NEWSLETTER
MY
Fall 2011 Volume 37
Patient and Professional Inertia Major Barriers to Taking Control of Your Diabetes Dr. Edelman’s Corner
INSIDE Team Support Helps in the Diabetes Marathon Page 3
Getting the Most from Your Insulin Page 4
Question of the Month Page 5
A Menu of Love Page 6
Know Your Numbers Page 7
An Essential Diabetes Lifestyle Resource Page 10
TV Aurora Gold Winner Page 11
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atient and professional inertia refers simply to the delay in appropriate treatment due to a whole host of reasons but mainly ignorance, fear of change, unbreakable old habits and misinformation. Let’s tackle professional inertia first, as it is a HUGE problem and hampers timely and appropriate care for people with diabetes. When caregivers graduate from medical, nurse practitioner or physician’s assistant school, multiple studies have shown that their practice habits get stuck in the mud. If a new treatment or device comes along,
getting providers of care to become knowledgeable about them, and then change their practices enough to prescribe them for their patients, is really tough and takes a long time…sometimes up to 10 years! I spend a lot of my time educating professionals to take better care of all of us with diabetes and it is so frustrating when I speak to doctors who have never prescribed Byetta or Victoza and have never heard of continuous glucose monitoring. This happens on a very regular basis and I just want to scream OMG, but I don’t, unless I am alone in my car! Patient inertia is different, as the individual living with diabetes is his or Inertia (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 Margery Perry Terrance H. Gregg CEO, DexCom, Inc. Daniel Spinazzola President, DRS International Contributing Authors Jennifer Braidwood Julia Baron dLife Staff Steven Edelman, MD Talia Edelman Robert Lewis Candis Morello, PharmD, CDE Joseph Nelson, MA, LP
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 Roz Hodgins Director, External Affairs Jennifer Braidwood Manager, Outreach and Continuing Medical Education Jimm Greer Manager, Social Media David Snyder Manager, Exhibit Services
MyTCOYD Newsletter Editor: Jennifer Braidwood Assistant Editor: Talia Edelman 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. ©2011 All rights reserved.
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Inertia (continued from page 1)
her own biggest barrier to achieving control. The best way to define patient inertia is to give you some examples. First, a young, smart and dedicated doctor with type 1 diabetes since childhood is still using a syringe and vial to give himself fast acting insulin throughout the day. The syringe is so old you cannot see the labeling on the side and the needle is extremely dull. The insulin is also being exposed to light, heat and agitation (all factors that make the insulin less potent). For some reason, he is not using an insulin pen, which delivers very accurate doses and the insulin is protected from the environment. Second is a person who has type 2 diabetes and will not take her statin medication to keep her LDL cholesterol at goal because she read on the internet that her Lipitor causes muscle aches. Give me a break. Heart disease is the number one killer of all Americans and these very safe statin drugs have done more to reduce heart attacks than any other prescription drug. These medications have been used in 100s of millions of people worldwide and have withstood the test of time. The third example is a patient of mine who would rather take an herbal remedy from the local vitamin store for his diabetes, even though he does not know what the heck is in it, than an FDA approved oral medication where we know the pros and cons, as well as the
efficacy of the therapy. He tells me that the powder he bought is from the East African subterranean multileaf monkey bush, also known as E.A.S.M.L.M.B. to the crooked company that makes it, and that it is “natural”. I tell him that strychnine is natural! Are you getting the picture? Do you have patient inertia?
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Knowledge wipes out fear, ignorance, misconceptions and inertia. This is what Taking Control of Your Diabetes is all about.
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Reversing patient and professional inertia comes with timely, consistent and appropriate education as well as eliminating misinformation from family, friends, the internet and people who work at some of the herbal and vitamin stores. Professionals need to remember to continuously improve upon their original medical education in diabetes and allow more time for mandatory continuing diabetes education. Patients may need the help of a clinical psychologist, but for sure, knowledge is the key. Knowledge wipes out fear, ignorance, misconceptions and inertia. This is what Taking Control of Your Diabetes is all about. See you at a conference soon!
