TCOYD 2014 Spring Newsletter

NEWSLETTER

MY

Spring 2014 Volume 47

Make Love, Not War:

Embrace The Medications And Devices That Will Keep You Healthy Dr. Edelman’s Corner

INSIDE The Couch Potato Workout Page 3

Treat Your Feet Page 4

Following The Trend Page 5

Running Toward A Cause Page 6

Novo Pen Echo And Recipe From Chef Lewis Page 7

How To Count Carbs Page 8

Question Of The Month Page 9

Diabetes: The Impact On Family Members Page 10

Know Your Numbers Page 11

I

can’t tell you how many times I’ve heard my patients make statements such as, “I hate taking all of these medications. How can I get off of them?” or, “I hate my glucose meter (or continuous glucose monitor) and I want to run it over with my car!”

As a caregiver, one of the biggest frustrations I have is when a patient comes back to clinic and has stopped his or her important blood glucose, hypertension, or cholesterol medications and says something like, “Was I supposed to refill it?” or “I went on vacation without my meds and I didn’t feel any different so I stopped taking them.”

Another situation that drives us caregivers totally bonkers is when people

with diabetes show up for clinic visits without their glucose testing logbooks or meters and say something like, “I didn’t think you wanted to see it” when, in fact, a patient’s logbook numbers are a vital component of the visit.

Why do so many folks with diabetes resist, even despise, being pro-active in managing their diabetes and find any reason possible to stop their medications?

Some will even turn to vitamins or Make Love Not War (continued on page 2)

Make Love Not War (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 Edward Beberman Christine Beebe Audrey Finkelstein S. Wayne Kay Margery Perry Daniel Spinazzola

Contributing Authors Jennifer Braidwood Steven V. Edelman, MD Robert Lewis, Chef Jeremy Pettus, MD Craig Wargon, DPM

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 Jennifer Braidwood Manager, Outreach and Continuing Medical Education 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. ©2014 All rights reserved.

supplements that make unproven not only to you but also, to your close claims in fancy brochures because friends and family, because it will be a they seem more ‘natural.’ If it has the tremendous burden on all of you if a word ‘natural’ it has to be good, right? serious problem develops. You owe it Well…strychnine is natural! to yourself and your family to stay as I could go on and on, but here’s healthy as possible for as long the thing, every person with diabetes as possible. needs to embrace their medications and Instead of resenting the fact that testing devices because these are the you need to take medicine and check tools that will keep your blood sugars, you healthy while look at it this way, Preventing serious illness and living with diabetes. your glucose meter disease is a blessing not only The harsh reality is or CGM device is to you but, also, to your close your own personal that without these friends and family, because it laboratory right in tools, diabetes can be deadly, especially will be a tremendous burden the palm of your if ignored and hand and that’s on all of you if a serious untreated. We are problem develops. You owe it pretty darned so fortunate to live to yourself and your family to powerful. People in in a time when stay as healthy as possible for earlier times would all these tools are have given anything as long as possible. available to help us. to be able to have Just 20 years ago, such control over when we started TCOYD, there was their health. These devices give you so only one medication for treating type much information about your diabetes 2 and two insulins for treating type 1. and put you in the driver’s seat. If Today, we have nine different classes you will make your diabetes a top of medication for treating type 2 and priority in your life and learn to view an array of insulins for type 1. We can your medications and devices as your individualize treatment so that each friends, you will surely reap the reward person gets exactly what works best of improved health.

Listen folks, stop whining and for them. start embracing your medications and We know that proper glucose, devices for what they are...your lifeblood pressure, and cholesterol saving and information-giving control will help you friends. And remember the old avoid blindness, kidney adage, Make Love, Not War! failure, amputations and, let’s not forget, heart attacks and strokes.

Preventing serious illness Steven Edelman, MD and disease is a blessing Founder and Director Taking Control Of Your Diabetes

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TCOYD in Motion

hip. Hold, then slowly lower.

