Summer Quarter Newsletter

NEWSLETTER

MY

Summer 2013 Volume 44

Being Too High or Too Low: An Important Balancing Act Dr. Edelman’s Corner

INSIDE 5 Foods That Can Help Your Diabetes and Your Mouth Page 3

5 Tips for Your Best Doctor’s Vist Page 4

28 Conferences and Counting Page 5

The Jerry Lund Story, Part 3 Page 6

Know Your Numbers

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ll of us living with diabetes have been told time and time again to keep our blood sugar levels as close to normal as possible in order to avoid those scary, horrible, and potentially devastating complications of diabetes. Medical professionals now know from multiple large clinical studies that by keeping glucose levels down, as measured by the A1c, people with diabetes can prevent the onset and delay the progression of eye (retinopathy), kidney (nephropathy) and nerve (neuropathy) disease.

Page 7

Ask Your Pharmacist Page 8

Fit to Eat Page 9

Connecting with iBGStar Page 10

Question of the Month Page 11

Diabetes Do’s and How To’s Page 12

As a result of these studies, some of the major diabetes organizations recommend that the A1c be kept below 7.0% (average blood sugar of ~150mg/dl over the last 2-3 months) and others say it should be even lower at 6.5% (average blood sugar of ~130mg/dl or less over the last 2-3 months). As a result of these

guidelines, both people with diabetes and their providers are attempting get A1c’s as low as possible. However, there is a downside when trying to reach these goals, and it is hypoglycemia.

Hypoglycemia is one of the biggest barriers when trying to get your A1c to goal. It can lead to annoying symptoms Balancing Act (continued on page 2)

Balancing Act (continued from page 1)

Special Acknowledgements Board of Directors Steven V. Edelman, MD Founder and Director, TCOYD Sandra Bourdette Co-Founder and Executive Director, TCOYD S. Wayne Kay s2a Molecular, Inc. Margery Perry Terrance H. Gregg DexCom, Inc. Daniel Spinazzola DRS International Contributing Authors Janice Baker, MBA, RD, CDE Jennifer Braidwood Anuj Bhargava, MD Sandy I. Chong Robert Cuddihy, MD Steven Edelman, MD Michael Goldberg, DMD Candis M. Morello, PharmD, CDE

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 Michelle K. Feinstein, CPA Director of Finance and Administration Antonio Huerta Director, Latino Programs Jennifer Braidwood Manager, Outreach and Continuing Medical Education Jimm Greer Manager, Multi-Media David Snyder Manager, Exhibit Services Robyn Sembera Associate Manager, CME and Outreach

MyTCOYD Newsletter Editor: Jennifer Braidwood Assistant Editor: Robyn Sembera 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. ©2013 All rights reserved.

2 My TCOYD Newsletter, Vol. 44

like shaking, sweating, palpitations not cause hypoglycemia, such as (rapid heart beat) and extreme metformin, pioglitazone (Actos), hunger, commonly leading to eating DPP4 inhibitors (Januvia, Onglyza, everything in the fridge. If untreated, Trajenta and Nesina), Invokana, hypoglycemia can lead to seizures, Cycloset and Welchol. However, coma and death. Yes, you can die from insulin and a class of pills called hypoglycemia and, unfortunately, it sulfonylureas (glypizide, glyburide is not all that uncommon. The folks and glimepiride) can lead to who are most at risk are the ones who hypoglycemia, which makes glucose have had diabetes for a long time and testing very important. do not feel the early warning signs of Avoiding hypoglycemia 100% of an on-coming hypoglycemic episode, the time may be impossible for you, a condition commonly referred to especially if you are on insulin, so be as hypoglycemia sure to talk to your unawareness. caregiver about Testing your blood sugar Hypoglycemia is frequently throughout the day potential solutions also the cause of that are right in relation to meals, exercise many motor vehicle and other activities is the best for you. Getting accidents, work on the right way to avoid hypoglycemia. and recreational medication(s) related injuries, if you are a and problems with relationships. If type 2, and getting a continuous you have type 1 diabetes, you must glucose monitor if you are a type take insulin and insulin is one of 1, are essential for the successful the greatest offenders. Testing your management of hypoglycemia. blood sugar frequently throughout Lastly, your A1c goal should be the day in relation to meals, exercise, individualized as discussed in Dr. and other activities is the best way Edelman’s Corner, How Sweet is to avoid hypoglycemia. Better yet, it Sweet Enough? (Spring 2011, Volume is important to obtain a continuous 35). Getting your blood sugar down glucose monitor if you haven’t done so to a normal range in order to avoid already. This device gives you a blood complications while, at the same time sugar value every five minutes, 24 hours avoiding hypoglycemia, is not an easy a day, and has alarms to let task but it is an important you know if you are getting balancing act that must be too high or too low. addressed.

