Dr. Edelman’s Corner
hen I was diagnosed with diabetes in 1970, all of the diabetes educational literature said that people with diabetes (PWD) should NEVER EVER drink alcohol. I believe one of the main reasons PWD were told to avoid alcoholic beverages was because if you had alcohol on your breath and became hypoglycemic you could mislead the person who might be attempting to help you, which would ultimately delay the treatment you might desperately need. Even today, many healthcare professionals tell their patients that they should not drink at all. If you have diabetes and like to consume alcoholic beverages on occasion, there are a few common sense things you should know. In the same manner as dealing with desserts and sugary foods, a PWD need not avoid them completely, but merely know how to deal with them in terms of keeping their glucose levels in an
acceptable range. What goes without saying? First, if you are underage, you must wait until you are 21 years of age to drink. Second, no one should drink and drive. In addition, testing your blood glucose level frequently or checking your continuous glucose monitor, if you have one, is extremely important.
Knowing what your glucose level is during a night of drinking, eating and dancing, for example, is essential in order to avoid any issues or problems. Now that we have the obligatory suggestions out of the way, let’s talk about drinking and diabetes. Excessive consumption of low calorie alcoholic drinks on an empty stomach can supposedly lead to hypoglycemia, however, I do not think this is a very common occurrence. A more typical scenario is an elevated glucose value when food is consumed concurrently and the alcoholic drink is on the sweeter side. The calorie and fat content of alcoholic drinks can vary greatly and affect your diabetes differently (see above table). On one end of the spectrum we have sugary drinks like pina coladas, margaritas and mohitos. They have tons of simple carbs and will jack up your glucose level pretty quickly, especially when you’re munching on chips and bar food at the same time. Also, some of these sugary drinks, such as Baileys (yum!), have a high fat content as well. Drinks that have fewer calories and no fat are better suited for PWD. Beer, wine (white or red), hard alcohol like vodka, scotch, whiskey, gin, etc. are examples. I bet you did not know that Guinness is the lowest calorie regular beer (see the Edelman Report on Alcohol and Diabetes by visiting our
YouTube channel TCOYD1). If you use mixers, try to stick with things like diet cranberry juice, diet tonic, diet ginger ale (great with bourbon) and club soda or mineral water. Like everything in life, moderation is the key. We all have our individual preferences for certain types of alcohol and tolerability for the amount we can consume responsibly. With that said, becoming intoxicated is an occasional reality, so surround yourself with friends and family who know you have diabetes, get yourself to a safe place, test your blood sugar frequently, don’t ever get behind the wheel of a car and don’t throw up on your friends new carpet! Now, just to set the record straight, I am not an alcoholic, nor am I trying to be inappropriate by talking about getting drunk, but it can be a reality, so why not be prepared and discuss it straight up. People with diabetes can pretty much enjoy any type of food or beverage that anyone else can and drinking alcohol is no exception. When it comes to drinking and diabetes, we need to exercise some common sense rules, keep a close eye on our glucose levels, be in a safe environment, choose the drinks that minimally disrupt our glucose values and practice moderation. Cheers!
he world of diabetes management is constantly evolving. New devices and new drugs are always on the horizon. Recently, Giant Biosensor and Tandem Diabetes Care have launched two new products to help manage your diabetes more effectively and conveniently.
