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Fall, 2000:.doc.doc.doc

  1. 1. Fall, 2000 Control Solutions News and Views From the Field of Diabetes Management Gary Scheiner MS, CDE Maura Emery MA, RD, CDE Bret Boyer PhD Integrated Diabetes Services Control Solutions is published by Integrated Diabetes Services, the diabetes self-care specialists. Day, evening and weekend consultations are available for all ages. Services include:  Basic diabetes education  Blood sugar “tune-ups”  Insulin pump therapy  Weight management  Nutrition counseling  Exercise planning  Preventive health  Psychotherapy 610-642-6055 300 E. Lancaster Ave., Suite 111 Wynnewood, PA 19096 © 2000, Gary Scheiner , MS, CDE
  2. 2. Peer Counselors Sought Remember how it felt when you were first diagnosed with diabetes? Wouldn’t it have been nice to have someone in your area to talk to who was about your own age, with similar interests, who was experienced at living with diabetes? Integrated Diabetes Services is seeking peer counselors to provide just such a service. All it takes is a positive approach to living with diabetes and a willingness to share your personal stories and experiences. When someone comes to us in need of a peer to talk to, we will match them as closely as possible to a counselor from our database. We will then call the counselor and provide them with the name/phone number of the person in need of help so that a phone call or get-together can be arranged. We are looking for anyone who has had diabetes for at least three years. Parents and partners of people with diabetes are also needed. For more information or to add your name to our list of peer counselors, please call Integrated Diabetes Services at (610) 642-6055. Stress Has Met Its Match. And his name is Boyer. Bret Boyer. With the Holidays just around the corner, there’s no better time to delve into those oft-ignored psychological issues that impact our diabetes. For most of us, just getting diabetes was very stressful. Some of us felt frightened, some depressed. Some still feel as if they are in a cage; others feel that their life is headed for a premature end. Still, many of us who have had diabetes for many years realize that we can live a full, happy and satisfyingly active life as long as we learn to manage it. Some of us even find that we live a much healthier lifestyle than we did before! Diabetes requires us to change our behaviors while face frightening possibilities in the present and future. Many life difficulties can impair our ability to live up to that challenge. For example, it can be extremely hard to initiate new healthy behaviors when one feels depressed and hopeless. It is also very difficult to learn new skills and apply them consistently when one feels anxious and fearful. Furthermore, if depression or anxiety becomes severe enough, our ability to cope with and manage our diabetes may seem nearly impossible. Even if we are not feeling depressed or anxious, the stress of daily life can interfere with the control of our blood sugar levels. As shown in the diagram below, stress can increase the amount of sugar that the body releases into the blood stream. This metabolic change can increase blood sugar levels. When our bodies are preparing for the challenge of coping with stress, our blood sugar can go higher than expected – even if eating patterns are unchanged. In
  3. 3. addition, when we feel “stressed-out,” we often become less careful and consistent about what and when we eat, our medication, our exercise, and checking our blood sugars. Then, when our blood sugar is unexpectedly high, we may feel even more stressed. Thus, diabetes may increase our level of stress AND our level of stress may increase our blood sugar levels. For that reason, effectively managing stress becomes extremely important for controlling our blood sugars. At Integrated Diabetes Services, we/ve added a new treatment component to help you manage your diabetges. Dr. Bret Boyer, who has type-I diabetes, is offering psychological services to address issues such as stress, fear, depression, anxiety, disordered eating and pain. Dr. Boyer, a clinical health psychologist, provides confidential psychotherapy, relaxation training, guided imagery, cognitive behavior therapy, and nonpharmacologic pain management. So, if you’re feeling overwhelmed, if stress is playing havoc with your blood sugars, if it’s getting hard to control what your eat, if you’re feeling depressed or anxious, or if fear or pain are hindering your ability to effectively manage your diabetes, give us a call. Bret is with us every Friday for private consultations. He has contracts with many insurance companies, so direct billing may be possible. For more information or to schedule an appointment, please call 610-642-6055. NEW PRODUCT FOCUS: Avandia® In most cases, the “root cause” of Type-2 diabetes is not a lack of insulin. It is insulin resistance. In other words, the pancreas makes insulin, but the insulin is not utilized well by the body’s cells. Smith Kline Beecham’s Avandia®, described as an “insulin sensitizer”, helps lower blood sugar levels by getting to the root cause of the problem. Avandia® acts by improving the body’s sensitivity to insulin so that the insulin still being produced by the pancreas can do its job much more effectively. In a 26-week clinical trial, Avandia® lowered fasting blood sugar by an average of 76 mg/dl, and lowered HbA1c by an average of 1.5 percentage points. Because Avandia® addresses the underlying cause of diabetes, it may take a few weeks to produce noticeable improvements in blood sugar levels. Unlike an earlier medication (Rezulin) with a similar mechanism of action, Avandia® has not been shown to cause any liver damage. Avandia® has been approved for use with other diabetes medications such as Metformin, Glyburide and Glipizide. Side effects from Avandia® are minimal. Some weight gain may occur as a natural response to tighter blood sugar control.