If you have type 2 diabetes, there are several medications now approved Steven Edelman, MD by the Food and Drug Founder and Director Administration that do Taking Control Of Your Diabetes

By Dr. Michael Goldberg, D.M.D., dLife Columnist

B

elieve it or not, there are actually more bacteria in your mouth right now than there are people on Earth! If you allow all those germs to settle into your gums then you have a serious problem, gum disease!

What we eat and how we chew are important components of oral health.

Unfortunately, if you have diabetes, and poor glucose control, you are at a much higher risk for gum problems.

Let’s take a look at some specific foods to see how and why they impact your mouth and diabetes.

Parsley

they’re part of a healthy meal plan, combined with exercise, and saved for Parsley is best eaten raw to special occasions. get the maximum oral advantage, which comes from its fiber, folic acid, vitamins A and C, magnesium, Aside from being low glycemic, and iron. All these are necessary for raw celery requires you to chew well healthy gums and teeth. which, as long as your bite isn’t off, Parsley also contains “volatile is important in maintaining the flow oil,” which is known to neutralize of saliva. Having the proper flow of certain types of carcinogens. Since saliva is important in controlling oral cancer is on the rise, this acidity and inflammation in the should be of particular value. Parsley mouth. It’s fibrous content is also good also has flavonoids, which are for helping reduce plaque on your antioxidants that help the body fight teeth. If you have diabetes, plaque is inflammation such as gum disease. more likely to cause inflammation and Parsley, however, is high in (70% cacao or more) gum disease. Chewing celery can help oxalates, which may be a problem if Researchers in Japan have reduce plaque. you have impaired kidney function concluded that, at least from a decay Celery’s other benefits include or gallbladder problems. Talk to your standpoint, antibacterial agents found its ability to help the body respond to physician and proceed with caution in the cocao bean offset the sugar inflammation, lower blood pressure, and moderation if you suspect you levels and may help prevent decay. and help bone regeneration. have theses issues.

High levels of cacao also contain flavonoids, which have been shown to help control insulin sensitivity.

Green tea can help reduce bad So dark chocolate can help fight breath for an hour or two. It has inflammation, prevent cavities, and also been shown to reduce gum help control diabetes. It’s a miracle inflammation and kill bacteria that food, but only if used in moderation.

According to the ADA, sweets can 5 Foods That Can Help Your Diabetes be eaten in small amounts as long as and Your Mouth (continued on page 10)

Celery

Dark Chocolate

Green Tea

Taking Control Of Your Diabetes

3

Taking Control

By Anuj Bhargava, MD

S

trong partnerships with your health care providers can play a key role in your overall health. However, it can be a challenge to build a partnership in the short 15-20 minutes of face time you have during an appointment. Here are five tips and helpful tools from MyDiabetesHome.com to make the most of those minutes.

1

Bring a list of all of your medications Give a list of your medications to your health provider to save appointment time and get better health care. Include the name of each drug, dosage you’re taking, and number of times a day you take it. That includes herbal remedies and over-the-counter drugs, too—even multivitamins.