Repeat, then switch sides. Aerobic: run in place.

e’ve all had that silent debate in our heads, the one where you go over the pro’s and con’s of heading to the gym, for a walk or run, or cozying up on the couch and watching the latest episode of your favorite TV show.

It’s a hard fight, but on the days where your workout routine takes a backseat to How I Met Your Mother or The Bachelor, we want to offer you a great alternative to being a total couch potato.

Every hour-long television program contains approximately six commercials breaks that last at least three minutes each. You can get a fantastic total body workout without missing a scene. Also, exercise during commercial breaks means you’re not snacking, which is also a big plus.

We turned to Prevention.com’s Couch Potato’s Workout because it’s great for beginners but it’s also good for exercisers of every level, since extra bouts of activity throughout the day help to keep your metabolism revved up.

Here’s what to do: Complete 10-15 repetitions of each exercise and finish up with the aerobic component until the show starts again.

Commercial Break 1: Couch Pushups (chest and triceps) Facing your couch, kneel on the floor about two feet away from it.

Cross your ankles, and place your hands shoulder-width apart on a cushion edge. Slowly bend your arms, and lower your upper body until your chest touches the couch.

Hold, then press up again. Aerobic: jumping jacks.

Commercial Break 2: Side Crunches (obliques) Lie on your couch on your left side with you legs together and your knees bent. Place you right hand behind your head with your elbow toward the ceiling. Wrap your left arm across your waist. Contracting the oblique muscles along your right side, lift your shoulder off the couch, bringing your rib cage toward your

Commercial Break 3: Armchair Stands (quadriceps, gluteus) Sit on the edge of your chair or couch with your feet shoulderwidth apart. Without using your arms, press into the floor with your feet, and stand, tightening your butt muscles as you rise. Keep your abdominals tight and your back straight. Hold, then slowly lower yourself. Before you touch the chair, stand up again. Aerobic: walk or jog up and down stairs.

Commercial Break 4: Armchair Dips (triceps) Sitting on the edge of your chair or couch, place your hands on the edge on either side of you. Move your feet out so that your butt is off the chair, and your knees are bent at 90-degree angles. Bending your elbows so they point behind you, lower yourself as far as comfortable.

Hold, then slowly press up again.

Aerobic: Circle your fists in the air to imitate boxing a punching bag.

Commercial Break 5: Leg-up Couch Crunches (abdominals) Lie on your back on your couch with your knees bent, your feet up on one end, and your hands behind your head. Pressing your lower back into the couch, slowly lift your The Couch Potato Workout (continued on page 7)

Taking Control Of Your Diabetes

3

Ask Your Podiatrist

Thick, hard calluses that rub against your shoes or the ground can actually puncture the skin. This is unlikely to happen to people with normal sensation in their feet because the feeling of pain would alert them to stop walking and address the problem

By Craig Wargon, DPM, Podiatric Surgery, Kaiser Permanente, Santa Clara, CA long before it gets too serious. On the other hand, a person with diabetic neuropathy may not feel anything until it’s too late! The underlying skin may be punctured and an infection may have started without of your foot. Some people have a t’s probably no surprise that the person knowing. If untreated, greater propensity to form calluses this could lead to an infected people with diabetes can sometimes find themselves having than others, especially around the diabetic ulcer, which is even worse. heel, which can lead to dryness to deal with a number of different Don’t worry, you can easily or cracking. Because diabetes can foot problems. Even ordinary foot prevent these serious problems from cause changes in happening by following just a few problems like the skin of your simple precautions and taking some calluses, if not Calluses can be a common foot, calluses can time every day to treat your feet! taken care of, issue for a lot people, even occur more often can lead to some individuals who do not have and build up pretty serious v Know your diabetic foot risk faster, and they complications. level by asking your physician or diabetes. Calluses are most can also be quite So, it’s really podiatrist to test your protective often the result of repeated important to stay sensation and circulation. If you friction or pressure and they tender, which is a good thing. ahead of the curve have diabetic neuropathy or can occur from improper You’re and tackle issues poor circulation, seek medical fitting shoes. probably asking as soon as you start attention for your calluses from yourself, ‘why on to notice them. a podiatrist or other medical Calluses can be a common issue earth is tenderness a good thing?’ professional on a regular basis.

