MY
NEWSLETTER
TCOYD IS A 501(C)3 NONPROFIT CHARITABLE EDUCATIONAL ORGANIZATION
Spring 2016 DR EDELMAN’S CORNER WITH JEREMY PETTUS, MD
When Diabetes Gets Complicated Inside PA G E 4
Favorite Free Apps PA G E 6
Ask Your Doctor PA G E 8
Giving Back PA G E 1 0
Upgrade Your Glucose Meter! PA G E 1 1
Case of the Month PA G E 1 2
Home Run Breakfast PA G E 1 3
Faces of TCOYD PA G E 1 4
53 Years of Diligence PA G E 1 5
Eating Well
And what could be more complicated than diabetes complications? Yes, that’s right. It’s not a fun or funny topic. In fact, it’s the opposite of those things, but it is something that we do need to talk about. I’d like to take this opportunity to introduce you, our readers, to my friend and colleague, Dr. Jeremy Pettus. I first met Jeremy when he did his endocrinology training at UCSD. Like me, Jeremy also has type 1 diabetes. Since he completed his endocrinology fellowship and arrived on staff at UCSD and the VA, Jeremy has been very involved with TCOYD and has been directing the dedicated Type 1 Track at our TCOYD conferences. Collaborating on this article together, what we want to discuss is not how to prevent complications, or the rates of complications, or other “medical” things, but rather the struggle we all face when confronting them. Because we have differing perspectives on this topic, I thought it would be relevant to talk about this from our own points of view
— Jeremy having never really developed complications (knock on wood)— and the fact that I have several. This difference is really the result of when we were diagnosed and how much things have changed relatively quickly. We hope that you will all find something you can relate to in our stories that represent the history of diabetes over the last several decades. Jeremy’s Story I was diagnosed in 1995 at the age of 15 (that makes me 29), which was very shortly after the Diabetes Control and Complications Trial (DCCT) study was published. As many of you know, this was the study that finally proved that controlling blood glucose mattered in terms of reducing complications. I still can’t believe that this took until 1993 to definitively prove. This C O N T I N U E D O N PA G E 2
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 David Ahn, MD Jennifer Braidwood Adam Brown Steven V. Edelman, MD Arnon Krongrad, MD Chef Robert Lewis Jeremy Pettus, MD TCOYD Team Steven V. Edelman, MD Founder and Director Sandra Bourdette Co-Founder and Executive Director Michelle Feinstein, CPA Chief Financial Officer Jennifer Braidwood Vice Executive Director Jill Yapo Director of Operations Michelle Day Director of Meeting Services Robyn Sembera Manager of Continuing Medical Education Sarah Severance Manager of Events and Fundraising Collin Stephens Manager of Health Fairs and Marketing Lynne Scharf Administrative Assistant MyTCOYD Newsletter Robyn Sembera Editor in Chief Sarah Severance, Jennifer Braidwood, and Lynne Scharf Assistant Editors Leah Roschke Design 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. ©2016 All rights reserved.
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I echo what Jeremy said about the future. When I see patients who have been diagnosed recently, I want to tell them how fortunate they are and how bright their futures are. Thanks to so many medical advances, people with diabetes can have long and healthy lives. D R E D E L M A N ’ S C O R N E R F R O M PA G E 1
was REALLY good news for me because when I was diagnosed I was immediately put on “intensive” control and had it beaten into me that if I didn’t control my BG levels, there would be consequences. I was put on two shots of insulin, Regular and NPH, and given a crappy meter and on I went. (At least I had a meter though, and never had to check my urine). So, fast forward 20+ years, and I have worked my butt off to avoid complications. I say this in NO WAY to try to brag, as I honestly believe that this comes down to luck as much as control, so don’t hate me. I’ve had more than my fair share of highs and lows and emergencies, but have avoided (so far) the classic long-term complications of eye, kidney and nerve disease. To me, this seems like a game that I can never win. When you think about it, we work day and night, hour-by-hour, carb by carb, all in the hope that NOTHING will happen. Isn’t that strange? At the end of the day, all of our work is really in trying to level the playing field with everybody else. If we get through the day and nothing happened, that’s as good as it gets. This point really hit home with me a couple of years ago when I was at the Children With Diabetes conference in Orlando. They offered free eye screening, and I had some time to kill so I got my eyes checked out. After the exam, the doc told me my eyes looked good. He asked me how long I had had diabetes, and he made the passing comment, “Wow, that long? Good job.” I got up and walked
Dr Steve Edelman
Dr Jeremy Pettus
out, but then had this extremely strong reaction and got very emotional. I had done a good job. I don’t think anybody had ever told me that, including myself, so validation of 20 years of work all hit me with one single comment. Since then, I’ve been an advocate of meters and CGMs that tell us not only when we are screwing up, but when we do something right! Because, man, there is a real lack of positive reinforcement with this disease and you can only work for nothing to happen for so long. So celebrate your DIAversary, celebrate that good BG day, celebrate that A1c result because YOU EARNED IT! The alternative is just living and waiting for something bad to happen, and that sucks. Now, as time marches on, chances are that I may get some form of complication that will hopefully be minor and not interfere with my life. The thing I am preparing for is to not blame myself. I work my butt off to stay under control and, if something happens, it happens, and I just have to try my best to keep fighting the good fight. I’m also super enthusiastic about the future given the extremely rapid improvement in therapeutics, and I have no doubt that every year with this disease will be easier than the last.