MedSimple™ allows you to easily record, track and update your medications, dosage information, and who prescribed them for you.

MedSimple can also help you set up dose and refill reminders and inform you of many cost saving options.

When you use MedSimple through MyDiabetesHome.com, it auto-fills your VisitOptimizer report, a printable report that lists your medications, health numbers, goals, and questions to bring to your visit.

4 My TCOYD Newsletter, Vol.33 Vol. 44

2

Bring a log of your blood glucose readings Your blood glucose values are the blueprint of how your body responds to medication, food, exercise and stress. If you want to get your car fixed, would you go to the mechanic without your car? It’s the same idea with your blood sugars. The doctor won’t know how to accurately ‘fix’ or regulate your levels without seeing what might be causing the issue.

Knowing your levels helps the doctor make informed decisions that are best for your body.

The MySugars tool on MyDiabetesHome.com allows you to easily enter blood glucose readings when you take them— before and after your three major meals, before bed, and other times when you test.

3

Know your numbers It’s common for people with diabetes to have more than one health care provider. Keep all of the members of your health team on the same page by bringing your latest health numbers to your appointment. This prevents duplicate lab tests and can save you and your healthcare provider time and money.

Record and update your A1C, blood pressure, cholesterol, and weight in the MyNumbers tool, which will auto-fill in the VisitOptimizer report you can bring to your appointment.

4

Keep a list of questions for your doctor Ditch the ‘doorknob questions’ when you utter the words, “Uh, doctor, one more question…” as the doctor’s body is in the room, hand on the door and mind already on the next patient.

Instead, keep the focus on you by making a list of questions and health concerns to bring to your visit. A list will keep you and your provider on track and maximize your time together.

Create your list using the questionnaire on MyVisits. This tool allows you to enter your goals and questions for your

health care provider at the click of a button and it automatically includes them on your personalized VisitOptimizer report.

Once you ask your questions, be prepared for the answers.

Take important notes on your VisitOptimizer report or bring a tape recorder, note pad, or trusted relative or friend to help.

5

Be your own health advocate Be prepared to discuss your symptoms, when you feel them, and how strong they appear. Ask your doctor to explain the diagnosis and treatment options. Don’t be afraid to ask your doctor to stop, repeat, or slow down. Remember, your doctor is on your team and wants the best for you.

If you have a constant ache or pain and think it’s something serious,

28 Conferences and Counting!

express your concern without having a fixed idea on the treatment you should be given. However, trust your instincts—if something doesn’t sound right, or a lab test or diagnosis doesn’t make sense, believe in yourself and voice concern.

Anuj Bhargava, MD Iowa Diabetes and Endocrinology Center President, Iowa Diabetes and Endocrinology Research Center CEO, My Diabetes Home

Giving Back

By Jennifer Braidwood

R

andall and Rita Brown attended their 28th TCOYD Conference and Health Fair in Savannah, Georgia on May 18, 2013. “We attend as many conferences as possible because we learn something new at each and every one of them. There is always a fantastic new speaker that we’ve never heard before or a new vendor that helps me in my quest to keep my diabetes under control,” said Randall Brown shortly after he and his wife Rita attended the Savannah conference. Randall has been living with type 2 diabetes since 1968 and Rita is one of his biggest advocates.

Randall and Rita Brown give an annual gift to TCOYD. “We donate to give back. Dr. Edelman and TCOYD have helped me so much.

Rita and I donate every year as a way to say thank you. Just recently, we

added TCOYD to our will because I really believe that Dr. Edelman and TCOYD saved my life. Not only that, but TCOYD taught me that I can live a long and healthy life with diabetes and most importantly, that I can be happy.”

Randall and Rita Brown also give annually because they want TCOYD to be able to continue their mission of educating and empowering individuals with diabetes. “Everyone cannot give a fortune, but every little bit helps. If we all give, as a collective we can help so many others with diabetes. The diabetes epidemic is growing by leaps and bounds. When you attend a TCOYD conference,

you help yourself take control of your diabetes. But when you donate to TCOYD, you can also help a family member, friend, neighbor, and the next generation to live a longer, healthier life with diabetes.”

