2010 Spring Vol 32

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Spring 2010 Volume 32

TCOYD’S EXTREME DIABETES MAKEOVER PROGRAM

The Next Big Thing To Hit the Online Airways Dr. Edelman’s Corner

inTHISissue 1 Dr. Edelman’s Corner 3 The Friend Factor 4 Finding a Balance 5 Question of the Month 6 Victoza (liraglutide) Stress 8 Chronic and Your Heart 9 Know Your Numbers 10 Diabetes in Motion 11 Diabetes Etiquette 12 The Spirit of Giving (Photo) The participants of Extreme Diabetes Makeover and the Extreme Diabetes Makeover “Dream Team” enjoy the sunset at the TCOYD office.

he rumors are true! TCOYD is coming out with a cutting edge, reality-based, documentary-style online series that has the potential to do something that has not been done before.

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Our Extreme Diabetes Makeover (XDM) program will not only show the nondiabetic world what it is like to live with diabetes on a day-to-day basis, but it will also be a comforting eye-opener for the millions of people living with diabetes, helping to validate the multiple emotional and physical barriers that come with their condition.

With the help of an expert film crew and personal HD Flip Cams, XDM is following seven PWD (5 type 2’s and 2 type 1’s) from various walks of life for 5

months as they are given the tools to help take control of their diabetes.

We are documenting the successes as well as the challenges of the participants as they work with our “Dream Team” of diabetes healthcare professionals to assist them in their journey. The Dream Team members include: Dr. Steve Edelman, Diabetologist; Bill Polonsky, Clinical Psychologist; Janice Baker, Dietitian; Angela Norton, Certified Diabetes Educator; and Larry Verity, Exercise (Makeover, continued on page 2)

Special Acknowledgements Medical Advisory Board Chair: Ingrid Kruse, DPM Veterans Affairs Medical Center Alain Baron, MD CEO, Elcelyx Pharmaceuticals 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 Doug Burns Susan Guzman, PhD Candis M. Morello, PharmD Courtney Shakowski, PharmD Joe Piscatella

TCOYD Team Steven V. Edelman, MD Founder and Director

Sandra Bourdette Co-Founder and Executive Director

Jill Yapo Director of Operations

Michelle Day Director of Meeting Services

Makeover (continued from page 1) Physiologist. As an added bonus, our fantastic fitness trainer from NBC’s “The Biggest Loser,” Kim Lyons will make an appearance in the show, while spending an afternoon with the group sharing her fitness expertise and working the participants to their limits!

Premiering this fall on TCOYD.org and RealAge.com, a top-of-the-line consumer health website, Extreme Diabetes Makeover is filled with the true stories of real people, all struggling with diabetes, who have two things in common: poor control of their diabetes and the desire to improve their condition.

The diverse group, includes Celeste, a 68 year old astrology consultant living with type 2 diabetes; Daron, a 38 year old individual who is living in a homeless shelter and has type 2 diabetes; Chet a 53 year old San Diego State University Aztec cheerleading legend and county worker with type 2 diabetes; David, a 22 year old UCSD student who has been living

Steven Edelman, MD Founder and Director Taking Control Of Your Diabetes

with type 1 diabetes since the age of four; Tim, a 62 year old lawyer living with type 2 diabetes; Renee, a 55 year old professional woman with type 2 diabetes and Liz, a 30 year old events professional and exercise instructor with type 1 diabetes. Watch them as they work to lower their A1c’s, change their life-long habits and battle their emotions in order to take control of their diabetes.

XDM is the most exciting project we have done at TCOYD since our very first conference at the San Diego Convention Center in 1995! I wanted to call it “Pimp My Diabetes,” but I got shot down! Trust me, you won’t want to miss this much-anticipated dose of diabetes reality!

Antonio Huerta Director of Latino Programs & Exhibit Services

Roz Hodgins Director of Development

Alice Howe Manager of Continuing Medical Education & Website Development

Julia Baron Marketing and Communications Associate

MyTCOYD Newsletter Editor: Julia Baron, Editor 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. ©2009 All rights reserved.