Steve’s Story I was diagnosed in 1970 at the age of 15 (and that makes me old, haha!), which was when many doctors did not know, or were not convinced, that controlling the glucose levels had any benefit. I was assigned to an ONCOLOGIST (a cancer doc) to take care of me and was put on just ONE shot of insulin, NPH and Regular, in the morning, which was totally inadequate to control my blood sugar levels throughout the day and night. I was told to test my urine for glucose four times a day, but never told to change my dose, even though, most of the time that strip turned dark blue, meaning I had a ton of glucose in my urine. For the longest time there were no A1c tests, no meters, no pumps, no insulin pens, no CGMs… sorry for the double negative, but, no nothing! My control was quite bad for many years even though I did what I was told to do. I knew it was bad because I was always thirsty, “peed” a heck of a lot, was frequently tired, had sores that would not heal and just felt lousy. It became a way of life. As a result of years of high glucose levels I currently have a boatload of complications. Ready for the list? First, I have proliferative retinopathy and macular edema requiring tons of laser burns to the back of my retina and injections of medication into my eyeball to help preserve my sight. As a result, my vision is really not that great, and I can tell you this is one complication you cannot escape during every minute of your waking hours. Big screens, large fonts, magnifying glasses, and special eyewear are all part of the visual paraphernalia that I have to schlep around. I know that what goes on in your eyes also goes on in your kidneys, and I do not want to be on dialysis, for sure, for sure! That is my biggest fear. My kidney function is not that good either, but it has been stable for several years, so I am grateful. Every time I get my blood drawn I am afraid to look at the results for fear that my creatinine or eGFR (kidney function tests) are getting worse. Every time I get a pain in my back area or have a little swelling I am thinking this is it…
my kidneys are shot...my luck has run out. And my other complications? The list goes on: Partial hypoglycemia unawareness, really bothersome gastroparesis, and the syndrome of limited joint mobility, which has required three trigger finger surgery repairs and a very painful frozen shoulder. I am embarrassed about having complications. Here I am, a diabetes specialist who has been teaching doctors and patients about diabetes for the past 28 years and I often feel as though I have totally failed myself. I have to remind myself I did the best I could with the information and tools I had in those early years. I have a ton of patients who are doing great with their diabetes and I am happy for them, yet envious at the same time. I hear motivational speakers who stand at the podium and proudly announce that they have no complications after many decades. For those of us who have been kind of ravaged by diabetes, it doesn’t feel that good. It sometimes comes off as, “Look at me...I made it and those of you with complications are losers. I did it right and you did it wrong.” I know none
of these healthy folks mean any harm, but that doesn’t stop me from telling Jeremy to get over his fear of ONE DAY possibly developing complications. I try to focus on the positive and get support from my close friends. None of my family members nor my patients know about my complications. I HATE sympathy! When folks tell me, “You look good”, I am thinking, “If they only knew.” I would like to close by saying that I echo what Jeremy said about the future. When I see patients who have been diagnosed recently, I want to tell them how fortunate they are and how bright their futures are. Thanks to so many medical advances, people with diabetes can have long and healthy lives. Well, that’s it folks. I hope by sharing our personal stories of living with diabetes, Jeremy and I have been able to help bring some reality to the stigma most of us feel just because we have diabetes and especially so if we have complications. Now, back to the challenge of educating and motivating folks with diabetes about avoiding complications so they can live long and healthy lives.