TCOYD would like to say a generous thank you to Randall and Rita for traveling to our conferences around the country all of these years and for their dedicated and continued support.

Taking Control Of Your Diabetes

5

Interview #5

May 23, 2013 Current Weight 195 71 pounds lost BP: 122/72 A1c: 5.9 Total Cholesterol: 155 LDL: 91

A TCOYD Extreme Diabetes

Makeover:

The Jerry Lund Story - Part 3

By Jennifer Braidwood

fast. Although Jerry attributes most of his success sold six boxes of my fat to completely clothes this weekend,” revamping his said Jerry Lund during his diet, (see: The fifth interview with Jerry Lund Story, Sandra Bourdette, Spring 2013, Vol. 43) Executive Director he said that creating of TCOYD. Jerry an exercise regimen Lund, TCOYD’s 2013 was also an integral Extreme Diabetes component to Makeover participant, better health. has spent the last We asked Jerry to seven months on tell us about his exercise an intense mission program before he started to completely his, “Extreme Diabetes Makeover” revolutionize his diet, with TCOYD. “My exercise program exercise regimen and basically, his entire life. “I was taking before all of this, for probably a all my old clothes out of their boxes good 10-12 years was basically, well, and hanging them up on racks to sell nothing. I occasionally road my bike at the swap meet this past weekend, around on the boardwalk,” Jerry and I came across an old sport coat. said, and then he paused for a long stretch of silence, “I mean, gosh, I had bought the sport coat maybe six or seven years ago and I decided I can’t really think of anything else to put it on. I couldn’t believe how big it was. I was completely shocked.

“I had bought the sport coat There was enough room in there maybe six or seven years ago... for another person!” Seven months I couldn’t believe how big it ago Jerry needed a big change, a was. I was completely shocked. wake up call so to speak. At 266 There was enough room in pounds and a newly diagnosed type there for another person!”

2 diabetic, things needed to change for Jerry and they needed to change

‘‘I

6 My TCOYD Newsletter, Vol. 44

I used to do for exercise.”

Starting an exercise routine after close to twelve years of being completely sedentary is no easy task.

We wanted to know how Jerry got started. “I started off really slow.

When I started dieting, I knew I had to exercise too, so I created a plan. I hated the gym. I couldn’t stand the thought of even being in one, so that was out of the question from day one. I started to ride my bike more, maybe an hour or so on the weekends coupled with some stretching exercises in the pool for about 20-30 minutes for the first two months. Then I got a set of dumbbells. I started doing a small routine of exercises at my home every night after work. I remember the first time I tried to do a jumping-jack, my feet didn’t leave the ground. I actually had to lean on my kitchen counter to support myself. That was one of many moments throughout this process when I realized that I really did have a big problem.”

Jerry spent the next couple of months focusing on creating a workout regimen that not only fit nicely into his schedule, but was something that he enjoyed and felt comfortable doing. Every night after work, for about 15-20 minutes, Jerry did a

Know Your Numbers

combination of dumbbell exercises, jumping-jacks, crunches and pushups. On the weekends he rode his bike and did exercises in the pool.

Jerry hates the gym, so he doesn’t workout at the gym, simple as that.

The key factor in any successful workout regimen is that you have to do something that you enjoy doing, that you can look forward to doing every day and make a part of your daily routine. If you don’t like to run, then don’t run! If you don’t like the gym, then don’t sign up for a gym membership! But, if you like to dance, find out where you can take a dance class a few days a week or if, like Jerry, you like to bike, then grab a bike and start cruising the boardwalk.

