueller, taurant that fit certain MPH and Esther Hill, PhD in 1990, nutritional criteria. Healthy Dining was inspired by the “We approach resfight against obesity and the chaltaurants and encourage lenges presented when trying to them to participate maintain a healthy diet while on in our program. We the go. At the time, Esther’s son had explain the benefits been diagnosed with type 2 diabetes, of identifying healthy and the family found it increasingly menu items, no difficult to know what they were matter the size of the
The Key to Dining Out the Smart Way
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Know Your Numbers
Health Educator Erica Bohm is VP & Director of Strategic Partnerships for Healthy Dining. She coordinates restaurant enrollment and promotes the Healthy Dining program and website to the public and media. She develops strategic partnerships within the restaurant industry and with the many “stakeholders”— employers, health agencies, and others—who publicize HealthyDiningFinder.com to their populations as part of wellness initiatives.
1. The A1c value gives an estimation of the average blood glucose value over the past: a. 1 to 2 months b. 2 to 3 months c. 3 to 4 months d. 2 to 3 weeks 2. The A1c value gives an estimate of what the post meal or postprandial blood glucose values have been. True or False
3. The ideal A1c value that is appropriate for most people with diabetes is: a. Less than 6% b. Less than 6.5% c. Less than 7% d. Less than 7.5%
Answers:
3. Try using less oil, butter, salt, etc. Moderation is key!
he A1c test is one of the most important laboratory procedures to inform people with diabetes about their overall glucose control. Want to test your knowledge? Take the TCOYD A1C quiz below!
nitude of the post meal or postprandial blood glucose values. Testing with glucose meters or continuous glucose monitoring devices can tell us more about the typical glucose excursions that occur throughout the day in response to food, exercise, stress and other variables that can potentially affect our numbers.
2. Don’t look at eating healthy as a sacrifice. Stick with the healthy foods you already enjoy and find different meals to work with. There are many benefits to eating well, including better control of your diabetes!
T
1.) The A1c value gives an estimate of what the average blood glucose value has been over the past 2 to 3 months. Glucose binds to the red blood cells (RBCs) in our bodies, which have a life of about 2 to 3 months. At any time, we can measure the percentage of glucose bound to RBCs and then compare the values to normal individuals. Those living with diabetes who have moderate to poor control of their disease have a higher percentage of glucose bound to these RBCs, and therefore, have a higher A1c level.
1. Do a personal inventory of the foods you enjoy that are healthy, such as fish or chicken. Find menu items that incorporate these ingredients, that are also low in fat, carbohydrates and calories, yet provide protein, vegetables and whole grains.
By Steven Edelman, MD
3.) The goal for A1c values must be individualized. In general, we aim for less than 7%. Keep in mind, there are many factors that should influence your particular goal including, but not limited to: age, heart disease, hypoglycemia or low glucose unawareness. It is important that you discuss these issues with your caregiver.
Here are some quick tips for those looking to improve their current diets:
Do You Know Your A1c and What It Means?
2.) The A1c test provides information on the average blood glucose value and does not give any information on the mag-
the importance of these factors is key in choosing healthier courses and eating them in moderation. Sometimes, this can be off-putting for people who are used to eating certain foods and are not as willing to change their diet. “Limiting carbohydrates, calories and fats is key in controlling diabetes. Information is power. With the information on the website, people with diabetes can choose the choices that are right for their particular dietary regimen,” says Bohm.
Taking Control Of Your Diabetes
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Taking Control
RUNNING the
Coast for Diabetes By Julia Baron
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he sport of running requires discipline, patience and dedication. Training is tiring and time consuming, yet the results of tireless efforts are positive. For people living with diabetes, discipline, patience and dedication also play a significant role in controlling the disease and living a happy, healthy life. For Jerry and Jenifer Armstrong, both diabetes and running are integral parts of their day-to-day lives and have helped shape who they are.
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“I want to serve as a resource for people living with diabetes and their families...” –Jerry Armstrong
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Jerry and Jenifer are no ordinary couple. Jerry is a local police officer with a passion for ultramarathon running and Jenifer, a nurse and mother, has been living with diabetes for 24 years. Inspired by his wife’s determination and spirit, Jerry decided to dedicate his free time to his wife and son Jalen and becoming an advocate for diabetes.
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With six of his family members living with diabetes, Jerry wanted to make a significant impact and raise awareness for the disease. “I want to serve as a resource for people living with diabetes and their families. Although I don’t have diabetes, it is a cause close to my heart,” says Jerry. On October 30th, with the help of his family and team of supporters, Jerry plans to run 500 miles along the coast of California to raise money for the Iron Andy Foundation, a not-for-profit organization dedicated to providing education and support for young people living with diabetes through special diabetes camps. Jerry met founder, Iron Andy (Andy Holder) at a race in Kentucky last year. He was immediately inspired by Andy’s dedication to young people living with diabetes. Living well with type 1 diabetes himself, Andy knows first hand the challenges of controlling his condition and training for marathons and triathlons. “He is such an inspiration. When I met him, I knew I wanted to be a part of what he was doing to help kids with diabetes. This is when I had the idea for Run the Coast,” says Jerry. The Run the Coast race will begin on October 30th at the Golden Gate Bridge and end November 12th in downtown San Diego. Jerry will be joined by Team Iron Andy, which consists of: Andy Holder, Amy Gonsalves,
Want to Get Involved? You can help Team Iron Andy by making a donation or participating in either the Dean Karnazes Silicon Valley Marathon on October 31st or the Santa Barbara Marathon on November 6th. Both of these marathons will be opportunities to run with Jerry and Team Iron Andy during this two-week event. For more information about Run the Coast and to donate, visit www. runthecoast.com.