If you suffer from low blood sugar while sleeping you should check out the Giant Biosensor Night Sweat Alarm. Giant Biosensor, a company that has been manufacturing physiological sensing devices since the mid 1990s has created this alarm in order to detect perspiration and a drop in skin temperature while you are sleeping, symptoms commonly associated with nocturnal hypoglycemia. The device can be comfortably worn on your wrist or ankle and a soft buzz and vibration gently stimulates the user to wake up. This device is similar to the Sleep Sentry but far less expensive. Night Sweat Alarm is sold online for $139.95 at www. nightsweatalarm. com. If you are in the market for a new pump
be sure to check out Tandem’s t:slim. The pump is the size of a credit card and as slim as a smart phone, and may be worn comfortably under clothing, without bumps or bulges. Not only does it look sleek, Tandem has worked to make improvements to insulin delivery that encompass form factor, insulin management, and battery power technology. Through measured transfers from the insulin reservoir to the infusion line, t:slim’s proprietary Micro-Delivery Technology provides small amounts of insulin for bolus and basal delivery. Most pumps require users to purchase and dispose of dozens of costly conventional batteries. The t:slim rechargeable, eco-friendly power source offers a reliable substitute that’s more economical and easier on the environment. Additionally, for all you tech savvy
individuals, t:slim’s integrated micro-USB connectivity allows easy, convenient charging and unsurpassed speed when downloading pump data to t:connect, a Mac and PC compatible web-based software application. Take control of your diabetes and be sure to stay current and up to date on the latest and greatest advancements in diabetes care and management.
By Adrienne Nassar, MD
t’s summertime, which usually means summer vacations, traveling, airports and a whole host of varying factors that can affect your diabetes. If you are traveling abroad this summer make sure that your vacation is a breeze by taking control of your diabetes and taking control of your vacation! You might be surprised but everything from climate and time zone changes, different living conditions, and various local cuisines all affect blood sugar control. Before you get your bags packed and your boarding passes printed read on. You might just find that you are forgetting a few key things for a healthy and happy summer vacation. Prior to international travel, you should meet with your diabetes health care provider to discuss your current glycemic control. Also, it’s a good idea to request a physician letter listing your diabetes type, necessary medications, and your need to carry syringes and other sharp objects onto an airplane. You should always plan/expect for delays
when traveling, especially these days, and pack twice as many diabetes supplies and medications as needed. Having too much is a good thing; not having enough could potentially be dangerous to your health. Remember, insulin potency in the U.S. is U-100 but in other countries may be U-40 or U-80 concentration so read insulin labels carefully if you need to obtain insulin in other countries! Also, the unit of blood glucose measurement in the U.S. is mg/dL but in other countries is mmol/L so be aware of what the manufacturer’s default blood sugar units are if buying a glucose meter overseas.
Simple precautionary measures will help to ensure that your summer travel is as flawless as your new tan, so be sure to remain up to date on immunizations, wear a diabetes medical alert necklace or bracelet, and call your medical insurance company prior to travel to ensure travel health insurance coverage. If you are going to be traveling by plane, always research the current Transportation Security Agency (TSA) guidelines regarding labeling and handling of your diabetes medications and supplies. You can research available health care facilities in destination countries by visiting local American embassies and foreign tour offices. Prior to travel, it may be a good idea to review the U.S. Department of State website http://www.state.gov/travel/ for information regarding passports, travel warnings, and emergency situation information for Americans abroad.
During travel, it’s a good idea to pack snacks in addition to glucose tabs or gels in case your blood sugar falls. Be sure to pack any and all diabetes supplies in your carry-on luggage so it is easily accessible and you don’t have to worry about the potential of lost luggage and medications. You might also consider buying some sort of daytime travel pack so
you always have your medications and supplies with you, whether you are on a tropical beach or site-seeing in a bustling city. If you are using an insulin pump be sure to meet with your healthcare provider to discuss an alternative basal-bolus insulin regimen in case the pump malfunctions while you are vacationing. Alternatively, you can contact your pump company regarding renting an additional backup pump if needed during international travel. This summer be sure to work together with your healthcare provider and address some of the key issues mentioned above prior to hitting the road, the sky or the water. Diabetes doesn’t have to hold you back, especially on vacation. Bon voyage!
