2015 Spring Vol 51

NEWSLETTER

MY

Spring 2015 Volume 51

Sharing Your Diabetes Dr. Edelman’s Corner

INSIDE Sugar Surfing Page 3

Struggling with Weight Control - Saxenda Page 4

Giving Back...

Page 6

Product Theater Page 7

A Pathway to Advocacy Page 8

Got 10 Minutes?

Page 10

Question of the Month Page 11

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haring Your Diabetes’ can be done in many different ways. In this ‘Dr. Edelman’s Corner’ I’m going to describe two of them.

I have been a physician specializing in diabetes at the Veterans Affairs Medical Center and University of California at San Diego since January of 1987 and, if you do the math, that is over 28 years! For most of that time I was seeing patients one-on-one, which had been the traditional approach since the beginning of time. Then, several years ago, I decided to try something different…Shared Medical Appointments or SMAs. An SMA for diabetes is when 5-10 people have their doctor visit all together in a small conference room over a 90-minute period. They share their medical issues, concerns, laboratory results, frustrations, personal struggles, successful ideas, and techniques with each other. Sharing their trials and

tribulations, as well as their successes, is tremendously helpful and the vast majority of participants absolutely love these shared medical appointments.

I wish I could take credit for the idea but SMAs have been around for a long time, although not utilized as much as they should be. UCSD had the foresight Sharing Your Diabetes (continued on page 2)

Sharing Your Diabetes (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 Margery Perry Daniel Spinazzola Andrew Young

Contributing Authors Jennifer Braidwood Steven V. Edelman, MD Melissa Lee Stephen Ponder, MD, FAAP, CDE Tricia Santos Cavaiola, MD Robyn Sembera

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 Communications David Snyder Manager, Exhibit Services

to get these going a few years ago.

All of the patients in an SMA agree ahead of time to share their personal information. There is a moderator to keep me on time and to interject diabetes information that relates to a topic that is brought up by someone in the group. My moderator is Suzanne Lohnes, who is a CDE, as well as a person living with diabetes. The third staff person in the room is a scribe who takes notes while I am talking to each patient (I love that part!) and takes care of any prescription or referral needs. I have many patients so I put them in groups according to their sex, age, and type of diabetes.

What amazes me the most is that people who, for years, were having the hardest time with their diabetes control, and the ones I originally thought would not benefit from an SMA, suddenly improved greatly when they joined the group! I was not succeeding in my role as their diabetes doctor and I felt guilty about not being able to help them. When these folks

saw how their peers were handling diabetes and shared their experiences, it was the key to helping them overcome those long-term barriers.

Another way of ‘Sharing Your Diabetes’ is my personal story. This is about sharing my own continuous glucose monitor (CGM) numbers with Sharing Your Diabetes (continued on page 12)

Robyn Sembera Manager, Continuing Medical Education and Publications Sarah Severance Administrative Assistant

MyTCOYD Newsletter Editor: Robyn Sembera Assistant Editors: Jennifer Braidwood and Sarah Severance 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. ©2015 All rights reserved.

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All of the patients in an SMA agree ahead of time to share their personal information.

TCOYD in Motion

By Stephen Ponder, MD, FAAP, CDE

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method of frequently collected ugar Surfing™ serves as a blood glucose data. A CGM device metaphor for dynamic diabetes reveals the cresting waves and management in contrast to what shifting tides of human blood sugar most of us have been taught, static levels throughout the day. This diabetes management. Surfing is new approach provides a platform something that can only be done upon which to well by a human being. A machine Sugar Surfing blends the make thoughtful decisions about cannot be trained reactive and proactive to Sugar Surf… abilities of human beings food, insulin, at least not yet. to manipulate the ebb and exercise and even The reason is flow of blood sugar levels stress management straightforward: in response to a variety of ‘in the moment’.

In fact, almost diabetes self-care different circumstances. any of the ever is part reactive present forces that and part proactive. influence one’s blood sugar level Sugar Surfing embraces both can be managed with Sugar Surfing concepts and weaves them into a principles. dynamic model of care.