TCOYD IN MOTION
Our Favorite BY DAV I D A H N, M D
The App Store is crowded with diabetes
That’s why we tested them out MyFitnessPal Free for iPhone and Android For Tracking Nutrition/Carbohydrates MyFitnessPal is the most popular health app of all time, and for good reason! It has the largest searchable food database, with over 5 million different items, from homemade recipes to fast-food chains and restaurants. Users can track their nutrition for the purpose of weight loss and/or counting carbohydrates. It’s like carrying a Calorie King guide in your pocket, but it’s searchable and constantly updated. To simplify the hassle of logging food, MyFitnessPal can even use your smartphone’s camera to scan barcodes and instantly record nutrition information!
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MySugr Free for iPhone and Android For Monitoring Diabetes Built by a team of people with diabetes, MySugr is an adorable app that helps users log their sugars, carbohydrates, and medications. The app features statistics and graphs, including an estimated hemoglobin A1c that updates as you record your sugars. Like all the other apps in this article, MySugr includes support for Apple Health, meaning that glucose data can be imported automatically from newer wireless glucose meters like the Accu-chek Connect. For $2.99 each month, Pro Mode adds reminders to check your blood sugar and the option to generate PDF and excel reports for your doctor’s visits.
Free Diabetes Apps apps, but how do you know which ones to choose?
and created a list of our favorite ones. Diabetes Kit Free for iPhone and Apple Watch For Monitoring Diabetes Similar to MySugr, the creator of Diabetes Kit built the app to help himself keep track of all his various numbers such as sugars and medications. The unique aspects of Diabetes Kit are its companion Apple Watch app and its number-driven user interface, with multiple useful graphs and dashboards to help you learn from your data. Unfortunately, unlike the other apps listed here, Diabetes Kit does not include a feature to estimate A1c. Also similar to MySugr, $9.99 a year unlocks Pro Mode, which includes reminders and the option to generate PDF reports.
Sugar Streak Free for iPhone For Motivation to Check Sugars Sugar Streak is great for people who have a hard time remembering to check their blood sugar. During setup, users pledge to check their sugar anywhere from once to four times each day. By recording their sugars and fulfilling their pledge each day, users build a sugar streak! As their streak gets longer without being broken, they earn points more quickly, and the points can be redeemed towards small prizes like gift cards. Meanwhile, the app creates a glucose logbook with real-time statistics like estimated A1c, and can generate reports to assist with future doctor’s visits. Unlike the previous two apps, Sugar Streak does not track activity/nutrition/medications. Conclusion These are just a few of our favorite apps for managing the various aspects of diabetes. While using a diabetes smartphone app might not be for everyone, we think many of our readers will enjoy at least one of our suggestions. The quality of diabetes apps have come a long way from just a few years ago, and they should only continue to improve!
For more updates in the diabetes world of technology, check out the newly created TCOYD blog, TechCOYD by going to blog.tcoyd.org.
David Ahn is the Editor-in-Chief of TechCOYD, and Endocrinologist at UCLA. He has a curious obsession with health technology, particularly as it relates to Diabetes and Metabolism. His writing on digital health has been featured on MedPageToday, AACE Newsletters, iMedicalApps.com, and KevinMD.com.
TA K I N G CO N T R O L O F YO U R D I A B E T E S TA K I N G CO N T R O L O F YO U R D I A B E T E S
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ASK YOUR DOCTOR
Facing the Erectile Dysfunction in A R N O N K R O N G R A D, M D
Men, their partners, and their doctors should have open conversations about ED because it matters and in most cases can be corrected.