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Celebrity fitness trainer Kim Lyons works with Liz, Daron and David to test their stamina.

The Friend Factor How Your Relationships With Others Affect Control of Your Diabetes

By Doug Burns

obstacles have a common bond.

Become creative. I thought that Dr. Edelman had too many friends.

Though it was difficult in the beginning, I siphoned many of my new friends from his surplus and we are all better for it!

We are built with a need to develop thought of my kids and my friends Friends have supported me and interact with other people. implores me to treat this disease through dire situations and their Friendship fulfills a key component better—to forget the mistakes and help is always before me. The next in life—acceptance. From our push forward. The thought of other time our friend or physician tells us beginning to present, we pursue athletes with diabetes does the same we need to lose weight, start testing acceptance from others and ourselves thing. We have a solution for others more, start exercising or check our more than anything else in life. Many and ourselves. sugar right now, remember the of the kids I’ve spoken with in juvenile Diabetes creates various obstacles halls said they joined gangs for that that all of us must address. By helping Proverb: “Wounds from a friend very reason—they wanted to be someone else it lessens the power these can be trusted, but an enemy accepted somewhere. obstacles have. It’s virtually impossible multiplies kisses.”

Lack of friendships can be crushing. to help someone else when we are It implies rejection. Rejection kills our focused solely on our own problems spirit and leads to low self-esteem, low and/or circumstances. Finding friends Doug Burns is an self worth and isolation. It contributes means being friendly and friendship internationally to and heightens depression as well. requires us to put others first. respected fitness What does this have to do with People from our past, our work, our consultant and diabetes? Controlling a disease that experiences, places we frequent and, of record-holding strength athlete. requires daily attention becomes even course, social networks all offer Doug has also had more chaotic and, therefore, loses its chances to help and befriend each type 1 diabetes since importance. Friendship and acceptance other. Friends we text and connect the age of seven.

Doug feels blessed to have been able to are as vital as the foods we eat. with online create an ever growing bring a message of overcoming to people all Diabetes is like other obstacles we opportunity to meet and keep up with over the world. He has keynoted on diabetes meet in life. It takes a healthy people throughout the world. and health and fitness for senate hearings, perspective to persevere, treat and Friendships hold us accountable and children’s and adult conferences, public overcome them. People with friends, provide needed feedback for both sides. schools, and juvenile detention centers.

Doug resides in Northern California whether they are family or others, are Most of us have a list of friends, but and authored The Diabetes Antidote. He more apt to control their diabetes. if you’re searching, remember to find serves on the Board of Directors for the Friends provide us with accountability friends, reach out and be friendly.

ADA, JDRF, Father of the Year, and various sports associations. and a reason to live better. The Those of us with diabetes and other

ow important are your friendships with regard to living above the confines of diabetes? Surprisingly, they are more important than many of us realize. Friends give meaning to our lives and are a main reason we strive to succeed in our pursuits.

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Taking Control of Your Diabetes 3

ug

Fi

e...