“I love being on the sand and in the water so, eventually, I bought a paddle board and started spending my weekends on the beach. Now, my exercise regimen basically includes a 20-minute routine, seven days a week, of kettlebells, dumbbells, push-ups, jumpingjacks, and crunches . On Saturday and Sunday I do about an hour of paddle boarding and, if I’m feeling up to it, a little jog on the beach afterwards.”

With a great diet and exercise routine, your body obviously starts to change physically. We asked Jerry to tell us some of the differences that he has seen. “Well, my belly doesn’t hit the table when I slide into a booth at a restaurant, so that’s great. And my knees don’t crack and creak and I don’t have to

By Steven Edelman, MD

J

ohn is a 65-year-old male with type 2 diabetes since the age of 53 and is on multiple daily injections of insulin. Before meals during the day he takes 10 units of Humalog (fast-acting insulin) and at bedtime he takes 30 units of Lantus (slow-acting basal insulin). One night recently, John had a terrible and unusual hypoglycemic reaction that led to a refrigerator raid at three o’clock in the morning and an extremely high blood sugar level when he awoke the next morning. What happened?

The cause of this event is that John mixed up his vials of Humalog and Lantus. At bedtime (10pm) he mistakenly took 30 units of Humalog instead of Lantus and he had a very severe low blood sugar at 3am requiring his wife to give him a glucagon shot. The moral of this story is to BE CAREFUL!

SAT SUN MON TUES WED THUR FRI

B 81 101 79 135 122 476

L 111 157 162 115 153 209

D 117 151 166 121 163 213

hang onto a railing when I’m going up and down stairs. I’ve realized I actually have bones in my shoulders.

I used to have a lot of swelling in my legs and ankles; now, I hardly have any. I just feel great physically.”

The interview was coming to a close and we asked Jerry about his ‘next steps’. He is a mere five months away from the end of his “TCOYD Extreme Diabetes Makeover.” “I still plan on getting back on my surfboard. At first, my

BT 146 109 67 149 99 182

3am

34

overall goal was to surf again this summer. However, I guess you could say that my goal is shifting a bit.

I am not thinking about surfing as much as I am how amazing it feels to just be healthy. So, I guess that’s the goal, continue to be healthy and continue on this path.” Jerry sold all of his “fat clothes” as he likes to say, at the swap meet last weekend. Now he doesn’t really have a choice but to move forward, or else he’ll have nothing to wear!

Taking Control Of Your Diabetes

7

Ask a Pharmacist

Alogliptin: New “Gliptin” for Type 2 Diabetes Mellitus

A

logliptin (Nesina), the fourth and newest di-peptidyl peptidase IV (DPP-4) inhibitor, was approved by the US Food and Drug Administration in January, 2013 for use in people with type 2 diabetes mellitus (T2DM). Two other one-tablet combination products, Kazana (alogliptin and metformin) and Oseni (alogliptin and pioglitazone), will also be available this summer.

What are DPP-4 inhibitors?

“Gliptins”, also known as DPP-4 inhibitors, decrease the breakdown of incretin hormones. Incretins (e.g.

GLP-1, GIP are gut hormones that cause the release of insulin from

8 My TCOYD Newsletter, Vol. 44

the pancreas in response to blood glucose rising after eating a meal.

The benefit of DPP-4 inhibitors is that they provide additional glucose control without increasing risk of low blood glucose (hypoglycemia) and they do not cause weight gain like many other medications used to treat diabetes. DPP-4 inhibitors come in tablet formulations and can be taken orally once or twice daily without regard to food or beverages.

How is Alogliptin different from other DPP-4 inhibitors?

Similar to two other DPP-4 inhibitors, sitagliptin (Januvia) and saxagliptin (Onglyza), alogliptincontaining products require dose adjustments for reduced kidney function. The four metformincombining gliptins are comparable in cost and efficacy. Nonetheless, alogliptin is the first agent available as a single tablet in combination with pioglitazone (Actos).

Additionally, in contrast to other DPP-4 inhibitors, alogliptin is not known to have major drug interactions.

