2010 Winter Vol 31

®

Volume 31, Fourth Quarter 2009

ARE ALL EDUCATORS IN OUR OWN WAY Dr. Edelman’s Corner

inTHISissue 1 Dr. Edelman’s Corner Care of Your Skin 3 Taking Know Your Numbers 4 To Carb or Not to Carb Treatment of 6 The Diabetic Retinopathy 7 Question of the Month 8 Meditation–A Complimentary Therapy Gastro9 GERD: Esophageal Reflux Disease in Motion: 11 Diabetes Step Forward and Move Ahead Would TCOYD Be 12 Where Without Philanthropy?

was honored this year by the American Diabetes Association with the “Outstanding Educator in Diabetes” award. As I prepared my acceptance speech, and attempted to thank as many people as I could who supported me in my journey, I came to the realization that we are all educators in our own way.

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My wife, Ingrid, is a podiatrist specializing in diabetes; my mother, Joyce, has been a school teacher for over 30 years; my sister, Susan, is an investigative reporter for the New York Post; and my brother, Barry, is a clinical psychiatrist. While they work in varied fields, they are all superb educators, contributing to society’s knowledge base in different ways.

In my address to a large group of diabetes professionals from around the world, I told them my personal and professional story with diabetes. I developed diabetes when I was 15 years old. I lost 20 pounds and had the classic symptoms of excessive thirst,

urination and tiredness. I remember being yelled at by the other kids at the drinking fountain because I took so long to quench my thirst. My teachers reprimanded me for falling asleep during class when I could barely keep my eyes open. As I think back on those days, they highlight the importance of educating the public about diabetes and wiping out ignorance and intolerance.

I completed my professional diabetes training at the Joslin Diabetes Center in Boston and it is there I learned that getting PWD (people/person with diabetes) to put (Educators, continued on page 2)

Special Acknowledgements Medical Advisory Board Chair: Ingrid Kruse, DPM Veterans Affairs Medical Center Alain Baron, MD CEO, Ethos 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 Lorena Drago, MS. RD, CDN, CDE Bill King Joseph Nelson, MA, LP Paul E. Tornambe, MD, FACS, ASRS Janet Trowbridge, MD, PhD James Wolosin, 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 of Meeting Services

Antonio Huerta Director of Latino Programs & Exhibit Services

Roz Hodgins Director of Development

Alice Howe Manager of Continuing Medical Education & Website Development

Julia Lafranchise Coordinator of Social Media & Program Support

MyTCOYD Newsletter Editors: TCOYD Team 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.

2 MyTCOYD Newsletter, Vol. 31

Educators (continued from page 1) diabetes high on their priority list is a Steven Edelman, MD key component for long-term success.

Founder and Director As a young faculty member at UCSD Taking Control Of Your Diabetes and the Veterans Affairs Medical Center, I spent a lot of time and energy trying to educate healthcare professionand normality of feeling guilty, fearful, als on how to take better care of their anxious, frustrated and depressed about patients with diabetes. It was slow going. Diabetes care was not improving our own diabetes or about the diabetes fast enough at the community level and of a loved one. I have also come to appreciate that the type 3 diabetic (any I started taking these crucial messages person who lives with, or cares about, directly to those who are most affected someone with diabetes) plays a critical by this condition, the people with role in the ultimate diabetes. ...we must all first realize success of the PWD Since the beginning and,must be educated, too. that every one of us of TCOYD in 1995, we The key message here is have been pushing three plays an important role that we must understand in diabetes education... main themes and they that every one of us plays have never lost their a significant role in diabetes education, importance or magnitude: whether we are a person with diabetes, 1. You have the main responsibility for taking control of your diabetes. a type 3 diabetic, a health care professional or a member of the general 2. You are your own best advocate. public. Why? Because we must arm 3. Be smart and be persistent. ourselves with the latest up-to-date Simply stating these themes is one information, be sensitive to the many thing, but getting folks to take emotional issues involved with diabetes ownership of their health is another… management and be able to share our that was, and continues to be, the challenge. At that very first conference, knowledge in an effective and individuI recognized how thirsty PWD were for alized manner. We are all educators in our own way. We have the responsibilinformation about their condition and ity, to ourselves and others, to keep that much more needed to be done.