*This article contains sensitive and mature material. Reader discretion is advised. While it is a sensitive and personal topic, an estimated 20% of American men have erectile dysfunction (ED), the inability to maintain an erection sufficient for sexual activity. Among diabetic men, who are also at risk for loss of libido, the rates are higher. One study found that in men age 55-75 years with type 2 diabetes the rate of ED is over 70%. ED can be a first sign of diabetes, heart disease, and other illnesses. Your doctor needs to know if you have ED so he can consider evaluating you for other potentially serious illnesses. Secondly, erections may be an important element of intimate relationships; their absence can erode self-esteem and precipitate depression. Men, their partners, and their doctors should have open conversations about ED because it matters and in most cases can be corrected. They should also understand the treatments available. Just as medical science has delivered many treatments for diabetes – oral medications, injections, inhalers – it has delivered many for ED. The treatments for ED include oral medications: Viagra, Cialis, Levitra, and Stendra. They have helped many men to regain erections without needles, devices, or surgery and, like all medications, they can cause side effects, e.g. headache. Another treatment is injection of medication into the penis or delivery with pellets placed in the urethra. These treatments are more powerful than the oral medications, but can cause pain, bleeding, scarring, and erections that persist. Another treatment is an external vacuum device that mechanically induces an erection. Once achieved, the erection is maintained by a rubber band that fits at the base of the penis.
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Hard Truth the Age of Healthcare Consumerism They should also understand the treatments available. Just as medical science has delivered many treatments for diabetes – oral medications, injections, inhalers – it has delivered many for ED. Penile implant surgery is a durable remedy in that it allows an erection essentially any time. Penile implant surgery has several benefits: • Takes an hour to do • Has been around for over 40 years • Has helped hundreds of thousands of men • Is associated with high rates of satisfaction • Can be done as an outpatient procedure in most cases • Does not affect sensation, orgasm, ejaculation, or urination Penile implant surgery may not be covered by insurance, which may force patients to act as true healthcare consumers shopping for quality, convenience, and choice. One easy way to look for service is to search online for flat-fee “penile implant surgery packages.” The other way is to shop on a site like Surgeo, which selects highly qualified surgeons and packages them at a clear cost. Diabetes causes a diverse set of issues, including ED. Given the treatments available, there is every reason to talk about it with your doctor and find the right option for you. If that treatment is penile implant surgery, find a qualified surgeon and know your costs. Remember, if your surgery is not covered by insurance, look for surgery packages as a way to simplify your shopping.
TA K I N G CO N T R O L O F YO U R D I A B E T E S
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GIVING BACK
Meet the Board! BY JENNIFER BRAIDWOOD
Taking Control Of Your Diabetes has an all-star Board of Directors that aides and advises TCOYD through the year. TCOYD would like to extend a very special thank you to all of our board members for providing un-ending support and guidance. Now let’s meet a few more of TCOYD’s fabulous board members! Name: Edward Beberman Occupation: Attorney, Beberman, Stoffel & Beberman Tell us a little bit about yourself. What do you do for a living, what are your passions, what makes you SING!? I moved to San Diego in 1976 with my wife Luann and began law school. Upon passing the Bar Exam I opened my own firm. Along the way, Luann decided to become a lawyer as well. I focused my practice on business and contract litigation but about half way through my career I began to concentrate on trust and estate litigation. I have served on a number of non-profit boards and I am now firmly and happily ensconced on the board of TCOYD. The jury is still out and it’s probably too soon to know for sure, but I am enjoying retirement. Fortunately, both my passion and Luann’s are travel and food, and while we did our fair share of partaking in the past, retirement should give us ample time and opportunity to continue to pursue those interests. How did you get involved in the diabetes space? I was diagnosed with Type 2 Diabetes in 1990. In the course of my treatment, Dr. Edelman was one of my physicians but insurance plans separated us for a number of years. About four years ago my numbers were escalating at a rate that made me nervous, and I contacted Steve for