Because pain is your body’s alarm for a lot people, even individuals v Wear proper fitting shoes with who do not have diabetes. Calluses system and it lets you know when ample room in the toebox. are most often the result of repeated something is wrong. At some point Women of course, should in your life you have probably friction or pressure and they can avoid severely pointed or heard that people with diabetes occur from improper fitting shoes, high heel shoes. or if you have certain foot problems can develop a condition called v Over the counter inserts such or deformities, such has bunions or “peripheral neuropathy,” caused by as Superfeet may help with hammertoes. Structural imbalances nerve damage that often results in calluses on the ball of the foot. weakness, pain, and a progressive that are inherited can also lead v Use a pumice stone (if you don’t decrease of sensation in your feet. to calluses, especially on the ball have neuropathy) regularly

4 My TCOYD Newsletter, Vol.33 Vol. 47

after showering or bathing.

Apply a moisturizer daily (avoid the area in between the toes). v For stubborn calluses, especially around the heels, consider a lotion that contains agents which chemically breakdown the callus (called a kertolytic).

A common brand is Amlactin and is available over the counter. I often tell patients to apply this at night and cover the feet with stockings. This really helps drive the medicine into the troubled areas and softens the callus so that you can gently scrape off the top layer the next day with a pumice stone after bathing. This often needs to be done several days in a row until the callus is under control. v Beware of “Eggs” and corn cutters. These ‘cheese grater’ or blade-like devices can be risky, especially for people with diabetes. It’s easy to slice off a healthy layer of skin with these types of products. v Avoid so-called corn removers that contain salicylic acid in liquid or the adhesive form.

These products can cause problems if used improperly. v Inspect your feet often. Be alert for signs of infection, which can include redness, draining, foul odor, swelling or obvious breaks in the skin. v And last, contact your healthcare provider if you have any concerns.

Following The Trend (A Dexcom Study) By: Jeremy Pettus, MD, Endocrinology Fellow, UCSD, TCOYD Type 1 Track Co-Director

T

he use of continuous glucose monitoring devices (CGMs) is quickly becoming the standard of care when it comes to helping individuals with type 1 diabetes manage their condition. This is largely a result of more studies showing the clinical benefits of these devices including an ability to lower the A1c (typically on the order of 0.5%), reduce the amount of hypoglycemia, and increase the time being in a desirable glucose range. As studies continue to show benefits, more and more insurance companies are reimbursing for CGM devices with nearly all commercial payers covering the devices in type 1 diabetes, and some even expanding to type 2 diabetes.

However, a fundamental question remains: what are individuals with diabetes doing with the information provided by the devices to reach these beneficial outcomes? Keep in mind that CGM trials are different than your typical pharmaceutical

trial. Clinicians are very used to giving an individual with diabetes a drug and seeing what happens to the A1c; however, with CGM trials, clinicians are not specifically giving anything to the person with diabetes other than more information. Therefore, any change in A1c or reduction in hypoglycemia must be coming from something specific that CGM users are doing. So what are they doing?

To help answer these questions, we conducted a survey of 222 patients with type 1 diabetes who were deemed successful CGM users (wore the device for more than six days a week).

They were asked 70 multiple-choice questions on varying aspects of their diabetes care. While patients made many adjustments in their care based on CGM values, the most striking findings were how they were adjusting their insulin doses based on the glucose trend information provided by their CGM devices.

