TCOYD Newletter - Winter 2011 Vol.34

NEWSLETTER

MY

Winter 2011 Volume 34

Sweeten Your New Year’s Resolutions Dr. Edelman’s Corner

INSIDE A Startling Wake Up Call – What You May

Not Know About Sleep Apnea

Page 3

New Additions for Your Diabetes Toolbox Page 4

Winter Skiing Tips Page 6

Up Close & Personal with XDM Participants Page 8

New Cities Added for 2011 Conferences Page 12

On the cover: (from bottom left) Alice Howe, Julia Baron, Dr. Steve Edelman, Sandy Bourdette, Michelle Day, (from top left) Roz Hodgins, Antonio Huerta, Jennifer Braidwood, Jill Yapo, Jimm Greer and Michelle Feinstein. Not pictured: David Snyder.

Staff New Year’s Resolutions, page 11.

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or all of us living with diabetes, there has never been a better time to make some New Year’s resolutions about taking and keeping control of our diabetes with confidence. In years past, it has been extremely difficult to achieve our individual goals due to the lack of safe and effective medications and devices. 2011 truly marks a new era for people with any type of diabetes in terms of living a long and healthy life. The moving target and biggest challenge, which will require education, motivation and self advocacy from all of us, will be getting access to these advances.

For those of us with type 1 diabetes, we have fast and long acting insulin analogs, insulin pumps and pens, home glucose monitors and continuous glucose monitors (CGM). I feel that the availability of CGM devices is the single

greatest advance for people with type 1 diabetes since the discovery of insulin 90 years ago. One of my resolutions is to educate healthcare providers about this powerful technology, alert and educate the people most affected by this condiResolutions (continued on page 2)

Special Acknowledgements Medical Advisory Board Chair: Ingrid Kruse, DPM Veterans Affairs Medical Center Alain Baron, MD CEO, Elcelyx Therapeutics John Buse, MD, PhD University of North Carolina Jaime Davidson, MD Dallas, TX Mayer Davidson, MD Drew University Daniel Einhorn, MD Diabetes & Endocrine Associates Robert Henry, MD Veterans Affairs Medical Center Irl Hirsch, MD University of Washington

Board of Directors Steven V. Edelman, MD Founder and Director, TCOYD Sandra Bourdette Co-Founder and Executive Director, TCOYD S. Wayne Kay CEO, Response Biomedical Corp.

Margery Perry Terrance H. Gregg President & CEO, DexCom, Inc. Daniel Spinazzola President, DRS International

Contributing Authors

Steven V. Edelman, MD Chris Sadler MA, PA-C, CDE Julia Baron Roz Hodgins Urban Miyares

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 Alice Howe Senior Manager, Web Development Roz Hodgins Director of Development Julia Baron Manager, Public Relations and Outreach Jennifer Braidwood Continuing Medical Education Associate Jimm Greer Administrative Assistant David Snyder Exhibit Services Associate

MyTCOYD Newsletter Editor: Julia Baron Design: Hamilton Blake Associates, Inc. MyTCOYD Newsletter is offered as a paid subscription of Taking Control Of Your Diabetes.

All material is reviewed by a medical advisory board. The information offered is not intended to constitute medical advice or function as a substitute for the services of a personal physician. On the contrary, in all matters involving your health, TCOYD urges you to consult your caregiver. ©2010 All rights reserved.

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Resolutions (continued from page 1)

a fraction of the people in the country tion that CGM can help them live a with type 2 diabetes have been premuch more normal life and fight each scribed Byetta or Victoza) and once and every road block that the insuragain, to fight like hell to get it for ance industry puts in front of me in them. On the horizon are newer order to get access for my patients. medications that are effective and safe It is a rare person with type 1 diaas well as patch pumps and even more betes who would not benefit from a weight loss agents.