I have always believed that presenting learning about living healthy, happy real information infused with humor is and productive lives with diabetes.

The theme of this newsletter is ‘back a key component to information to basics’ and it features some of the best retention and contributes to our articles we’ve featured in past issues on overall success in making positive topics such as carbs, physical activity, changes. Another vital strategy is to meditation, your skin, eyes and directly address the emotional barriers stomach. Enjoy! of diabetes, which opens our minds to absorbing information by acknowledging and addressing the commonality

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Taking Care of the Skin You’re In

By Janet Trowbridge, MD, PhD

Put down the back scratcher and pick up the moisturizer. Products like Sarna and Eucerin Calming Cream can help sooth and relieve the itch. If prevention fails, your doctor can prescribe an antihistaOne of the major complaints people harsh environment. Helping your skin mine or other medications designed with and without diabetes have is serve its barrier role and preventing to treat the itch, especially if it is itchy skin. The bad news is that itchy pesky itch is as easy as this: preventing you from getting rest. skin can be an annoying and chronic 1. Moisturize, Moisturize, Moisturize!

Finally, it is important to keep condition that, if left untreated, can Frost yourself with moisturizer! in mind that intractable itching lead to damaged skin from constant 2. Avoid hot showers, excessive sun, can be a sign of serious disease, itching and rubbing. The good news synthetic clothing and powerfully such as liver or kidney problems or is there are a variety of simple chlorinated hot tubs and pools. even malignancies. So, if you have strategies you can follow to “beat Grease up! frosted, hydrated and generally the itch.” First, know that your skin is 3. Don’t scratch. Scratching leads babied your skin barrier and the the body’s biggest immune organ and to skin damage and, guess what? itching persists, seek the advice of serves as a first line barrier against a More itching. a medical professional.

here are a number of skin conditions that affect people with diabetes. They have impressive polysyllabic names like necrobiosis lipoidica, diabetic dermopathy and acanthosis nigrica and are best diagnosed and treated by a dermatologist.

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KnowYour Numbers

By Steven Edelman, MD

hat is clear from this person’s logbook is that on a daily basis the numbers jump from as low as 35 to as high as 478 mg/dl. What must be so frustrating for this person is that there are no consistent trends, which makes it almost impossible as a provider to make any adjustments in the dose of insulin or oral medications. For example, if the morning pre-breakfast values were always high, then increasing the nighttime dose of medication would be appropriate; however, if 1/3 of the numbers are low, 1/3 are high, and the last 1/3 are just right, then any adjustment would not be appropriate and could possibly be dangerous. What is amazing is that the A1c was 7.1%, indicating “great control”, but it is important to remember that the A1c is just an average and does not reflect the day-to-day ups and downs. Usually, in cases like this one, the person will need to improve the consistency of his/her daily eating and exercise schedule in order to reduce the day-to-day fluctuations.

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Taking Control of Your Diabetes 3

To Carb or Not to C Carb?

arb, that four-letter word: Beware of using it, much less eating it. In a blink of an eye, our world has become a carb-free zone. Should people with diabetes jump on the low-carb wagon?

That is The Question Let me help you unravel the carbohydrate knot:

By Lorena Drago, MS, RD, CDN, CDE u Carbohydrate is the nutrient in foods that raises blood glucose the most. People with diabetes need to budget their carbohydrate intake. “Carb Budgeting” does not mean “Carb Bankruptcy”.

You will still be able to eat carbs. u The amount and type of carbohydrate eaten determines how high blood glucose will rise after a meal. u Carbohydrates begin to raise blood glucose levels 15 minutes after a meal.