By Steven Edelman, MD
hat do you think is one of the biggest obstacles to overcome when trying to control diabetes? Is it the fear of needles or having to check your blood glucose 3-4 times a day? Is it the belief that there’s no need to treat diabetes? Is it the concern of gaining weight from medication? Or is it just that there are too many pills to remember to take? Well, at least two of these obstacles have been addressed, when, just this past January, the U.S. Food and Drug Administration (FDA) approved Jentadueto, a combination of Tradjenta (linagliptin) and Glucophage (metformin) specifically used to treat those with type 2 diabetes.
trations. Linagliptin, a Di-Peptidyl Peptidase-4 (DPP-4) inhibitor, stops the breakdown of hormones in your body responsible for increasing the amount of insulin made based on the amount of food you eat. As a result of the way both medications work, neither causes low blood glucose (hypoglycemia)—a benefit for anyone with diabetes. In addition, by taking a combination medication like Jentadueto, the number of medications needed on a daily basis is reduced.
benefit of Jentadueto is that it does not cause weight gain. Since Jentadueto is made of two drugs, the adverse effects may result from one or both. As for metformin, usually an upset stomach is the most common occurrence. However, this In some studies, Jentadueto may be avoided by taking the medidecreased hemoglobin A1c (a long- cation with food, or in the middle term measure of diabetes control) of a meal. Very, very rarely, metforby as much as 1.6%, which is fairly min can cause lactic acidosis, which Jentadueto is a combination pill high. This means if you are about includes symptoms such as shortness containing two diabetes medica1.5% away from reaching your A1c of breath, weakness, muscle pain and tions—metformin and linagliptin. goal (usually < 7% for the average nausea. Kidney function is monitored Metformin helps to both improve adult with no complications), to catch symptoms before they occur. how well your body’s insulin works Jentadueto may be a good option for One concern with linagliptin is a as well as to decrease the amount of you to discuss with your healthcare possible increased risk of developing glucose your liver makes which helps provider. In addition to not causing a common cold or pneumonia, as control morning glucose concenhypoglycemia, another attractive well as extra strain on your pancreas.
Also, while not an issue if you take Jentadueto alone, taking a drug from the class of sulfonylureas (which includes common medications such as glipizide or glyburide) may place you at an increased risk of developing hypoglycemia.
Jentadueto comes in 3 different strengths, 2.5 mg of linagliptin combined with 500 mg, 850 mg or 1000 mg of metformin. It is taken twice daily with meals (likely breakfast and dinner), and may be increased slowly over the course of a few weeks to help reduce the chance of stomach discomfort due to the metformin.
Jentadueto has arrived as a new option in the fight against type 2 diabetes, combining two common medications into one, making it more convenient and easier to take control of your diabetes. If you are in need of a higher A1c reduction (verify with your doctor!), and do not want the weight gain commonly associated with other diabetes medications, then you might be singing a new tune with Jentadueto.
new campaign called This Week I Will invites people with type 2 diabetes to make a difference in their own lives and in the diabetes community. It is based on the philosophy that managing diabetes involves taking small steps each week that lead to effective behavior change over time. Participants will make a week-long pledge to commit to a specific behavior change to improve their diabetes management. As a reward for committing to small changes each week, participants will earn the opportunity to direct a $5 donation to the diabetes-related charity of their choice. TCOYD has been selected as one of five charity partners benefitting from This Week I Will. For each pledge made on behalf TCOYD, Amylin Pharmaceuticals, Inc., will donate $5, up to a maximum of $20,000. TCOYD is truly honored to be selected as a charity partner for a campaign that supports and motivates people with type 2 diabetes in their efforts to manage
this challenging condition. Pledge participants will not only be committing to improve their diabetes one week at a time but also helping to support TCOYD in our efforts to change peopleâ&#x20AC;&#x2122;s lives across the country with our TCOYD Conferences and Health Fairs. The pledge is hosted on Diabetic Connect, a social network for people living with diabetes, and can be shared on other social networks, such as Facebook and Twitter. To make a pledge on behalf of TCOYD visit www.ThisWeekIWill.com. Though making a behavior change can be challenging, sharing the commitment in a supportive online community can help you follow through on your pledge. This week, what will you do for your diabetes? Even small changes make big differences! The This Week I Will campaign will begin in early August 2012.