B e h t a l g a n n i a g M n i d a m ster c o c n Be J

gler

By Susan Guzman, PhD

id you ever marvel at a master juggler who can throw all kinds of objects in the air and, seemingly, without looking, manage to keep them Here are some strategies for all afloat? I have observed those who are increasing your “diabetes living well with diabetes have developed juggling” skills: skills that are comparable to those of a 1) Recognize that even master jugglers master juggler. They toss up in the air drop balls—it’s the nature of all of life’s stuff—work, family, friends, juggling. Having diabetes involves diabetes self-care and even some ups and downs, frustrating results and occasional fun—and strive to find a days you just don’t feel like “doing balance. Occasionally, things get out diabetes.” Accept that this is the of balance and a ball will drop. Despite normal experience of living with these minor oversights, it seems that diabetes and does not make you these masters subtly observe when a ball a “bad diabetic” or mean you’ve has fallen, carefully adjust their stance, “blown it.” Try to let go of what is pick up the dropped ball and toss it back done and focus on what you can into the air. Even if the juggler happens do right now. to misstep and all of 2) Decide how many “Having diabetes involves ups the balls tumble to balls (and which) to and downs, frustrating results, the ground, he throw in the air. There and days you just don’t feel simply starts over, are only so many hours like “doing diabetes.” one ball at a time. in the day and only I am inspired by the many master so much energy to spend. Make diabetes jugglers that I know and I am conscious choices about what you amazed when they manage to find a put into your day. Choose what is healthy balance in all of the work of really important, especially when checking blood glucose, adjusting food you are in a time of high stress and and medication, remembering to fit in pick diabetes self-care activities exercise however they can, while also that will give you the biggest payoff having a job, dealing with relationships (like making sure you take your and coping with the stresses of tough meds/insulin and exercise).

D

Susan Guzman, PhD, Director of Clinical Services, Behavioral Diabetes Institute (Far Right photo) Dr. Guzman is a licensed clinical psychologist specializing in diabetes, both as a researcher and a clinician.

She developed and leads the multiweek depression series, “Feeling Good Again: Breaking the Depression/Diabetes Connection”.

She is also project coordinator for BDI's Behavioral and Emotional Attitudes towards Diabetes (BEAD) study, which investigates the impact of type 2 diabetes following diagnosis, and has previously been involved in studies examining family-based interventions in diabetes as well as psychological insulin resistance.

4 MyTCOYD Newsletter, Vol. 32

times. They have the ability to notice when things have gotten out of balance or a ball or two has been dropped and simply take necessary steps to get back on track. These master diabetes jugglers recognize that the goal is to find balance between having good (not perfect) control of their diabetes and having a meaningful life.

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3) Reconsider if you are juggling chainsaws! Sometimes we choose to put harmful things, high-stress jobs, unhealthy relationships or dangerous behaviors in our lives that jeopardize our wellbeing and make finding balance nearly impossible for any length of time. Be honest with yourself and consider making a change that makes your physical and emotional self-care more of a priority.

Just as the master juggler has learned the rules and physics of juggling, the master of diabetes has learned the rules and patterns of his own body and recognizes that diabetes management requires change, flexibility and an attitude that keeps diabetes in its proper perspective. Remember, this requires practice and perseverance and you too can do it!

Question

of the Month

By Steven Edelman, MD

I have an unusual ethical and psychological question. I find that everywhere I go, I seem to scan the environment, seek out, and quite frankly, take Splenda packets. I shove them in my pockets in a cool calm manner like I am doing something completely normal and acceptable. I use Splenda (or other zero calorie products) as my sweetener to avoid getting high blood sugar and to reduce the amount of calories that I intake. Is this wrong? Should I be afforded special privileges as a person who has to live with diabetes?

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nswer: I honestly tried to get a clinical psychologist to answer my question but they all chickened out! So, after thinking about it for a while, I have decided to answer my own question to the best of my ability.

Stealing is wrong....plain and simple. However, is taking a few extra Splenda or Equal packets for later use stealing? Having diabetes does limit the amount of real sugar you can use and artificial sweetener packets are readily available in restaurants and fast food establishments.

I think it is fair to say that when you feel guilty about doing something, it is probably wrong and when I take more than a modest number of packets I do feel guilty. On the other hand, when I only take a few packets, I feel okay.

So, the answer to my question is that like everything in diabetes, the key is moderation! This answer leaves the door open to interpretation so if you have opinions or feedback that you would like to share about this issue, please comment on the discussion board of our TCOYD Facebook page. If you haven’t yet joined us on Facebook, please do. It’s easy.