Carb Counting–3 Simple Steps: 1. Carb Oh Carb: Where Art Thou? Look in your refrigerator. Can

Lorena Drago, MS, RD, CDN, CDE is a registered dietitian, certified diabetes educator and Hispanic Educator Specialist. She is the author of the book titled, “Beyond Rice and Beans: The Caribbean Latino Guide to Eating Healthy with Diabetes”. Lorena also works as a consultant, conducting lectures, self-management workshops and diabetes patient education for managed care organizations, businesses and individuals. www.lorenadrago.com

4 MyTCOYD Newsletter, Vol. 31

2. How Many Carbs?

Find out how many carbs are in the foods you eat. For example, 4 ounces of orange juice has 15 grams of carbohydrates and 1 cup of raw broccoli has 5 grams of carbohydrates. Although both foods have carbohydrates, they don’t contain the same amount. Something else to remember when counting carbs is that size does matter. For example, a 1-ounce bagel has 15 grams of carbohydrates, while a 4-ounce bagel has 60 grams. Bagels, like other foods, have grown almost 100% since their market debut. You don’t have to learn the carbohydrate content of every existing food, just the ones you commonly eat.

Helpful resources: www.calorieking.com, www.diabetes.org, www.eatright.org www.diabeteseducator.org

3. How Many Carbs Do I Need?

Find out from your Certified Diabetes you identify which foods have carbohy- Educator how many carbohydrates you drates? It is perhaps easier to count the can have at every meal to maintain foods that do not have carbohydrates your blood glucose levels as close to than those that do. Carbohydrates are normal as possible. In general, men found in: need from 60-75 grams of carbohydrates u All breads, cereals, legumes (beans), per meal while women need from 45-60 starchy and root vegetables, pasta grams of carbohydrate per meal. The and rice total amount depends on your age, u All fruits and fruit juices gender, activity level, medications/ u All vegetables insulin, height and weight. u Milk, yogurt, cottage cheese u Sweets, candy, cakes, cookies Carbohydrate Tips: u Ketchup, barbecue sauce, u Glycemic Index (GI) – This tool balsamic vinegar measures the effect of carbs on blood Carbohydrates are not found in: glucose levels during digestion. A u Meats, poultry, fish carbohydrate that digests quickly, u Eggs like white bread, has a higher u Oils, margarine, mayonnaise, glycemic index than a carbohydrate and other fats that digests slowly, like barley. The

u

u

u

higher the GI, the faster glucose enters the blood stream. Low GI foods have a value lower than 55.

The GI is affected by many factors, such as cooking time and the presence of fat. For example: u Boiled spaghetti cooked for 5 minutes - GI 34. u Boiled spaghetti cooked for 10-15 minutes - GI 40. u Potato chips - GI 75 u Baked potato - GI 93 For more information about Glycemic Index, visit www.snac.ucla.edu/pages/resourc es/handouts/HoGlycemic.pdf Sugar Free Foods? – You pick a cookie. The nutrition label claims 20 grams of carbs, 0 grams of sugar and 10 grams of sugar alcohols. Too good to be true or creative accounting? u All carbohydrates are not created equal. Glycerin, polydextrose, dietary fiber and some sugar alcohols have negligible effects on blood

Carb Count

u

u

glucose levels.

Word of caution: Maltitol, one type of sugar alcohol, may impact blood glucose levels in some individuals.

Sugar alcohols may also cause gastrointestinal distress.

Remember, Low-carb does not equate Low-cal.

Putting It All Together Eating a meal is not just about identifying and quantifying carbohydrate foods. Fats and proteins are also part of your meal. Discuss with your registered dietitian how much fat and protein you should include in your meals. I always tell my patients to watch their p’s and q’s (portions and quality) Be mindful of your portions and select high quality carbs, proteins and fats.

A healthy and realistic eating plan is a work in progress that needs fine tuning to keep your blood glucose numbers in check!