Steven Edelman, MD Founder and Director Taking Control Of Your Diabetes
Team Support Helps in the Diabetes Marathon
not going to judge the patient on how well they did the treatment, and when it’s done, it’s done. With this model the healthcare professional doesn’t need to know anything about From the Desk of Joseph Nelson, MA, LP, CST the patients life, their family, or their level of motivation. When it edical care is often times seen comes down to it, they really don’t as a brief event. It is intended even need to know the patient! The patient also doesn’t need to let to diagnose a problem, decide on the healthcare professional in on a treatment and have the patient how his or her life works, and how follow through with the recomit will affect the treatment that is mendation. Eventually, the patient being suggested. This acute model gets better and all is well and good. is straight-forward and simple and This type of care (the acute model) it works well for colds, broken arms, has been effective and is the model and the flu; however, for diabetes medical professionals continue to count on for most urgent health care we need a different model. needs. This is how health professionals are trained and this is also how A vital part of successful most patients have come to believe treatment is an open and medical treatment is supposed to be. continuous dialogue that Unfortunately, with diabetes, this includes the small and large model of care causes confusion and life issues of the patient. creates significant communication and treatment problems for patients The model that works for diaand providers alike. betes requires quite a commitment The first challenge with this from both the person with diabetes acute model is that patients do not and the health professional. The have much communication with their healthcare professionals. They commitment is to jointly manage get treatment recommendations and the disease. The patient and the are expected to follow through with healthcare professional must both be willing to engage in an ongoing them. There is no discussion about the treatment and there is no follow discussion about treatment options up with the health care professional; and expectations. A vital part of afterall, the healthcare professional is successful treatment is an open and
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continuous dialogue that includes the small and large life issues of the patient. It is important to create an awareness of the interaction between diabetes and day to day life. This health care partnership is very different from the acute care model. Individuals with diabetes are likely to find it is far more supportive in helping manage their disease. Joint goals, rather than two sets of goals, allow patients and healthcare professionals to foster a positive partnership with a similar outcome in mind, living a happier and healthier life. Even though this is an excellent model for diabetes care it is still trying to push its way to the forefront of diabetes healthcare practices. The chronic care model, or health care partnership, is most commonly recommended and used by certified diabetes educators. It is important for patients and providers alike to remember that coordinated care works best if patients are willing to share honestly about their life and how diabetes fits or doesn’t fit into it. Make a change in YOUR treatment plan today and start a dialogue with your health professional about how you might work together more effectively! Joseph B. Nelson, MA, LP, CST, is a Licensed Psychologist with Golden Valley Psychotherapy Associates in Minneapolis, Minnesota. He is a Masters level Licensed Psychologist and a Board Certified Sex Therapist. He has worked as a therapist for 34 years and for the last 5 years has been engaged in a psychology private practice.
Taking Control Of Your Diabetes
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Ask Your Pharmacist
By Candis M. Morello, PharmD, CDE
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such as metformin and TZDs (thiazoladinediones like Actos®, pioglitazone or Avandia®, rosiglitazone) help improve insulin sensitivity, thereby improving IR. Other oral medications used in T2DM called DPP-4 inhibitors (like Januvia®/ sitagliptin, Onglyza®/saxagliptin and Tradjenta®/linagliptin) have been shown to affect insulin producing beta cells and improve diabetes control. Two classes of injectable agents GLP-1 angonists (Byetta®, exenatide) and GLP-1 analogs (Victoza®, liraglutide), also known as incretin mimetics, have been Injection Tips keeps the insulin dosing at once used with insulin and may allow for Both the dose of basal insulin as per day. For example, if the basal a reduction in daily insulin requirewell as the insulin injection site play insulin dose is 90 units daily and ments. Another injectable agent, a large role in glucose control. Let’s the A1C is 8%, then increasing the pramlintide (Symlin®), is an amylin use Lantus® (insulin glargine) as an dose by about 10% (to 100 units per analog that has also been successfully example. If the basal insulin dose is day) means injecting two 50 unit used with insulin and has caused over 80 units in one site, the absorp- injections at the same time per day. reduced daily insulin requirements. tion of that insulin is not always as Also, new research shows that for Unlike the other injectable agents, predictable or at the same rate as split dosing, such as in this example, however, pramlintide can only be with smaller doses. One option is injecting in different locations of the used in people who use mealtime to evaluate the A1C— the marker abdomen (preferably opposite sides insulin (like lispro, aspart, glulisine, of glycemic control. If the A1C is of the body) improves absorption or regular insulin). within 0.5% of the target value, and A1C values. then increasing the insulin dose to Make Muscle by Moving! over 80 units in that one injection Adding Other Diabetes Another way—and really the may help reach the goal. However, Medications most effective—is to combat IR if a greater A1C reduction is needed, Oral tablets and injectable by shrinking fat and strengthenthen split the dose of the insulin. diabetes drugs can also be added to ing muscle. This does not require This requires two injections but improve the insulin regimen. Agents running marathons or being a
nsulin resistance (IR) is one of the hallmark features of type 2 diabetes (T2DM). Glucose requires insulin to enter muscles and other tissues so that it can be used as energy in our bodies. Essentially, insulin acts as the key to open the door for glucose entry. With IR, somehow the lock has changed shape and insulin does not work as effectively to get glucose transported into cells. Instead, glucose remains in the blood causing hyperglycemia and long-term complications. For many people with T2DM very large daily doses of basal insulin are required to combat the barrier of IR. There are three ways to maximize the use of insulin in people with T2DM and IR including: practicing helpful injection techniques, adding other diabetes medications that combat IR, and building more muscle.