Is Alogliptin right for me?

The hemoglobin A1C reflects long-term blood glucose over the preceding 2-3 months and is used to measure diabetes control. If you aim

to achieve a mild reduction in your A1C (like 0.5%), adding alogliptin to healthy food choices and active lifestyle may help you achieve your A1C goal. Since alogliptin has not been studied in people with type 1 diabetes, it is only approved for blood glucose control in type 2 diabetes. Available in 6.25 mg, 12.5 mg, and 25 mg tablets, alogliptin is taken orally once daily.

It can be used in conjunction with metformin, sulfonylureas (glipizide, glimepiride, or glyburide), glitazones, other diabetic drugs, and insulin.

Discuss with your doctor and review your current medication list, including prescription and non-prescription products, and herbal and vitamin supplements before you take alogliptin. Caution should be exercised if you are taking medications that can cause low blood glucose, or if you are pregnant or planning to be pregnant.

What can I expect from Alogliptin?

When used alone, alogliptin provided an A1C level reduction of 0.4% to 0.6% in 26 weeks. It also improved blood glucose levels.

Overall, alogliptin is well tolerated in most users. The common side effects of alogliptin include runny nose, headache, and upper respiratory infection. With the development of pancreatitis during gliptin therapy as a growing concern, more post-marketing studies are warranted. Higher risk of acute pancreatitis is seen in patients

Fit to Eat

with alcohol or tobacco use, gallstones, or high triglycerides.

Patients should stop taking the drug and report symptoms of acute pancreatitis, which is characterized by severe upper abdominal pain and vomiting, to their doctor immediately.

The bottom line.

Alogliptin appears to be a well-tolerated, safe, and effective alternative to other gliptin agents.

DPP-4 inhibitors can be added to diet and exercise, or other antidiabetic therapies, to achieve additional A1C reduction and blood glucose control in T2DM patients, particularly those who are close to A1C goal or inadequately controlled by other regimens. If you are concurrently taking metformin or pioglitazone, alogliptin is also available in single-tablet combining formulation to reduce pill burden.

Though there is no increased risk of low blood glucose, monitoring of liver and kidney functions and side effects including pancreatitis are necessary in the use of alogliptin.

Submitted by: Candis M. Morello, PharmD, CDE, FASHP; Associate Professor of Clinical Pharmacy and Associate Dean for Student Affairs at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences and Clinical Pharmacist at VASDHS Sandy I. Chong, PharmD, Candidate 2014 at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences

By Janice Baker

on’t like to cook? Don’t want to cook? Don’t have time to cook?

Dislike sorting through recipes, or having to fuss with cleaning? You’re not alone and that’s ok! It’s possible to eat healthy for diabetes and manage your weight with some simple ideas. And you can save a lot of money at the same time, especially if you are used to eating out several times per week. Save your money for good quality shoes or new dancing music and stomp diabetes into submission!

One of my personal favorites for eating on the go is “wraps”. Made with a whole grain flatbread, lean protein, flavorful spread and colorful, nutritious produce, you can make up a meal any time of day to eat hot or cold. And there’s plenty of variety in wrap and filling choices to keep you from getting bored or feeling deprived.

Ideas to get you started: Wrap choice suggestions: Flatout flatbread (found at Costco and most grocery stores) or La Tortilla Factory (low carb and whole grain tortillas in several varieties).

Spread suggestions: Roland foods pesto (try the basil and tomato pesto, a light spread is all you need for wonderful flavor) salsa of your choice, mashed avocado or guacamole, thinly spread olive oil based mayonnaise, or mustard.

Add the veggies: Dark green leafy lettuces, spinach, thin slices of cucumbers, shredded carrots, shredded cabbage (red or green), pepper strips, canned or frozen veggies, such as asparagus, artichoke hearts, hearts of palm, or roasted peppers (be sure to rinse canned items to remove excess sodium or oils and squeeze excess water from frozen items).