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advice. Eventually Steve asked me to join the board. My reason to join was because I thought I owed him something and it would be a chance to repay a debt, but after participating on the TCOYD board for over a year, I find this board and the TCOYD staff absolutely amazing and cannot believe the number of people who benefit from the efforts of those who are involved in the day-to-day operations. Why do you serve on the TCOYD board? Again, I have discovered that this group makes a difference in people’s lives, and that’s important to me. Plus, I have met some truly amazing people who will become friends for life. What makes TCOYD a great organization? It’s great to have a worthy cause, but no cause can succeed but for the people behind the cause. TCOYD has GREAT people who are devoted to advancing the cause outside of their personal gain. Name: Andrew Young Occupation: President and CEO of CoreMedica Laboratories Tell us a little bit about yourself. What do you do for a living, what are your passions, what makes you SING!? At the heart I believe I’m a humanist, strategist, and entrepreneur. What really excites me is using my abilities – strategic thinking, turning ideas into
reality, and influencing people to take actions that improve their lives – on important projects with terrific people. How did you get involved in the diabetes space? I am blessed with Type 1 diabetes… and let’s face it, it’s a major challenge. It gives me real empathy and compassion for everyone with medical issues. And outside of having T1, I’ve gained tremendous appreciation for healthcare workers, health innovations, and optimizing my own health as best I can. Building on that, in 2008 I began working for Diabetes in Control. It was a very fulfilling, fun experience for 6 years and then we sold the company. What makes TCOYD a great organization? TCOYD is an amazing and successful organization. It fulfills its promise to the diabetes community more efficiently and effectively than any non-profit I’ve seen. First-hand I’ve witnessed the exceptional quality of their work and the deep, positive impact they make. No wonder I wanted to contribute to its mission and growth! Focus, grit, and love. The founders and the team have been running the ultra-marathon of diabetes education and empowerment without letting up and they lead the pack. Luann and Edward Beberman
Name: Chris Beebe Occupation: President, QuantumEd Consulting and Principle Partner, PEP Networks LLC Tell us a little bit about you! What do you do for a living, what are your passions, what makes you SING!? Currently I am able to use my passion for educating and activating patients with chronic diseases to become informed consumers of their healthcare and share in their medical decisions. I founded a company that develops online education programs to do just that! Because I have career experience in healthcare delivery, patient care, physician education, pharmaceuticals, and teaching, I also provide consulting services. I love being physically active and outside – I grew up on a farm in Michigan so a great day is walking, running, biking, playing golf, or gardening! I love learning and teaching others! I could be a professional student – I take classes constantly whether epidemiology, improv acting, or French! Part of learning is traveling and I love to travel, both in the U.S. and abroad. How did you get involved in the diabetes space? I began my career as a Certified Diabetes Educator and Dietitian and did this for over 20 years. My interactions with the daily challenges of patients living with diabetes made me realize that I could truly make a difference in their lives. Working at the Diabetes Research and Training Center at the University of Chicago I was able to conduct research and quickly translate innovative findings into practice. Later as a hospital outpatient executive I was able to advocate for patients to receive high quality care regardless of their circumstances. As President of Healthcare and Education for The American Diabetes Association I was able to influence national issues for patients with diabetes including leading the team that obtained reimbursement for diabetes education and supplies. I later joined a pharmaceutical company to head their granting program that supported diabetes education programs for physicians and other healthcare professionals.
Andrew Young
Chris Beebe
Why do you serve on the TCOYD board? I have known Dr. Edelman for many years and admired the work of TCOYD and his passion for improving the health of persons with diabetes. I was co-chair of the TCOYD Conference & Health Fair in Chicago and saw first-hand the value of the program but most importantly I felt the passion and dedication of the entire TCOYD team. So when I moved to San Diego and Steve asked me to be on the Board I didn’t hesitate. TCOYD fills an educational gap for people with diabetes in that it provides practical, realistic education in an interactive and motivating format. TCOYD provides information in a way that wants you to seek more and more information! How great is that!? Name: Audrey Finkelstein Occupation: Executive VP Sales, Marketing and Clinical Support, Aspire Bariatrics Tell us a little bit about you! What do you do for a living, what are your passions, what makes you SING!? I started my career as a high school teacher. Six years later I began a career in medical sales and continue to be involved in bringing exciting new products to market. As a teacher I tried to sell children on the benefits of education. In sales and marketing, I work at introducing new concepts and devices to enhance the lives of people in need. My passion is helping people make INFORMED decisions about their healthcare.