Food

Serving Size

15 grams per serving Fruit and fruit juice 1 small fruit or 4 ounces juice Starches: bread, cereal, 1 ounce bread, 1/2 cup cooked rice, pasta cereal, 2/3 cup cold cereal, 1/3 cup cooked rice or pasta Starchy vegetables: corn, peas 12 grams per serving Milk

5 grams per serving

½ cup 8 ounces

Yogurt

6 ounces

Non-starchy vegetables: spinach, carrots, broccoli

1/2 cup cooked or 1 cup raw

New in 2010 TCOYD Diabetes Makeover Project ntroducing our reality based documentary style video series!

Our ‘TCOYD Diabetes Makeover’ will introduce five people with diabetes who have a strong desire to get their diabetes under good control to a ‘Dream Team’ of diabetes care professionals who will offer them regular guidance and practical advice as they work to control their disease and live a normal life. Video crews will follow their progress, both as individuals and as a group, for 5 months. We will visit with them at home, with their families and during their daily lives, including their visits with the ‘Dream Team’. Watch our TCOYD website for the announcement of our cast of people with diabetes and the identity of our ‘Dream Team’ of diabetes professionals.

We will film from January through June. The show will be posted on our website, as well as our TCOYDtv YouTube channel, 3 segments a week for 26 weeks, beginning in May.

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Stay tuned!

Taking Control of Your Diabetes 5

The Treatment of Diabetic Retinopathy: Past, Present and Future

By Paul E. Tornambe, MD, FACS, ASRS

OST PEOPLE WITH DIABETES GO BLIND BECAUSE THEY ARE SEEN TOO LATE. Most cases of diabetic blindness are preventable. If present treatment techniques are instituted appropriately, and in a timely fashion, most people with diabetes should be able to enjoy lifelong vision. The tragedy today is that many people with diabetes still don’t get to our attention until significant retinopathy has developed.

The general rule of thumb is that those who develop diabetes in childhood should have their eyes examined the first time at about age 13 (puberty), and those who develop diabetes after age thirteen should have an eye examination promptly after the diagnosis is made.

Women who develop gestational diabetes, or diabetes that is first diagnosed during pregnancy, should also have a retinal examination.

Pregnant women with diabetic retinopathy must be monitored more closely during the pregnancy.

Medical management of blood sugar, blood pressure and lipids, diet and exercise, remain the best means to prevent, delay, and minimize the chances of developing significant diabetic retinopathy. In the mid-

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1970’s the National Eye Institute conducted many clinical trials that clearly defined when and how to begin treatment for those who develop diabetic retinopathy. Those guidelines have not changed, and if followed, will significantly decrease the incidence of severe visual loss.

before it is clinically apparent, and may influence the decision to treat with laser earlier than might be determined by other tests alone.

If laser treatment fails, an operation called a vitrectomy is performed. During this operation the vitreous jelly inside the eye is removed (don’t worry, like the Retinopathy Management appendix, the vitreous has no useful Laser photocoagulation still function and just causes trouble). remains the corner stone for the The abnormal blood vessels are also management of both background removed and/or cauterized. We have (mild) diabetic retinopathy and performed vitrectomy since the midproliferative (severe) retinopathy.

1970’s. The instruments have been To properly greatly refined and determine the the operation is I believe that within the next extent of helpful in most five years we will continue to diabetic cases. Vitrectomy reduce the incidence of retinopathy a surgery is a blindness from diabetes... complete eye significant operation examination is performed with with some risks but, when indicated, color photographs of the retina. the benefits of vitrectomy far outA diagnostic test, optical coherence weigh the risks. This operation tomography (OCT) is also routinely should only be performed by a used to determine if there is damage Retina Specialist, an M.D. who to the retina or the back of the eye has taken at least one year (and from diabetes. OCT is a very usually two years) of extra subspeaccurate picture of the eye. It cialty training in Retinal and permits much higher resolution Vitreous Disease. You may locate of the macula. The OCT study is a Retina Specialist in your area painless, takes a few minutes to by going to the American Society perform, and requires no injections. of Retina Specialists web site: The OCT can determine swelling www.retinaspecialists.org

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Future Therapy As Yogi Berra said, “The future isn’t what it used to be!” New pharmacologic treatments to both prevent diabetic retinopathy and treat diabetic retinopathy are on the horizon.