CGM device, which will help them Your New Year’s resolution needs predict the unpredictable and reduce to be focused on getting smart and the frustrating ups and downs of this getting access. You cannot rely on condition. At this time next year, I your healthcare hope to share “It is a rare person with type 1 provider to more informadiabetes who would not benefit research every tion about the Artificial Pan- from a CGM device, which will help potential new them predict the unpredictable option to help creas Project, ultra rapid and reduce the frustrating ups and get or keep your diabetes under acting insulin downs of this condition.” control. You and more need to know your individual goals for advances in the prevention glucose (A1c), cholesterol levels and and reversal of type 1 diabetes. blood pressure. Help your caregiver For all of you out there with type take better care of you by being an 2 diabetes, we have several new oral active partner in your diabetes manmedications as well as a new obesity agement. Keep up-to-date with the drug just approved by the FDA. opportunities provided by the new One of the biggest advances is the healthcare reform act and do not back development and availability of the down from your insurance company if relatively new class of agents called GLP-1 agents or Incretins (Byetta and you are being denied a drug or device that you and your doctor have deterVictoza). These medications not only mined to be beneficial for you. It is a lower glucose levels safely without sweet time for obtainable New Year’s causing hypoglycemia, but they also help with weight loss. Several medica- resolutions that will help us live life first and be diabetic second. tions we use now to treat I wish you all a happy and type 2 diabetes cause healthy New Year. weight gain and hypoglycemia, which is frustrating for PWD and healthcare providers. It now comes Steven Edelman, MD down to educating the Founder and Director medical community (only Taking Control Of Your Diabetes

A Startling Wake Up Call What You May Not Know About Sleep Apnea

From the Desk of Chris Sadler, MA, PA-C, CDE

M

y wife had complained about my loud snoring for years, but I never associated it with how fatigued and sleepy I felt, especially in the afternoons. I would often struggle to keep my eyes open when charting on my patients at the end of the day or when reading medical journal articles. I just wrote it off as being tired due to working long hours and pushing myself too much. I had recently become more informed of sleep apnea and its telltale symptoms after we did a research study in our patients with type 2 diabetes. In this study conducted by Dr. Einhorn, 35 percent of our patients had sleep apnea (49 percent of men and 19 percent of women tested had the disorder).

I had even diagnosed sleep apnea in

many of my patients, but didn’t recognize the same symptoms in myself.

After another day of falling asleep into a stack of charts on my desk, I finally asked my wife, “Have you ever noticed if I stop breathing during the night for short periods?”

She initially said she wasn’t aware of it, but within a few days she came back to me saying that indeed there were frequent pauses in my breathing during the night. Sure enough, a diagnostic sleep study followed and I joined the ranks of the millions of people who have been diagnosed with obstructive sleep apnea.

Sleep apnea is a common condition that typically goes undiagnosed.

Signs and symptoms include: • Excessive daytime sleepiness • Waking with an unrefreshed feeling after sleep Symptoms of sleep apnea that are often • Having problems with memory unnoticed by those who are affected: and concentration • Episodes of not breathing (apnea) during sleep • Experiencing • Loud snoring. Almost all people who have personality sleep apnea snore, but not all people who changes snore have sleep apnea • Headaches • Restless tossing and turning during sleep • Heartburn or • Nighttime choking or gasping spells a sour taste

Christopher E. Sadler, MA, PA-C, CDE Chris is affiliated with Diabetes and Endocrine Associates in La Jolla, California. He specializes in intensive insulin therapy using MDI and insulin pumps, management of type 2 diabetes and other endocrine disorders. He is the current president-elect of the American Society of Endocrine Physician Assistants.

Author or coauthor of several journal articles and abstracts on continuous glucose monitoring and other diabetes related subjects. Mr. Sadler has presented at local and national conferences on diabetes related topics. He also has extensive experience in clinical research. Mr. Sadler is past president of the San Diego Association of Diabetes Educators and currently the vice president of the American Society of Endocrine Physician Assistants.

in the mouth at night • Getting up during the night to urinate (nocturia) • Sweating and chest pain during sleep

Risk factors for obstructive sleep apnea include:

• Excess weight. Fat deposits around your upper airway may obstruct your breathing. However, not everyone who has sleep apnea is overweight. Thin people develop the disorder, too.

