Winter Quarter Newsletter

NEWSLETTER

MY

Winter 2013 Volume 42

New Year’s Resolutions:

For 3 Weeks… or Lifelong Changes?

Dr. Edelman’s Corner

INSIDE I Want a New Drug Page 3

Breaking Free from Depression Page 4

Question of the Month Page 5

The Jerry Lund Story Page 6

Know Your Numbers Page 9

Novel Test to Determine Future Risk of Type 2 Page 10

Product Theater Page 11

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e all do it! As the New Year comes around, we make promises to ourselves and our loved ones about eating better, exercising more, losing weight, checking our glucose more, getting our A1C down, etc., etc., etc. Eighty percent of yearly health club memberships are sold in the first 10 days of January and by mid-February very few of those folks are still visiting their new gym. Most of us need to figure out what kind of real and PERMANENT changes we can realistically make for the long term.

I always liked to exercise but was never consistent. I used to go to the gym once a year… to pay my dues! A few years ago I finally made a commitment to do aerobic activities 4-5 times a week. I got into cycling, thanks to my good friend Phil Southerland, and now I am addicted.

I either go to a spin class at my health club, ride my old spin bike at home or ride

along the San Diego coastline and other bike trails. I often cycle with friends to shoot the breeze and, of course, stop at our favorite Starbucks turn-around rest stop.

Cycling has become a lifelong change that is now part of my weekly routine and I love it. This is the key…you have to really like or love or become comfortable with the changes and make them part of your life.

New Year’s Resolutions (continued on page 2)

Special Acknowledgements Board of Directors Steven V. Edelman, MD Founder and Director, TCOYD Sandra Bourdette Co-Founder and Executive Director, TCOYD S. Wayne Kay Margery Perry Terrance H. Gregg DexCom, Inc. Daniel Spinazzola DRS International Contributing Authors Jennifer Braidwood Steven Edelman, MD Juan Pablo Frias, MD Susan Guzman, PhD Robert Lewis Jeremy Pettus, MD William Polonsky, PhD, CDE

TCOYD Team Steven V. Edelman, MD Founder and Director Sandra Bourdette Co-Founder and Executive Director Jill Yapo Director of Operations Michelle Day Director, Meeting Services Michelle K. Feinstein, CPA Director of Finance and Administration Antonio Huerta Director, Latino Programs Jennifer Braidwood Manager, Outreach and Continuing Medical Education Jimm Greer Manager, Social Media David Snyder Manager, Exhibit Services Robyn Sembera Associate CME Manager and Outreach

MyTCOYD Newsletter Editor: Jennifer Braidwood Assistant Editor: Robyn Sembera Design: Hamilton Blake Associates, Inc.

MyTCOYD Newsletter is offered as a paid subscription of Taking Control Of Your Diabetes. All material is reviewed by a medical advisory board. The information offered is not intended to constitute medical advice or function as a substitute for the services of a personal physician. On the contrary, in all matters involving your health, TCOYD urges you to consult your caregiver. © 2013 All rights reserved.

2 My TCOYD Newsletter, Vol. 42

New Year’s Resolution (continued from page 1)

For years and years, another New Year alone! (Just kidding about that one!)

What about my diabetes would come around and I would state confidently each time that I was going to management? I am the first to admit that I have had lifelong difficulties getting cut out mac and cheese, nachos, french fries, red meat and all desserts, including my A1C under 7% without excessive hypoglycemia. As a person living with warm bread pudding with a scoop of type 1 diabetes for 42 years and as a vanilla ice cream on top (my favorite). diabetes specialist, I am the first to These promises to myself pretty much recognize that we all have barriers that only worked for a few weeks; then I felt keep us from reaching our metabolic like a failure and a whimp when I broke goals. It is tough to not them.

To be honest, I also Weight loss is damn hard and get down on yourself expected many of my we do not yet have any magic when the labs come overweight patients to bullets to reduce weight... back abnormal or higher than you wished or were cut out the things they striving for. When talking to myself (not loved and lose weight upon my medical out loud in public), or my patients, I try command and, of course, that didn’t to figure out the toughest issue causing work any better for them than it had the problem and then address it head-on. for me!

As I have learned from my good buddy I finally figured out that we are not Bill Polonsky of the Behavioral Diabetes what we eat but how much we eat! I Institute, your A1C is just a number and have lost 14 pounds over the past two not a reflection of being a good or bad years by reducing my portion size while person. Remember, reaching our goals still eating what I really like, including, is not a sprint, but rather, a marathon. on occasion, warm bread pudding and vanilla ice cream. The recommendation Hang in there and try not to get discourof reducing caloric intake and maintain- aged if you are not where you want to ing good portion control is now the main be in terms of your diabetes control.

