2015 Summer Edition

NEWSLETTER

MY

Summer 2015 Volume 52

The Goofus and Gallant of Diabetes Dr. Edelman’s Corner

INSIDE Keeping It All in Perspective Page 3

Ask Your Pharmacist Page 4

Giving Back Page 6

Product Theater Page 7

See Me. See Diabetes.

Empowerment Challenge Page 8

Summer Recipe by Diabetic Living Page 10

Preventing the Shark Attack (Topic of the Month) Page 11

R

emember Highlights? For over 60 years it has been a very popular magazine for kids with lots of stories and games that make you think.

When I was younger, I loved the section called Goofus and Gallant.

They were two guys, one of whom was kind of dorky and goofy and always did everything wrong, and the other was polite, proper and did everything right. Look at the scenarios below and see if you relate to Goofus or Gallant.

Goofus has type 2 diabetes and hates to take prescription medications, adamantly refuses insulin, and his goal in life is to “get off all medications.”

As a result, he stopped his medications or takes them very sporadically before his doctor visits…if he shows up at all.

He has poorly controlled glucose values (A1c above 8%), elevated LDL

cholesterol levels, and high blood pressure. He does, however, take tons of over the counter supplements from the vitamin store to treat anything from diabetes, memory loss, and male pattern baldness to daytime tiredness and reduced energy. He constantly brags to his friends and family that he does not take any prescription medications at all!

Goofus and Gallant (continued on page 2)

Goofus and Gallant (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 John Garrett, MS, 4th Year Student Susan Guzman, PhD Candis M. Morello, Pharm D Brittany Newton, 3rd Year Student Jeremy Pettus, MD

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 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.

2 My TCOYD Newsletter, Vol. 52

Gallant also has the diagnosis of type 2 diabetes, as well as the commonly associated cardiovascular issues of abnormal cholesterol and high blood pressure. His diabetes medication list includes Glucophage (metformin), Invokana (canagliflozin), Bydureon (once weekly exenatide), Novolog (insulin aspart), and Lantus (insulin glargine). He is also taking two drugs to control his blood pressure (fosinopril and diltiazem) and one pill for his cholesterol control (simvastatin). Gallant would rather not have to take the long list of medications; however, he has a good relationship with his doctor, understands how important medications are for the prevention of complications down the road, and takes his medications religiously (not just on Christmas and Easter). His A1c is 7.2%, LDL is at goal (below 100), and BP on average is extremely good (~125/82 mmHg).

If you have type 2 diabetes, are you more like Goofus or Gallant?

In this scenario, Goofus has type 1 diabetes and wears a Tandem insulin pump, but his A1c has been well above 9% for years. He tests his blood glucose level from zero to two times a day because he says, “I can feel what my BS is so I do not need to test.” Goofus drinks regular soda because he “does not like the taste of diet.” He adamantly refuses to use a continuous glucose monitor that has been offered to him by his endocrinologist even though he has had several hypoglycemic reactions at work, while driving his car, and at home; some severe enough to require assistance from others. When he recognizes his lows, he typically eats two or three Snickers bars. He gets up at night to urinate two or three times and is really tired and falls asleep during the day on the job. His wife commonly threatens to divorce him because she is tired of trying to watch over him. He was prescribed an ACE inhibitor (medication that protects the kidney) and a statin to keep his LDL cholesterol low but he stopped taking Goofus and Gallant (continued on page 12)

TCOYD in Motion

had to bail some of his patients out of jail after they were arrested for being “publically intoxicated” when they really just needed some juice!

Police officers had never heard of hypoglycemia before so they just assumed all these poor hypodiabetics were drunk.

Another thing that jumped out at me was how doctors had to decide whom to give insulin to. Insulin was available but it was still in limited supply so it had to be rationed. They made the decision to basically under-dose a large number of patients rather than appropriately dose a few. “We felt it more humanitarian to prolong the lives of many old and