A machine can’t predict human Sugar Surfing allows a person behavior from moment to moment, to understand how to make the nor can it reliably predict the best use of CGM or any other

future. The best any machine can do is respond or react. Our current artificial pancreas (AP) technologies still lag far behind a healthy working pancreas. Over time this will improve as AP’s incorporate ultrarapid acting insulin preparations to better match insulin to food as well as the possibilities available from a stable glucagon reservoir to reverse a trending low BG. Glucose sensors are still limited by a small lag time between what is measured in blood and under the skin (where current generation CGM sensors do their measuring) along with a host of other seemingly apparent barriers. Research continues into fully implanted glucose sensors placed deeper within the body. Someday, many or perhaps even all of these barriers will be overcome. However, until we are presented with a highly reliable and effective totally closed-loop AP, people will need to learn to Sugar Surf as a complement to blood sugar meters and CGM. To be fair, a pancreas can’t really predict the future either. But it really doesn’t need to. Due to its unique position within the body, the pancreas “sees” the nutrients we consume from food and drink as they first enter the bloodstream. Since it has insulin already produced and ready for immediate use, it can get a jump ahead of rising blood sugar levels and release a proper amount of insulin to keep sugar levels from Sugar Surfing (continued on page 5)

Taking Control Of Your Diabetes

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Ask Your Healthcare Provider

Struggling with Weight Control

By Tricia Santos Cavaiola, MD

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f you have ever struggled with your weight, you’re not alone.

More than one third of adults in the U.S. are obese (that’s 78.6 million people!). With the rise in obesity, there has been a rise in obesity-related medical conditions, including type 2 diabetes, heart disease, strokes and some cancers.

These are some of the leading causes of preventable death. More recently, there have also been increasing options available for the treatment of obesity, including various lifestyle interventions, medications, and surgeries. On December 23, 2014, the FDA approved Saxenda, a new medication for weight management.

What is Saxenda?

Saxenda is an injectable medication approved for use in adults who are obese (BMI of 30 or greater) or overweight (BMI of 27 or greater) with at least one obesityrelated condition, such as type 2 diabetes or other diseases mentioned above. Saxenda is a glucagon-like peptide-1 (GLP-1) receptor agonist.

What does that mean? GLP-1 is a naturally occurring hormone made in your gut that is released when food from a meal reaches your small intestine. This hormone works to help your pancreas secrete insulin, make you feel full quickly,

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decrease your appetite, and slow the movement of food through your stomach. GLP-1 receptoragonists (Saxenda and others) act like GLP-1 and will have many of the same effects. Currently, there are several other GLP-1 receptor agonists used in the treatment of diabetes. Saxenda has the same active ingredient (liraglutide) as Victoza, another GLP-1 receptor agonist used for the treatment of type 2 diabetes.

What kind of results can you expect?

Saxenda was evaluated in three clinical trials with almost 5,000 obese and overweight subjects.

During these trials, patients were also counseled on lifestyle changes including diet and activity. On average, patients lost 4.5% of their weight from baseline. That is a 13.5-pound weight loss for someone who weighs 300 pounds, or a 9-pound weight loss for someone who weighs 200 pounds.

Patients taking the highest doses of Saxenda lost the most weight.

What are the adverse effects?

The most common adverse effects of Saxenda are similar to effects seen with GLP-1 receptor

agonists used to treat diabetes.

They include predominantly GI (gastrointestinal) side effects such as nausea, decreased appetite, vomiting, diarrhea, and constipation. It can also cause low blood sugars if you are taking certain diabetes medications that put you at risk for hypoglycemia, such as sulfonylureas. More serious side effects are rare.

In rodent studies, Saxenda was associated with C-cell tumors of the thyroid gland. Some of these tumors were cancerous (medullary thyroid carcinoma.) These tumors have not been seen in humans using Saxenda or other GLP-1 agonists, perhaps because humans have far less C-cells in the thyroid and human C-cells have less GLP-1 receptors.

Saxenda may be associated with inflammation of the pancreas (pancreatitis), but further studies are needed to determine the risk.

The FDA is requiring further studies to determine effects of Saxenda on the cardiovascular system as well.

How is it used?

Saxenda is administered once daily by injection, subcutaneously in the abdomen, thigh, or arm. It comes in a prefilled pen. The drug is started at the lowest possible dose to avoid nausea and other adverse effects. The dose can be increased weekly by your doctor as long as you are tolerating the medication

well. Patients who use Saxenda should be evaluated after 16 weeks to see if the medication is working. If a patient has not lost 4% of their body weight by this time, it is recommended that the drug be discontinued as it is unlikely to be effective.

Is Saxenda right for you?

Saxenda is a novel weight loss medication in that physicians and other health care providers have extensive experience in using medications in the same class (GLP-1 receptor agonists) to treat diabetes. Saxenda may be right for you if you are obese or overweight with type 2 diabetes or other weight-related diseases. Medications for weight management should always be used in addition to diet and exercise and under the supervision of a qualified physician. Although Saxenda is similar to diabetes medications and has the same active ingredient as Victoza, it is not indicated for the treatment of type 2 diabetes. Saxenda is also not approved to be used in patients who are taking insulin.