CGM Study (continued on page 12)

Taking Control Of Your Diabetes

5

Giving Back

By Jennifer Braidwood

arbara Laskaris first got involved with TCOYD about twelve years ago when she took her father, who has type 1 diabetes, to a TCOYD conference and health fair in San Diego, California. “I have watched my father’s health deteriorate through the years due to his resistance to change and refusal to manage his disease, so the cause of educating people with diabetes is very personal to me,” said Barbara.

In 2012, Barbara put together her first team of Ragnar Relay runners called “The Ambulance Chasers,” to participate in a 200-mile relay race that happens annually in Southern California.

“Our team decided that if we were going to run, we were going to do something good for people in the process. Many of the team members have connections to the diabetes community and we felt that

6 My TCOYD Newsletter, Vol. 47

TCOYD was an organization that could potentially benefit greatly from our efforts.”

This past year, The Ambulance Chasers went national and not only participated in their home race in Southern California that took place in April, but they also have plans to participate in both the Chicago Ragnar Relay and the Colorado Ragnar Relay.

So far, Barbara and The Ambulance Chasers have run close to 1,000 miles with the aim of supporting TCOYD and diabetes education and have raised close to $40,000. “Dr. Edelman’s mission to educate and empower people with diabetes to live healthier, happier lives and to take control of their disease through these conferences is such a powerful tool that has the capacity to reach so many people and change so many lives. I am proud to

raise money that I know will make a difference.”

You too can help TCOYD continue our mission of educating and empowering people with diabetes and help inspire others, so that one day we can all see a life free of diabetes.

Please make your gift today!

Visit www.tcoyd.org and click on the “Giving” tab. If you are interested in joining The Ambulance Chasers Ragnar Relay team and supporting TCOYD or participating in other fundraising efforts, contact Barbara at BarbaraLaskaris@gmail.com.

Product Theater

The Couch Potato Workout (continued from page 3)

head, shoulders, and upper back off the couch. Hold, then slowly lower. Aerobic: Knee lifts. While standing, alternate bringing your right elbow down to meet your left knee, and vice versa.

Commercial Break 6: Scissors (adductors and abductors) Lie on your back on your couch (you may need to angle yourself for more room) with your hands (palms down) under your butt and your legs straight up in the air. Keeping your knees slightly bent and your feet flexed, slowly spread your legs as far apart as comfortable. Hold, then slowly bring your legs together, resisting as you press them in. Aerobic: Side slides. Step your right foot out to the side, then slide your left foot to meet it. Repeat in the opposite direction, doing this as quickly as you can.

Farmers’ Market Roasted Vegetable Soup Per Serving: Calories: 134 • Total Fat: 2.39g • Dietary Fiber: 8.05g • Protein: 7.35g • Total Carbs: 26.44 • Sugars: 5.37g

The NovoPen Echo From Novo Nordisk

N

ovo’s new insulin injective device, the NovoPen Echo, is the first and only pen device available in the United States that provides both precise and half-unit dosing. The NovoPen Echo also has a memory function that records the dose and time passed since the last injection for extra reassurance. It can remind busy teens, parents, caregivers, or adults on the go, when and how much their last dose was.

The half-unit dose increments allow for finer adjustments, which can be particularly important for children. In addition, twelve fun removable skins are available for a customized look, including kid-friendly designs.

Here’s an overview of features that are available on the NovoPen Echo: Half-unit dosing:

u Fine-tune your dose from 0.5 units up to 30 units for precise dosing that works with even a small snack

Memory function:

u Automatically records the dose and time since your last injection

Short button travel:

u Reduces injection movement

Dials and exact dose:

u The dose button can turn backward and forward to help you choose the right dose without wasting insulin u You can dial your dose up and down u You’ll know when to change the cartridge because NovoPen Echo doesn’t allow you to dial anymore units u You may hear or feel an end-of-dose click

Ingredients:

2 carrots, diced 4 mushrooms, diced 1 red pepper, diced 1 large onion, diced

1 can drained cannellini beans 1 small butternut squash, peeled, seeded, and chopped 3 garlic cloves 2 tsp canola oil 2 sprigs fresh thyme