Sleep Apnea (continued on page 5)

Taking Control Of Your Diabetes

3

Ask Your Pharmacist

Onglyza & Kombiglyze XR The Newest Additions to the Type 2 Diabetes Treatment Toolbox

By Steven Edelman, MD and Julia Baron

By Julia Baron

O

nglyza (Saxagliptin) from Bristol-Myers Squibb is a member of a new class of drugs used to treat diabetes known as DPP-4 inhibitors. In order to understand how this drug works, you need to know how the body regulates glucose control. In addition to insulin, our body releases certain incretin hormones named GLP-1 and GIP. These hormones are released from the gut in response to the ingestion of food at meal times. They also work to lower blood glucose by stimulating insulin release, and suppressing the release of glucagon (this is a good thing since glucagon causes the blood sugar to go up). In type 2 diabetes, the levels of GLP-1 and GIP are below normal. Similarly in type 2 diabetes, once these incretin hormones are released, they are rapidly inactivated in the gut by an enzyme called DPP-4.

control include: No weight gain, very low risk of hypoglycemia and it is highly tolerated. In studies, side effects associated with Onglyza are similar to taking a fake pill or placebo.

Kombiglyze XR from AstraZeneca and Bristol-Myers Squibb, is the newest diabetes combination pill consisting of Onglyza and Glucophage (metformin). Glucophage is the most Here is where Onglyza widely used medication for type 2 Onglyza is FDA approved for comes in: diabetes and has been prescribed in use in patients with type 2 diabetes Onglyza works by inhibiting the who have not been able to achieve the US since 1995. The combination enzyme (DPP-4) that breaks down of a DPP-4 inhibitor, such as Onglyza adequate glucose control with diet the incretin hormones GLP-1 and and Glucophage represents a safe, and exercise. Onglyza can be used GIP. Therefore, these hormones are alone or in combination with other powerful and simple way to achieve not degraded, but instead their dura- oral medications. The recommended your A1c goal with minimal risk of tion of action is prolonged. Thus, hypoglycemia and weight gain. Like dose of Onglyza is 5mg taken once Onglyza works by other diabetes medications, a prescripdaily with “Onglyza and Glucophage enhancing the tion for Onglyza and Kombiglyze XR or without represents a safe, powerful and food. For action of these is required. Your healthcare provider simple way to achieve your A1c people with will determine if any of these new hormones and, as a result, decreases kidney prob- agents is appropriate for you. goal with minimal risk of blood glucose hypoglycimia and weight gain.� lems, a dose For more information on both Onglyza levels. Onglyza adjustment and Kombiglyze XR, visit the following: can automatically sense when is required. Onglyza is not for use in www.bms.com blood glucose levels are too high, people with type 1 diabetes, children www.onglyza.com as it works best to stimulate insulin www.astrazeneca.com or during pregnancy. Onglyza is not release only when blood glucose a replacement for insulin therapy. levels are elevated, preventing the Some of the benefits of Onglyza risks of low blood sugar. besides its ability to improve glucose

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Question

of the Month

By Steven Edelman, MD

[

I

]

’m finding that these days, there are a lot of sugar-free cookies and cakes being sold in grocery stores. Are these really a better alternative for people with diabetes?

Answer: Sugar-free desserts have slightly fewer carbohydrates than regular desserts.

The sugar is replaced with sugar alcohols, which have less of an impact on blood glucose levels.

• Remember that sugar-free cookies and cakes still contain other sources of carbohydrates, such as flour.

• Sugar-free is neither calorie-free nor carb-free. You should carefully read the food label and count both the calories and carbohydrates.

• As always, moderation is key, whether the cookies and cakes are sugar-free or otherwise.

Sleep Apnea (continued from page 3) • Increased neck circumference. A neck circumference greater than 17 inches (43 centimeters) is associated with an increased risk of obstructive sleep apnea.

• High blood pressure (hypertension). Sleep apnea is more common in people with hypertension.

• A narrowed airway. You may have inherited a naturally narrow throat. Or, your tonsils or adenoids may become enlarged, which can block your airway.

• Being male. Men are twice as likely to have sleep apnea.

• Being older. Sleep apnea occurs two to three times more often in adults older than 65.

• Family history. If you have family members with sleep apnea, you may be at increased risk.

• Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat.

• Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who’ve never smoked.

• Prolonged sitting. Studies suggest that long periods of daytime sitting can cause fluids to shift from your legs when you recline at night, narrowing airway passages and possibly increasing the risk of obstructive sleep apnea.

The CPAP machine made by ResMed is comfortable and easy to use.

sure machine my symptoms have dramatically improved. No longer do I struggle to stay awake at work and I feel more energetic. My wife is also sleeping much better without my In addition, there are also signifi- loud snoring. cant consequences directly related If you or someone you love is to untreated sleep apnea includexperiencing the symptoms of sleep ing worsening insulin resistance, apnea, a simple conversation with increased blood glucose, obesity, your doctor can initiate an appropriheart disease and even sudden death. ate evaluation that may not only After treatment with a CPAP improve symptoms, but dramatically or Continuous Positive Airway Pres- improve health.