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Question of the Month
certified weight lifter. By simply adding daily activities like walking, swimming, dancing or bike riding, you can get your heart pumping strong, reduce weight and improve IR and A1C values. Additionally, by lifting small weights to improve arm and leg muscles, which use lots of glucose, you can improve IR and help control diabetes. Consider joining a gym, working with a certified trainer or exercising with friends to keep you motivated. In addition to improving diabetes, exercise has many other health benefits (Table 1). Be sure to get your exercise program approved by your health care provider before you begin.
The Bottom Line There are multiple ways to optimize your diabetes control even if you need high doses of insulin to combat IR. Using proper injection techniques and possibly adding medication are certainly options, but the best way to improve IR is to move, move, move‌. everyday!
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62-year-old man with type 1 diabetes for 35 years was being evaluated by his orthopedic surgeon for elective knee surgery to be performed in the morning. The doctor told him not to take his long acting basal insulin (Lantus) that night before surgery. The patient complied and when he got to the operating room his blood sugar was over 400 mg/dl, even though it was normal at bedtime the night before. Not only was the surgery cancelled but, also, this poor and misinformed patient had a heart attack, probably brought on by a condition called diabetic ketoacidosis that is caused by having very little insulin in the system. So, how should you prepare before going to the operating room if you have diabetes? Answer: You need to do your homework. This physician almost killed his patient due to ignorance. This patient should have been knowledgeable enough to challenge his doctor. If you are on insulin, the issue is of extreme importance, compared to folks only on pills to control their diabetes. For sure, ask your regular diabetes caregiver as a start. If you are on basal insulin, you most likely will not need any reduction as surgery is a stress on the body and in fact, some patients need more than normal. Others may have their insulin reduced slightly depending on the type of diabetes, the length of surgery and other variables. The bottom line is that you need to take control of your diabetes‌especially during surgery!
Get Moving! Here’s Why! Improve insulin sensitivity Reduce insulin resistance Lower daily insulin doses Lose weight Lower blood pressure Lower LDL and increase HDL Feel happier Improve DIABETES CONTROL Table 1
TCOYD Corporate Sponsors Platinum Gold
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Taking Control Of Your Diabetes
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Living Well
A Menu of
Love By Chef Robert Lewis
this dish is simple, it is still full of flavor. The extra virgin olive oil, garlic and lemon give it a clean, fresh taste. And the brightly colored vegetables add texture and hare the love is all flavor that are a great combination about showing a friend or that with fish! Portobello mushrooms special someone just how much you add a steak-like element your love him or her. My Salmon Skewers sweetie won’t want to miss. of Love recipe is perfect even for To take advantage of the full those who have little experience health benefits of salmon, you’ll cooking. Let me share with you want your fish to be fresh. When some tips and techniques to help choosing salmon, look for these you exercise your culinary muscles three signs of quality: healthfully and with flair! What better way to express love to your sweetie than to prepare a Serve this dish with some cooked brown rice. meal that is not only delicious but Serves 4. Nutrition per serving: 226 calories, 26.5 grams fat, 9.31 grams carbohydrates also extremely healthy? The easiest way to stay healthy is by staying on filets ize fresh salm put in your own kitchen, where 2 medium-s r of garlic in a ja 2 tablespoon you have control over the quality d fresh choppe and quantity of the ingredients. in olive oil rg vi a tr ex ¼ cup basil esh or dried The salmon in my recipe is high in 1 teaspoon fr juice fresh lemon 2 tablespoon Omega-3 fatty acids, and the fruits 1 red pepper and vegetables pack lots of antiers 2 green pepp n oxidants. Part of why I always have io on 1 red ello or button 1 large Portob loved salmon is because preparing mushroom it is so simple and even though s mboo skewer
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4 ba