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Taking Control of Your Diabetes 5

Victoza I (liraglutide) “V” is for Victory for Type 2 Diabetes: The Once Daily GLP-1 Candis M. Morello, PharmD & Courtney Shakowski, PharmD

(Left) Candis M. Morello, PharmD, CDE, FCSHP, Associate Professor of Clinical Pharmacy at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences and Clinical Pharmacist at VASDHS (Right) Courtney Shakowski, PharmD Candidate 2011 at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences

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helps insulin secretion. Conversely, as glucose concentrations lower, Victoza stops working, preventing hypoglycemia. GLP-1 also decreases the secretion of glucagon from the pancreas. If glucagon increases, it leads to an increase in glucose production and increase in blood glucose.

Additionally, GLP-1 works in the brain to promote What is Victoza?

“Victoza, a GLP-1 analog, appetite suppression, GLP-1 is an incretin works by mimicking the which ultimately hormone. You may find important functions of leads to sustained yourself asking, “What GLP-1 in the body.” weight loss. Lastly, are incretins?” Incretins GLP-1 helps regulate the rhythmic are hormones released from the contractions of the stomach, which are intestines after eating a meal that too fast in people with type 2 diabetes. cause the pancreas to secrete insulin, This typically leads to the dumping of decrease glucagon secretion and nutrients into the intestines and promote appetite suppression. One of the most important incretin hormones elevations in glucose. By replacing is the glucagon like peptide-1 (GLP-1). GLP-1, people with type 2 diabetes can achieve better glucose control Unfortunately, if normal GLP-1 were to be administered, it would rapidly be after eating, as well as, weight loss.

Similarly, Byetta increases GLP-1 deactivated by natural enzymes in the body. Novo Nordisk, the developer of effects, but acts as a GLP-1 agonist.

Victoza, has figured out a way to trick Currently, it requires twice daily the body by developing a drug that injections compared to Victoza, which only requires one injection per mimics the action of GLP-1, but day. However, a once weekly Byetta different enough that it does formulation is currently under review not get rapidly degraded by by the FDA. the body’s enzymes.

n January of 2010, the Food and Drug Administration (FDA) approved the use of Victoza (liraglutide) in the United States in adults with type 2 diabetes in order to improve glycemic control in addition to diet and exercise.

Now, Victoza joins Byetta (exenatide) in the class of drugs called GLP-1s.

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How does Victoza work?

]

Is Victoza right for me?

In addition to diet and exercise, Victoza will help people with type 2 Victoza, a GLP-1 analog, works by mimicking the important functions of diabetes achieve good glycemic control.

GLP-1 in the body. First, it causes the The earlier glycemic control is achieved pancreas to secrete insulin in a glucose- (targeting an A1C of less than 7% for dependent manner. This means when most people) the better! This will help glucose concentrations rise, GLP-1 prevent the onset of long-term

microvascular (small vessel) complications that can arise from poor glycemic control.

Before you start taking Victoza, tell your provider if you have had thyroid cancer, a history of pancreatitis or stones in your gallbladder.

These conditions may predispose you to serious side effects of Victoza and you should avoid using this product. Remember to consult your provider before starting any new medication to ensure that a proper dose and schedule can be determined.

Victoza has little risk of causing low blood glucose when used alone.

It is important to know that your risk for low blood sugar is higher if you take Victoza in combination with another medication that causes low blood sugar, such as glimepiride, glipizide or glyburide. Signs and symptoms of low blood sugar include: sweating, headache, confusion, irritability and hunger.

Talk to your primary care provider about the medications you are taking that might cause low blood sugar, in addition to how to recognize and treat low blood sugar.

What can I expect?

Most importantly, you can expect The Bottom Line a decreased A1C by 1.0% – 1.5%, Insulin is not the only hormone which will help accomplish your in the body affected by diabetes. goal of achieving glycemic control.