Get help and support from your loved suggestion I give to my patients. Weight ones or caregiver and remember, they loss is damn hard and we do not yet have any magic bullets to reduce weight, could be the same person!

Take control and let 2013 be different however, we do have tools such as the in terms of making not just short-lived old and new oral medications (Belviq resolutions, but rather lifelong changes... and Qsymia), Symlin, GLP-1 agents changes that you embrace, enjoy, crave (Bydureon and Victoza) and bariatric and become part of your daily routine. surgery. I know we all have to figure Even if it is only one small out what works best for us on permanent change, make it an individual basis but, for for a lifetime. I am excited me, I now like to order my for you! own appetizer or salad and share a main dish, or visa versa. I love looking at the dessert menu and ordering Steven Edelman, MD the best one with four Founder and Director Taking Control Of Your Diabetes spoons or forks…even if I am

Living Well

I Want a New Drug!

hormone that is made by the beta cells of the pancreas, the same cells that make insulin. In healthy people, Other medications for type 1 amylin is released with insulin into the diabetes beyond insulin blood stream when we eat. It works by slowing down the speed at which our

By Jeremy Pettus, MD stomach empties food, tells the liver to temporarily stop producing glucose, and reduces our overall appetite.

Together, these mechanisms make f you have type 1 diabetes, you must have wondered to yourself us eat less and help to regulate our at some point why there seems to be a new drug available for blood sugar after eating. Since types type 2 diabetes everyday, but those of us with type 1 are stuck 1s generally don’t have any beta cells, with just insulin. Insulin is literally a lifesaver for people living not only are we deficient in insulin, with type 1 diabetes, but despite our advances with insulin but we are deficient in amylin, too.

Symlin was approved in 2005 to use therapy, the majority of patients do not reach an A1C goal along with insulin in type 1 diabetes. of less than 7%. Furthermore, insulin can lead to weight gain, Large clinical trials have shown that hypoglycemia, and its variable absorption can be extremely injecting Symlin at mealtimes can frustrating. Sure, curing the disease entirely would be great, lower your A1C (generally about 0.5%), but I think most of us would be happy with another medication cause you to lose a little weight, and that could help make living with the disease a little easier. lower your total insulin dose. The downsides of the medication are that Take a look at the figure below for resentment between different types it is a separate injection before each of diabetics, but just to bring your what I call the “diabetes scorecard”. meal and can cause nausea. If you attention to the lack of alternative You can see that type 2 diabetics haven’t heard about the medication, medications for type 1s. The good have many different classes of I would start by getting some informanews is, this is changing! Let’s start medications to choose from while tion online at https://symlin.com and by talking briefly about Symlin, and asking your healthcare provider if it type 1s only have insulin and pramlintide. You may be wondering then talk about what is coming down might be worth trying. the road. what pramlintide is, and I’ll get to Symlin is a synthetic version of that in a second. I also included Matching Patient with a Protocol the hormone amylin. Amylin is a the date when the drugs became As both a patient and a physician, available. Insulin was I have had a good amount of experdiscovered in 1921, and then ience with Symlin. In the right Classes of Drugs Available there was a huge gap until patient, it can work wonders. However, Type 2 Diabetes Type 1 Diabetes Biguanides (metformin) Insulin (1921) 2005 when the FDA approved as I mentioned above, it requires 3-4 Thiazolidinediones (TZDs) Pramlintide (2005) pramlintide (trade name extra injections a day and the effects Alpha-glucosidase inhibitors Sulfonylureas Symlin), the only other on lowering your A1C are there, but Dipeptidly peptidase medication approved for not that robust. That being said, 4 inhibitors (DPP-4 inhibitors) GLP-1 agonists type 1 diabetes.

Symlin has demonstrated that other Bile Acid Sequestrants The point of showing medications can effectively be used to Dopamin Agonists Pramlintide you this figure is not to cause Insulin some inter-disease rivalry or New Drug (continued on page 8)

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Taking Control Of Your Diabetes

3

Taking Control

Breaking Free from What You Need to Know and Do

By William Polonsky, PhD, CDE and Susan Guzman, PhD

D

epression is like a black hole. It can take the joy out of life, drain your energy and motivation, and cause you to feel hopeless and worthless. Even worse, depression can make the tasks required to manage diabetes seem much more difficult and, therefore, may seriously hurt your long-term health.