Scott Jozefowski and John Moore, all living with type 1 diabetes; Monica Otero who is living with type two diabetes; and David Clark, Connie Dockendorf and Iso Yucra who are all friends and/ or loved ones of people with diabetes (type 3’s). We wish the team the best of luck and we will see them at the finish line!
Fit to Eat
Making the Most of
Dessert By Janice Baker, RD, CDE, CNSC
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ost of us look forward to dessert after a meal—usually after dinner. Desserts, being sweet, creamy and delicious, are some of our favorite comfort foods. Unfortunately, desserts are usually high in calories and low in nutrients. The trick is to save the rich desserts for truly special occasions and to make other desserts a nutritious part of your diet.
Question of the Month By Steven Edelman, MD
Using Fruit for Dessert
content of dessert by using skim milk or other low-fat dairy products. Fresh fruit that is in season is Replace part of the oil with prune a treat when dressed up with other puree (use a jar of prune babyfood), nutritious additions. Try dipping it in non-fat vanilla yogurt, sprinkled applesauce or buttermilk. However, no matter how healthwith a little cinnamon. Another ful or rich the dessert of choice is, idea is to peel and chop apples or pears, sprinkle them with a teaspoon portion control is always the major influence on how many calories you of sugar or other sweetener per will be consuming. Using small cups or cup of fruit, then microwave until tender. Stir in a few raisins or berries dishes, instead of larger bowls or plates and pairing up a very small portion of if you like, but don’t add water— a rich desert or piece of candy with the fruit creates its own syrup as it cooks. Enjoy the fruit warm by itself some fresh fruit can help maintain the calorie balance needed to achieve and or sprinkle with a crunchy low-fat granola cereal to make a fruit crisp. maintain a healthy weight. You might also enjoy adding some chopped walnuts or sliced almonds, in Pudding k p m u P y s a E which adds fiber, protein and heart healthy fats. together.
Homemade Desserts
For puddings, icings and pie fillings, you can use non-nutritive sweeteners such as Splenda. Reduce the fat
pumpkin or 1 cup canned ree pumpkin pu ) -serving size 1 package (4 la il onfat van sugar free n pudding umpkin pie 1 teaspoon p spice im milk 1 ½ cups sk
dients Mix all ingre r idual bowls o iv Place in ind t. se l ill unti glasses and ch cup ings. Each 2/3 Makes 4 serv s fat, m ra g 0 , lories serving: 77 ca dium, ol, 380mg so 2mg cholester rams ohydrate, 2 g 15 grams carb tein. s pro fiber, 4 gram
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’ve never eaten a meal first thing in the morning, but my doctor tells me that with diabetes, I have to eat breakfast. I seem to end up eating things that are bad for me, like a donut or Danish. What do you suggest I eat instead? Eating a well-balanced breakfast in the morning is good for everyone, including those with diabetes. The breakfast does not have to be large, but having a morning meal does help with over eating at lunch. Pick a variation of meals that you enjoy that are also healthy and easy to prepare. Peanut butter on a toasted English muffin, oatmeal, a small bowl of cold cereal and low-fat yogurt are just a few examples. If you wake up early and do not feel like eating right away, take a “breakfast kit” to work and eat it a little later in the morning.
Taking Control Of Your Diabetes
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Taking Control
Diabetes Need Not Keep You Grounded By Julia Baron
So what’s next for Douglas?
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lying an airplane with type 1 diabetes hasn’t always been an option. In fact, for years, no one in the world was allowed to operate an aircraft if they were living with the disease. For Douglas Cairns, this meant the end of his career as a pilot. Little did he know, it was only the beginning. In 1986 at the age of 25, Douglas was diagnosed with type 1 diabetes. This came as a shock to him in more ways than one. At the time, he was a pilot in the Royal Air Force and was merely participating in a routine health screening when he received the news. “I was devastated. They told me, ‘you have diabetes and you were a pilot.’ I didn’t know what to do,” says Douglas. Shortly after being diagnosed, Douglas switched career paths. He moved to London where he was involved in financial asset management. From 1996-2002, he was based in Bangkok, Thailand where he was working to set up a joint venture. Although he was successful in his position, flying was still something he yearned to do. In 1999, Douglas heard news
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that the United States had a different system for pilots with diabetes— you could fly and maintain a pilots license if your blood glucose was under good control (100-300 g/dl) during flight. Finally, in 2003, Douglas took to the skies again for his first diabetes advocacy mission. His goal was to fly around the world for a project he called “Diabetes World Flight” (DWF). In the process, he also managed to raise $26,000 for diabetes research.
