Eric Holzman, a type 1 diabetic, teaches a course on managing diabetes. The course covers topics like the role of insulin, types of diabetes, blood glucose testing, medication including insulin, diet, exercise, and problem solving techniques for diabetes management. The goal is to teach diabetics the skills to maintain normal blood glucose levels and good health through tight control of what they eat, medication, exercise, testing and responding to changes in their condition. The course emphasizes an evidence-based and problem-solving approach drawing on Holzman's experience as a diabetic managing his condition daily.

1. A Diabetic’s Guide to Managing
Diabetes
Instructor: Eric Holzman, PhD, Type 1 Diabetic
by Eric Holzman

2. An Introduction to Diabetes and
Diabetes Management
(or Why You Can’t Learn Everything in A Day)
Lecture 1
by Eric Holzman

3. A Diabetic’s Guide to
Managing Diabetes
We Need Insulin to Use the
Fuel in the Food We Eat
• Three sources of fuel in our food: carbohydrates, protein and fat
– Carbohydrates (CHO) are mostly found in plant-based foods.
– Protein and fat are in animal-based foods, nuts and legumes.
• Our digestive system converts all carbohydrates to glucose (a sugar).
• Glucose passes from our digestive system to our blood stream.
• Glucose enters our cells, where it is metabolized (burned).
• Insulin is required to transfer glucose across the cellular boundary.
Protein and Fat
Carbohydrates
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4. A Diabetic’s Guide to
Managing Diabetes
Diabetes is Caused by the Body’s
Inability to make or use Insulin
• Specialized cells in the pancreas create insulin.
• Type 1 diabetes: body attacks pancreas, destroys insulin-making cells.
• Type 2 diabetes: insulin is ineffective in transporting glucose across cell wall.
• Diabetics have too much glucose in their blood.
• Over time, high blood glucose wears out the entire circulatory system.
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5. A Diabetic’s Guide to
Managing Diabetes
My Story—Taking Control of My Daily Health Care
• Diagnosed with Type 1 diabetes in 2000.
• My Symptoms were classic.
– loss of weight
– unquenchable thirst after meals
– 300 mg/dL glucometer readings (90 mg/dL is normal)
• I took control of my health.
– Visited an endocrinologist for confirmation
– Began a permanent low carbohydrate diet
– Started frequent blood glucose testing
– Began injecting insulin
– Read books on diabetes and human physiology
– Joined a diabetes internet list
– Developed my own daily regimen
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6. A Diabetic’s Guide to
Managing Diabetes
Managing Diabetes Means
Controlling Blood Glucose All the Time
• Doctors and other medical professionals are on the periphery.
– diagnose, provide occasional advice, write prescriptions, & treat complications.
• We diabetics must control our disease every day.
• Our goal: a normal blood glucose (sugar) level all the time.
• Success often requires a permanent diet and weight loss, daily physical
activity, frequent blood glucose testing and medication.
Medication testing
testing Exercise
testing
Blood Glucose
Level
Diet
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7. A Diabetic’s Guide to
Managing Diabetes
You Cannot Beat Diabetes Unless You are on a Diet
• If you eat whatever you want, you will not live a normal lifespan.
• Medication cannot enable you to eat whatever you want.
• Carbohydrates (foods from plants) are the problem.
• You will have to eliminate most “worthless” carbs from your diet.
• How low carb is low enough? Depends on how well you control your
blood glucose level.
These are “no-no’s”
Yogurt instead of milk
Low-carb & healthy way to maintain
weight (for thin Type 1 diabetics)
Eat as much as you can
(low-carb source of A high-carb luxury
vitamins, minerals, fiber) (with few exceptions)
Mostly high carb & low in A diabetic’s perspective
A diabetic’s perspective
nutrition—be careful!
on the food pyramid.
on the food pyramid.
Can make all
the difference Source: Harvard School of Public Health
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8. A Diabetic’s Guide to
Managing Diabetes
Medication—both you and your doctor have a say
• Your doctor prescribes your medication, but you determine the dose.
• Insulin—acts over the short term (minutes, hours).
– The size of each dose is 100% your decision.
– The dose changes continuously.
• meal-to-meal,
• morning to night,
• day-to-day,
• during sickness,
• with activity level
• Pills—act over long term (days and weeks).
– Your doctor selects a particular medication.
– You observe the effect on your blood glucose level.
– You provide feedback to the doctor, who changes your prescription.
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9. A Diabetic’s Guide to
Managing Diabetes
Exercise is Worth the Time and Effort
• Improves your health.