By Jeremy Pettus, MD, Assistant Professor of Medicine, UCSD faithful patients rather than attempt to Type 1 Track Co-Director, TCOYD secure marvelous results in a few.” As some of you might know, the previous recently got my hands on a it requires brains to live long with “treatment” for type 1 diabetes was publication from Elliott Joslin diabetes, but to use insulin requires that he wrote regarding his first more brains.” Sounds to me like this starvation so results, as you might imagine, were not good. Patients were experiences treating patients who guy got it. In fact, I want to make on the razor edge had diabetes with insulin. The up t-shirts that say, between dying publication was written in 1922, “It takes brains to “We felt it more of DKA (diabetic after insulin had been available for use insulin,” with ketoacidosis) humanitarian to prolong only a handful of months. What an arrow pointing and dying of I found most striking were the to my pump on the lives of many old starvation. Then, similarities between what patients my arm. and faithful patients suddenly, insulin and providers were dealing with Joslin goes rather than attempt to comes into the then and what we deal with now. on to describe his secure marvelous picture, a lifeJoslin discusses in great detail the first experiences results in a few.” saving treatment, difficulty of adjusting insulin levels, with hypoglycemic and it is up to and modifying diets and exercise patients. Keep these docs to distribute it. It was also levels. With all these different factors in mind that hypoglycemia didn’t mind boggling that doctors would only to manage Joslin explains, “Insulin really exist before insulin and is intermittently treat patients; they is a therapy that is primarily for the largely something we have created would stabilize their patients with wise and not for the foolish, be they with medical interventions. patients or doctors. Everyone knows Apparently, the good Dr. Joslin Keeping It All in Perspective (continued on page 5)

Keeping It All in Perspective I

Taking Control Of Your Diabetes

3

Ask Your Pharmacist

Another SGLT-2 Inhibitor Has Come Your Way!

By Candis M. Morello, Pharm D, CDE, & John Garrett, MS, 4th Year Student Pharmacist

J

ardiance (empagliflozin) has recently made its appearance on the marketplace to help people with type 2 diabetes stay in control. This SGLT-2 inhibitor is also available as a combination pill called Glyzambi, which is mixed with Trajenta (linagliptin), another commonly used diabetes medication that works by a different mechanism to control the glucose levels.

What is Jardiance (empagliflozin)?

Jardiance is the third drug in a new class of diabetes drugs called SGLT-2 inhibitors, along with Invokana (canagliflozin) and Farxiga (dapagliflozin). The main advantage of Jardiance, as well as Invokana and Farxiga, compared to many of the older diabetes drugs is that it is less likely to cause hypoglycemia, and can lead to weight loss.

How Does Jardiance Work?

Jardiance lowers your A1c and

4 My TCOYD Newsletter, Vol.33 Vol. 52

blood glucose in a very interesting way- you pee out the excess glucose. Our body is very good at reabsorbing urinary glucose back into the bloodstream. It does this primarily by a transporter located in the kidney called SGLT-2 (Sodium Glucose Transporter).

Jardiance is a SGLT-2 inhibitor, so when Jardiance blocks this transporter, glucose is excreted out of the body through the urine and will lead to an overall decrease in blood glucose, as well as weight loss. The amount of glucose that is excreted from the body into the urine with Jardiance treatment is approximately the equivalent of 40-50 sugar cubes a day.

What Can You Expect?

When starting Jardiance, you can expect a moderate decrease in your A1c (0.5-1.0%, depending on your

baseline A1c), moderate decrease in your fasting plasma glucose of 30 mg/dL, a decrease in your weight (2.5%-5.0% in your body weight or about three to six pounds), and a small but significant decrease in your systolic blood pressure (2-4 mmHg). The improvements mentioned above were seen in clinical trials and your response may be even better. Since it may cause you to urinate more frequently, it is advised that you take Jardiance in the morning. After a few days, the frequent urinating should decrease and you should use the restroom at about the same frequency as you would before taking Jardiance.

Some women may be more prone to urinary tract infections or female genital yeast infections so paying attention to proper hygiene is important. In addition, some individuals (especially the elderly or those on diuretics or water pills) with low blood pressure may get

dizzy, especially initially upon standing.

Is Jardiance Right for You? If you have type 2 diabetes, Jardiance may be an excellent choice. It is a well-tolerated medication that by itself does not cause low blood glucose or hypoglycemia and will lead to weight loss. For certain people with reduced kidney function, this drug may not be for you. Your caregiver will check your kidney function (eGFR or estimated glomerular filtration rate) before prescribing Jardiance.

Jardiance may be considered as an add-on to your diabetes regimen or can be used alone. As an add-on to metformin instead of a sulfonylurea (such as glipizide or glimepride), patients see a better reduction in A1c, and have less hypoglycemia with weight loss.

The Bottom Line If you are seeking better diabetes control without hypoglycemia and weight loss, Jardiance may be a good option for you.

Keeping It All in Perspective (continued from page 3)

insulin when they were sick and then take them off it when they got better. How upset would you be if somebody took away your insulin after you got over the flu?!