  4. 4. For more information on Avandia®, speak with your physician or visit Lifescan has introduced a new FastTake® test strip that requires 40% less blood than its older strips and uses “capillary action” to automatically draw the blood drop into the tip of the test strip. This new design permits better accuracy and alternate site testing – users can get a blood sample from their arm instead of the fingertips. The benefits of alternate site testing include less painful testing (there are far fewer nerve endings on the arm than on the fingertips) and the opportunity for fingertip calluses to heal. For more information, visit THE PUMP ROOM PUMP CLUB Carb Counting King & Queens Congratulations to the winners of the Carbohydrate Gram Counting Contest at our September Pump Club meeting. Contestants were asked to estimate the carb content of five complex meals and a giant jug of pretzels. Those who guessed closest overall were deemed the winners. 1st Place: Wendy Taylor 2nd Place: Len Weinberg 3rd Place: Arleen Pogue Pretzel Jug Winner: Kelly Kane A consolation prize for being off by the most went to Rev. Ed Poole (Ed was off by more than 3000 grams). Ed was awarded a free consultation with Maura Emery, dietitian at Integrated Diabetes Services. Don’t miss the November meeting: “Pump vs. Pump vs. Pump.” Representatives from all three pump companies (MiniMed, Disetronic and Animas) will present their best case for why you should choose their pump over the others. This is a must-attend for anyone who is considering a pump for the first time, as well as those who will be eligible for a pump upgrade in the near future. The program will be held 7:30 pm November 1st at Friends Central School in Wynnewood, PA. As always, there will be plenty of refreshments and socializing. For information or directions, call Integrated Diabetes Services at (610) 642-6055. D-TRON IS FINALLY HERE After months of preparation and fine-tuning, Disetronic Medical Systems is now ready to unleash its new, feature-rich insulin pump, the D-Tron. Those going on Disetronic pumps for the first time will be eligible to choose either the D-Tron or the older H-Tron model. For those looking to upgrade from the H-Tron to the D-Tron, Disetronic will be offering a free upgrade on a case-by-case basis. Patients of Integrated Diabetes Services who have purchased an H-Tron pump since March 2000 will almost certainly be eligible for the upgrade.