Most of these treatments are directed toward a protein called vascular endothelial growth factor, or ‘VEGF’, which causes blood vessels to leak (as with background diabetic retinopathy), or which causes new, weak, abnormal blood vessels to grow into the eye (proliferative diabetic retinopathy). These anti-VEGF treatments come in pill form, but some require an injection into the vitreous cavity. We are hoping that these drugs may someday be available in an eye drop form!

These drugs will likely not take away the need for the laser or vitrectomy altogether, but may reduce the amount of laser needed and decrease the number of eyes requiring vitrectomy surgery.

I believe that within the next five years we will continue to reduce the incidence of blindness from diabetes and maintain and, even restore vision, in significantly more eyes than we do today. But, it still requires that we diagnose diabetic retinopathy in a timely fashion.

In five years people with diabetes will still go blind if we get to them too late!

Dr. Tornambe is a past president of the American Society of Retina Specialists (A.S.R.S.) and is in private practice with offices in Poway and La Jolla, California. www.retinaconsultantssandiego.eyemd.org

Question

of the Month

By Steven Edelman, MD

Can someone have both type 1 and type 2 diabetes? I was diagnosed with type 1 diabetes 25 years ago as a child. Both of my parents have type 2 diabetes and I’m wondering if I can get that, too.

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nswer: Unfortunately, yes. I have a number of patients with both types of diabetes. Type 1 diabetes is an autoimmune condition where the body’s antibodies attack the insulin producing cells in the pancreas and destroy insulin production. Type 2 diabetes is an insulin resistant condition where the body produces insulin, but can’t use it effectively.

The causes of each condition are very different and can occur together in one individual. Typically, people are diagnosed with type 1 diabetes first, but over time, they can start to develop the metabolic syndrome that is so common in type 2 diabetes. Metabolic syndrome, which is strongly associated with insulin resistance and type 2 diabetes, consists of a group of cardiovascular risk factors, such as abnormal cholesterol levels, elevated blood pressure, tendency to have blood that clots easily (hypercoaguable state), and abdominal, or central, obesity. Having a strong family history of type 2 diabetes will also increase the likelihood.

If you think about it, type 2 diabetes is very common in our society, so if you have type 1 diabetes, and also have the risk factors for getting type 2 diabetes, you may find yourself with both. Managing type 1 and type 2 diabetes at the same time involves replacing the missing insulin by injection or insulin pump, and adding oral medications to enhance the effectiveness of the administered insulin. Because of insulin resistance, people with type 2 diabetes in addition to type 1 diabetes frequently require more insulin than those with type 1 alone.

TCOYD Corporate Sponsors Platinum

Gold Silver

Taking Control of Your Diabetes 7

ME D I TA T IO

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Joe Nelson is a licensed psychologist ad certified sex therapist in Golden Valley, Minnesota. The issues of those he sees for psychotherapy include adjusting to the diagnosis of diabetes as well a depression and anxiety.

You can contact Joe Nelson at mindfuljoe@hotmail.com.