Saxenda may not be right for you if you have problems with stomach emptying (gastroparesis) as it could make this problem worse. Saxenda should not be used in patients with severe kidney or liver disease, or with a family history of thyroid cancer or multiple endocrine neoplasia.

Sugar Surfing (continued from page 3)

traveling too high after eating. It also possesses the ability to stop releasing insulin very quickly, almost immediately, to reduce the risk of low blood sugar. You might call it nimble!

Sugar Surfing blends the reactive and proactive abilities of human beings to manipulate the ebb and flow of blood sugar levels in response to a variety of different circumstances.

This brief history of diabetes management technologies and principles sets the stage for why the book Sugar Surfing has been written: as a tool to instruct and educate users of glucose sensing devices to empower themselves in the art of informed decision making.

Pivoting is at the heart of Sugar Surfing and is discussed in the book. All surfing skills are applied to make this happen. Much like ocean surfing, the longer you do it, the better you get. Where you set your personal target zone or zones is always you or your doctor’s choice. When starting out, higher and wider ranges are always a good idea.

As your skills improve start to lower the target and maybe make the range narrower as you gain experience.

A few words of caution: “Don’t overdo it!” It’s easy to make things too hard on yourself at first and often times you just can’t keep blood sugars in range no matter what you do. We all have those days, including myself. They are nothing to be ashamed of. I simply consider my mistakes and missteps as chances to learn new things about my unique diabetes control.

You should, too. When I checked into the mindset of tight control, I also left behind any baggage of guilt and shame. I certainly respect my diabetes, but I no longer fear it like I did in my younger days. Sugar Surfing is freedom and most of all allows me to kick diabetes in the rear each day. Since becoming a surfer, my A1C has been in the low 5% range the past two years.

In addition to the book, I conduct Sugar Surfing workshops when invited and sponsored by a community. For more information about both, go to sugarsurfing.com.

Taking Control Of Your Diabetes

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Giving Back

Meet the TCOYD Board Members!

The first in a five article series

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ARGERY PERRY, one of TCOYD’s first and longest standing board members, got connected with Dr. Steve Edelman shortly after her daughter was diagnosed with type 1 diabetes at the age of seven. “I had two choices, complete denial, or learn as much as I possibly could about the disease. I obviously chose the latter.” Margery found herself gravitating towards the research side of type 1 and soon became concerned with the fact that the latest diabetes management information and the newest advancements in technology weren’t making it into physicians’ offices and then out to the people who needed it the most, the ones with diabetes. “Early on I got heavily involved with the Whittier Institute, the University of California at San Diego, and the JDRF. I was the Chair of the Lay Committee for the JDRF and eventually became the Chair of the Research Committee.”

By Jennifer Braidwood

Dr. Edelman became Margery’s daughter’s endocrinologist and Margery immediately wanted to know what he was doing in diabetes research and management, “...and that’s when I found out about TCOYD. At the time, there wasn’t, and there still isn’t, another non-profit in this specific space that empowers people with diabetes to take control of their condition. Dr. Edelman has taken the way he deals with his patients on an individual basis and has made that available to tens of thousands of people. When you attend a TCOYD conference he makes you feel like you are the only person in the room.

It really seems as though he’s talking specifically to you, and he empowers you to become you own advocate. Dr. Edelman has such a great personality and he is a fantastic communicator.

When people are dealing with a

chronic disease there are a lot of psychological issues that go along with it and when a physician also has the same chronic disease as his patients, something very special happens.”

“The reason I continue to support TCOYD through an annual gift as well as my service as a board member, is one of the many reasons why others should donate and continue to support the TCOYD mission. More often than not, advancements in diabetes aren’t making it into the clinical setting and then getting distributed by physicians to people with diabetes. Dr. Edelman and TCOYD are the ones empowering the diabetic community directly to take control, and when it comes to diabetes you HAVE to be your own advocate and seek out the best possible care for yourself or the person you love. Donate and you allow TCOYD to continue their fantastic mission of patient education and empowerment.”

Taking Control Of Your Diabetes Is Generously Supported By: Platinum Foundation Support

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Platinum Corporate Sponsors

Gold Corporate Sponsors

Silver Corporate Sponsors

Product Theater

How Well Do You Understand Your Results?

Article provided by LifeScan, Inc.