The incretin hormones are also Furthermore, you can expect affected. We now know an emerging significant and sustained weight class of drugs, GLP-1s, which in loss. This doesn’t mean you can combination with diet and exercise quit your diet and exercise plan! help to achieve glycemic control As you know, regular exercise and and promote weight loss. This is maintaining a well-balanced diet great news because many of the are crucial to good current “...GLP-1 works in the brain glycemic control. therapies to promote appetite When first starting for type 2 suppression, which ultimately Victoza, you might diabetes leads to sustained weight loss.” also expect nausea, actually cause as it is the most common side effect. weight gain, which can be very However, as your body adjusts to frustrating! Keep your eyes open this medication within a few weeks, for long-acting GLP-1s. These the nausea will decrease. In the agents would only require weekly mean time, eating small, frequent injections rather than daily ones. meals, chewing sugar free gum, or This would mean another victory sucking on sugar free lozenges for people with type 2 diabetes! may help.

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(Top) Renee is excited to learn about new therapies to control her diabetes.

(Middle) David and “Dream Team” Dietitian Janice Baker discuss his latest numbers.

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Liz tries out a new and healthy recipe in the kitchen!

Taking Control of Your Diabetes 7

Chronic Stress & Your Heart

By Joe Piscatella

of stress: significant peaks were found e are all used to traditional between 7 and 10 o’clock on Monday cardiac risk factors such as elevated cholesterol, diabetes, smoking, mornings, when the occurrence of high blood pressure and family history. heart attacks was 21% higher than But these days, research is being focused during the rest of the week. The low was on Saturdays. on a link between chronic stress and So, do you retire from the world to heart attacks. reduce stress? Of course not. The fact is If there is a common element to that we live in a fast-paced, out-of-time modern life, it is that we lifestyle and The first step is to make a are a hurried, harried and Type Adecision to take control, to “stressed-out” society. fostering decide to manage your stress Most people simply do rather than have it manage you. culture that not have enough time for combines to their overcommitted and overscheduled lives. Chronic stress hits produce high levels of frustration, anxiety and anger. There will always everyone from the elderly couple dealing with extensive medical bills to be traffic jams and checking overdrawn accounts. And there will always be the young mother who is rushing from stress. The secret is not to avoid stress, work to drive carpool. Such unbridled but to manage it. stress can have a significant adverse The first step is to make a decision to influence on cardiac health. People take control, to decide to manage your under stress tend to smoke, eat highstress rather than have it manage you. fat food and lead sedentary lives, all of Next, identify what causes you to which increase heart attack risk. But feel stressed. Is it coming from your job, chronic stress can also impact heart your home, or both? Are you always out health more directly including: of time? Do you exhibit Type A u Surges in heart rate and blood personality traits? pressure Finally, do something positive about u Increases in cholesterol combating stress. Make a conscious u Promotion of artery wall effort to do one or two things each day inflammation to help you handle your stress. A few u Constriction of coronary arteries, examples include going for a jog or a which can result in heart attacks walk, taking a hot bath, building extra u Heart rhythm irregularities, which time into your schedule, practicing can trigger sudden cardiac death positive self-talk, breathing deeply, u Increases in blood clotting keeping a journal and getting enough An eight-year study of day-of-thesleep. week variations in heart attack

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Joe Piscatella is the author of the bestseller book Don’t Eat Your Heart Out. In 1977, at the age of 32, he underwent an emergency openheart bypass surgery after experiencing chest discomfort while playing tennis. His prognosis was not good, his doctors did not expect him to be able to watch his kids grow. Refusing to accept his prognosis, he did extensive research and interviewed medical experts. He created a plan for a healthy, balanced life-style that he could implement. Joe wrote his outcome in his book and in 1982 he founded the Institute for Fitness and Health. Today, Joe is one of the country’s leading authorities on changing behavior to increase health and productivity.

incidence showed the incredible impact

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]

KnowYour Numbers

By Steven Edelman, MD

am a 30-year old woman with type 1 diabetes and have been living with this condition for many years. I am growing frustrated trying to control my diabetes.

I have an insulin pump and recently got on a continuous glucose monitor (CGM).

My A1c is not that bad, however I seem to yo-yo up and down on a daily basis. I try to be as regular as possible, but I travel a lot and that makes things difficult.