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A Complimentary Therapy

By Joseph Nelson, MA, LP

believe meditation is a practice When I got home I worked with that can benefit anyone. I started some other professionals to offer the meditating when I was a sophomore same program in our clinic. The in college some 35 years ago. I found program was called the Mindfulness the practice to be a powerful calming Based Stress Reduction and Relaxation influence. The type of meditation I Program, known as the MBSR program. practiced years ago was known as There are now hundreds of these vipassana or insight oriented programs around the country and meditation. At the time, can be found by looking online; Transcendental Meditation was just Google MBSR. becoming quite popular, so I believe I believe people who have I took the training for that people who diabetes can benefit from this and began practicing two have diabetes program or other forms of times per day as they meditation in a number of ways. can benefit instructed. This was also from this quite calming and gave me a type program or other forms of meditation in of rest that is rather unique to a number of ways. The relaxation that this practice. These were very comes from meditation is worth the helpful tools in my young effort all by itself. We are all challenged adulthood, when life was very by worry and stress. Meditation gives busy and there was not much a ‘time-out’ from our usual challenges importance placed on living mindfully. and offers an opportunity to practice a Unfortunately, however, I fell off the technique of settling the mind and body cushion. One day for no good reason, through the simple activity of focused I quit meditating. breathing. After practicing meditation It was about twelve years ago at regularly, the attitudes of patience, a conference called the National acceptance, non-judging, and letting go Institute for the Clinical Application become part of your daily experience. of Behavioral Medicine that I heard Jon This practice helps stave off anxiety Kabat-Zinn speak about the research he and depression. If you have lived with had done using a program he developed diabetes for a long period of time, you which incorporated Mindfulness may appreciate how important these Meditation as its central component. attitudes are in living day-to-day with The program was offered to patients at the unpredictability diabetes brings.

Mass General Hospital. These patients I hope you will consider giving had chronic pain, depression, anxiety, meditation a try as complimentary diabetes, migraines, and any number therapy. of other conditions which had been Check out the following resource: resistant to conventional treatment.

Full Catastrophe Living by The results he presented were Jon Kabat-Zinn astoundingly successful.

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GERD: GASTRO-

ESOPHAGEAL REFLUX DISEASE

By James Wolosin, MD

astro-esophageal reflux, or GERD, is a very common condition that affects up to 20% of the population in America. If you have diabetes this problem may be even more common and more severe. When blood sugars are elevated and diabetes is poorly controlled, the stomach does not empty properly leading to an increased frequency of reflux, heartburn, and indigestion.

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Although the lining of the stomach is resistant to the damaging effects of acid, the esophagus is not, and even small amounts of acid regurgitation can injure the lining causing pain and ulceration. A one-way valve known as the lower esophageal sphincter is located between the stomach and the esophagus. It is designed to allow food and fluid to enter the stomach and prevent backflow into the esophagus; unfortunately, this valve frequently malfunctions and allows acid reflux to occur. The most common symptom that occurs is a burning feeling in the chest called heartburn (even though there is no relationship to the heart itself). Other symptoms may include chest pain, regurgitation of fluid, nausea, vomiting, and difficulty swallowing. If acid backs up all the way to the throat, then “extra-esophageal” symptoms may occur. These include sinus irritation, hoarseness, laryngitis, worsening asthma, and even pneumonia.

Although the lining of the stomach is resistant to the damaging effects of acid, the esophagus is not, and even small amounts of acid regurgitation can injure the lining causing pain and ulceration.

Feeling the Burn For most people, GERD is simply a mild nuisance condition that leads to heartburn after large meals or overindulging. For others, it can be a very serious condition leading to complications such as ulcers, bleeding, and even cancer. The stomach normally secretes acid that aides in the first stages of digestion.

Hiatal Hernia Many people with GERD will also be diagnosed with hiatal hernia.

This occurs when the opening in the diaphragm through which the esophagus passes enlarges and the stomach slides upward into the chest. The “sliding” hiatal hernia predisposes the individual to acid

reflux. Unlike other hernias, hiatal hernias usually do not need to be repaired surgically.

How Do You Know?

A diagnosis of GERD is often made solely on the treatment of symptoms and treatment can be started right away. In some cases, further testing is necessary. A barium swallow or upper gastrointestinal x-ray may be advised. Upper endoscopy is a more accurate test that allows the physician to pass a slim tube with a digital camera on the tip into the mouth, esophagus, stomach, and intestine (under sedation of course!). This provides the detailed information regarding the tissue lining these various organs and also allows biopsies to be taken.

In some cases, measurement of esophageal acid exposure over a 24-hour period may be advised.