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taying healthy is challenging for everyone. And to stay healthy with diabetes, it’s important to understand your blood sugar numbers. According to Dr. William Polonsky, Co-Founder and President of the Behavioral Diabetes Institute, “Nearly one third of people with diabetes say they can’t make sense of their blood sugar results1 and many may feel overwhelmed by too much information, information that isn’t clear, or simply by the day-to-day effort required to manage diabetes.”

The new OneTouch Verio® Blood Glucose Meter aims to address this need, because it helps people with diabetes better understand their results without any extra effort. The large screen presents helpful information at a glance, and there’s no need to scroll or push buttons. It features a color-coded range indicator, making it easy to see whether a result is below range, within range, or above range. When the meter displays a low result, it even prompts the user to treat the low glucose result and retest in 15 minutes. The meter also looks for signs of progress and provides positive reinforcement right on screen.

After using the OneTouch Verio® Meter for one week, 94%

of people with diabetes said it made their test results simple to understand.2 In fact, Dr. Polonsky believes, “The OneTouch Verio® Meter can help patients feel more confident about managing their blood sugar by providing helpful

feedback about their results.”

The OneTouch Verio® Meter and OneTouch Verio® Test Strips are now available nationally.

For more information about the OneTouch Verio® Meter, visit www.OneTouch.com.

1 Survey of 18,457 U.S. diabetes patients who test their blood glucose, US Roper, 2011. 2 Study conducted in the UK and the US with 102 patients with diabetes. 2013. LFS 15 – 5111B

Taking Control Of Your Diabetes

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Taking Control

A Pathway to Advocacy

By Melissa Lee, Interim Executive Director Diabetes Hands Foundation

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ike so many people diagnosed insurance denial? I need help. with diabetes, my personal There are 90 million people journey began with a jarring in the United States with prestart—a diabetic coma, confusing diabetes, 29 million people with new tasks to perform, numbers diabetes, and millions more that revealed the quality of care feeling alone and helpless. How I received and never the quality is that even possible? Something of my commitment. I faced A1c has to change. Each of us deserves results in the 10-15% range for to have our stories heard. We many years until I was empowered are stakeholders in our own by the discovery of community healthcare story, even as we are (that I found at TuDiabetes. shut out from conversations org) and organizations like about, “the patient,” “the TCOYD, which advocates for taxpayer,” “the customer,” and passing the best of what we know “the diabetic.” about diabetes The word management advocacy turns When you admit to your directly into the friend that their joke about some people away. hands of the diabetes is rooted in myth It sounds like patient. and stigma, you have just legalese. Surely done advocacy.

The more I advocates are the began to engage people you can within the diabetes community, call on to rush in on your behalf the more I discovered that the and fight for your rights, right? stories we all had to tell were Yes, that’s one definition, but meaningful—all of these voices the word, “advocate” translates echoing the same themes: I feel quite literally to, “to voice.” With misunderstood. I can’t afford that being said, it’s important what I need. How do I appeal an to remember there are everyday

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opportunities for you, the person with diabetes, to apply your voice.

When you admit to your friend that their joke about diabetes is rooted in myth and stigma, you have just done advocacy. When you tell your physician that you don’t like the side effects of your medication and need to talk about alternatives, you have just advocated for yourself.

A letter to an editor about the misinformation in his or her piece in the news, that’s advocacy, too. And, yes, when you take it all the way to the Hill or just as far as your local representative’s email inbox, that’s also advocacy!

Here’s a quick update on what’s happening in diabetes policy right now.

The majority of people with diabetes are aware of the benefits of continuous glucose monitoring (CGM). A CGM will alert the individual of impending low blood glucose before it happens and help him or her see trends in glucose patterns. Currently, CGM is not covered under Medicare and millions of seniors with diabetes continue to face unnecessary hospitalizations from hypoglycemia.

The Medicare CGM Access Act of 2015 (H.R.1427 / S.804) is a bill that would ensure access to continuous glucose monitoring for eligible Medicare patients and help seniors achieve better glucose control and fewer complications.

Average state budget available per person with diabetes to prevent and detect diabetes (including federal grants)?

A. $750.00 B. $1,129.00 C. $3.50

D. 2.00

Bills have been introduced to the 114th Congress (2015-2016) for access to diabetes education through telehealth services (H.R.1726), access to medical nutrition therapy (H.R.1686), access to diabetes supplies (H.R.771), and the formation of a clinical care commission (H.R.1192 / S.586) that would foster more effective coordination of care among health care providers for people with diabetes and pre-diabetes.