Taking Control Of Your Diabetes

5

r e t n g i n i i W Sk Diabetes on the Slopes

By Urban Miyares

E

ven though my competitive skiing days are behind me, I just can’t help but yearn for those crisp winter days on top of a 12,000-foot peak, and then heading downhill— refreshing and invigorating.

But first, before hitting the ski slopes, whether for Alpine or crosscountry skiing, here are a few quick, pre-skiing tips to get you ready for a day or weekend of true enjoyment that also serves as a learning experience with your body and diabetes:

1

Are you physically ready?

Even though you may walk and exercise regularly, skiing is an activity that utilizes many different muscles that are left unattended to in one’s daily routine. You’re quickly going to be introduced to these forgotten muscles after a day on the powder.

2

Your pre-skiing warm up begins with stretching every day—something you should already be doing each morning.

You should now know and be doing some simple stretching exercises. Check with others or go online to get some stretching routines you can use. Make it com-

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fortable, and if it’s painful, talk to a medical professional right away, and before going skiing.

3

Pay attention to your legs.

To avoid muscle aches and pains, muscle cramps and spasms that many experience after their first day on the snow, nothing can beat walking as an exercise. Make a point to walk everywhere and take the stairs, instead of the elevator.

Exercise tip: One leg exercise I did, year round, was standing on the ball of one foot (make sure to hold onto something for balance), bending my knees slightly, for a count of 10, to start, and switching to the other foot and repeat the count; later, add to that count and see how high you can get.

4

Remember your sit-ups I hate sit-ups, but they are needed. Go slow here if you are not accustomed to doing them on a regular basis. I like to do sit-ups on the edge of the bed with my feet touching the floor, while watching TV or listening to music. Go ahead and use your arms if you must.

After a while, you may be able to lift your legs, or at least your knees, at the same time you bend at

Urban Miyares has had Type 1 diabetes for more than 40 years, and is a blinded Vietnam veteran. He is the U.S. National Alpine Ski Champion (1990-91), and considered the fastest total blind Alpine skier in the world, having reached speeds of 63 mph in many competitive downhill races. Urban is a regular speaker at TCOYD Conferences across the nation.

the waist to raise your body’s torso.

Whatever exercise routine you begin, hopefully weeks before your first day on the snow, do it gradually, frequently and don’t push yourself.

You’re not going for the World Cup, only an enjoyable and healthy day on the slopes or in the mountains with family and friends.

5

Don’t forget about blood sugars and your diet.

Skiing is physically exhausting and you can easily burn a few hundred calories quickly depending on the type of skiing and your overall activity. Don’t count on being able to take routine blood tests especially if the temperature is cold, as your glucose monitor may not work in such conditions. You need to avoid low blood sugar at all costs, as it

Giving Back

could lead to a number of medical complications and be the (preventable) cause of a skiing accident and/or injury.

When I ski, I tend to start out with a minimum blood sugar of 140 to 175. I constantly consume food throughout my day of skiing and between meals. For me, raisins and quick energy (not chocolate) food bars are great options. Eating nuts and popping a sugar-candy in my mouth was also common.

Most importantly, remember to constantly drink water throughout your day of skiing.

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Finally, and above all else, don’t overdo it.

Start out the day skiing on the beginner or intermediate slope, and gradually work your way to the more demanding ski areas, if you are comfortable. Most skiing accidents happen on “that last run,” when the skier is already exhausted. Know when to quit, have fun and enjoy the nightlife as you marvel at your blood sugar control and how a rigorous exercise, like skiing can be enjoyed when you have diabetes.

Above all else, test your blood sugar even more frequently over the next 24 hours. Also consider waking up in the evening to test after that day’s skiing, as bloodsugar rebounding is a common phenomenon when having fun on the snow.

See you on the mountain or at the après party at the lodge!

The Living Well With Diabetes Scholarship Fund

By Roz Hodgins

To learn more about giving, please contact: Roz Hodgins TCOYD Director of Development 1110 Camino Del Mar, Suite B Del Mar, CA 92014 (858) 792-4741 Ext. 20 or toll free: (800) 998-2693 email: roz@tcoyd.org

Our beautiful “giving” birdcage filled with donations at the San Diego conference on October 30th.