But there is good news: This article your genes, the amount of stress in will help you understand depression and how it may be linked to diabetes. your life, and how you think about By learning these ten important facts, yourself and your future. And having diabetes makes depression even more you take an important step toward likely. There are two reasons why feeling good again. this is so: So hang in there! You CAN overcome depression, handle diabetes u The psychological influence. more successfully and feel much, Managing diabetes takes much better again. attention and effort, and this can be burdensome. It can feel like 1. Depression and Diabetes: you have been given a full-time Why This is a Big Deal. job: a job that you didn’t apply Depression is painful all by itself, for, don’t want, and can’t quit. but depression and diabetes together is a dangerous combination. Having diabetes increases the chances of having a significant problem with depression, and depression can make it difficult to manage diabetes effectively. Scientific research has shown that depressed people are more likely to skip medications, get little exercise, have an unhealthy diet, and have difficulty managing their weight.

u

The biological influence.

Certain common medications (like beta blockers) and other diseases (like hypothyroidism) can sometimes cause symptoms of depression or make it worse.

Chronic pain (such as pain due to neuropathy) as well as sleep problems can also contribute to depression. In addition, chronically high blood glucose levels may worsen depressive symptoms.

2. Why is Depression So Much More Common for People with Diabetes?

Getting depression doesn’t mean 3. Getting Help for Depression you are crazy nor does it mean you is Worth the Effort. have a weak mind. The major factors Too many people never seek that contribute to depression are treatment for depression. As a result,

4 My TCOYD Newsletter, Vol.33 Vol. 42

they suffer with depression unnecessarily and for far too long. Depression is unlikely to go away all by itself; this is not because you are weak or haven’t tried hard enough. Even if you have tried some treatment in the past and it didn’t work, don’t give up. There are a number of new therapies that might help you now.

4. As a First Step, Talk to Your Doctor.

There are many different ways to treat depression, but which one is best for you? Talking to your doctor should be your first step. By working together with your doctor to identify the causes of your symptoms, he or she can help you select the best treatment for you.

5. Antidepressants Can Help, But They Are Not Perfect.

No one is happy about taking additional medications, especially if you feel like you are already taking too many. But antidepressant medications have helped millions of people to recover from depression and regain their lives.

When prescribed an antidepressant, your dose may need to be changed over the first several months, and it may take 4–6 weeks before you start feeling better. And these drugs aren’t foolproof.

In almost half of all cases, the first antidepressant that is tried doesn’t really help. But don’t despair; there are many kinds of antidepressant drugs and this just means you may need to try a second drug, or even a third, before you get real benefit.

6. Cognitive-Behavioral Therapy (CBT) Can Help.

There are many forms of counseling, but only one, CBT, has been consistently shown in scientific research to

Question of the Month

By Steven Edelman, MD

help people overcome depression.

CBT is based on our understanding that depression causes you to notice only the negative things going on in life. These are automatic forms of thinking that you may not even notice you are doing.

By helping you to see how depression is causing mistakes in how you think, CBT allows you to view challenging situations more clearly and learn how to respond to them in a more effective way.

7. Good Sleep and Regular Exercise: The World’s Cheapest Antidepressants.

Most of us don’t get enough restful sleep OR exercise, and those with depression are even less likely to be getting enough.

Deep, restful sleep (typically 7–9 hours/night) is a process that restores the mind and body. When sleep is disrupted or inadequate over long periods of time, it can lead to increased tension, difficulty concentrating, depressed mood, irritability and chronic fatigue. When fatigued, you are less likely to exercise. And when you are inactive, you may have more trouble sleeping. What a mess!

You may end up in a downward cycle of inactivity and disturbed sleep, which can lead to depression.

Regular physical activity, such as brisk walking for 30 minutes/day (or whatever you are able to do), has been shown to reduce the symptoms of mild and moderate depression. Besides boosting mood, regular exercise can provide protection against heart disease while also lowering blood sugar, blood pressure and “bad” cholesterol levels.

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hat is the best way to fine-tune basal rates on an insulin pump?

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

Answer: Fine-tuning the basal rate on your pump and your basal dose of Lantus or Levemir is very important. The basal insulin dose, whether given via an insulin pump or an injection of Lantus or Levemir, is meant to keep your blood sugar values perfectly level or flat between meals, overnight and during periods of fasting. If your blood sugar (BS) levels go up during fasting, your basal rate or dose of basal insulin is too low. If your BS goes down, your basal rate or basal insulin dose is too high.