Audrey Finkelstein
How did you get involved in the diabetes space? I was fortunate enough to become one of the founding “mothers” of Animas Corp., a manufacturer of insulin pumps. As I spent more time in the diabetes field, the diabetes community stole my heart. I had NEVER before met so many people who were so passionate about forming a community around a disease state. The outpouring of support from doctors, diabetes educators, families and industry made me want to be part of this extraordinary group of people. Why do you serve on the TCOYD board? First let me say how honored I was to be asked to serve. From the moment I met Dr. Edelman and Sandy Bourdette I was amazed at the commitment they had to the patients that they served. It’s one of the few organizations that truly put the patients at the center of everything they do. What makes TCOYD a great organization? The organization was created and continues to believe that patients with diabetes can succeed. The dedication and support starts with the top executives of the organization and trickles down to each and every person who works there. They understand what it takes and what is needed to give the patients they serve the education and moral support needed to be successful when living with a chronic illness. They do this with incredible dedication, much talent and yes, with laughter. TCOYD truly changes the lives of so many people with diabetes and the families that love them.
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P RO D U C T T H E AT E R
It Might Be Time for You to Upgrade Your Glucose Meter BY D AV I D A H N , M D
In a time when futuristic technologies like the artificial pancreas and pancreatic stem cells are on the horizon, glucose meters might seem like the least exciting area of innovation in diabetes management. However, new and improved features in modern glucose meters now make it a great time to consider upgrading to a new meter.
Accuracy is as Important as Ever
Wireless Mobile Phone Connectivity
No More Chips or Coding
Thanks to campaigns like Strip Safely (stripsafely.com) raising awareness of inaccuracy in older glucose meters, new standards were developed in 2013 that raised the reliability criteria for glucose meters. Now, 95% of results must fall within 15mg/dl for readings below 100 mg/ dl, and within 15% at or above 100 mg/ dl; also 99% of readings must fall within a “safe zone” of accuracy.
Two of the most recognizable brands have models that can now wirelessly transmit blood sugar readings to Android and Apple smartphones: the Accu-Chek Aviva Connect and OneTouch Verio Flex.
Although no-coding meters have been around for a while now, many people might still be using an older meter that requires the user to manually enter a code (or insert a coding chip) when changing to a new batch of test strips. In addition to being a hassle, this can be a source of error for glucose readings that might go unnoticed to the user. Current glucose meters do not require the use of chips or code entry.
According to marketing material, all the current meters mentioned in this article satisfied the new accuracy guidelines (ISO 15197:2013) , so your trusty old meter might be less accurate than current generation models. Even users of continuous glucose monitors (CGM) are not free from the issue of meter inaccuracy, since calibration of a CGM device with an accurate reading of blood glucose is extremely important in maintaining the accuracy and reliability of CGM.
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Thankfully, both meters use the same test strips and lancets that are covered by many insurance companies, so they don’t raise the monthly cost of testing supplies. Also, both devices have Apple Health connectivity that can automatically transfer glucose readings into iPhone apps like MySugr. Unlike the first wireless meters, the Accu-Chek Aviva Connect and OneTouch Verio Flex maintain battery life that is measured in years rather than days. Therefore, for less tech-savvy users, both meters operate seamlessly as a traditional glucose meter, with very little tradeoff.
Low-Cost Options, Without Compromises For users without insurance, the FreeStyle Precision Neo meter carries the motto of “accuracy meets affordability.” Contrary to what you might expect from a low-cost meter, the Neo actually feels upscale and more refined than a standard glucose meter
CASE OF THE MONTH
NO-HITTER BY S T E V E N V. E D E L M A N , M D
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with its sleek/thin frame and e-ink display (think Amazon Kindle). The Precision Neo appeals to users without insurance since it can be purchased over the counter without a prescription, and users can buy 50 strips for under $20 with a coupon (myfreestyle.com/neo). Unlike the other meters listed in this article, the Precision Neo does not wirelessly sync with smartphones.