T

his year, TCOYD established the The Living Well With Diabetes Scholarship Fund to support conference attendees needing financial assistance and who otherwise could not afford to attend one of the many TCOYD patient-centered conferences.

TCOYD invites you to support its efforts in assisting individuals to take control of their diabetes, by making a financial gift and becoming a partner of TCOYD. By supporting The Living Well With Diabetes Scholarship Fund you will provide financial assistance to those who are unable to pay for their conference registration.

Through the generosity of donors, TCOYD is able to extend a hand to those in need and who, with your help, will have the opportunity to learn how they can live well with diabetes.

Become a partner with TCOYD by supporting The Living Well With Diabetes Scholarship Fund with giving generously today.

For more information about the many ways to give, and the benefits of the newly established Director’s Council, please contact Roz Hodgins, Director of Development at (858) 755-5683 or email her at roz@tcoyd.org

Taking Control Of Your Diabetes

7

Taking Control

UP CLOSE An Inside Peek Into the Thoughts, Insights and Lives of Our Extreme Diabetes Makeover (XDM) Participants

By Julia Baron

M

eet seven people with diabetes, who in the beginning of the XDM program, only shared two things in common: Poorly managed diabetes and a true desire to improve their condition. Over a 22-week period, they were educated, empowered and motivated to take control of their diabetes with the help of a “dream team” of diabetes care specialists. They were given HD Flip Cameras to document their ups, downs, triumphs and tribulations. Through the good times and the bad, they helped show the world the importance of a team approach to diabetes care and the time, effort and patience that goes into managing the disease.

Here they are after the end of the program, up close and personal offering their advice, sharing how they were able to change their lives and how they continue to thrive.

Renee Stanton

Living Well with Type 2 Diabetes Birthday: Nov. 5th (Age 55) Diagnosed: More than 20 years ago Current City: El Cajon, CA

Aspirations: To become a motivational speaker for people with diabetes.

Words of Wisdom: Controlling your diabetes starts with small steps.

Don’t keep your diabetes a secret.

Find a buddy and/or mentor to help you through it.

Biggest Game Changer: Beginning my insulin regimen was tough for me. I blamed myself for having to use insulin. I thought after all these years of living with diabetes,

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I had failed and that is why I had to go on insulin. After talking with the dream team and finally adjusting my dosage, I realized that it was my body that needed the insulin. It was there to help me, not hurt me.

How the Program Changed Her Life with Diabetes: The program helped me clear up all the misconceptions I had about my diabetes. Since I have had the disease for so long, I had forgotten all the things I had been told to do over the years by my doctors. I was re-educated and re-enlightened more than I ever thought I could be! New research and medical innovations come up in the area of diabetes all the time. Things keep changing, and I keep learning!

David Lim

Living Well with Type 1 Diabetes Birthday: June 17th (Age 22) Diagnosed: Age 4 Current City: San Diego, CA

Dream Destination: Bali Words of Wisdom: Reach out to family and friends, and to your doctor and diabetes support groups in your area. Online diabetes forums are also a great resource, which allow different people with similar experiences to learn from each other. I believe that we are each other’s greatest resource, and that sharing our collective experiences, whether they are good or bad, will help immensely.

First Impressions of the Program: I actually did not apply to be part of the Extreme Diabetes Makeover program, however I am a regular patient of Dr. Edelman’s.

I experienced a very bad hypoglycemic incident in the middle of 2008 that left me unconscious and paramedics had to be called to revive me. When the program was getting started, Dr. Edelman reached out to me and asked me if I would like to participate.

On Growing Up with Diabetes: As I grew up, I began to understand what I was up against. I would worry about what would happen to me when I was older with the lack of control I had throughout my teenage years. I have to maintain

the changes I have learned from this program if I want to live a long and happy lifestyle.

Chet Carney

Living Well with Type 2 Diabetes Birthday: Jan. 2nd (Age 53) Diagnosed: 3 years ago Current City: San Diego, CA

Future Goal: Roller skate for a 100-mile stretch on the Pacific Coast Highway Words of Wisdom: You have to learn to crawl before you can walk. You have to learn to walk before you can run. Learn about your system and how it operates and then start taking control. For example, keep a results journal regarding what you eat, the medication you are taking and when you are testing. This will give you a clearer picture of what your system can and cannot do.