The best way to test your basal insulin dose is to have a continuous glucose monitor (CGM), a device that gives you a BS reading every five minutes, day and night. On your ‘test’ day, skip breakfast, fast until the afternoon and follow your BS values. If you do not have a CGM device you will need to test your BS frequently, every 60 to 90 minutes, and record them. If you think you will die of hunger, have an early breakfast, making sure you take the proper amount of fast-acting insulin to control your post meal BS and then watch your values until dinner. On a different day, have an early dinner and do not eat a thing until the next morning. With this technique you will be able to assess your basal rate or your basal insulin dose. You will also see if you need a secondary basal rate. You may need to do this on more than one occasion in order to really confirm your basal insulin needs. As a general rule of thumb, 50% of your total daily dose of insulin should be the basal component.

8. Get Up and Get Out! 9. Deal With Your Negative Depression may cause you to Feelings About Diabetes. withdraw from your friends and Sick and tired of diabetes? Many family and become isolated. It may people feel frustrated, scared, angry feel like you have lost your “get up or overwhelmed. They may believe and go”. You may even find it hard that they are “failing” at diabetes, to get out of bed on some days, or that complications are inevitable, to go outside. And all of this makes that nothing they try seems to work, depression worse and worse. By or that they are alone with diabetes. breaking out of this pattern, even Any of these can lead to “diabetes if it feels forced at first, you can burnout” which can cause or worsen begin to feel better again. depression.

Take small steps to become To address these feelings, there are re-engaged with life. Don’t sit around a few things you must first know: and just hope you will start feeling better some day. Get started now!

Depression (continued on page 12)

Taking Control Of Your Diabetes

5

TCOYD in Motion

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YD O C T A reme Ext etes Diab eover: Mak y Lund err J e h T Stor y

By Jennifer Braidwood

e would like to invite our newsletter readers to join us as we follow Jerry Lund, a 64-yearold man who, four months ago on September 26th, was diagnosed with type 2 diabetes. On that day, for the first time in his entire life, Jerry realized he was not just “husky”, or “a little overweight”, or that he needed to go on a diet for a little while. He realized he was extremely obese, a type 2 diabetic and things needed to change. So follow us, as we follow Jerry through his “awakening” as he calls it, and his journey through the next year of his life. We will feature Jerry and his story in each of our newsletters in 2013 as well as on our web site and social media pages.

Interview #1: November 10, 2012 6 ½ weeks since diagnosis Current Weight: 240 pounds 26 pounds lost

Day of diagnosis:

September 26, 2012 Starting Weight: 266 pounds Fasting Blood Sugar: 180 A1C: 9.0 BP: 180/110 Total cholesterol: 200 LDL: 129

6 My TCOYD Newsletter, Vol. 42

“No one ever told me I was fat,” Jerry Lund said on November 10, 2012 during his first interview with TCOYD. “I thought I was a pretty happy and well-adjusted guy. I develop clothing lines in the action sports industry and I have been doing that for most of my career. I live by the beach and I like to cruise around on my bike on the weekends. Growing up I loved to surf and play baseball.

Sure, I was always a little husky as a kid but, up until about six weeks ago, I never ever thought I was fat or unhealthy. I was just me, ya’ know?

And I was comfortable being me.

...I was always a little husky as a kid, but, up until about six weeks ago, I never ever thought I was fat or unhealthy.

There was nothing wrong with me.

I woke up in the morning and I felt good, I felt okay, I felt healthy.”

As a kid, Jerry was pretty active, but always struggled a little with his weight. As he got older, he got married, became a Dad and then, two hip replacement surgeries later, things started to change. That “always husky” kid turned into a really overweight and sedentary adult. Like most of us, other things started taking priority, such as raising a family, being a spouse, and working a full-time job.

Suddenly, surfing and playing baseball took backseats to things that seemed far more important, until they were no longer existent. Throughout the 70’s, 80’s and 90’s Jerry was on a diet rollercoaster. “I would gain some weight and think, ‘I should go on a diet for little while’ and then I would go on a diet and lose a bunch of weight. Then, a couple years later, I would gain all the weight back, and then some, so I would go on a diet again and lose a bunch of weight.

Eventually, my daughter, Natalie, grew up and moved out on her own. I got divorced and over these last ten years I’ve been….alone. There was no one there to look in my cupboards, to see what I was eating. I mean, what’s any better than a great big cheeseburger, an ice cream cone, or a big fat piece of cake? Things were good.”