  5. 5. If you choose to upgrade to the D-Tron, please call Integrated Diabetes Services immediately so that training on the new pump can be arranged. This training is FREE to you and essential because the D-Tron programs very differently than the H-Tron, and the cartridge change procedure has been completely revised. For information on the upgrade, please call Integrated Diabetes Services at (610) 642-6055. E x t e n d i n g Your Bolus Picking at Halloween treats. 7-Course family meals. Party after party after party. The Holidays are (in)famous for long, drawn-out dining. How is one to bolus to cover these situations? This looks like a job for the Extended Bolus!!! The extended bolus (also called a “square wave” or “split” bolus) can be very useful when eating large quantities of food over a period of time. That’s because bolusing for a large meal at the beginning of the meal can result in hypoglycemia right after eating, since the insulin peaks before the food has a chance to be digested. Then, high blood sugar will result because the food digests an hour or two later, after the bolus is past its peak. By using the extended bolus feature in your pump (spreading the bolus delivery over an hour or two) or splitting the bolus into two or three parts taken about an hour apart, you can distribute your insulin more evenly so that it better matches your digestion. Try it the next time a very large meal is planned, or if you plan to eat over an extended period of time (more than an hour). The key word is PLAN. You need to know ahead of time if the extended/split bolus will be needed. MiniMed CGMS Reads Between Meals MiniMed’s new Continuous Glucose Monitoring System (CGMS) is now available for use through a few physician offices around the Delaware Valley. The device is worm much like a pump – it is clipped to the belt and connected to the body via a tube and soft catheter (similar to an infusion set). The only difference is that the CGMS has no “quick disconnect” mechanism, so it must be worn at all times. CGMS analyzes interstitial fluid to determine blood glucose readings approximately every 6 minutes. The user must test their blood sugar with a monitor and enter the data into CGMS at least four times a day for calibration purposes. At this point, the CGMS data is simply stored in the device for downloading to a computer “after the fact”. MiniMed plans to upgrade CGMS so that it can alert the wearer in case the blood glucose level goes above or below preset threshold values.
  6. 6. NEWS YOU CAN USE Islet Cell Transplants: Phase 2 Ten centers, including six in the U.S., have been selected to expand the promising technique of transplanting insulin-producing pancreatic islet cells into patients with Type-1 diabetes. The centers include: NIH Transplant Research Center (Bethesda, MD) Univ of Miami/Diabetes Research Institute (Miami, FL) Univ of Minnesota/Diabetes Transplantation Institute (Minneapolis, MN) JDF/Harvard Center for Islet Transplantation (Boston, MA) Washington Univ. Diabetes Research Ctr. (St. Louis, MO) Pacific NW Research Institute (Seattle, WA) All sites will employ the protocol established in Edmonton, Canada. Approximately 40 “brittle” Type-1 patients will receive islet transplants over the next 18 months. Help With Health Insurance Complaints Pennsylvania Attorney General Mike Fisher has established a Health Care Unit designed to mediate or litigate complaints against health insurance companies and health care providers. If you feel that you have been treated unfairly by a health provider, health insurer or managed care organization, call the Health Care Unit toll-free at (877) 888-4877. Periods & Blood Sugar Control Adolescent girls who are having problems with irregular periods should take note: An article published in the Journal of Reproductive Medicine indicated that high blood sugars may negatively impact menstruation. A chart review of girls aged 10-18 revealed that those with menstrual problems had an average HbA1c that was almost 2 percentage points higher than those without such problems. A Useful Stat in Fighting Fat It has long been known that adding muscle raises the body’s metabolism, thereby helping to burn more calories and decrease body fat stores. Now, we can put a number on it: Every pound of muscle burns approximately 35 calories per day. Since we have to burn 3500 more calories than we take in to lose a pound of fat, this means that every pound of muscle we add will allow us to lose an extra pound of fat about every 3 months. So if you want to lose the weight, hit the weights!