The idea really just makes me want to hug a diabetic. Where is Dr. Edelman when you need him?

Back in the 1920’s, when insulin was such a rare and precious medication, could you imagine the caregivers’ frustration when patients would either not take the insulin they were given, or not take the appropriate dose? Joslin had this to say, “For the wise, who may be rich or poor, young or old, insulin is a benefit but, for the ignorant, who likewise may be young or old, rich or poor, it can be dangerous and the gift of insulin to such is like casting away pearls.” It just makes me

think of how much we still take this life-saving therapy for granted… both people with diabetes and our providers.

In the roughly 100 years since the discovery of insulin, we have certainly come a long way! We are living MUCH longer and healthier lives thanks to this one medication.

I like to think that Elliott Joslin would be amazed to learn that one day there would be entire groups of people with type 1 who would become successful individuals, including medical professionals, activists, moms, dads, athletes, and so on, and who would come together to change the world of diabetes.

“Keeping It All in Perspective” appeared first on WeAreOne, a website for medical professionals, industry representatives, activists, and bloggers who also have type 1 diabetes. To learn more about WeAreOne or join, please go to www.weareonediabetes.org

Submitted by: Candis M. Morello, Pharm D, CDE, Associate Dean for Student Affairs at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, Clinical Pharmacist at VASDHS. John Garrett, MS, Fourth Year Student Pharmacist at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences

Taking Control Of Your Diabetes

5

Giving Back

Meet the TCOYD

Board Members!

The second in a five article series

“

S

teve Edelman was my son Michael’s next door neighbor before TCOYD even existed,” said Dan Spinazzola, one of TCOYD’s founding board members. “I got to know Steve through my son and we developed a really close friendship. I was diagnosed with type 2 diabetes at the age of 50 and from the very beginning of my friendship with Steve he was always helping me get through tough times. He’s done everything in the world for me,” said Dan, President and owner of Diversified Restaurant Systems, a company that helps restaurants decrease their expenditures and increase their quality of food and service.

Dan, a whole-hearted businessman and one of TCOYD’s longest standing board members, has provided TCOYD with years of guidance regarding best business practices.

“When Steve asked me to be one of the board members for

By Jennifer Braidwood

TCOYD I saw a desperate need in myself, as well as the entire country, for an organization that could teach people how to take control of their diabetes because, let me tell you, I never met a dessert that I didn’t like! When I check my blood sugars and they are really low, I tell myself, ‘I need a donut.’ If my blood sugars are really high I say, ‘Screw it!

I’m going to have a donut’ and, if my blood sugars are right on track I say, ‘Wow, I’m doing great! I’ll have a donut!’

“Most of TCOYD’s board members are affiliated with the diabetes industry but I’m just the guy up the street and Steve wants to know what I think, so I am very honored to play my part.

I believe passionately in Steve, what he says, his knowledge base, and his theory behind starting an organization in order to directly educate people like me to be their own advocates so they can

Dan Spinazzola

lead healthier lives.

“The reason I continue to support TCOYD through an annual gift, as well as my service as a board member, is because there is so much passion within TCOYD and, along with that passion, there is intellect and energy.

TCOYD is concerned for people in this country with diabetes.

Dr. Edelman, Sandra Bourdette, TCOYD’s Co-Founder and Executive Director, and the rest of the staff there, they all care— a lot. They wouldn’t be there if they didn’t care.

“It is so important to give to organizations like TCOYD in order to allow them to continue providing valuable education, putting it directly into the hands of the people most affected by this disease, people like me and people like you. So remember to donate this year!”

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

6 My TCOYD Newsletter, Vol. 52

Platinum Corporate Sponsors

Gold Corporate Sponsors

Silver Corporate Sponsors

Product Theater

TRULICITY: Once Weekly Simplicity

By Candis M. Morello, Pharm D, CDE, & Brittany Newton, 3rd Year Student Pharmacist

I

n September 2014, Trulicity (dulaglutide) was approved by the FDA for treating people with type 2 diabetes. Coupled with healthy eating and regular activity, Trulicity can be used by itself or in combination with other diabetes medications. Trulicity joined Bydureon (exenatide extended release) as a unique product available for once weekly injections.

How Does Trulicity Work?

Trulicity is a glucagon like peptide-1 (GLP-1) analog.