Eventually, Jerry met Sandy Bourdette, the Co-Founder and

Executive Director of TCOYD, at a summer wedding. They became friends and soon found themselves spending weekends together, chatting on the phone, and really getting to know one another or, as Jerry likes to say, “someone in my life started bugging me.” That someone was, in fact, Sandy, who started to push Jerry and ask him questions about his health, such as, when was the last time he saw his doctor or had a physical; it started making things uncomfortable for him. “See, the only other person in my life who had asked me those things or bugged me about what I was eating or how much I weighed was my ex-wife, Michelle.

kept up their friendship while Sandy attempted to help Jerry get on the right track and to see a doctor. It had been 7 years since his last physical exam. “Then, one night, everything changed. I was on the phone with Sandy and she asked me how I was feeling about a doctor’s appointment I said I had made. I had lied. I hadn’t made an appointment and I had no intention of making one. I remember it being a really awkward conversation. There was a lot of silence, maybe she knew I was lying. I told her I felt good about the supposed appointment, and told her to quit bothering me about it. Then the conversation ended. I thought it was all over, I probably wouldn’t talk to her again.”

I didn’t want to face the This is where everything changed number on the scale. for Jerry. He picked up the phone, Looking back now, I know called Sandy back and confessed he I was in denial. had been lying about making the appointment. “It took another person She and I once had this argument to convince me to take a really good about my weight. She asked me how look at my life and what I was doing much I weighed and I lied to her. She to it. Everything changed with that wanted me to get on the scale and phone call. She had pushed me so prove it, prove I weighed what I said hard over the last six months and I weighed. I thought it was ridiculous. she never gave up. I didn’t want to I never got on that scale. Sandy be pushed, but that’s what it took. It started ‘nagging’ me in that same took someone not giving up on me. I way. I didn’t want anyone questionmade the appointment the next day.” ing me. I was happy the way I was.

Jerry was diagnosed with type I didn’t want to change, but most 2 diabetes shortly after his doctor’s importantly, I didn’t want to face appointment. For the next few weeks the number on the scale. Looking he spent countless hours every night back now, I know I was in denial. I reading all he could about diabetes thought my weight was someone else’s care and management. “Before, I problem and not my own. I didn’t would ignore anything that had to have a problem with my weight, do with weight or health because, Michelle did, and now Sandy did.” in my reality, I thought I was fine. I For six months Sandy and Jerry wasn’t fine. Now, I can’t stand not to

read anything about diabetes care or weight management.”

Jerry began to make small changes after that initial doctors appointment. He started going to bed earlier and waking up earlier, eating better foods, and getting about 20 minutes of exercise every night after work. “I am going to do this every day. I am not going to skip a day. I communicate with my doctor a lot, over text or email. I told him that I was losing weight and you know what he said?

He said, ‘that’s a good start.’ He’s right, it’s a good start. I have a long way to go.”

Interview #2: December 26, 2012 3 months since diagnosis Current weight: 220 pounds 46 pounds lost Fasting Blood Sugar: 93 A1C: 6.3 BP: 150/90 Total cholesterol: 156 LDL: 99 We caught up with Jerry again the day after Christmas and asked him how his last six weeks have been and what has changed. “You know, I am starting to realize a lot of things.

There are these things I used to worry about I thought were normal worries because they were such an ingrained part of my life. I would worry about a seatbelt on an airplane not fitting around me. I would worry

Jerry Lund Story (continued on page 8)

Taking Control Of Your Diabetes

7

New Drug

(continued from page 3)

help patients with type 1 diabetes and has really opened the door for a renewed interest in alternative therapies. So what else is coming?

GLP-1 Agonists You may have heard of drugs called GLP-1 agonists. Currently, three drugs in this class are available for patients with type 2 diabetes: Byetta, Victoza, and Bydureon.

They are also injections and are given anywhere from twice a day to once per week. In type 2s they have some similar effects as amylin in that they can lower your A1C and actually cause some weight loss.

Recently, some small clinical trials have shown that these medications may have a beneficial effect in patients with type 1 diabetes as well. Furthermore, a good number of patients living with type 1 diabetes have already started taking these medications in an “off-label” fashion, meaning that these medications are not yet officially approved for use in type 1 diabetes. The real advantage to these medications is that the injections are less frequent. We don’t know exactly how well these medications work or if they are more effective than Symlin, however, the manufacturers are pursuing more trials in patients living with type 1 diabetes. The goal is to show their efficacy and get them FDA approved for treatment.