I

Question: My carbohydrate to insulin ratio is 10:1 and my correction factor is 1:35 with a goal of 100mg/dl. See the download of a typical day. What could be the cause(s) of my erratic control?

Answer: Although easier said than done, trying to keep your glucose levels in a good “zone” while avoiding the extreme highs and lows is the key to success.

First of all, when you are high, make sure you have the appropriate correction dose. If you are giving yourself more than you need, it will drive you down into the low range. Also, be careful not to “stack” your dose by taking several correction doses too closely together in time (typically you should wait at least an hour before giving a second correction dose).

On the other end of the spectrum, make sure you do not over treat your lows, which will drive you back up too high and then you will definitely be on the roller coaster. Also, test to make sure your carbohydrate to insulin ratio is appropriate (pre and post meal testing) because if you are not giving yourself enough insulin with meals, you will commonly be too high after eating creating the up and down cycle. Make sure you have your upper and lower alert levels set appropriately (i.e. 80 mg/dl for the low and 180 mg/dl for the high). You will defeat the purpose of having a CGM device if you have your limits too high and too low. Remember to pay attention to the alerts and do something when you cross the line in order to avoid the extremes.

Lastly, it will take you several months to learn how to correctly interpret your CGM readings and make the appropriate micro-adjustments throughout the day.

TCOYD Corporate Sponsors Platinum

Gold

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Taking Control of Your Diabetes 9

Diabetes in Motion: Step Forward and Move Ahead!

Live Conferences - TCOYD and MTC In the fall of 2010, we will hold four ‘Taking Control Of Your Diabetes’ conferences and health fairs along with three ‘Making The Connection’ continuing medical education symposia.

Registration for all the events will be available on our website.

These are cities and dates we will be visiting: September 11 Providence TCOYD / MTC September 25 Des Moines TCOYD / MTC October 30 San Diego TCOYD / MTC November 13 Native American, Oklahoma City TCOYD

San Diego Mini-Series Evening Programs Wednesday Wednesday

July 28 September 22

6:30 – 8:30 p.m.

6:30 – 8:30 p.m.

San Diego Area Latino Mini-Series Evening Programs Monday Monday Monday

June 7 September 13 November 8

6:00 – 8:00 p.m.

6:00 – 8:00 p.m.

6:00 – 8:00 p.m.

(Top) Dr. E takes a break with some of the fantastic children featured in, "Kids With Diabetes Say the Sweetest Things.”

(Right) Dr. E interviews Dr. Irwin Goldstein about diabetes and sexual health.

10 MyTCOYD Newsletter, Vol. 32

San Diego Area Latin Conferences Two will be held in the North County at Tri-City Medical Center and one will be held in the South County at the San Ysidro Health Center. The dates will be announced.

TCOYD-TV We are currently filming our 4th season of TCOYD-TV. There will be six episodes this year that will begin airing in the coming weeks and will be listed on our website.

This season, we will include new lifestyle pieces featuring dietitian Janice Baker and exercise physiologist Larry Verity that recur in every episode. Dr. Edelman will also interview several children with diabetes about their condition and what they do to manage it. The segment will be called, “Kids With Diabetes Say the Sweetest Things.”

We will continue to focus on a specific topic with Dr. Edelman hosting and interviewing expert guests throughout the season.

1

DON’T offer unsolicited advice about my eating or other aspects of diabetes.

You may mean well, but giving advice about someone’s personal habits, especially when it’s not requested, isn’t very nice. Besides, many of the popularly held beliefs about diabetes such as, “you should just stop eating sugar” are out of date or just plain wrong.

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DO offer to join me in making healthy lifestyle changes.

Not having to be alone with efforts to change, like starting an exercise program, is one of the most powerful ways that you can be helpful. After all, healthy lifestyle changes can benefit everyone!

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Diabetes management is a full-time job that I didn’t apply for, didn’t want and can’t quit. It involves thinking about what, when and how much I eat, while also factoring in exercise, medication, stress, blood sugar monitoring and so much more—each and every day.