On Becoming Activated: It encourages me to keep going!

This is a program I can live with and stick with. Cheating is not an option. If I stick with this program,

I will be able to have my diabetes under control, for good.

Greatest Obstacle During the Program: Loss of French fries as a regular part of my diet and getting down on myself if I wasn’t losing weight was tough for me. I love French fries and I thought I could never eat them again! After going through the program and learning about nutrition and moderation, I learned how my system could handle French fries.

In terms of my weight, I learned not to be let down by weigh-ins. It was just my body adjusting to the new me, and eventually, I lost the weight.

Liz Van Voorhis

Living Well with Type 1 Diabetes Birthday: Dec. 31st (Age 30) Diagnosed: Age 15 Current City: New York, NY

Accidental XDM Moment: Dropping her Dexcom CGM in the toilet Words of Wisdom: Find a great physician who is not only your healthcare provider but also a true partner and team member who is genuinely involved in your diabetes care. Knowing that they have your health and best interests in mind is reassuring and essential in taking control of your diabetes.

Biggest Game Changer: Getting a continuous glucose monitor (Dexcom) was amazing.

The visibility that it provides for my diabetes is unparalleled and has changed my life. I have up to the minute, accurate results. I think a

lot of my success in this program was due not only to my motivation to stay under control, but to my Dexcom for allowing me to know my numbers even when I am on the go.

On Everyday Life with Diabetes: Diabetes is a disease you have to face everyday. Even though I’ve had great results and learned tips and tricks to improve my diabetes, when things in your life change, it can throw off your control. I moved across the country, changing my living situation, job and routines.

Unfortunately, that requires a bit of a re-do to get things adjusted, but it’s possible if you work at it.

Tim Smith

Living Well with Type 2 Diabetes Birthday: Aug. 31st (Age 62) Diagnosed: 5 years ago Current City: El Cajon, CA

Hobbies: Cooking, collecting classic cars, shooting canons, hiking, and soon, maybe piano (to name a few) Words of Wisdom: It helps to gather in groups for mutual support. Doing it alone is so overwhelming and can often discourage people. Being in a group setting makes you realize you are all in the same boat. Also, if you live with diabetes your whole life, you have a greater awareness than people who were just diagnosed (especially type 2’s). For someone like myself who lived many years without diabetes and now have it, you get a certain perspective that

Taking Control Of Your Diabetes

9

Taking Control

you otherwise wouldn’t if you were without a support system.

Teaching Moments: When I first came to TCOYD that Saturday, I quickly recognized the diversity of the group and the commonality that we all had. As diverse as we all were, we all shared a common element. I think that to me was a very significant realization for me.

I learned that diabetes doesn’t pick and choose. It is non-discriminatory disease that can affect anyone at anytime.

New Diet and Exercise Regimens: Cooking is my passion. Now, I am more conscious about the weight and content of a recipe. I used to think that everything tasted better with butter and sugar. As for exercise, I am still very active.

I hike, take long walks before or after lunch and go to the gym.

Daron Howard Living Well with Type 2 Diabetes Birthday: Oct. 5th (Age 38) Diagnosed: 3 years ago Current City: San Diego, CA

Memorable Quote: “I’m not crazy, I’m just a little dysfunctional!”

Words of Wisdom: When you are first diagnosed with diabetes, it can be scary. Some might think it is a death sentence (although it is not). Talking face to face with your healthcare provider is very important. Asking questions and doing your research is even more important. There are tons of websites including TCOYD.org and RealAge.com that have great

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information on diabetes and what you can do to take control.

On Living in a Homeless Shelter with Diabetes: In the shelter, it was difficult to stay under control. The food that is served is designed to fill you up and has a lot of carbs. As I learned in XDM, your body turns carbs into sugar, causing changes in your blood sugars. Even when I was low, it was difficult to find juice because the kitchen was only open at certain hours. I would have to beg the staff to give me juice so that I would not pass out.

Missing in Action: There was a point when I fell off the face of the earth. I was unhappy with myself and had no confidence.

I was using drugs and I felt ashamed and embarrassed. When I came back to TCOYD to give the program another try, everyone showed me support. They didn’t judge me, they embraced me and helped me stay off drugs and control my diabetes. They took a chance on me and I appreciate that more than anything.

today to help myself?”