My TCOYD TCOYD Newsletter, Newsletter, Vol. Vol. 42 40 8 My

Thinking Outside the Box In addition to the GLP-1 drugs, other classes of medications may have promise in type 1 diabetes. A new class of drugs called SGLT-2 inhibitors work in the kidney by actually causing patients to waste sugar into the urine. The kidney normally is very good at reabsorbing all the sugar in the body, however, by causing a patient to urinate out some of the sugar in the blood, you can lower your blood sugar and potentially lose a little weight. This is a great example of “thinking outside the box” in diabetes as this would be the first therapy to focus on the kidneys.

Clinical trials in type 1 diabetes are now underway.

Looking to the future, I believe we will see more therapies for patients with type 1 diabetes become available within the next five years. Such medications would help to fill a major gap in treating people living with the disease. Make sure to check in with your healthcare provider at regular intervals, not only for your routine diabetes care, but to see if there have been new developments in this area. And don’t forget, Symlin is available now, so if you haven’t heard of it, do some research and talk to your doctor about whether it would be right for you.

Jeremy Pettus, MD, is an endocrinology fellow at the University of California, San Diego and living with type 1 diabetes.

Jerry Lund Story (continued from page 7)

about not finding a parking spot close enough to a store’s entrance and I would worry about walking down a set of stairs because eventually I would have to walk back up them.

I find myself not worrying about that kind of stuff anymore.”

Jerry is now exercising 25 minutes every day after work and for two hours per day on the weekends. He has gone from a size 46 waist to a 40 and from a XXXL shirt to an XL. “Lucky for me I have diabetes because that is really my main source of motivation to keep active and healthy.”

“I look good! I look in the mirror and I like what I see and I know in another 6 weeks I’m going to like it even more.

Jerry’s more active lifestyle has allowed him to have an easier day-to-day life, from working a trade show to lifting boxes at his place of business to walking up a flight of stairs. Jerry says that the physical aspect of his life is being returned to him when he didn’t even know it was missing in the first place. We asked Jerry what motivates him to keep going and he wasn’t ashamed to say, “I look good! I look in the mirror and I like what I see and I know in another six weeks I’m going to like it even more. But my main goal is to get back on my surfboard, to surf again. I haven’t surfed in 10 years. My knees

Know Your Numbers

feel better, my legs feel better. I’m not carrying around 46 pounds anymore and that is pretty amazing. I wonder what it’s going to be like when I’m not carrying around 80 pounds anymore.”

The main thing that Jerry wanted us to know during this interview was that he wasn’t on a diet any more and he wasn’t on an exercise plan anymore. “See, diets and exercise plans are so temporary. You go on a diet but eventually you go off of it. I have realized that this is not a diet, this is just the way I eat now and exercise is part of my life now.

It’s a lifestyle modification, a lifestyle makeover!” Side note: At TCOYD we like to call it an Extreme Diabetes Makeover!

We asked Jerry to share one final thought before we ended the interview. “One thing I have learned from Sandy and from Dr. Edelman, it’s not what you eat but how much you eat. Eventually, I will be able to enjoy an occasional ice cream cone, or a cheeseburger. I’m not ready for that yet, but I’ll get there.”

By Steven Edelman, MD

T

his 42-year-old male with type 2 diabetes is working really hard to control his diabetes. He is testing four times a day without missing a single time and his numbers look excellent. It seems as though he is totally in control.

However, there is something definitely wrong with this picture. The numbers do not vary much and there are too many numbers that are exactly the same or end with zero or five, which is mathematically not likely. In addition, there is no food or blood on the logbook, which is pretty common given the circumstances of when and where blood sugars are tested. This person had a HbA1c of 15%, indicating that his average blood sugar level is in reality 250 to 350 mg/dl!

So, what’s the deal? Unfortunately, after a little questioning, I figured out that he was just making up these numbers since he either did not test at all or was afraid or ashamed to tell me his real numbers.

I cannot stress how important it is to realize that having bad blood glucose levels does not mean you are a bad person or that you are an utter failure at controlling your diabetes. Falsifying your glucose values does only two things: it hurts you and doesn’t allow your caregiver to assist you with adequate and proper care. When it comes to diabetes management we must all overcome the emotional barriers of dealing with “bad numbers”. It’s a little tough, but in the long run, you are much better off giving real numbers, even if they aren’t what you were hoping for.