Currently, not one single state ensures that their Medicaid population is properly screened for gestational diabetes. Not one!

Gestational diabetes affects both mom and baby and 50% of women diagnosed with Gestational Diabetes will be diagnosed with type 2 diabetes within a decade of their pregnancies; 12% within a month of their pregnancies. Her child will also have an increased risk of type 2 diabetes. The Gestation Diabetes Act (or GEDI Act. S.84), which will allow for these important screenings to take place in addition to seeking and

expanding public health research on gestational diabetes as a whole, has no major organization backing it as a legislative priority this year.

The state of California had a Sharps waste bill proposed in 2014 (AB 1393). This would have forced Californians to purchase a sharps can for every sharp (syringe, pen needle, lancet) they purchased, placing the burden of cost back on the patient and failing to address the real safety issue of illegal sharps. It was fought by patient advocates and failed, thanks to the power of patients using their voices. Unfortunately, five additional states in the U.S. have similar bills in their sights right

More than $1,000 in state funds specifically for diabetes (2012)

www.ncsl.org/portals/1/documents/health/DiabetesBudget912.pdf

now: Minnesota, Massachusetts, Rhode Island, New York, and New Jersey.

Out of our 50 great states, in 2012, only 12 states had

more than a mere $1,000 total in their state budgets specifically for diabetes prevention and screening.

Thirty-six of our 50 great states allocated $0 specifically for diabetes. I wish I were kidding.

The healthcare climate today is stuck in a political gridlock, to the point that it can feel useless to fight, but you should consider two things: No one can tell your story, and every citizen has the right to be heard by by his or her representative. That’s actually the most beautiful thing about a representative democracy. Your congressional representatives care about the votes in their district.

With each new legislative session, we have opportunities to comment on federal and state policies affecting people with diabetes. With each new device or drug discussed by FDA, we have opportunities for commenting on a docket, WE, the PEOPLE. The path before us is not an easy one, but the road is wide enough for us all to walk together and we need you to walk with us.

You have a story. Share it. You have a voice‌ Melissa Lee is a blogger and advocate, currently serving as Interim Executive Director of Diabetes Hands Foundation and also writing both for A Sweet Life online magazine and her own blog Sweetly Voiced.

Taking Control Of Your Diabetes

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Living Well

Got 10 Minutes?

Article provided by:

®

In our fast-paced world, it’s hard to find time to do all the things required to simply get through the day—and having diabetes lengthens the to-do list. The good news: You don’t have to spend oodles of time managing your eating plan.

Here are nine easy ideas that may lead to better diabetes control and health. Each takes just 10 minutes or less, so pick one or two and get started right away.

1

Preportion snacks and treats

At the beginning of the week or right when you get home from the supermarket, divvy up sensible servings of crackers into a dozen baggies. Package nuts, cookies, and other snacks and treats the same way. Make it easy to grab a healthful treat in the proper portion without being dependent on vending machines or convenience stores!

2

Make a carb-counting cheat sheet

Jot down about 25 of the carbohydrate-containing foods you eat frequently. Use an online database, such as the USDA

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nutrient database, to find the carb grams in those foods (in the portions that you eat most often).

This is a quick and insightful exercise that can help you get an accurate look at your carb intake.

3

Mix a bean salad

Whip up a portable bean salad you can enjoy with lunch or dinner.

It can be as simple as draining and rinsing canned beans and mixing them with diced tomato, onion, and avocado. Beans are high in protein, folate, potassium, and magnesium, making them ideal for the heart. They’re also high in both soluble and insoluble fibers, either to promote blood sugar control or improve insulin function.

4

Slow down and savor your meal

5

Quench thirst without adding calories

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Eat Breakfast

When you’re busy, slowing down is the last thing on your mind. Taking a few extra minutes to really experience your meal can make eating more satisfying and help you avoid overeating.

Turn off the TV and sit at the table. Taste each bite, noticing the colors, textures, and aromas. Try to eat in peace a few times per week.

After all, it only takes 10 minutes!

Get creative with a pitcher of water. Add lemon and oranges slices or cucumber and mint. Have extra berries? Toss them in!

Eating breakfast is associated with healthier cholesterol levels, better insulin sensitivity, and greater intake of several vitamins and minerals, including potassium, calcium, vitamin C, and iron. For breakfast, try to balance the intake of carbohydrates, protein, and fat.

A great example is whole grain toast with peanut butter, a glass milk, and an apple. Plan ahead to have a variety of grab-and-go options—such as hard-boiled eggs, fruit, low-fat yogurt, cottage cheese, and cereal and milk— measured and ready to carry.

