NEWSLETTER MY Getting Activated Getting Activated Dr. Edelman’s Corner Dr. Edelman’s Corner Once a person with diabetes is labeled as non-compliant in their medical record, healthcare professionals who read the record in preparation for a visit have already developed a preconceived notion that this person does not follow the rules. It is a common situation that is pervasive among healthcare professionals and has been proven difficult to change. So why is it that many people with diabetes have high A1c values? The reasons are diverse, ranging from emo- tional and physical barriers to uninformed caregivers. Frequently, there is limited access to the best therapies currently available. Of the many variables that influence glucose control and the even- tual development of diabetes complica- tions, the “activation” of the person living with diabetes to take a more dedi- cated role in his or her care is the most critical. Activation basically means that the PWD has been educated, motivated and empowered to take control of their diabetes with a positive attitude. As we spoke about in our previous newsletter, Extreme Diabetes Makeover I have never met a person with diabetes who does not want to live a long and healthy life. However, people with diabetes who do not have perfect glucose control are often labeled as “non-compliant.” I see this all too often in the hospital among the medical students, residents, endocrine fellows, dietitians, CDEs and other faculty and staff. INSIDE Fall 2010 Volume 33 Getting Activated (continued on page 2) The Artificial Pancreas Project Page 3 Vitamin D What You Don’t Know About the Sunshine Vitamin Page 4 What You Should Eat When Dining Out Page 6 What is Your A1c Telling You? Page 7 Going the Distance for Diabetes Awareness Page 8
Once a person with diabetes is labeled as non-compliant in their medical record, healthcare professionals who read the record in preparation for a visit have already developed a preconceived notion that this person does not follow the rules. It is a common situation that is pervasive among healthcare professionals and has been proven difficult to change.
So why is it that many people with diabetes have high A1c values? The reasons are diverse, ranging from emo-tional and physical barriers to uninformed caregivers. Frequently, there is limited
access to the best therapies currently available. Of the many variables that influence glucose control and the even-tual development of diabetes complica-tions, the “activation” of the person living with diabetes to take a more dedi-cated role in his or her care is the most critical. Activation basically means that the PWD has been educated, motivated and empowered to take control of their diabetes with a positive attitude.
As we spoke about in our previous newsletter, Extreme Diabetes Makeover
I have never met a person with diabetes who does not want to live a long and healthy life. However, people with diabetes who do not
have perfect glucose control are often labeled as “non-compliant.” I see this all too often in the hospital among the medical students, residents, endocrine fellows, dietitians, CDEs and other faculty and staff.
INSIDE
Fall 2010 Volume 33
Getting Activated (continued on page 2)
The Artificial Pancreas Project Page 3
Vitamin D What You Don’t Know About the Sunshine Vitamin Page 4
What You Should Eat When Dining OutPage 6
What is Your A1c Telling You?Page 7
Going the Distance for Diabetes AwarenessPage 8
SpecialAcknowledgements
(XDM) will soon be available to millions of people around the globe to view online. TCOYD’s XDM program successfully addresses how to help people with out of control diabetes to become active in their own healthcare. Trust me, it’s not rocket science.
For our first XDM program we accepted seven individuals living with diabetes who have extremely poor control of their condition (A1c values mostly between 9% and 11%, indicat-ing an average blood glucose value of more than 250mg/dl). Over a 5-month period, they greatly improved their control and completely changed their attitudes about living a normal and proactive life with diabetes. TCOYD helped provide them with a dream team of diabetes specialists including myself; Dietitian Janice Baker, RD, CDE; Nurse educator Angela Norton, RN, CDE; Exercise physiologist, Larry Verity, PhD, FACSM; and Clinical psychologist Bill Polonsky, PhD, CDE. We gave them the attention they needed, gained their trust and addressed their emotional and physical barriers. This occurred only after we were able to truly connect with the group and develop a meaningful understanding of the issues that were preventing them from living successfully with their diabetes.
There is no question that we helped to activate these individuals who were generally dis-heartened with the day-to-day frustrations of this chronic condition and all of the demands put forth by our professional commu-nity. I have always won-dered how well physicians
would do when asked to prick their fingers and test their glucose three to four times per day, follow a consistent and rigid diet, exercise each day with consistent duration and intensity, take medications regularly including insulin injections and deal with the require-ments to see multiple care profession-als throughout the year as part of their diabetes treatment.
What does it take to activate someone living with diabetes? It takes understanding, sincerity, knowledge and the ability to empathize with individuals in regard to what it is like to live with diabetes on a day-to-day basis. It also takes a conscious shift in attitude from categorizing someone living with diabetes who has poor control as non-compliant, to regarding them as not being active in their own condition.