Even though it is synthetic, it acts similarly to the hormone GLP-1 naturally produced by the body, which is deficient in type 2 diabetes. GLP-1 normally is released from the intestines when carbohydrates and fats are consumed. It helps enhance pancreatic insulin release, slows the stomach of emptying food, and suppresses appetite. This is known as glucose-dependent insulin release and is important in preventing low blood glucose (hypoglycemia) events. In addition to increasing insulin release, Trulicity decreases glucagon production especially

after eating, which helps to limit elevated glucose levels.

In addition to affecting the pancreas, Trulicity also works in the brain. Here it acts to suppress appetite, which leads to eating less and results in weight loss. Lastly, Trulicity works in the stomach.

In people with type 2 diabetes, the stomach often empties the nutrients into the rest of the intestines too rapidly. GLP-1 analogs help slow and regulate these actions, which in turn controls glucose concentrations after eating.

How Is Trulicity Used?

Trulicity is formulated in an easy to use pen. Pick any day of the week that works best for you and make that your “Trulicity Day!” It’s as easy as uncapping, placing the pen on an injection site, unlocking, and pressing the auto injector button. After pressing to inject, hold for 5-10 seconds until you hear the release click. You never see the needle! Your doctor or pharmacist will help you decide what the best injection site will be for you; typically this is your stomach, thigh or upper arm. You should change the injection site week-to-week by

either changing the area or rotating within the same area. Once used, the pen can be disposed of in a sharps container. New pens should be stored in a refrigerator, away from light, and in the original box.

What Can You Expect?

Trulicity lowers both fasting and postprandial (after meal) glucose in people with diabetes. A reduction TRULICITY (continued on page 9)

Taking Control Of Your Diabetes

7

Taking Control

See Me. See Diabetes.

Launches Its First Empowerment Challenge

By Susan Guzman, PhD, The Behavioral Diabetes Institute

W

ouldn’t it be nice to feel like others “get” what it’s like to have diabetes, and to feel encouraged and supported in your daily life?

As a diabetes psychologist, I have had the opportunity to hear hundreds of stories about life with diabetes. The people I know fall across the whole spectrum of diabetes: young and old, type 1 and type 2, low and high A1Cs, newly diagnosed and those with 50+ years, athletes and couch potatoes, those who embrace diabetes and those who try hard to ignore it. No matter where on the spectrum they fall, they are all good people doing their best every day with what is in front of them.

It is because of all of these people that I feel compelled to do more. Every day there are too many missed opportunities to explain diabetes correctly (news articles, bad jokes, doctor visits, even casual conversations). I get very frustrated when I hear type 2 diabetes described as the “obesity” version of diabetes. Why do we keep replaying that old tape when we have so much evidence that genetics, environmental factors, and other biological causes have

8 My TCOYD Newsletter, Vol. 52

a key role in the onset of type 2 diabetes? Why do people “suffer” with type 1 diabetes, and why is type 1 considered the “bad” or “severe” type?

See Me. See Diabetes. (SMSD) is a movement to promote a change in the way we think and talk about diabetes. The goal is to challenge misinformation and stereotypes, and put forward messages to help all people with diabetes feel understood, empowered, and cared for.

On March 7th, 2015 at the TCOYD conference in Santa Clara, CA, SMSD launched with our first initiative, the No “–IC” Challenge— a commitment to not use the word “diabetic” to describe people with diabetes.

What’s the big deal with the word “diabetic?”

It is not helpful to label someone as their disease. People have diabetes; they aren’t their diabetes (you wouldn’t call somebody with cancer a “canceric”). While it is easy short hand to say “diabetic”, it doesn’t communicate anything helpful about diabetes. People with

diabetes are a very diverse group of people with different needs, living a life with diabetes.

The No “-IC” Challenge encourages people living with diabetes to tackle misinformation and stereotypes by taking the opportunity to say what diabetes is and what they would like others to know about it.

When you say “diabetic,” what are you really hoping people will understand? Say that instead.

For example, if you are at a restaurant with co-workers and decide not to have dessert, or feel pressured to join in, instead of saying, “I’m diabetic so I can’t have any,” say: “I have type 2 (or type 1) diabetes and I am careful about the carbohydrates I eat. I can have sweets, but have to pick and choose when it is healthy for me to have them.” This extra effort challenges misinformation and educates others about diabetes.

What if being called “diabetic” doesn’t bother me?

The purpose of this challenge is to take a small step towards promoting empathy and understanding about life with diabetes, not to make people offended by the word “diabetic”.