am not a huge baseball fan but I know that a no-hitter is a big deal in the major leagues. When you are dependent on fast and long-acting insulin or on a pump, a no-hitter is unfortunately a rare event. Going 24 hours and staying between the lines (80 – 180 mg/dl) is not easy unless you are standing perfectly still and not eating or exercising, kind of like a British Royal Guard. Staying in the zone really involves so many factors that we have spoken about at many of the TCOYD conferences, in videos, books, and newsletters. Preventing highs entails giving the right amount of insulin at the right time in the right manner (all at once or spread out in a square wave bolus if you are using a pump) for a given amount of food where you know the percentages of carbohydrates, protein, and fat. Oh yeah…and don’t forget to give yourself the insulin at least 20 minutes before eating and reduce the amount of insulin if you are planning to exercise after eating. Make sure you take into account the intensity and duration of the exercise, as well. You must be looking at the trend arrow on your CGM to see if your glucose is on the way up C O N T I N U E D O N PA G E 1 6
Conclusion Don’t let outward appearances fool you. Many modern glucose meters like the Accu-Chek Aviva Connect and OneTouch Verio Flex are highly accurate and can wirelessly communicate with Android and Apple smartphones. For cash-strapped users or those lacking insurance coverage, the FreeStyle Precision Neo offers a low-cost option that still maintains accuracy and topnotch build quality.
No-Hitter!
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TAKING CONTROL
A Home Run Breakfast with B Y A D A M B R O W N , D I AT R I B E . O R G
Seven things I do to beat the hardest meal of the day.
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ith diabetes, the stakes are high in the morning. A well-managed breakfast can dramatically improve my time in zone (70-140 mg/dl) for the rest of the day. Conversely, I might regret poor choices at breakfast three, five, even eight hours later. Unfortunately, the morning brings a perfect storm for blood sugar spikes: highcarb and sugary food options, insulin resistance and inactivity, time demands, stress, and caffeine. Breakfast is also the most likely meal to prompt outrage: “How can I be LOW right now?! I did the same thing yesterday and was HIGH!”
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The full article (see link below) shares what I’ve learned through diabetes trial-and-error about managing breakfast, including many personal examples collected over the past few weeks. The tactics that have had the biggest impact on my diabetes are listed first, though all seven have made a major difference. At the end of the article, I’ve added two other approaches that might improve blood sugar around breakfast (cut caffeine and reduce stress), but I couldn’t confirm them from my own data. Please send feedback or other tactics by email (diatribe.org/contact-us) or on Twitter (@asbrown1); I love hearing from readers!
To read this article in detail with more tips and examples, visit diaTribe.org/breakfast.
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Cut carbs. I often eat scrambled eggs or have nuts for breakfast.
Eat non-traditional foods for breakfast: almond flour, nuts and seeds, lentils, etc.
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I’m NOT a healthcare provider. Always confirm changes with a professional, especially when adjusting your insulin.
MY TCOYD NEWSLETTER, VOL 54
Dose insulin 20+ minutes before eating carbs, and wait longer if blood glucose is above target or when eating something really sugary. More breakfast insulin: I use a more aggressive morning correction factor and more early morning basal to cope with higher AM insulin resistance.
THE FACES OF TCOYD
Diabetes
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Be active, especially by walking after breakfast.
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he next time you attend a TCOYD conference, come join us in the health fair and take silly pictures with your loved ones and the TCOYD staff in our latest addition to the health fair, The Faces of TCOYD Photo Booth! Step away from a conference feeling empowered, educated, and motivated to take control of your diabetes with a fun reminder of a great day! Get those gorgeous smiles and crazy faces ready and we hope to see you soon!
Get real-time glucose data from CGM to track your blood sugars and make adjustments after breakfast, learn what works, and optimize overnight insulin.
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Eat a smaller, earlier dinner and don’t snack around bedtime.
diaTribe.org
For conference cities and dates, see the back cover or visit our website: www.tcoyd.org TA K I N G CO N T R O L O F YO U R D I A B E T E S
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LIVING WELL
Fifty-Three Years of Diligence, Dreams and Diabetes With help from Dexcom’s continuous glucose monitoring technology, Judith Jones-Ambrosini enjoys her life as a chef, diabetes journalist and author of The Sisterhood of Diabetes – Facing Challenges & Living Dreams.