Diabetes is scary enough, and stories like these are not reassuring! Besides, we now know that with good management, odds are that you can live a long, healthy and happy life with diabetes.

DO realize and appreciate that diabetes is hard work.

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Diabetes Etiquette

DON’T look so horrified when I check my blood sugars or give myself an injection.

It’s not a lot of fun for me either.

Checking blood sugars and taking medications are things I must do to manage diabetes well. If I have to hide while I do so, it makes the task much harder for me.

For people Who DON’T Have Diabetes

DO ask how you might be helpful.

If you want to be supportive, there may be lots of little things I would appreciate your help with. However, what I really need may be very different than what you think I need, so please ask first.

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DON’T offer thoughtless reassurances.

When you first learn about my diabetes, you may want to reassure me by saying things like, “Hey it could be worse; you could have cancer!” This won’t make me feel better. To add to that, the implicit message seems to be that diabetes is no big deal. However, diabetes (like cancer) is a big deal.

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DON’T peek at or comment on my blood glucose numbers without asking me first.

These numbers are private unless I choose to share them. It is normal to have numbers that are occasionally too low or too high.

Your unsolicited comments about these numbers can add to the disappointment, frustration and anger I already feel.

DON’T tell me horror stories about your grand-mother or other people with diabetes you have heard about.

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DO be supportive of my efforts for self-care.

Help me set up an environment for success by supporting healthy food choices. Please honor my decision to decline a particular food, even when you really want me to try it. You are most helpful when you are not being a source of unnecessary temptation.

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DO offer your love and encouragement.

As I work hard to manage diabetes successfully, sometimes just knowing that you care can be very helpful and motivating.

Brought to you by:

The Behavioral Diabetes Institute P.O. Box 501866 San Diego, California 92150 858-336-8693 ©2007 Behavioral Diabetes Institute. All Rights Reserved.

To learn more, please visit us at www.behavioraldiabetes.org

Taking Control of Your Diabetes 11

TCOYD Conferences & Health Fairs 2010 Schedule February 6 February 27 March 20 April 24 April 25 May 8 May 22 September 11 September 25 October 30 November 13

Taking Control Of Your Diabetes 1110 Camino Del Mar, Suite “B” Del Mar, CA 92014 | www.tcoyd.org

Augusta, Georgia Sacramento, California Kalispell, Montana Honolulu, Hawaii Kauai, Hawaii New Orleans, Louisiana Raleigh, North Carolina Providence, Rhode Island Des Moines, Iowa San Diego, California Native American Program Oklahoma City, Oklahoma

Tel:

(800) 998-2693 (858) 755-5683 Fax: (858) 755-6854 Nonprofit Organization U.S. Postage

P A I D ®

San Diego, CA Permit No 1

TCOYD is a not-for-profit 501(c)3 charitable educational organization.

The Spirit of Giving

By Roz Hodgins

t Taking Control Of Your Diabetes, the support we provide to people living with diabetes and their loved ones makes a difference on so many levels. We help make it possible for people to achieve their personal goals and take control of their disease. Whether it be reducing their blood sugar levels, lowering their A1c’s, losing weight or working with family members who care for a loved one with diabetes, TCOYD relies on your continued support

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throughout this very personal process.

TCOYD relies on private philanthropy to sustain our critical work.

Your monthly gift, whether large or small, provides the sustained income we need to propel our outreach to people with diabetes throughout the country, while educating and empowering them to live well with their diabetes.

Become a monthly donor and your gift will automatically be transferred from your credit or debit card each

month, providing a fast, easy and secure way for you to partner with TCOYD in our mission.

To donate, visit www.tcoyd.org and click on “Make a Donation.”

You can choose to make a single one-time gift or establish a recurring gift. Every donation helps TCOYD achieve our mission, to educate and motivate people with diabetes to take a more active role in their condition.

Thank you for your kindness and generosity!

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: 1-800-998-2693 email: roz@tcoyd.org