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1. The freshest salmon filet will be firm to the touch. 2. The flesh will be a nice light red (containing high amounts of health enhancing Omega-3 oils). 3. The fish won’t smell “fishy.” A light, mild scent is what you should seek. Your butcher at the market will be happy to cut your salmon into 1-inch cubes, the perfect size for our recipe. It has been said that the way to the heart is through
ers of Love Salmon Skew if your 1-inch pieces and cut it into the job for you. on lm sa n ki S 1. ’t already done l. butcher hasn juice in a bow sil and lemon igerate for 1-2 ba l, oi c, rli d refr 2. Mix ga ith salmon an Combine it w minutes hours. water for 10 ewers in cold from sk o em bo th m ep ba ke 3. Place . (This will em th g in ild before bu e peppers, burning.) eces. Alternat s. pi ch in 1to er s in 4. Cut veggie ooms, and salmon on skew rning tu , es onions, mushr ut in m for 8 to 10 ill degree gr t 5ho 37 a a 5. Place on king sheet in ba a on e ac often, or pl 12 minutes. oven for 10 to
Know Your Numbers
Strategy to Improve Your Overnight Blood Sugars By Steven Edelman, MD
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his log book is from a 27 year old female with type 2 diabetes for 3 years who is currently on two oral agents during the day (metformin or Glucophage and sitigliptin or Januvia) as well as an injection of long acting basal insulin (insulin detemir or Levemir) at night. As you can see from the logbook, the bedtime blood sugar values are pretty consistently high, well over 200 mg/dl. The other time of day when the numbers are not at goal is first thing in the morning before breakfast, however, they are not as high as the bedtime values. This woman was asked to titrate upward her bedtime Levemir dose of insulin by 2 units every night until her morning numbers were consistently below 140 mg/dl. After several weeks she has gone from her starting dose of 10 units at night up to her current 62 units. Will she ever get her mornings down to her goal? Well, one of the most important trends I see is that the bedtime numbers are extremely high and one of the first goals is to bring those down to less than 180 mg/dl at bedtime in order for the overnight basal insulin to work more effectively. She will need to reduce her calories at dinner, exercise after dinner or take a dose of fast acting insulin with her dinner to improve her nighttime numbers, because increasing her basal insulin at night is not addressing the main problem.
the stomach. This is almost always true, so why not try being a chef for your friend or loved one? Here’s one last hint: True love would be doing the dishes, too! Are you feeling the love already? Check out Chef Robert Lewis’ website, happydiabetic.com. You’ll find more recipes.
Robert Lewis of Bettendorf, Iowa, a professional chef since 1976, was diagnosed with type 2 diabetes in 1998. Also known as ‘The Happy Diabetic,’ he brings encouragement and good eating to audiences around the country, creating five star recipes that are delicious and healthy for all — including those with diabetes.
Taking Control Of Your Diabetes
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Demystifying the RealAge Test and Your Results By Julia Baron
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ge may not just be a number anymore. That’s right. In fact, it may have to do with several lifestyle factors rather than actual years under your belt. Many Americans are finding this to be true through the latest innovation in online health assessments, The RealAge Test. More than 27 million people have taken the newly revamped assessment, only to be surprised by the difference between their actual age and their biological age.
The New Real Age Test The newest version of the test, released in early 2011, features the most accurate scientific calculation of age based on factors ranging from walking your dog to your own opinions of your health. Not only does the test give you your actual biological age based on your answered criteria, it also offers a solution to your aging woes. For example, someone who is 55, exercises regularly and has no history of heart disease may actually be biologically younger. On the other hand, someone who is overweight, does not engage in regular exercise and has high blood pressure may be older than their actual age accord-
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ing to the test. Despite their results, the personalized “Grow Younger Plan” offers tips and tricks to help you not only feel younger, but add years on to your life, specifically focusing on areas where you need improvement.