Ready-to-change PenFill cartridge: u PenFill cartridges are sold separately

1 14oz can no salt added diced tomatoes 32 oz no salt added vegetable stock 1/2 tsp black pepper 1 1/2 cup kale, shredded 1/4 cup chopped parsley

Preheat the oven to 425 degrees. Spread vegetables in a single layer on a sheet pan, drizzle on the oil, and mix with your hands to evenly distribute the oil. Roast for 30 minutes, stirring them halfway. Pour the tomatoes and thyme over the vegetables and roast another 15 minutes, just until the tomatoes and the vegetables have turned slightly golden brown. Remove thyme stems. Use a spatula to transfer the vegetable and tomato mixture into a large saucepan, then slowly add the stock. Season with pepper and simmer for 10 to 20 minutes. Add the kale and the cannellini beans and simmer 5 minutes, until the kale has wilted. Add the parsley, stir to combine, and remove from heat. Serve warm. Serves 6 Chef Robert Lewis, ‘The Happy Diabetic’ was diagnosed with type 2 diabetes in 1998. Chef Lewis has published three cookbooks – Cook Fresh, Live Happy; Get Happy, Get Healthy; and Simply Desserts.

Taking Control Of Your Diabetes

7

Taking Control

How To Count Carbs In Combo C

ounting carbohydrates in dishes made with multiple ingredients is a cinch when you have measuring cups and nutrition facts at your fingertips. Here’s help for times when your only clue is how the food looks on your plate.

1. Count hot dishes by the cup.

A mix of meat with vegetables in a savory sauce, including stew and many Asian food entrees, has around 15 grams carbohydrate per cup. For dishes made with pasta or grains, such as lasagna or chicken with rice casserole, count 30 grams carbohydrate per cup.

2. Think: spoonable or forkable?

If soup is so thick and hearty you could nearly eat it with a fork, such as Ramen noodles, or if it’s loaded with legumes, such as chili or split pea soup, estimate 30 grams carbohydrate per cup. Broth-base soups and cream soups made with water average 15 grams carbohydrate per cup.

3. Scan with your hand. An adult’s hand, when spread, typically spans 7-8 inches from thumb to pinky finger. That’s the width of a medium flour tortilla, which has 20-25 grams carbohydrate. Use your hand to size

8 My TCOYD Newsletter, Vol. 47

up tortillas at burrito bars. Some are as much as 13 inches across, packing 55 grams carbohydrate— not counting the filling.

Article provided by Diabetic Living® Magazine

u

Coleslaw: 1/2 cup = 15g carb u Potato salad: 1/2 cup = 22-30g carb

6. Study sandwich standards.

Although there are countless ways to build a sandwich, the bread used as the base contributes most of the Calculate pizza by the crust, carbohydrate. Follow this guide which is where most of the for estimating the carbohydrate carbohydrate is. A medium in sandwiches made with typical (12-inch) thin crust pizza topped savory toppings. with sauce, vegetables, cheese, u Breakfast meat on English and meat, that’s cut into 8 pieces muffin: 30g carb has 20-25 grams carbohydrate per u Burger on standard-size bun: slice. A regular crust pizza averages 30g carb 30 grams carbohydrate per slice. u Sandwich made with sliced bread: 45g carb Identify main ingredients u 6-inch submarine sandwich: in salads to estimate the 45-60g carb carbohydrate count. If your favorites are higher in carbohydrate (and creamy with lots of fat), opt for a smaller serving. Here’s how common salads stack up: u Leafy garden salad (without dressing): 1 cup = 2-5g carb u Meaty salad (such as chicken, tuna, or egg): 1/2 cup = 7g carb

4.

5.

Question of the Month

7. Count a “bread” for breaded meats. “Naked” meat that’s grilled or broiled is carbohydrate-free (and generally lower in fat). But if a breaded chicken patty or serving of six chicken nuggets is your treat, count 15 grams carbohydrate to account for it. For larger breaded meat patties, such as country-fried steak, count 30 grams carbohydrate.