s e s t e e t e b D Diiaab s h s t h t y y M s M ru h s t h t u &T prah frequently quotes her friend Maya Angelou saying, “When you know better, you do better” and I agree. The more you know about how to take care of your diabetes, the better you will do and the healthier—and happier —you will be. On average you probably spend about a dozen hours a year with your health care providers. That leaves about 8,724 hours when you are alone making every day decisions that affect your diabetes. Decisions like, what’s the best thing for me to eat, should I exercise today, what type of exercise should I do, and how often should I test my blood sugar? I travel around the country talking with people who have diabetes and I know how confusing diabetes can be. There’s a lot to know and a lot to do. Here are 5 myths and truths to help you do a little better.
1. Myth: There is only one
diabetic diet to follow. Truth: False! People with diabetes are advised to follow the same diet as all Americans, eat a
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variety of vegetables and fruits (five cups/day), whole grains, lean protein, low-fat dairy, healthy fats, and fiber. A healthy meal plan is one that allows you to reach and maintai your weight and health goals.
3. Myth: If my diabetes is
under control there’s no need to see my doctor. Truth: The truth is, regular appointments with your doctor, every three to six months, will keep you in your best health. Some complications can begin with few or no symptoms so you might not necessarily know something is going a bit haywire. High blood pressure is known as “the silent killer” because there are no symptoms. At the early stage of eye disease you won’t notice any change in your vision. Seeing your doctor regularly can catch problems before they happen and keep your diabetes under control.
4. Myth: If my doctor says
2. Myth: Diabetes is the leading
cause of heart disease, blindness, kidney disease and amputation. Truth: Every time we hear diabetes mentioned we also hear this list of complications. Diabetes is not the leading cause of heart disease, blindness, kidney disease and amputation, poorly-controlled diabetes is. Psychologist and certified diabetes educator, Dr. William Polonsky says, “well-controlled diabetes is the cause of nothing,” and I would like to add, except for a healthier and happier you.
it’s time for me to take insulin, I’ve failed. Truth: You haven’t failed! Type 2 diabetes is progressive for most people. That means over time your insulin-producing (beta) cells make less and less insulin until it’s not enough for your body. Almost half of all people with type 2 diabetes have to start using insulin at some point. You might think you could have avoided insulin therapy if you exercised more or were more regimented with your diet but, the truth is, eventually your beta cells just stop producing enough insulin and more often than not there was nothing you could have done to avoid it from happening.
5. Myth: People who use insulin
have less control over their diabetes. Truth: Using insulin isn’t a result of poorly managed diabetes. It just means insulin is the best medication to control your blood sugar. People who have poorly managed diabetes are people who don’t have their blood sugars in good control. I’ve been using insulin for 40 years, since I got type 1 diabetes at the age of 18, and I have excellent control of my blood sugar and great health. The more you know, the better you’ll do with your diabetes. And that’s good news – because it puts the power to be healthy in your hands. Read everything you can, talk to others, discuss your test results with your doctor and what to do about them, and keep coming to TCOYD events. Learn everything you can about diabetes and you’ll become excited to do your best and have your best health!