  7. 7. Shake, Rattle and Shoot Insulin pens are more popular than ever. But did you know that NPH insulin in cartridge form takes extra effort to mix evenly? If you use NPH in an insulin pen, you need to roll and tip the pen at least 20 times to get the NPH evenly dispersed. Less than that and you could be giving yourself more or less actual insulin than you are injecting. Be sure the insulin appears to be evenly cloudy before injecting it. And word from the experts is that rolling is a better technique than shaking. Beta Blockers and Type-2 Diabetes In a study published in the New England Journal of Medicine, patients with high blood pressure may increase their risk for developing Type-2 diabetes if they use a class of antihypertensive drugs called beta blockers. Patients in the study who were taking beta blockers had a 28% higher risk of developing diabetes than control subjects taking no medication. Those taking other types of blood pressure medication were at no greater risk of developing diabetes. If you currently use a beta blocker and are at risk for developing diabetes (due to obesity, family history or minority status), you may want to discuss the use of an alternative blood pressure medication with your doctor. Protein Particulars People with diabetes are often given advice on protein that is based on theory, rather than scientific evidence. For example: Common Advice: “Eat protein with carbohydrate to slow the absorption of the carbohydrate.” Scientific Evidence: In no studies has added protein slowed carbohydrate absorption or affected peak blood glucose levels after meals. Common Advice: “Always include protein with your bedtime snack because protein will keep the blood glucose levels from dropping during the night.” Scientific Evidence: No clear cut answer is ailable, but protein may not be needed. Even if protein is added, the effect on blood glucose is not likely to be great. Common Advice: “Treat an insulin reaction with a Fast-acting carbohydrate and follow it with protein to provide a later source of blood glucose. This will prevent blood glucose from dropping again.” Scientific Evidence:
  8. 8. The one study on the subject concluded that adding protein to the treatment of hypoglycemia only added unneeded and often unwanted calories. Scientific findings prove that protein has little or no affect on blood glucose levels. Substituting protein for carbohydrate can improve blood sugar control (since less carbohydrate is eaten), but protein has little or no affect when added to a meal or snack that includes carbohydrate. Based on the research review, some patients may benefit from a diet that consists of 30% of calories from protein rather than the previously recommended 10-20%. However, this should individualized based on clinical data such as blood lipid levels, blood sugar control and medical history. Munchin’ With Maura Nutrition Q&A Maura: I’m one of those people who gains 5-10 pounds every holiday season. How can I prevent it this year? Avoiding Holiday weight gain means that you will need to establish some new holiday traditions. Here are a few ways to make healthful changes without losing any of the holiday spirit: 1. Reduce tension and stress. The holiday season is a time of anxiety, rush and tough decisions. The added tension often triggers eating, and even shifts us into a crisis pattern of continuous nervous eating. Remember STRESSED spelled backwards is DESSERTS. 2. De-emphasize food. We may need to spend less time cooking and baking. Focus more on the meaning of the holidays. Create new traditions that don’t revolve around food. 3. Cut back on fat and sugar. Serve lighter meals and fewer desserts. If you bake holiday goodies, cut down, and try cutting back on fat and sugar in favorite recipes. 4. Encourage moderation. Learn to be content with one serving. Cut your pie into eight pieces instead of six. We don’t need to stuff our family and friends to show them how much we love them. 5. Keep temptation out of site. Clear away food immediately after meals and put snack foods away. Fill candy dishes with decorations or a sprig of evergreen. 6. Relax. It’s all right to eat a big meal mow and then. Don’t worry. One meal will not sabotage your weight. But we need to remember a big traditional meal is just that – one meal. 7. Exercise regularly. With all the food and sitting around, physical activity is a welcome change. It reduces stress, and gives us renewed vigor and enthusiasm. Enjoy the Holidays!! Nutrition Program Update
  9. 9. Our free monthly “Good Nutrition” lecture series will continue through the Holiday Season. Saturday, November 4th, our topic will be “Preventing Weight Gain During the Holidays”. Saturday, December 9th,our topic will be “Exercise Without Exercise”. Learn how to burn lots of calories through normal daily chores & activities. On Saturday, January 6th, we will get the New Year off to a good start with the “Resolution Revolution”. All programs are held from 11am –12:30 pm at Integrated Diabetes Services. Our next “Downsizing With Diabetes” group behavior change/weight management class will commence on January 15th. The 10-week program includes an individualized needs assessment and follow-up plan. Group classes are held on Monday evenings from 7-8:15 pm. Class size is limited. For information or to schedule your individual assessment, please call Maura Emery at (610) 642-6055. Top-10 Reasons to See A Registered Dietitian (as published in Diabetes Self Management magazine): 1. You want to improve your diabetes control 2. Your lifestyle or schedule has changed 3. Your nutrition needs are changing (growth, pregnancy, aging) 4. You’ve begun an exercise program or your diabetes medication has changed 5. You feel bored or frustrated with you meal plan 6. You have unexplained high and low blood sugar levels 7. You’re concerned about your weight or cholesterol levels 8. You’ve developed nutrition-related complications such as high blood pressure or kidney disease 9. You’d like an update on what’s new in diabetes nutrition 10. You’d like a routine review of your meal plan. Patient Spotlight: Mary Groves Having taught elementary school for nearly forty years, Mary Groves knows that knowledge is power. However, when she was diagnosed with Type-2 diabetes 15 years ago, she did like so many people do – she procrastinated. “I was in no hurry to learn more about it,” says Mary. “Then one day I was helping a friend into the building and saw the Integrated Diabetes office. My need to know made me stop by, and I’ve been coming back ever since.” It took Mary just a few visits to learn how to monitor her blood sugar, count carbohydrates and feel more comfortable about exercise. A graduate of our Downsizing With Diabetes program, Mary has also learned how to balance food in her daily life. She is losing weight gradually and, more importantly, maintaining her losses.