8. Limit appetizers to one piece.

A single Thai spring roll, an Italian bread stick, or a lettuce wrap provides about 15 grams carbohydrate—not counting dipping sauces. Want an appetizer meal? The total calories and carbohydrate in an appetizer often equal (and sometimes surpass) an entrée, so if you order multiple dishes, split them with friends.

9. Tally tablespoons. When served family-style, such as at an Italian restaurant or steakhouse, use a tablespoon to size up servings as you put food on your plate. For example, 4 level tablespoons (1/4 cup) baked beans add up to 15 grams carbohydrate and 8 tablespoons (1/2 cup) corn provide 15 grams carbohydrate.

10. Triple the carb count when fruit is made into dessert. A small apple or 3/4 cup blueberries has only 15 grams carbohydrate, whereas just 1/2 cup apple crisp or 1/8 of a blueberry pie has 45 grams carbohydrate. To make room for these occasional treats, choose low carbohydrate foods for the rest of the meal.

By Steven Edelman, MD

I

don’t ever get up in the middle of the night to snack; however, my morning blood glucose is sometimes higher than it was at bedtime.

Why is this?

Answer: Although this seems to be a more common concern in people with type 1 diabetes, this can often times happen with people who have type 2 as well. Higher morning blood sugars are commonly due to the “Dawn Phenomenon.” The Dawn Phenomenon refers to the natural release of excess hormones, such as the growth hormone, in the morning between 5 am to 8 am. This results in an increase of the blood sugar levels at dawn, or early morning. Less commonly, one can have high blood sugars in the morning as a protective response to low blood sugars during the middle of the night. This is referred to as the, “Somogyi Effect.” Another reason for a high blood sugar in the morning is that you may simply need a higher dose of your usual diabetes medication (insulin and/or pills). Lastly, another explanation for a higher glucose level in the morning compared to your bedtime value the night before is a complicated metabolic term called excessive hepatic (medical term for liver) glucose production. The liver inappropriately produces too much glucose at night and is very commonly seen in people with type 2 diabetes. In the latter situation, basal insulin and oral medications such as metformin may be needed.

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

9

Living Well

Shedding A New Light On Diabetes: The Impact On Family Members

M

anaging your diabetes requires a lot of you. Maintaining a healthy diet, getting the right amount of exercise, keeping up with your medication regimen, checking your blood sugar levels, and making decisions with your health care team are just a few things that you have to do regularly to maintain control. It’s understandable that this can be overwhelming at times. But remember that you are not alone!

Your family members should be an integral part of your team and provide you with support through the ups and downs of living with diabetes; however, it’s important to keep in mind that the weight of living with diabetes that you may sometimes feel, your family members probably feel, too. By involving your family in your diabetes care and management, they can significantly impact how well you self-manage your diabetes and your overall experience. In addition, your family will feel more involved, less burdened, worried, or frustrated. What it comes down to is, diabetes is truly a family affair!

The Hidden Impact on Family Members A recent global survey study looked at the experiences and unmet needs of people with diabetes, their family members, and health care providers. This study was called Diabetes Attitudes, Wishes and Needs 2 (DAWN2™).

It was the first large study to look at the impact of diabetes on family members from these perspectives. Diabetes is known to be a burden for people living with diabetes; what these findings brought to light is the hidden impact of diabetes on family members.

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Know Your Numbers

Key findings showed that many family members reported: v Feeling burdened and distressed v Worrying about the risk of hypoglycemic events v Feeling frustrated that they do not know how to help the person they care for v Wanting to be more involved in the care of their loved one v Having a need for more psychosocial support and education v Feeling a positive impact on at least one aspect of their lives, such as healthier eating habits For more detailed information about the global surveys, DAWN™ and DAWN2™, as well as for practical tools and resources, visit www.dawnstudy.com.