On April 25th 2011, a recordsetting flight to the North Pole (90 degrees north) called Diabetes Flight 90 (or Diabetes Polar Flight) is on the books. The temperature is predicted to be approximately -10º F. Now that’s cold!
flight, he has been able to accomplish diabetes flight 48 which broke the existing record to land in all 48 contiguous states by 33 hours while raising over $27,000 for diabetes research; diabetes flight 50 by flying “I was devastated. They to all the states which also broke told me, ‘you have diabetes the existing record to land in all 50 and you WERE a pilot.’ states. As of now, Douglas has no I didn’t know what to do.” intentions of being grounded “I was ecstatic! I got a twin anytime soon. Flying is his passion engine aircraft and began DWF. I and to be able to promote diabetes wanted to show people with diabeawareness in the process is a special tes what they can do, not what they achievement. cannot do.” “Diabetes is controllable. I wont On his flight, Douglas was able let it stop my from doing what I to see the inequalities of various love and neither should anyone countries’ healthcare systems. He else,” shares Douglas. found that many people did not have He will be featured as a guest access to basic diabetes care such as speaker at our upcoming San Diego insulin or testing supplies. conference on October 30th! Since Douglas’ first diabetes Check tcoyd.org for details!
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Giving Back
Ted and Arline Greene: Lending A Hand to the Latino Diabetes Community By Roz Hodgins
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significant multi-year gift has been made by Arline and Ted Greene to further TCOYD’s Latino programs. This initiative supported by the Greene’s spirit of generosity will enable TCOYD to take a much-awaited step to translate our Taking Control of Your Diabetes book into Spanish, making it available to the thousands of Spanish speaking people who are living with diabetes. This effort has been long overdue and will incorporate the important TCOYD messages of education, motivation and self-advocacy, while making every effort to ensure the messages are culturally appropriate to the Hispanic/Latino population. This book will be a welcome addition to the resources made available at all TCOYD conferences across the nation, online and to diabetes professionals who are working to reach the Spanish speaking population. The Greenes are no strangers to diabetes and the Latino culture. Ted is the co-founder and former CEO of Amylin Pharmaceuticals, a biotech company dedicated to providing new treatments and therapies for people living with diabetes. He currently serves on the board of directors for Tandem Diabetes Care—a company committed to creating diabetes products that enable a flexible lifestyle. In addition, he is also chairman of Satiogen Pharmaceuticals where he is co-inventor of several novel concepts for treating diabetes and obesity. Arline is has type 2 diabetes and has a personal understanding of what it means to live well with the disease. Her father passed away
due to complications associated with the disease. He was instrumental in helping educate Hispanic students, so in his honor, she set up the Alberto Radillo Scholarship fund at Santa Ana College in 2001. To date, she has helped 92 Hispanic students majoring in math and science with tuition and book fees, and currently, four of these students are attending medical school. Ted and Arline have been avid supporters of health causes for most of their lives, as well as programs aiding students of Latino descent. This
To learn more about giving, please contact: Roz Hodgins TCOYD Director of Development 1110 Camino Del Mar Del Mar, CA 92014 (858) 792-4741 Ext. 20 or toll free: (800) 998-2693 email: roz@tcoyd.org
was a natural step in their decision making process of where to direct their giving. “When we learned of the Latino program fostered by TCOYD, we could not help but jump in and offer our support to lend a hand to this vulnerable population. TCOYD is definitely making a difference in the area of diabetes patient education, and Ted and I are pleased to be a part of this initiative,” Arline says of their recent commitment. We thank them for their endless generosity toward our organization and the Latino community.
TCOYD Corporate Sponsors Platinum Gold
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Taking Control Of Your Diabetes
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TCOYD Conferences & Health Fairs 2010-2011 Schedule September 25 October 30 November 13
2010
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2011
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Diabetes in Motion
Extreme Diabetes Makeover Premieres September 27th! By Julia Baron
F
inally, the moment we have all been waiting for! TCOYD’s newest project, Extreme Diabetes Makeover, will premiere online at TCOYD.org and RealAge.com on September 27th to viewers around the world. This cutting-edge series takes reality programming where it has never gone before—into the lives of the 26.2 million Americans living with diabetes, documenting the challenges they face while battling this chronic condition. Tune in as we follow 7 unique
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My TCOYD Newsletter, Vol.33
individuals, all living with diabetes, who have two things in common: poor control of their diabetes and the desire to improve their condition. Watch them work with a “Dream Team” of diabetes experts over a 22-week period as they battle their emotions, test their limits and explore new ways to manage their condition. Join us as we show the world
what it means to take control of your diabetes! For schedules, bios, trailers and more, visit www.tcoyd.org or www.RealAge.com