Lean protein: Lean meats, such as roast beef, ham, turkey (look for low sodium varieties), home cooked or store bought roast chicken, thin slices of natural cheese (Swiss or provolone), egg, tuna or salmon salad, smoked salmon, herring or sardines.

On the side: Fresh fruit, such as bananas or apples can be combined with nut butters (peanut or almond) for added protein. Also veggies, like baby carrots, for extra fiber, water and antioxidants. For a drink, go with water, milk, coffee, or tea!

Janice Baker, MBA, RD, CDE, CNSC, BC-ADM, Registered Dietitian, Certified Diabetes Educator, Certified Nutrition Support Dietitian, Board Certified-Advanced Diabetes Management. Find her information at: www.BakerNutrition.com, www.Facebook.com/BakerNutrition or www.Twitter.com/JaniceBakerRD

*(Avoid bologna, salami, Spam, and other high fat/sodium highly processed meats).

Taking Control Of Your Diabetes

9

Connecting iBGStar® with the Diabetes Community

By Robert Cuddihy, M.D., Vice President, Medical Diabetes Head at Sanofi US

A

s anyone living with diabetes knows, daily blood glucose monitoring is a vital part of everyday diabetes management.

Exercise and healthy eating habits are certainly important parts of an overall diabetes management plan, but regularly checking blood glucose levels is also an integral aspect of diabetes management and requires careful attention from the 26 million Americans who are living with diabetes and those who care for them.

To help with this need and provide blood glucose monitoring that truly integrates into the lives of people living with diabetes, Sanofi US launched the iBGStar® blood glucose monitoring system in May 2012. Since then, we’re proud to see that iBGStar® has carved its own place among the diabetes community with its flexible and accurate offerings. iBGStar® is the first U.S. Food & Drug Administration (FDA) cleared blood glucose meter that is compatible with the iPhone® 3G/3GS/4/4S and iPod® touch 2/3/4. You can now also connect your iBGStar® to the iPhone® 5 and iPod® touch 5 using Apple’s authentic Lightning™ to 30-pin Adapter (sold separately).

With the iBGStar® Diabetes Manager App, you can check your blood sugar readings, manage your diabetes info, and share

10 My TCOYD Newsletter, Vol. 44

Important Information

The iBGStar® meter and lancing device are for single patient individual use. Do not share them with anyone including other family members. Do not use on multiple patients. All parts of the kit are considered biohazardous and can potentially transmit infectious diseases, even after you have performed cleaning and disinfection. iPhone®, iPod touch® and Lightning™ are trademarks of Apple Inc.

5 Foods That Can Help Your Diabetes and Your Mouth (continued from page 3

results with your family members or your healthcare teams, whenever, wherever—using mobile technologies that have become integral in our lives today. Additionally, iBGStar® can be used as a stand-alone meter and results can by synced to your iPhone® or iPod touch® later on, which is great for those of you always on-the-go. As technology and healthcare continue to join forces, we will continue to provide innovative solutions to help people living with diabetes.

Currently, iBGStar® is available at Apple Retail Stores and all Walgreens stores nationwide, Apple.com, Walgreens.com and through Diabetic Care Services.

For more information, check out www.ibgstar.us.

cause decay (as long as you don’t add sugar). Green tea lowers acidity, which is another reason it helps prevent cavities.

Green tea has powerful antioxidants that help fight cancers as well. It has been shown to fight obesity and to lower cholesterol, and it also improves blood circulation.

Green tea will stain your teeth, though not as much or as quickly as black tea, so it is best to remove as much plaque as frequently as possible (brush and floss).

Low-Fat Yogurt

You need calcium for healthy teeth and bones. One cup of yogurt has 300 mg of calcium and many brands add vitamin D to help the absorption and use of calcium.

“Live” cultures in yogurt also act as a “probiotic”, helping put good bacteria into the

Question of the Month

digestive system, which also includes the mouth. Studies show that low-fat, sugar-free yogurts have a positive effect on the dental biofilm, reducing decay and promoting healthy gums.