Question of the Month

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Get some greens

Low-calorie, low-carb, filling salad greens take the edge off your appetite and can help you eat less.

For a time-saver, use bagged greens and pre-cut veggies such as shredded carrots or broccoli/cauliflower combo packs. Splash a little vinegar or citrus juice over your salad for low-calorie flavor.

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Review your food record

It’s not enough to simply write down your food intake. Reviewing it weekly or even daily will help you identify your dietary weaknesses.

If you see that you lack fruits, vegetables, beans, or any food group, set a goal to consume at least one additional serving per day or week.

Do you find that you consume too much meat or starch at dinner? Vow to eliminate those second helpings.

9

Brown-bag it

A typical fast-food lunch might saddle you with half the calories and close to all the saturated fat and sodium you should eat in an entire day! Plus, such meals tend to lack whole grains, fruits, and vegetables.

It takes minutes to pack up leftovers from dinner or stock your work fridge with the fixings you need for a week’s worth of lunches. Bring whole grain breads and wraps, sandwich meats, fruit, yogurt, and chopped veggies.

By Steven Edelman, MD

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liviah, one of my youngest friends with type 1 diabetes, asked me two questions. First, she wanted to know why I picked pink for the color of my Dexcom G4 continuous glucose monitor (CGM) and second, why did her blood sugar jump so high after breakfast.

First of all, if you look at the picture you will see that we SHARED (see Dr. Edelman’s corner) our CGM devices. I am holding her blue one and she is holding my pink one. I wanted to show her that I was not embarrassed or ashamed to show that I also get high numbers and that those numbers do not determine if I’m a good or bad person. Even as a medical professional with diabetes, I’m not perfect!

Answer: Well…after speaking to her mom, it was clear to me that they were doing everything they were supposed to be doing. They counted the carbs and gave a bolus but Oliviah’s BS still went over 380 mg/dl. I told her mom that there were three things that contributed to her post breakfast high. First, she was not pre-bolusing before eating breakfast.

It is important to give ~30-50% of what the insulin dose will be at least thirty minutes before consuming the food. Secondly, PWD are more resistant to insulin in the morning so, for a given amount of carbs, more insulin is usually required and it is not uncommon that someone has a more aggressive insulin to carb ratio for breakfast compared to lunch and dinner. Lastly, they need to pay attention to the trend arrow. It was headed upward at breakfast time and this almost always calls for more insulin than usual for a given blood sugar and insulin to carb ratio. The extra insulin will vary between 50 and 150% more than the calculated dose, depending on the BS level and the trend arrow.

Oh, and I picked a pink CGM because I like the color!

Taking Control Of Your Diabetes

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TCOYD Conferences & Health Fairs 2015 Schedule

February 7

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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

Augusta, Georgia Augusta Convention Center Santa Clara, California Santa Clara Convention Center Austin, Texas Austin Convention Center Honolulu, Hawaii Honolulu Convention Center Kansas City, Kansas Overland Park Convention Center Native American - Santa Rosa, CA Hyatt Vineyard Creek Hotel San Diego, California San Diego Convention Center Omaha, Nebraska CenturyLink Center Phoenix, Arizona Renaissance Glendale Hotel & Spa

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Sharing Your Diabetes (continued from page 2)

five close friends and my significant other, using my new Dexcom Share Monitor (see Winter 2015 Newsletter). This was hard for me at first, as I was afraid they would judge me because of my crazy ups and downs! It turns out that I really love having people close to me, supporting me, and being alerted when I get too low. Trust me when I tell you that your true friends and loved ones want to be involved and help in any way they can. Kerri Sparling, a very creative and bright diabetes writer and blogger

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(www.sixuntilme.com), was for years quite adamant about not sharing her personal information.

However, Kerri recently came out of the glucose-data-closet and is now sharing her CGM data with others. We all have our internal privacy set point, but I think that most of us, deep down, do want people to care about us and help us…as long as the support comes in the right way and not like the “diabetes police” that clinical psychologist, Bill Polonsky, frequently talks about.

I know that sharing intimate details may go against your grain but, when it comes to your diabetes, there are many ways to share which may be very helpful to you. You need to find the form of sharing that you are most comfortable with. In reality, it is hard to live alone with diabetes and there really is no reason you should have to, especially when you are surrounded by people you care about and who care about you.

Steven Edelman, MD Founder and Director Taking Control Of Your Diabetes