On Growing and Learning from the Program: I couldn’t believe how much the makeover program increased my self-confidence in managing my diabetes.

I became so orderly and efficient in terms of caring for myself. I was encouraged not just to test frequently but also to understand the numbers on my meter and how they related to exercise, eating, etc. Before the program, I noticed that my doctors would have me log my numbers, but do nothing with them. They would sneeze and say, “See you later!” Now I understand Celeste Kelley what I need to do to improve my Living well with blood sugars.

Type 2 diabetes Birthday: July 13th Greatest Challenges: Before (Age 68) the program began, I saw myself as Diagnosed: 20 my greatest challenge. I needed to years ago get out of my own way. I knew that Current City: with this program, there was no Escondido, CA Favorite Quote: “Be outrageous. time to fall asleep at the wheel. It’s get up and go. Although there were It’s the only place that isn’t crowded” many times when I wanted to avoid Words of Wisdom: Get involved with your diabetes. It may being active, I knew it wouldn’t be tough at first, but get a friend or work. I was motivated and my team family member to help support you motivated me as well. Eventually, I gained the self-assurance to make it and treat it one day at a time. all happen.

Ask yourself, “What am I doing

Know Your Numbers

TCOYD New Year’s Resolutions Sandy Bourdette: Instead of a resolution, I would like my 401k to do well this year!

Michelle Day: I will meditate for 5 minutes every day, focusing on the here and now and not on my never ending to do list.

Jill Yapo: I will think more positively and learn to relax a little!

Alice Howe: I want to continue getting straight A’s in my Masters in Nursing Program.

I am also taking up piano.

Julia Baron: To be more adventurous in 2011! I hope to travel to the South Pacific and go skydiving.

David Snyder: I resolve to be more peaceful, easeful and useful.

Jimm Greer: I don’t do New Year’s resolutions. I just try to make changes whenever I can!

Antonio Huerta: I vow to live a simple life and live within my means.

Jennifer Braidwood: In true Eckhart Tolle fashion, I want to realize whole heartedly that the present moment is all I truly have, to make the NOW the primary focus of my life.

Roz Hodgins: I hope to build our pyramid of support for TCOYD. Michelle Feinstein: I will try to be more organized at home.

We wish you all a safe and joyful New Year! See you in 2011!

Keeping Your Basal to Bolus Insulin in Balance

By Steven Edelman, MD

W

ilson is a 54-year-old male with type 2 diabetes who has recently started using insulin. His current regimen includes 90 units of Lantus at night and about 15 units of Novolog before meals. Wilson eats a pretty consistent breakfast, lunch and dinner at 7am, 12 noon and 6pm respectively.

As you can see from his logbook, he is frequently getting low over night and in between meals, just before lunch and in the afternoon.

He is on too much insulin, but which one? Lantus or Novolog?

Answer: When an individual on a multiple daily injection regimen, consisting of a basal and bolus insulin, the ratio should be close to 50% of each. This is not a hard and fast rule but in this case, it appears that he is on too much basal insulin since he gets low in between widely spaced meals and in the early morning. His current ratio of basal to bolus insulin is 90:45 or 67% basal and 33% fast acting. This lopsided ratio may indicate too much basal or not enough bolus insulin, and in Wilson’s case, it is the former.

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Taking Control Of Your Diabetes

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

New in 2011:

Diabetes in Motion

On the Road with TCOYD

By Julia Baron

W

e are very excited to announce three new cities that will be added to the TCOYD mix! In 2011, we will be holding conferences, health fairs and CME programs in Tucson, Arizona; Albany, New York; and Tampa, Florida.

“We are very excited to be

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My TCOYD Newsletter, Vol. 34

Tucson, Arizona April 2, 2011 Tucson Convention Center

Albany, New York June 11, 2011 The Desmond Hotel & Conference Center

broadening our reach to these three new cities. We will be able to offer education and empowerment to a multitude of new folks who otherwise may not have been able to attend a TCOYD conference in another city,”

Tampa, Florida October 1, 2011 Tampa Convention Center

says Dr. Edelman of the new lineup.

Full conference schedules and registration information will be available approximately 2 months before each scheduled event. Check TCOYD.org or your inbox for details!