“Many of us can pinpoint that moment of diagnosis like a freeze frame in our minds. For me it was a cold dreary October day in 1962. I was a student at the time. I developed what I thought was a terrible cold from surfing in the chilly waters of the Atlantic Ocean (instead of nose into the books). The symptoms grew to extreme thirst, hunger, weakness and a feeling of fatigue that wouldn’t go away. Next thing was waking up in a hospital room with shock and disbelief and a diagnosis of Juvenile Diabetes. “Quickly I learned a new routine very different from my carefree student lifestyle. I became an expert at learning the tools available to us in those dark ages of diabetes care– sterilizing glass syringes and sharpening 23-gauge stainless steel needles to inject a daily shot of insulin. I learned how to balance food with the “Exchange Diet” and became an expert at trickling drops of urine into test tubes to test for sugar. When home blood glucose meters appeared on the horizon, it seemed a major epiphany. That was life in the old days of diabetes. Today we have Dexcom! “The technology of the Dexcom CGM, insulin pumps and advanced medications are making it easier to live our diabetes lives with a more rhythmical beat. For me these technologies are the cure at hand right now and I encourage others with diabetes to get on board if they are not already there. The Dexcom G5Mobile continuous glucose monitoring (CGM) system is a breakthrough tool that provides real time glucose 14
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information on a smart device. Compared to traditional finger stick meters, which only provide data at a point in time, a CGM shows speed and direction of glucose excursions and gives alerts for action. By tracking trends one has the ability to make smart adjustments in treatment.” Over the years Judith has learned to make friends with her diabetes and become an active member in the diabetes community serving as a board member of the American Diabetes Association, DESA (Diabetes Exercise and Sports Association), Diabetes Sisters, Wise Women of Diabetes retreats and Divabetics, as well as volunteer at Children With Diabetes (CWD), as a certified health educator and as a professional chef providing healthy cooking demonstrations and spreading the message of optimal glucose control at diabetes conferences. Oh, and you might see her giving a Tai Chi class at a TCOYD conference! Her attitude is that a healthy outlook of diligence and dreams makes for a healthy life. Judith is currently working on a new book entitled POINT MEN - Leadership, Courage & Influence about men who have advanced progress and enrichment in diabetes. Of course included in the book is Dr. Steve Edelman, one of the great and noteworthy gifts to the diabetes community.
E AT I N G W E L L
Chef Robert Lewis’ Oh-So-Easy Springtime Finds! Fresh Grilled Farmers’ Market Salsa Servings 8 2 large ears of corn, husked 1 t extra-virgin olive oil, plus more for brushing Salt and freshly ground pepper 1 can of tomatoes 1/4 cup red onion, diced into 1/4-inch pieces 1 can black beans, drained 1/4 cup chopped cilantro
Brush the corn liberally with olive oil and season well with salt and pepper. Grill, turning every few minutes, until golden all over and cooked, about 12 minutes. Let the corn cool and cut off the kernels. Discard the cobs. Mix the tomatoes, onions, drained black beans, cilantro, and roasted corn. Per serving: Calories: 32 Total Fat: 8.8 Total Carbs: 6.3g Dietary Fiber: 2.9g Sugars: 2.2 Protein: 3.4g
California Mission Fig Salad Servings 4 12 oz fresh spinach 1/2 red onion sliced 2 dried figs, chopped 3 T sunflower seeds ½ cup cherry tomatoes 3 oz crumbled goat cheese
Top the spinach with the red onions, figs, sunflower seeds, tomatoes, and goat cheese. Drizzle the top with dressing. Calories: 257 Total Fat: 17.33g Total Carbs: 16.80g Dietary Fiber: 3.66g Sugars: 10.36g Protein: 8.91g
Salad dressing 6 t balsamic vinegar 3 t extra virgin olive oil 1 t Dijon mustard 1 T honey
T= tablespoon
t= teaspoon T A K I N G C O N T R O L O F Y O U R D I A B E T E S 15
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or down, which should have a major influence on the amount of insulin you take. Are you getting the point? No-hitters are tough and almost impossible, especially for us type 1 folks but also for the majority of anyone with any type of diabetes. If you test your glucose with a meter 2-4 times a day you might be lulled into a false sense of security, especially if you only test before meals. Don’t forget there are 1,440 minutes in a day and a glucose value from your meter only gives you a snapshot of what your sugar value is at that one point in time. This may be fine for many type 2s out there but not for anyone on multiple daily injections or a pump. CGM is the major tool we have to attempt a no-hitter. The artificial pancreas will be our saving grace but in the meantime, test a lot, look at your CGM a ton, learn from your mistakes, stay positive and live life to the fullest. Off to see a San Diego Padres game! 16
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