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...the test give you your actual biological age based on your answered criteria, it also offers a solution to your aging woes.
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The reworking of the RealAge Test was a lengthy and intricate process. It included the creator of the original RealAge Test, Dr. Michael Roizen, and was led by Dr. Keith Roach, Chief Scientific Officer for RealAge. The team examined multiple relevant medical studies, clinical trials and data from the Centers for Disease Control, the U.S. census and the National Center for Health Statistics, to identify which factors contribute to a longer, healthier life, and also, the factors that can shorten it. Factors such as blood pressure, heart disease, diabetes control, weight, diet, stress levels and amount of exercise are crucial
in determining your real age, as well as dental health, level of happiness and use of multivitamins can add or subtract a percentage of your real age. “We read about 530 articles relating to factors that impact your real age. Determining this number can provide you with ways to live a vibrant, more active life,” Says Dr. Roach. In addition to the questions, all test-takers can access each piece of literature that was studied in creating the test by utilizing the Medline links at the bottom of the page. In total, the test measures 60 different aspects of one’s lifestyle in order to calculate how well the body is functioning. “Each and every question on the RealAge Test is supported by the most up-to-date clinical research in order to provide the most accurate results,” adds Dr. Roach.
Diabetes and Its Impact on Your Real Age The RealAge test can offer a great perspective into the lifestyle habits of people living with diabetes, but do not be discouraged. Everyone’s diabetes is different. This is why the test asks specific questions relating to A1c, physical activity and nutritional values, which offer an incredible amount of insight into how well controlled someone’s diabetes is and what areas can help them improve. “It is all about control. Those who have A1c levels closer to seven will see little impact on their real age, whereas those with an A1c of 12 will likely see a significant impact on their real age, adding a few years,” says Dr. Roach. Other factors that impact diabetes and your real age are the number of vegetables and fruits you consume, how much exercise
you are getting on a daily/weekly basis and positive lifestyle factors shared by family members that are adopted by the person living with diabetes.
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Results of the test can also help you set goals specific to controlling your diabetes such as a comprehensive exercise schedule or a balanced meal plan.
The site also offers a weight loss tracker, a walking tracker and goal plans specific to your needs in order to help you on your journey to better controlling your diabetes. “The RealAge test is a great motivator for people living with diabetes. All of the research having to do with diabetes and the test is as recent as 2005 and will continue to be updated as new studies are released,” states Dr. Roach.
Maintaining Good Health Habits The RealAge test is a great tool for anyone who is looking to improve their overall health. Taking the test is simple and requires only 45 minutes to one hour of your time. Your results are detailed and easy to access and/or change at any time. By answering the questions as thoughtfully and accurately as possible, you will be able to target exactly what needs work in your life and what is currently helping you stay young. Making changes as necessary and maintaining good habits can yield positive results, not only for your real age, but for your body as a whole!
Taking Control Of Your Diabetes
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An Essential Resource for the Diabetes Lifestyle By dLife staff
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on’t know about dLife? If you have diabetes, you should! dLife is the number one community network and resource for people living with diabetes and caregivers. By providing information, inspiration, and connection, dLife’s award winning media outlets, dLife.com and dLifeTV help millions struggling to manage their diabetes and gain control. At dLife.com, visitors will discover objective, trustworthy, and inspiring health and lifestyle information that is easy to access and available 24/7. With thousands of articles covering a wide array of diabetes topics, a vast database of diabetes friendly recipes, plus fun and engaging videos, quizzes and polls, there is something for everyone who is trying to fill a gap in their diabetes toolkit. Want some variety in your diabetes diet? Check out the dLife Recipe Finder that contains over 9,000 recipes, all of which can be sorted by course, main ingredient, carbs, calories, fat, or sodium counts. Have a nagging question you haven’t been able to answer? You can browse the 4,000+ questions and answers in the dLife.com Q&A. Or as a member, submit your
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own to the panel of experts, which include diabetes educators, dietitians and pharmacists. Feel like chatting with someone you can relate to? Join the dLife Community, the largest online network of people living with diabetes or caring for someone who does. Beyond just casual conversation, many people have built friendships and support networks with others who “get it.” A common refrain heard from community members is, “Now I don’t feel so alone.” Everyone is welcome to sign up for a free membership at dLife.com, entitling them to weekly eNewsletters with the latest diabetes news, information, diabetes-friendly recipes and nutrition tips. Plus members are eligible for special diabetes offers and savings. The dLife Network also includes dLifeTV—appointment viewing for anyone with diabetes.