Yogurt is also a great source of protein, vitamins, and some minerals that are important for healthy gums.

Additionally, yogurt has been shown to improve “T” cell function, which helps the body fight inflammation (gum disease).

This content is provided by dLife.

Do you have questions about living with diabetes? dLife has a wealth of information to give you the answers you need to manage your diabetes health. dLife offers a community network and resources for people living with diabetes and their caregivers. By providing in-depth expert information, inspiration, and community connection, dLife’s awardwinning dLife.com and dLifeTV.com help millions of people, just like you to gain control of their diabetes health.

Become a dLife member for FREE and receive free eNewsletters with the latest diabetes news and information, 9,000+ diabetes-friendly recipes and tips on better managing your diabetes. Join now at www. dLife.com/joinnow and receive a free cookbook by entering promo code TCOYD13.

Join dLife on Facebook, follow dLife on Twitter, watch dLife on Youtube or at dLifeTV.com

By Steven Edelman, MD

I

am 70 years old and have lived with type 1 diabetes for 37 years. I have no evidence of eye, kidney or nerve disease and I am grateful for that (my A1c values have almost always been less than 6.5%). However, I have developed hypoglycemia unawareness and I do not feel the symptoms of low blood sugar values like I used to. I also have problems with an irregular heartbeat and had a heart attack several years ago.

My doctor tells me my A1c is too low and that I need to loosen up my control but I am hesitant to do so. What are your thoughts?

Answer: First of all, congrats on keeping your A1c down and having no micro-vascular complications. However, you now have hypoglycemia unawareness and must be very careful to avoid low blood sugar levels as they may make your heart condition worse. I would say being closer to 7.5% may be a safer range for you. I would also recommend getting a continuous glucose monitor to help you avoid extreme fluctuations with your blood sugar levels.

It is important to remember that A1c goals need to be individualized for all people with diabetes.

A special thanks to all of our Facebook fans who sent in questions for Dr. Edelman!

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Taking Control Of Your Diabetes

11

TCOYD Conferences & Health Fairs 2013 Schedule

February 23

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November 2 November 23

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

Tel: (800) 998-2693

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

Tucson, Arizona Santa Clara, California Honolulu, Hawaii Kauai, Hawaii Savannah, Georgia San Francisco, California Living Your Best Life – A Conference for Type 2’s Worcester, Massachusetts Omaha, Nebraska Albuquerque, New Mexico San Diego, California

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San Diego, CA Permit No 1

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Diabetes Do’s and How To’s A New Book By Riva Greenberg

T

he only action-step guide of “what to do” and “how to do it” to take care of your diabetes!

So often when Riva Greenberg travels across the US speaking to people with diabetes, they ask her: “Can I eat fried chicken?” “What’s the best thing to have for breakfast?”

“My blood sugar’s fine in the morning, so why is my doctor telling me to take another pill?”

There is a lot of confusion that circles around diabetes care and management. Many questions are asked and sometimes those questions go unanswered, leaving people with

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My TCOYD Newsletter, Vol. 34

diabetes in a fog of uncertainty. Now you have something to clear up the confusion—a practical guide of action steps in Greenberg’s new book, Diabetes Do’s & How-To’s.

Diabetes Do’s & How-To’s is for people with diabetes and those who take care of them. Through 65 “Do’s,” and numerous “How-To’s” to choose from, you’ll learn how to manage your diabetes, including: what foods to eat and how much, how to eat healthy, how to normalize your weight if necessary, get in shape

with small, easy steps, manage your medications, get more from your doctor visits, stay positive and much more.

To see what others have said about Diabetes Do’s & HowTo’s and get your own copy, go to Amazon.com.

Riva Greenberg is also the author of 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It and The ABCs Of Loving Yourself With Diabetes. She also blogs on her web site, Diabetes Stories, and The Huffington Post.