• Makes diabetes management easier by increasing
insulin sensitivity: reduces your body’s need for
insulin.
• One of only two ways (the other is insulin) to lower
blood glucose rapidly.
• Just half an hour a day can make a difference.
– Immediate benefit.
– Short term lowering of blood glucose level.
– Can eat some forbidden food.
• The more you do, the more your body’s insulin needs
will be reduced.
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10. A Diabetic’s Guide to
Managing Diabetes
Weight—Less is More!
• Maintaining a healthy weight can be a challenge.
– We are genetically programmed to eat a “see-food” diet.
– In our society, food is always available!
• The more you weigh, the more insulin your body needs.
• Too much weight can cause Type 2 diabetes.
• Maintaining enough weight can be a problem for some Type 1 diabetics.
Increasing risk for
Type 2 diabetes
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11. A Diabetic’s Guide to
Managing Diabetes
Blood Glucose Testing is Essential for Success
• There is some glucose in your blood at all times.
• A glucometer measures the amount of glucose in a blood sample.
• Diabetics can have readings many times above normal.
• Your activity influences your blood glucose level throughout the day.
– Eating
– Exercise
– Medication
– Time of the day
• Frequent blood testing enables us to “see” the changes.
• Decision making is required to respond to changes.
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12. A Diabetic’s Guide to
Managing Diabetes
Diabetes Management is About Observing,
Recording and Responding to Change
• I maintain my blood glucose level within the normal range daily.
– Low carbohydrate diet (100-120 grams a day)
– Walking 25 minutes (1½ miles) a day. Stationary bike 10 minutes a day.
– seven blood glucose tests a day
– self-regulation of my insulin doses as needed
• My daily written record tells me how my body changes over time.
– how many grams of carbohydrates I ingest at each meal
– how many units of insulin I inject at each meal
– how many minutes I exercise
• Accuracy and consistency are essential so I can observe the changes.
– in testing
– counting of carbohydrates
• My skill in problem solving helps me respond to the changes.
• After many years, the testing, weighing, calculations and insulin
injections have become second nature.
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13. A Diabetic’s Guide to
Managing Diabetes
Success in Managing Diabetes
Means “Normal” to Me
• Normal glucometer readings.
– Monthly average of 200+ readings ranges is normal.
– 80+% of daily blood glucose tests are <100 mg/dL (90 mg/dL is normal).
– Blood glucose readings are rarely far below normal.
• Normal HbA1c test result (4.0% to 5.9%).
• Excellent overall health.
• Eat a healthy diet of foods that taste good and are satiating.
• Ability to do the activities I enjoy.
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14. A Diabetic’s Guide to
Managing Diabetes
Who Should Take this Course?
• Diabetics who want to avoid serious complications.
– Kidney failure, blindness, nerve damage, stroke,…
– Young diabetics have the most to lose and the most to gain.
• Diabetics who want to learn to control their diabetes better.
• Anyone wanting to learn what daily management of diabetes involves.
This is not a class for dummies.
You will have to think.
You will learn to solve problems.
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15. A Diabetic’s Guide to
Managing Diabetes
Why Should You Take My Course?
• My perspective differs from that of a doctor
– I am an engineer trained in problem solving techniques
– I am a diabetic who manages his diabetes every day
• Much of my course material is not in other courses or books on
diabetes care.
– I draw on my years of personal experience as a diabetic.
• We will delve into the details of tight blood glucose control.
• I teach diabetes control as if it were a subject in school.
– Simple, logical explanations
– Lots of examples
– Optional assignments to reinforce concepts
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16. A Diabetic’s Guide to
Managing Diabetes
My Qualifications are My Skills and Experience
in the Daily Treatment of Diabetes
• What I am not
– a medical professional (who does not have diabetes).
• What I am
– a Type 1 diabetic and insulin user.
– an electrical engineer with a PhD and 20+ years experience.
– very successful at managing my diabetes.
• experienced controlling my blood glucose level twenty-four hours a day.
• I know the feeling of a hypoglycemic reaction.
– familiar with medical textbooks, the same ones doctors and nurses study.
– cognizant of other diabetics and their experiences.
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17. A Diabetic’s Guide to
Managing Diabetes
As an Engineer, I am Trained in Problem Solving,
the Key to Diabetes Management
• Diabetes management involves constant problem solving
– daily changes in your body’s response to food
– changes in your activity level (weekends vs. weekdays)
– exercising and maintaining an acceptable blood glucose level
– responding to low and high blood glucose
• My body is an experiment requiring skills of
– observation
– accurate record keeping
– interpretation
– problem solving
– decision making
• These skills can be learned and become second nature with practice.