Now in its 15th season, dLifeTV is a half hour of dedicated diabetes programming each week (Sunday CNBC, 7PM ET, 4PM PT.) Every show delivers inspiring stories of celebrities, athletes and unique everyday people achieving amazing things with their diabetes; experts with the latest diabetes gadgets and news; plus cooking in the dLife Kitchen with Chef Michel Nischan. Over 350 dLifeTV videos are available for instant viewing in The Video Section on dLife.com Since its creation, dLife has been fulfilling on its mission to help those with diabetes take better care of themselves and build good diabetes management skills through simple lifestyle changes. Ultimately, the goal is to enable more people with diabetes to live longer and healthier lives.
TCOYD in Motion
The Gregg Foundation and CGM Change Lives! By Roz Hodgins
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COYD Board of Directors member, Terry Gregg, and his wife, Louise, recently funded a grant to provide continuous glucose monitors for three people with diabetes. CGM devices are used as aids in detecting hyperglycemia and hypoglycemia and for facilitating both acute and long-term therapy adjustments. Karen Westgate, the latest CGM recipient, shared that since she received her CGM on July 8th, she hasn’t had to have Engine 11 of her fire department make any house calls or transport her to the hospital—regular occurrences before getting connected to her wireless device! The CGM detects how fast Karen’s glucose level is rising or falling, allowing her to see a more complete picture of her blood sugar levels and to be pro-active in preventing the emergency situations that have been a common thread in her life with diabetes. The two other Gregg grant recipients are Sarah Hamilton and Michele Steuber, and they, too, are experiencing life changing results, all for the better, since connecting with their CGM devices. Thank you Terry and Louise for giving these three deserving women with diabetes the opportunity take better control! Gifts of all kinds make a difference in the lives TCOYD touches. With those who so generously give, the Living Well with Diabetes Scholarship Fund continues to help people who need financial assistance to attend a TCOYD conference. You are making a difference…thank you! To learn more about the many ways you can give to TCOYD, please contact Roz Hodgins, Director of External Affairs at (858) 755-5683 or email her at roz@tcoyd.org.
From left to right: Karen Westgate, Michele Steuber, Terry Gregg, Louise Gregg and Sarah Hamilton The Greggs are the donors who funded the grant supplying the CGM to these recipients.
TCOYD-TV: Proud Recipient of the 2010 Aurora Gold Award
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COYD-TV’s season four episode “Weight Management” was honored this month with the 2010 Aurora Gold Award. Aurora is an international independent film and video competition for commercials, cable programming, documentaries, instructional and corporate videos. TCOYD-TV is currently wrapping up its 5th season so be sure to check out all these educational and informative segments on our website! Visit www.tcoyd.org today and click on “Video”.
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TCOYD Conferences & Health Fairs 2011-2012 Schedule 2011 November 12 San Diego, California November 19 Latino Conf. Oceanside, CA February 11 March 3 April 14 April 15 May 19 September 8 September 22 October 27 November 10 TBA
2012 Washington, D.C. Sacramento, CA Honolulu, HI Outer Island, HI Raleigh, NC Missoula, MT Des Moines, IA San Diego, CA Austin, TX Native American
For schedules, bios, trailers and more, visit www.tcoyd.org
TCOYD is a not-for-profit 501(c)3 charitable educational organization.
The TCOYD Team says
We hope to see you soon at a TCOYD Conference and Health Fair! Top row (l to r): Antonio Huerta, David Snyder, Jill Yapo, Jimm Greer, Jennifer Braidwood, Michelle Feinstein; Bottom row (l to r) Roz Hodgins, Sandra Bourdette, Dr. Steven Edelman and Michelle Day.
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My TCOYD Newsletter, Vol. 34
Taking Control Of Your Diabetes 1110 Camino Del Mar, Suite “B” Del Mar, CA 92014 | www.tcoyd.org
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