Taking Control of Your Diabetes is Generously Supported By: Platinum Corporate Sponsors

Tune in next quarter to find out how Jerry is doing! You can also meet Jerry on our web site and our YouTube page, TCOYDtv. Click and watch his first video, “A TCOYD Extreme Diabetes Makeover: The Jerry Lund Story”.

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Taking Control Of Your Diabetes

9

Use of a Novel Test to Determine Future Risk of Type 2 Diabetes

glucose function, are combined with age and gender to produce a personalized score between 1 and 10 that indicates your likelihood of progressing from prediabetes to type 2 diabetes within five years. The lower your PreDx score, the lower your risk of developing type 2

By Juan Pablo Frias, MD diabetes within five years. The higher your PreDx score, the higher your risk of oday, over 26 million adults in the future type 2 diabetes.

United States have diabetes, and Your healthcare provider can use the approximately 80 million­—one of information provided by the PreDx test every 3 people over age 20—have along with other clinical information to “prediabetes,” a condition where determine the best diabetes prevention glucose levels are above normal but plan for you. not yet at a level to diagnose diabetes. Association currently recommends Periodic retesting with PreDx can that everyone be screened for diabetes also be used to monitor the impact of Prediabetes is a “red flag” for and prediabetes starting at age 45, healthcare providers and patients, your diabetes prevention plan, and guide and if you are overweight and have because it signals a higher risk for changes in your prevention strategy. future development of type 2 diabetes other risk factors for diabetes, such as Research has shown that a drop in and other medical conditions, such as high blood pressure, abnormal choPreDx score in response to lifestyle lesterol or a family history of type 2 heart disease. changes reflects a reduction in the risk diabetes, testing should begin before The good news is that the onset for developing type 2 diabetes. If there is age 45. Check out the ADA’s website no change or an increase in the PreDx of type 2 diabetes can be prevented, for full recommendations about or at least significantly delayed. score with your diabetes prevention screening http://www.diabetes.org/diaThis can be accomplished through efforts, adjustments in your plan can be betes-basics/prevention/pre-diabetes/. made to help achieve better results. increased physical activity, good You should definitely know whether nutrition, weight control and, if Unlike so many devastating diseases, your glucose levels are normal, in the needed, medication. The bottom line type 2 diabetes can be prevented or at prediabetes range or in the diabetes is that healthy living can prevent or least delayed. A PreDex test can give delay the onset of type 2 diabetes and range. If you do not, talk to your you a more complete picture of how healthcare provider soon! reduce the risk of heart disease and quickly you might be moving toward For persons with prediabemany other conditions! a diagnosis of type 2 diabetes.

The first step in the prevention of tes there is a relatively new blood As Dr. Edelman says in the most ® test called the PreDx test (Tethys type 2 diabetes is knowing whether recent edition of his book Taking Bioscience, Emeryville, CA). This or not you have prediabetes. This is Control of Your Diabetes, “The best way test estimates your risk of developing to prevent the terrible complications usually done by testing your fasting type 2 diabetes within the next five blood glucose level or your A1C of diabetes is to prevent diabetes in the years. The PreDx test measures seven first place.” Know your risk and take (measure of glucose levels over a 2-3 substances in your blood (called month period). Do you know what control! For more information about the biomarkers) that are associated with your fasting glucose or A1C is?

PreDx test, you can visit http://www. the development of type 2 diabetes, With these values in hand, your tethysbio.com/. not just glucose alone. Results of healthcare provider can determine these biomarkers, which measure whether or not you have prediabetes Juan Pablo Frias, MD, is the Director of Medical inflammation as well as fat cell and Affairs for Tethys Bioscience, Inc. or diabetes. The American Diabetes

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10 My TCOYD Newsletter, Vol. 42

Product Theater

In the Market for a New Meter?

The OneTouch Verio IQ Might Be The Perfect Fit For You!

By Jennifer Braidwood

H

ave you been thinking about upgrading your meter? With so many different options it can sometimes be hard to find one that is the perfect fit for you. However, if you are interested in having a meter that sheds some serious light on exactly why you are having highs and lows then you might want to consider the OneTouch®Verio™IQ. What’s great, and not to mention innovative, about the OneTouch® Verio™IQ is that it’s the first meter with PatternAlert Technology. The PatternAlert system looks for, you guessed it, patterns! If the meter notices patterns of high or low blood sugar levels it will alert you­—right on the screen. Once the meter has discovered a pattern, you can use the Tools for Life OneTouch® Verio™IQ

Pattern Guide to help you zero in on possible causes of the highs or lows.