  10. 10. “Follow-Up is so important, especially when you’re trying to lose weight,” explains Mary. “I always feel comfortable asking questions here. Nobody makes me feel dumb. It’s a very friendly office.” A resident of Merion, Mary is active with her church and loves spending time with her grandchildren Zachary and Kylie. Thanks for stopping by, Mary. You’re always welcome! THUMBS UP! Candace Enis, for lowering her HbA1c from 8.9 to 6.1! Brianna Barry, for setting the record in the 25-yard breaststroke for 9-10 year-olds in the Country Club Championship at LaSalle University. Marge Pilong, for lowering her HbA1c from 7.7 to 6.8! Howard Saunders, for quitting smoking and losing over 30 lbs! Marie Cunningham, for lowering her HbA1c from 7.6 to 6.6! Julianne Trout, for lowering her HbA1c from 11.3 to 8.6! Jim Taylor for his new position as program coordinator with the American Diabetes Association! Jason Banks for cutting his hospitalizations from 20 to 3 in the past year! Ashley Hall, for lowering her HbA1c from 9.1 to 7.4! CALENDAR OF EVENTS (Oct. ’00-Feb. ’01) October 28: Diabetes: A Family Adventure (education program for the whole family) at 12 Caesars on City Ave., Phila, 8:30-11:00 am. (contact JDF, 610-664-9255) November 1: Insulin Pump Club of Greater Phila support meeting at Friends Central School, Wynnewood 7:30 p.m. (610-642-6055) November 4: Good Nutrition lecture series at Integrated Diabetes Services, Wynnewood, 11am-12:30pm. (contact Maura Emery at 610-642-6055) November 8-10: A Very Special Boutique fundraiser at huntingdon Valley Country Club. (contact Susan Yannessa at ADA, 610-828-5003) November 11: Diabetes Day Expo at Chester County Hospital, West Chester. (call Nancy Marquette, 610-431-5000) November 18: ADA Diabetes Expo at Valley Forge Convention Center, 9:30am-4pm. (Call ADA at 610-828-5003) December 6: Neuropathy Association support group meeting at Integrated Diabetes Services, Wynnewood. (contact Barbara Wessell, 610-941-3506) December 9: “Good Nutrition” lecture series at Integrated Diabetes Services, Wynnewood, 11am-12:30pm. (contact Maura Emery at 610-642-6055) January 3: Insulin Pump Club of Greater Phila support meeting at Friends Central School, Wynnewood 7:30 p.m. (610-642-6055)
  11. 11. January 6: “Good Nutrition” lecture series at Integrated Diabetes Services, Wynnewood, 11am-12:30pm. (contact Maura Emery at 610-642-6055) January 15: “Downsizing With Diabetes” 10-week weight management program begins at Integrated Diabetes Services, Wynnewood. (contact Maura Emery, 610-642-6055) February 3: “Good Nutrition” lecture series at Integrated Diabetes Services, Wynnewood, 11am-12:30pm. (contact Maura Emery at 610-642-6055)