Giving Back
All in the Family inny Gordon attended her first TCOYD Conference and Health Fair in the mid 90’s as a representative of the JDRF. “I think I was at your very first conference, or maybe it was your second conference,” Gordon stated. Gordon had gotten wind of TCOYD through JDRF’s local San Diego chapter where she was serving as board Vice President. “I grew up in the health care movements of the 1970’s in a family that believed medicine should be a partnership between the healthcare professional and the patient.” Naturally, Gordon was impressed with TCOYD’s ability to give people with diabetes access to healthcare professionals who were involved in all aspects of diabetes management and research. “It was that personal
contact, that personal touch that was so unique and different.” Once Gordon had experienced a TCOYD conference she began attending with a different goal in mind, not as a representative of the local JDRF chapter, but as a concerned mother who wanted all the information about diabetes manage-
ment that she could get her hands on. “My daughter, Julie Hooper, was diagnosed with type 1 diabetes when she was just two years old. I brought her to her first TCOYD conference when she was five.” Gordon said it was at TCOYD conferences where she learned about continuous blood glucose monitoring, insulin pens, and pumps for the first time. “It brought us together, not just my husband, daughter and I, but the whole diabetic community. It is such a great opportunity to meet other people who have diabetes, to meet families that deal with diabetes every day, just like us. That is what makes TCOYD special.” Last month Julie Hooper graduated from Bowdoin College on the coast of Maine. However, Hooper says her greatest accomplishment was probably the
summer she spent Suva, Fiji, in 2011. “My father had received a grant from the State Department to promote media in Suva and was in need of a teaching assistant. The disclaimer was that it would be “unpaid” labor. The opportunity to teach broadcasting at a TV station in Fiji seemed like a manageable, even an enjoyable gig, so I jumped on the opportunity.” It was in Suva that Hooper met Rangeeta Prasad, a young reporter who produced the Hindi magazine show entitled Chana Masala. Prasad was beginning to work on a short documentary on type 2 diabetes, a growing concern
also learned much about living and working abroad as a type 1, an experience she says she will draw on when she moves to Italy as an English teacher in October of 2012. Hooper will also continue to write on diabetes and international travel, so be sure to check out her blog, http://type1traveler.com in Fiji. With little knowledge of the TCOYD would like to thank disease, she asked Hooper for help Ginny Gordon, Bob Hooper with research and production. “I and their daughter Julie for their got to accompany Prasad and her continued financial support of crew to a local clinic, where I was TCOYD. It’s people like you that able to see how diabetes manageallow us to continue our mission of ment is approached in Fiji. It was educating and empowering commufascinating to observe international nities of people with diabetes across treatment,” said Hooper. Hooper our nation!
e would like to introduce Robyn Sembera, the newest member of the TCOYD family. Robyn served as an intern for TCOYD during her final semester at California State University, San Marcos. During Sembera’s six month long internship she focused on marketing and outreach strategies and assisted with the planning and execution of our Continuing Medical Education initiatives. This past June, Sembera graduated from CSU San Marcos with an honors degree in Communications
and an emphasis in Public Relations and shortly after was offered a parttime position here at TCOYD. “It’s so amazing to be a part of what TCOYD does, I feel really lucky to be here,” Sembera said. All of us here at TCOYD are excited to have Robyn join the team.
For schedules, bios, trailers and more, visit www.tcoyd.org
TCOYD is a not-for-profit 501(c)3 charitable educational organization.
COYD is partnering with researcher Dr. Nate Heintzman at the University of California, San Diego (UCSD) with the aim to better understand the frequency of hypoglycemia and the use of glucagon emergency kits (GEKs). We need your help! Go online now and complete The Glucagon Rescue for Insulin-Dependent Diabetes (GRID) survey. It’s quick and easy and your participation will assist TCOYD and Dr. Heintzman in gaining valuable and sought after information. You
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must be at least 18 years old to participate and you must either have diabetes or be a caretaker (parent, spouse, ect) of someone who does. Nate Heintzman, PhD, is a professor in the Division of Biomedical Informatics in UC San Diego’s Department of Medicine, where he directs the Diabetes Management Integrative Technology Research Initiative (DMITRI) and participates in the Division’s ongoing iDASH program (Integrating Data for Analysis, Anonymization, and Sharing). Heintzman also serves as Chair of the Board for Insulindependence, a San Diego-based national non-profit organization that provides fitness and recreation programs for people with diabetes.
Go online now at http://goo. gl/7vmeC. A few minutes of your time is truly valuable to this study. TCOYD thanks you in advance for your participation!