Even if being called a diabetic doesn’t bother you at all, you can still take the challenge. One woman who has joined the SMSD community wrote: “When I first heard about the No -IC Challenge, I thought ‘eh, it doesn’t bother me all that much, but I’ll think about it.’ And I did, actually a lot. I work with children with special needs and work hard to

promote, “people first language” (children with autism rather than autistic kids). Today, the No-IC Challenge hit home, and pretty hard. I posted a picture of my Dexcom on Facebook, showing the 4th “Drop Rate” alarm and it wasn’t even 10a.m. yet. I was feeling defeated and weighing my options when a distant friend replied to my post with a picture of Wilford Brimley and the caption “What if I said Diabeetus?” I didn’t think anything of it. It wasn’t funny but it wasn’t offensive to me either. But then my husband saw it and was livid. He’s tired of people making diabetes jokes and making me feel like my disease isn’t important. After all, it’s not cancer and we DO have more options now...but it’s still something I have to fight and take into my own hands. I still wake up at 4 a.m. with scary lows and scary highs, and my husband is by my side through all of it. I’m realizing now that the No -IC Challenge is about more than me.” ­ – Brittany R., Santa Clara, CA We hope that you will take the challenge and we want to hear how it goes! SMSD is a supportive on-line community for people with diabetes to share their stories, their challenges, and their victories.

Join the movement and help us get the conversation started at SeeMeSeeDiabetes.com.

TRULICITY (continued from page 7)

of A1c from 0.7-1.6% can be expected when used by itself or in combination with other medications. Additionally, many patients have experienced weight loss while on this medication.

The most common side effects of Trulicity include upset stomach and nausea. These initial symptoms usually improve after a few weeks on the medication, as your body is getting used to it.

Because of how Trulicity works, it poses little risk of causing low blood glucose.

However, combining Trulicity with drugs such as insulin or sulfonylureas (glipizide, glimepiride, or glyburide) may increase the risk of low blood glucose.

Is Trulicity Right for You? Trulicity will help achieve glycemic control in type 2 diabetes patients along with diet and exercise. Although it isn’t recommended as the first medication to treat diabetes (metformin or Glucophage are usually first line therapy), it typically leads to a significant decrease in A1c, especially when coupled with other diabetes medications like metformin.

Proper blood glucose control is important to prevent longterm complications of diabetes

such as damage to blood vessels and nerves. Because of Trulicity’s unique once-weekly administration, it may be preferred by patients who have difficulty remembering to take their current medication or who want more flexibility.

Before taking Trulicity, it is important to inform your doctor of certain conditions. Tell your provider if you have any history of severe gastrointestinal (GI) disease, thyroid cancer, or family history of thyroid cancer. As always, it’s important to let your provider know of all prescription, over-the-counter, and herbal medications you are taking.

The Bottom Line Trulicity offers a simple, once-weekly way to control type 2 diabetes. This GLP-1 analog acts in many ways to help achieve glucose control and a healthier self. Unlike other diabetes meds on the market, Trulicity has little risk of low blood sugar and may even help with losing weight.

Trulicity really does equal simplicity in the fight against type 2 diabetes!

Submitted by: Candis M. Morello, Pharm D, CDE, Associate Dean for Student Affairs at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, Clinical Pharmacist at VASDHS. Brittany Newton, Third Year Student Pharmacist at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences.

Taking Control Of Your Diabetes

9

Living Well

Blackberry Salad with Pork Recipe by:

Servings 2 (1 1⁄2 cups greens, 2 ounces cooked pork, 1⁄2 cup berries, and 2 tablespoons dressing each) Carb. Per Serving 28 g Prep 25 minutes Roast 20 minutes Stand 3 minutes

10 My TCOYD Newsletter, Vol. 52

1 5- to 6-ounce piece pork tenderloin Salt Black pepper 1⁄4 cup blackberries and/or raspberries 2 tablespoons lemon juice 1 -1⁄2 tablespoons olive oil 1-1⁄2 tablespoons honey 3 cups packaged mixed baby salad greens (spring mix) 1 cup blackberries and/or raspberries 1⁄2 cup grape tomatoes, halved 1 tablespoon pine nuts, toasted* (optional) 1. Preheat oven to 425°F. Place pork on a rack in a shallow roasting pan. Sprinkle with a dash each of salt and pepper. Roast, uncovered, about 20 minutes or until an instant-read thermometer inserted in center registers 145°F. Remove from oven. Cover roast with foil and let stand for 3 minutes. Cool slightly.

Cut pork into 1⁄4-inch-thick slices.

2. For dressing, in a small food processor or blender combine the 1⁄4 cup blackberries, the lemon juice, oil, honey, and a dash each of salt and black pepper. Cover and process or blend until smooth. Strain dressing through a sieve; discard seeds.