The OneTouch® Verio™IQ also has a nice bright color display, 750-test memory, color-coded alerts and intuitive navigation, so it’s pretty easy to get the meter to do what you want it to do without having to read and understand a huge user manual.

It’s even fluent in Spanish. It’s also really useful when you are trying to

test in dark or dimly lit conditions because the top of the meter and color screen both light up. It stores and displays 7-, 14-, 30-, and even 90-day blood sugar averages thanks to an epic ability to remember your last 750 results. It also stores up to 50 pattern messages, which is great information to help with your adjustments.

From the first screen on, OneTouch®Verio™IQ delivers results, alerts and messages brilliantly on its big, bright LCD display. It even colorcodes your pattern messages, red for high and blue for low, so you can tell what they are at a glance. An ecoconscious rechargeable battery that only needs to be charged about twice a month is also pretty convenient.

When selecting a meter, make sure you get one that works well for you and your lifestyle. If you have a meter that is pretty simple but it keeps you on track with your diabetes management, that’s great. You may not need all the bells and whistles. However, if you are looking for something a little more advanced, the Verio™IQ may be the right meter for you.

o’s Chef Robert Love of Tortilla Soup ados Chopped avoc s oe s at ip m ch to n Tortilla 16 ounce ca ion, cut up on m Fresh cilantro iu ed m 1 ack beans bl d ne ai dr Fresh lime 1 can of corn ructions en oz fr of p Cooking Inst 1/2 cu diced

icken broth, ot combine ch s, onion, garlic, kp 2 clove garlic ro oc nt st la a ci In d 1. s snippe ained tomatoe bring to a boil.

4 tablespoon chicken, undr and r ga su sugar. Cover on d po an 1/2 teas cilantro, h . ot es br n r 20 minut 8 cups chicke t up beans and a 2. Simmer fo ken breast cu s, corn, black ic er ch pp s and pe lb le 2 ot 1/ 1 d simmer cover 3. Add chip tle peppers an uce. Bring to inutes . sa o ob ad e 2 or 3 *chipo tl lit m sauce g for about 20 little adobo finish cookin o or nc la B st ue :Q Garnish with jack cheese

Taking Control Of Your Diabetes

11

TCOYD Conferences & Health Fairs 2013 Schedule

February 23

March 23

April 27

April 28

May 18 September 21

October 12

November 2 November 23 Date/Location

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

Tel: (800) 998-2693

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

Tucson, Arizona Santa Clara, California Honolulu, Hawaii Kauai, Hawaii Savannah, Georgia Worcester, Massachusetts Omaha, Nebraska Albuquerque, New Mexico San Diego, California TBD Native American

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San Diego, CA Permit No 1

Visit us online at www.tcoyd.org TCOYD is a not-for-profit 501(c)3 charitable educational organization.

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Diabetes is an important part of your life, but it doesn’t have to run your life.

You are not a bad person because you developed diabetes. It is not your fault. You are not “bad” because you didn’t exercise today or because you ate more than you intended last night.

It is important to measure diabetes progress in a realistic manner. You can never be perfect with your diabetes care, nor do you need to be. So measure your progress with your results (for example, A1C, blood pressure and cholesterol), not your day-to-day behavior.

My TCOYD Newsletter, Vol. 34

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Remember, don’t let blood sugar readings determine your selfesteem. Blood sugar results may be important, but they are neither “bad” nor “good.” They are just information.

powerful benefits of good diabetes care, and understand how to fit diabetes into your life without blame or shame.

Don’t do diabetes alone. Talk to your doctor or enroll in a diabetes education program to get the support you need, learn about the

is the Co-Founder and Director of Clinical Services of the Behavioral Diabetes Institute a non-profit organization devoted to the emotional side of diabetes.

Yes, you can feel more confident and in control of your diabetes. And Make sure you have a specific and you can feel better again. To learn doable plan for action. If you just more about how to do so, and read have a vague sense that you should the extended version of this article, be “exercising more” or “checking visit www.behavioraldiabetes.org. blood sugars more often,” you might believe you are never doing William Polonsky, PhD, CDE is a clinical psyenough. To start, pick one action chologist, the Founder and Chief Executive Officer of the Behavioral Institute, and an Associate Clinical that might have a positive impact Professor at the University of California, San Diego on your diabetes. Be specific.

Susan Guzman, PhD, is a clinical psychologist and