Teamwork is The Key to Success When it comes to uncovering the impact that diabetes has on family members, the DAWN2™ study is just the beginning. More research needs to be done to learn about the psychosocial impact of diabetes and ways to address the unmet needs of both people with diabetes and their family members.

Remember, invite your family members to be a part of your team.

Here are a few tips you can try: v Ask a family member to go to doctor’s appointments with you. They can help by taking

By Steven Edelman, MD

W

hen you take a look at the logbook below, it’s perfectly obvious that the fasting and bedtime blood sugar values are consistently high.

Many caregivers would immediately increase the evening or bedtime insulin and/or oral medications to improve the morning levels. What is important to recognize here, is the main problem may be that this person is going to bed with levels that are too high. If the blood sugar values were in the mid 100’s at bedtime, the morning values may also fall within the desirable range with no change in the evening insulin dose or oral medications.

The first thing to do is to figure out why the bedtime numbers are so high and correct the problem, which could be a few things: not enough fast-acting insulin with dinner, too large of a meal at dinner time, or snacking after dinner.

Once the bedtime numbers come down, at least under 200mg/ dl, then it is important to watch the morning numbers to see if they also improve. An old rule in diabetes management is to make one change at a time.

notes, listening, and being there for support v Talk more openly about how you are feeling, what questions or concerns you may have, and what your needs are v Eat healthy meals together and be active together v Find educational and support programs (including support groups)

You have to work together, and communicate together. Remember, you are not alone, and your care team is there to support you.

By putting these strategies into practice together, it can benefit the entire family!

DAWN™ and DAWN2™ are trademarks and Changing Diabetes® and the Apis bull are registered trademarks of Novo Nordisk A/S. © 2014 Novo Nordisk All rights reserved.

0314-00020383-1 April 2014

Taking Control Of Your Diabetes

11

TCOYD Conferences & Health Fairs 2014 Schedule

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

February 8 Native American,

Pala, California

March 8 Sacramento, California

April 12 Honolulu, Hawaii

May 17 Raleigh, North Carolina

Tel: (800) 998-2693

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

PAID

San Diego, CA Permit No 1

June 7 Washington, DC September 6 Missoula, Montana

September 27 Des Moines, Iowa

October 18 Amarillo, Texas November 8 San Diego, California

Stay connected to TCOYD, visit www.tcoyd.org

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

CMG Study

number and not a trend. With these (continued from page 5) scenarios, patients surveyed reported that they would more than double their typical insulin correction dose One major advantage of CGM in response to Scenario A. On the devices is that they not only give flip side, they would either drastically you what your glucose level is, but reduce their insulin dose or not take also where it is going in the form of any at all in response to Scenario B. a rate of change (ROC) arrow. Take In other words, with the same glucose the two different scenarios that we presented to our survey patients shown of 220mg/dl, the response could vary dramatically from not taking any in figures A and B. Notice that in both figures the absolute glucose value insulin at all to taking a larger than normal dose, ALL depending on is the same at 220mg/dl. However, the ROCs. in Scenario A the glucose is rapidly This is a phenomenon that people rising, and in Scenario B the glucose with diabetes have been noticing is rapidly falling. This is extremely long before the advent of CGMs. important information that only a CGM device can provide as a typical Individuals with diabetes would finger stick only gives you the absolute frequently say that sometimes they

12 My TCOYD Newsletter, Vol. 47

would bolus and nothing would happen or sometimes they would bolus and their glucose would crash. This likely has a lot to do with where their glucose was heading prior to that insulin dose. If it’s going up, the dose will have more work to do and appear to not have an affect.

If it’s going down it will appear to be more effective.

What it comes down to is, with the help of a CGM device you can anticipate where your glucose levels are headed at any given time, and make some rather large adjustments to your insulin dosing; that will ultimately lead you to much better control. So, if you haven’t done so already, be sure to talk to your doctor about the benefits of getting a CGM.