What Can You Do? Treatment of GERD first entails lifestyle modifications. These include weight loss (if you are overweight), smoking cessation, avoidance of eating 3 or more hours before going to bed at night, and elevation of the head of the bed 6 to 8 inches. A diet that is low in fat and spices may be beneficial and, of course, one should avoid any foods that tend to precipitate symptoms. Control of diabetes is especially important as high blood sugars may slow down the rate at which the stomach empties, leading to worsening GERD. In addition, if diabetes is (GERD, continued on page 11)

Taking Control of Your Diabetes 9

Diabetes in Motion: Step Forward and Move Ahead!

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o you have diabetes and everything is “OK.” When your family or friends ask, you answer, “Yeah, I’m good, thanks for asking.”

But is “good” good enough? Are you fooling yourself and everybody else around you? Many of us with diabetes fall into this trap; it’s like a cocoon of denial that we choose to live in, protected from the invasion of interest from those around us.

Active control is a better way to live with diabetes.

People who intensively manage their diabetes reduce the risks, or prevent the risks, of diabetes complications. These people, much like successful people anywhere, share many of the same traits: u Great working knowledge and an insatiable quest for more information to better manage and treat their condition.

u

By Bill King

The optimistic belief in their ability to cope well with their condition for the long haul.

The ability to review data, trends and patterns with clarity and adjust accordingly.

The ability to honestly and effectively communicate with those who care about them, and with those who can help them.

An active lifestyle, keeping mind and body in motion.

The willingness to exercise, which benefits the body and the psyche.

Healthful eating habits. Most people who are successful realize the keys to their success are wellplanned, balanced meals, and limited over-indulgence.

Good, sound, sleep techniques.

The body needs rest, relaxation and sleep. A troubled soul can cause difficult sleep patterns and poor rest can lead to lower selfesteem and a lack of attention to detail.

about diabetes. But, without her in my life, I realize that I would not be as healthy and safe as I am today. In u the past, I would sit in my cocoon and tell her, “I am fine; don’t worry about me; I just checked myself and u I’m 118” (lie). Why did I act this way? The less I tell people, the less I have to face what I know is not the best for me. I can continue to go u forward without clarity and accept a level of care and a quality of life that u is not healthy, safe, or best for my body, mind and soul. u Today, with a greater knowledge of where I am and what I need to do to survive, stay healthy, and live a great life with diabetes, I am confident in my approach to achieve u a higher quality of life. Take each day and work to make improvements. Follow the lead of others with a proven path to success. Look closely at yourself and choose a better path. Take the active steps to change and move forward to the good life with diabetes. Love yourself My wife is a nurse and I sometimes and respect those around you who think she knows a little too much care about you.

Exercise Isn’t Just For The Gym he key to sticking with an exercise program is to find an activity you like. You do not necessarily have to go to the gym to exercise. You can go dancing or take a dance class. You can take up one of the many martial arts such as Aikido, Karate, Tae Kwon Do or Tai Chi. If an organized activity is just

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Bill King has been living with type 1 diabetes since October, 1984. Bill works with Animas Corporation, is a board member of the Diabetes Exercise and Sports Association (DESA), and travels the country motivating people to keep active in the balance of life with diabetes.

10 MyTCOYD Newsletter, Vol. 31

not for you, find other ways to get moving. Take the stairs instead of the escalator. Park at the farthest parking space in the parking lot instead of driving around and around looking for the one located nearest to your destination. Do you like to shop? Take a walk around the mall. Do you like animals?

Is it worthwhile to search for a physical activity that you enjoy? You bet it is. Regular exercise offers an almost endless list of physical and emotional benefits:

Volunteer to walk the dogs at your local SPCA or animal shelter. Are you just too busy or just don’t feel like leaving the house? Put on some lively music and dance while you cook dinner or vacuum the house.

Do push-ups, sit-ups, leg-lifts or walk in place during the commercials of your favorite show. Get creative.

Have fun. Make yourself a priority.