3. To serve, divide greens between two salad bowls or serving plates. Divide the 1 cup berries, the tomatoes, pine nuts (if using), and pork slices between salads. Drizzle with dressing. Serve immediately. *Test Kitchen Tip: To toast pine nuts, place them in a shallow baking pan. Bake in a 350°F oven for 5 to 7 minutes, shaking pan once or twice. Watch closely so nuts don’t burn.

Per serving: 283 cal., 13 g total fat (2 g sat. fat), 46 mg chol., 147 mg sodium, 28 g carb. (7 g fiber, 20 g sugars), 18 g pro.

Exchanges: 0.5 vegetable, 0.5 fruit, 1 carb., 2 lean meat, 2 fat.

Recipes from Diabetic Living, © Meredith Corporation. All rights reserved. Used with permission.

For more great recipes, visit DiabeticLivingOnline.com

Topic of the Month

Preventing the Shark Attack

By Steven Edelman, MD

I

am 28 years old and have type 1 diabetes. I am currently on an Animas insulin pump, as well as a continuous glucose monitor. I also just got the Vibe so I will not have to carry around my pump and CGM monitor. I have had the hardest time preventing my blood glucose values from spiking up well above 200mg/dl after eating. As you can see from my Dexcom photo, it looks like a shark fin! I usually get really urked and give myself a rage bolus, which sometimes works fine and at other times may lead to a hypo (see attached photo)!

Answer: This is a very common and frustrating problem for insulin users, especially if you have type 1. The insulin that you give via a pump or an insulin pen is given in the fatty tissue below the skin (subcutaneous tissue) and gets into your blood stream way too slowly. This leads to the blood glucose getting excessively high after eating since the nutrients (especially rapid-acting carbohydrates) get absorbed into the circulation a lot faster than the insulin does. This leads to a mismatch between the absorption of food and insulin action. There are several things you can do to help avoid a shark attack.

1

Give yourself a pre-meal bolus of fast acting insulin approximately 20-30 minutes before you actually eat.

You can give yourself about 30-40% of what you think you will need for that meal and then the rest later. This pre-bolus is called ‘priming the pump’. It has been shown to really limit the post-meal shark fin spike. If you wear a pump it is quite easy; however, if you are using an insulin pen you will have to give yourself two injections for the meal.

Try to limit the amount of rapid-acting carbohydrates

2

in your meal. This may be hard to do, but definitely eliminate drinks with a lot of sugar calories, and no fruit!

Spread out your caloric intake as best you can. I know

3

this seems like a pain but eat slowly and, if you can, save part of your meal for later as a snack. Mixing your rapidacting carbs with fat and protein can help as well.

Try Afrezza, the inhaled insulin that is now available.

4

It has a rapid-on rapid-off time course of action that will not only limit how high your glucose goes after eating, but also reduce your chances of having a delayed hypoglycemic reaction. Please see the Edelman Report on Afrezza on our website for more information.

Taking Control Of Your Diabetes

11

Upcoming TCOYD Conference & Health Fair Schedule

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

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PAID

2016

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Native American, California San Diego, California Orlando, Florida

Stay connected to TCOYD visit www.tcoyd.org

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

Goofus and Gallant (continued from page 2)

them because “he felt the same whether he took them or not,” and he read on the internet that statins cause liver damage, memory loss, and muscle aches.

Gallant also has type 1 diabetes and doesn’t have an insulin pump but instead, he takes multiple daily injections of his long-acting basal insulin (Levemir or insulin detemir), as well as his pre-meal fast-acting insulin (Humalog or insulin lispro). He tests his blood sugar level six to eight times a day and is hoping to get insurance

12 My TCOYD Newsletter, Vol. 52

approval for a Dexcom CGM device. Gallant struggles with the daily ups and downs, but at least his A1c is 6.8% with several mild hypoglycemic reactions a week.

If you have type 1 diabetes, are you more like Goofus or Gallant?

I know these examples may seem extreme to you but I see these types of folks in clinic every day! There is no question that Goofus wants to live a long and healthy life but has many misbeliefs and misaligned priorities. He may have fear, guilt, depression,

or just plain old lack of motivation to take control of his diabetes.

As a caregiver, it is disheartening and frustrating to see Goofus as a patient, year after year with little or no change. I rarely give up on these folks because I know if you continue to give support without judgment, the Goofuses of the world eventually do come around! For me, I personally can only relate to Gallant, as I am perfect...hahaha!

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