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18. A Diabetic’s Guide to
Managing Diabetes
My Goal is to Teach You the Skills You
Need to Manage Your Diabetes
• My focus: how to maintain a normal blood glucose level and overall
good health.
• What to eat and not to eat
• How to exercise
• The differences between insulin and other medications
• How to test your blood glucose consistently and accurately
• What information to record
• How to record key information with a minimum of effort
• How to respond to changes that occur every day
• How to avoid problems
• How to overcome the problems that do occur
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19. A Diabetic’s Guide to
Managing Diabetes
Can Good Diabetes Management Be
Achieved Without an Intensive Regimen?
• My diabetes regimen is intensive because my blood glucose level is very
sensitive
– to what I eat, to how much I exercise and to the amount of insulin I inject.
• Most type 1 diabetics must follow a similar regimen.
• The more intensive your regimen, the better your blood glucose control.
However…
• The vast majority of diabetics suffer from type 2, which varies in its severity.
• If your diabetes is mild, you may be able to regain a normal blood glucose
level
– by losing weight, cutting out desserts and increasing your activity level.
– by merely taking a semi-annual HbA1c test to monitor your overall condition.
– without taking insulin or any other medication.
• You can still learn a great deal from this course about diet and exercise.
• The condition of many type 2 diabetics deteriorates over time, so it is
important to learn what measures you can take to stay healthy.
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20. A Diabetic’s Guide to
Managing Diabetes
What We Won’t Talk About—
Most Medications and Complications
• Not much advice regarding medications…other than insulin.
• Information on medications is widely available
– diabetes periodicals such as the ADA’s Diabetes Forecast
– your doctor should advise you.
• No discussion on complications—we want to prevent them.
• If you are suffering from complications you should consult your doctor.
– You will need to control your blood glucose tightly, and this course can help
you do that.
Manage your diabetes and
prevent complications like these!
Ace Wallace, a
Don’t let it blues musician,
get this bad! went blind from
diabetes
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21. A Diabetic’s Guide to
Managing Diabetes
Course Overview
1. An introduction to the elements of my blood glucose control regimen.
2. Your body and what diabetes does to it.
1. The digestive system
2. Insulin
3. The liver
4. Type 1 and Type 2 diabetes
3. An engineer’s approach to blood glucose meters and testing.
– What’s important in a glucometer?
– How to measure your blood glucose level accurately and consistently.
4. Medication with an emphasis on insulin
– Overview of diabetes medications
– Type 2 diabetics and insulin
– How to use insulin
– The insulin metric
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22. A Diabetic’s Guide to
Managing Diabetes
Course Overview
5. Diet—a scientific view of eating
1. The history of eating—why we crave certain foods.
2. Carbohydrates, fat and protein
3. Vitamins and minerals
4. What to eat and what not to eat
5. How to eat
6. The carbohydrate metric
7. Recipes from someone who likes cooking
• My favorites
• How to reduce the amount of carbohydrate in your favorites
6. Exercise
1. The benefits
2. How to choose an exercise regimen that is compatible with your lifestyle.
3. The importance of exercising every single day.
4. The exercise metric
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23. A Diabetic’s Guide to
Managing Diabetes
Course Overview
7. My complete diabetes management regimen
• Review
• A week in my life using records from my own diabetes log-books.
• Examples of calculations.
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24. A Diabetic’s Guide to
Managing Diabetes
Don’t Just Believe What I Say—Learn for Yourself
• We tend to accept what doctors say without question.
• I am not a doctor.
• I make every effort to cite respected sources for my physiological and
dietary information.
• If something does not make sense, go to the references, and read
more.
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25. A Diabetic’s Guide to
Managing Diabetes
Ask Questions
• Do ask questions during class or one-on-one afterwards.
• I am a resource—take advantage of my knowledge.
• Diabetics can learn a lot from each other—talk to your classmates
about what works for them.
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26. A Diabetic’s Guide to
Managing Diabetes
Assignments are Intended to Make the
Work of Diabetes Management Easier
• Given at the end of each class.
• Optional, but strongly recommended.
• Not graded.
• Meant to help you learn the material more quickly and thoroughly.
• We will review the last session’s assignment in the following class.
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27. A Diabetic’s Guide to
Managing Diabetes
ASSIGNMENT #1
WHY ARE YOU HERE?
WHAT DO YOU WANT TO LEARN FROM THIS CLASS?
THINK ABOUT YOUR ANSWER AND BE PREPARED TO
DISCUSS IT IN OUR NEXT CLASS.
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