Get moving. Feel better!

u u u u u u u u u u

Improves blood sugar control Helps you meet your weight goals Lowers your risk for heart disease Strengthens your bones, heart and cardiovascular system Improves strength, flexibility, and endurance Improves circulation and flexibility Improves your sleep Heightens self-esteem Reduces feelings of depression, stress and anxiety Helps you feel relaxed, fit and healthy

GERD (continued from page 9) poorly controlled for many years, intestinal nerve damage can occur, leading to worsening problems with stomach emptying as well as abnormal movement of the esophagus itself.

Numerous medications are available for the treatment of GERD. Antacids, such as Maalox, Mylanta, Tums and Gaviscon, may provide relief for mild heartburn.

H2 blockers are a group of medicines that decrease acid output from the stomach and are effective for treatment of mild GERD. These are available over the counter and by prescription. H2 blockers include Tagamet, Zantac, Pepcid, and Axid.

Proton pump inhibitors, or PPI’s, are

a stronger group of medicines that suppress stomach acid secretion to a greater degree and are more effective in healing ulcerations of the esophagus associated with GERD. These include Prilosec (now available over the counter at a very reasonable price), Prevacid, Aciphex, Protonix, Nexium, and Zegrid. All of these medications are safe to take long term. For those patients who do not do well with medications, an effective surgical procedure called fundal plication may be considered. Minimally invasive endoscopic procedures are available to stop GERD, but their long-term effectiveness is uncertain and many consider these

DIABETES

to still be experimental.

GERD is a very common and treatable condition with the potential for serious complications if undiagnosed and untreated. It is especially important to control your blood sugar well because high blood glucose may have a negative impact on GERD over both the short and long term. It is important to speak with your physician if you are having persistent symptoms.

James Wolosin, MD, is a practicing gastroenterologist at the Sharp Reese-Stealy Medical Group in San Diego, CA. He is actively involved with clinical research and the development of new medications for the treatment of intestinal problems.

TAKING CONTROL OF YOUR

CONFERENCE & HEALTH FAIR

Sat. May 22 ◆ 9am - 5pm ◆ Raleigh Convention Center, Raleigh, NC

Co n fe re n ce 2 0 1 0

Sat. May 22, 5pm – Sun. May 23, 5pm Marriott Center City, Raleigh, NC

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 TBA

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

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

the lifeblood of Taking Control Of Your Diabetes—thank you!

Where Would TCOYD Be Without Philanthropy?

By Roz Hodgins

hilanthropy has enabled Taking Control Of Your Diabetes to meet the needs of the growing population of people with diabetes for 15 years. Thanks to people like you, our not-for-profit organization has grown from its first year of hosting just one TCOYD educational conference for people with diabetes and their loved ones, to 111 conferences held nationwide with more than 150,000 people attending.

Your support helps to further our efforts by allowing TCOYD to offer conferences at a reduced rate, far below the actual cost of $175.00 per attendee.

Through your generosity we have been able to expand our outreach to the Latino community, a population severely impacted by diabetes, and offered in

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Spanish at locations selective to this population. Additionally, TCOYD’s television and radio programs open up a world of diabetes education to thousands who never have the opportunity to attend a Taking Control conference.

Since 2006 we have been able to support the increased demand for our unique education programs for healthcare professionals, hence providing the latest diabetes information to doctors and nurses who in turn assist the patient with knowledge of how to better care for themselves.

Without your support, TCOYD would not be able to continue our outreach to the diabetes community.

Your commitment is important to us and I consider your personal involvement

TCOYD is pleased to announce that Roz Hodgins has joined our staff as Director of Development.

Roz is well acquainted with TCOYD, and the world of diabetes, as she served as Director of Development at The Whittier Institute for Diabetes at ScrippsHealth from 1996-2002.

Most recently she was Director of Major Gifts and Foundation/ Corporate Relations at The Scripps Research Institute. Roz will bring a personal touch to the fundraising experience by creating relationships with our donors, helping them understand that their contributions and support are the lifeblood of making a difference in those people seeking to take control of their diabetes.

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