The answer to improving care in this country is, in part, developing new drugs and devices, but also changing the attitudes of caregivers toward their patients with diabetes by encouraging them to become activated in their own self-management, while addressing their individual physical and emo-tional fears, needs and concerns. This takes time and is a multidisciplinary approach. We must allow for these vital requirements within our new health-care policies to take action. As patients and healthcare providers, let’s work
together to improve lives and ultimately change the face of diabetes in this country.
2 My TCOYD Newsletter, Vol.33
Medical Advisory BoardChair: Ingrid Kruse, DPM Veterans Affairs Medical Center
Alain Baron, MD CEO, Elcelyx Therapeutics
John Buse, MD, PhD University of North Carolina
Jaime Davidson, MD Dallas, TX
Mayer Davidson, MD Drew University
Daniel Einhorn, MD Diabetes & Endocrine Associates
Robert Henry, MD Veterans Affairs Medical Center
Irl Hirsch, MD University of Washington
Board of DirectorsSteven V. Edelman, MD Founder and Director, TCOYD
Sandra Bourdette Co-Founder and Executive Director, TCOYD
Steven Edelman, MDFounder and DirectorTaking Control Of Your Diabetes
Getting Activated (continued from page 1)
Taking Control Of Your Diabetes 3
CloSING thE loopArtificial pancreas projectCloSING thE loopArtificial pancreas project
From the Desk of Dr. howard Zisser, MD
This concept of automated control of glucose became a reality in the mid-1970s as researchers in Canada and Japan developed systems that automated glucose control. The system worked well and is still being used today to answer research questions. The main drawback to this system is that it requires continuous access to the vascular system, which is impossible to maintain due to risks of clotting and infection.
This field of investigation remained quiet for the next several decades. Meanwhile, insulin-pumping technology developed into an approved method of deliv-ering insulin in a novel fashion that mimics the natural delivery of insulin in the body. The two remaining pieces to the puzzle
were a reliable way to continuously measure glucose and a brain or pro-cessor to make automated decisions for insulin delivery.
The first generation of continu-ous glucose monitors, which can report glucose concentrations every 1 or 5 minutes, were approved for use about 5 years ago. Subsequent generations of these devices have improved in performance and accuracy. Once we were shown that using these devices could reduce both hypo and hyperglycemia at the same time, researchers and funding agencies became interested in com-bining these devices into systems using control strategies (the brains of the operation) that had histori-cally been used to carefully control chemical reactions or refinery plants.
There are many hurdles to conquer in order to reach the finish line specifically making an auto-mated insulin delivery system. First, one has to build a system. We have accomplished this at UCSB/Sansum by building our Artificial Pancreas System, which includes pumps from Insulet, Roche and Animas and also includes glucose sensors from DexCom and Abbott. This modular system allows researchers around the world use the tools that they need and ”drop in” any brain or control-ler that they want to test in order to tackle this problem without having to re-invent the wheel.
Until there is a true cure for type 1 diabetes, the artificial pancreas represents the best prospect to minimize rapid
and dramatic swings in blood glucose concentrations, further minimizing the short term risks associated with hypoglycemia (low blood sugar) or the long term risks associated with hyper-glycemia (high blood sugar). As early as 1959, Professor E. Perry McCullagh, an endocrinologist at the Cleveland Clinic, demonstrated the concept of an implantable artificial endo-crine pancreas. The closed-loop regulatory system, which consisted of a glucose monitoring device, transmitter and insulin syringe, was looked upon as the future treatment device for diabetes. All that was needed were the tools.
Did You Know? The Juvenile Diabetes Research Foundation (JDRF) was instrumental in establishing and funding a consor-tium of researchers around the world to tackle this problem. Please check JDRF.org for a research site near you.
Closing the Loop (continued on page 5)
Howard Zisser, MD, is the Director of Clinical Research and Diabetes Technology at Sansum Diabetes Research Institute where he conducts clinical trials on new and innova-tive therapies for type 1, type 2 and gestational diabetes. He currently manages trials investigating the JDRF funded Artificial Pancreas Project, the safety and efficacy of inhaled insulin, and implantable insulin pumps and implantable glucose sensors. Additionally, Dr. Zisser is Adjunct Professor, Department of Chemical Engineering, University of California, Santa Barbara.
From the Desk of Dr. howard Zisser, MD
4 My TCOYD Newsletter, Vol.33
What is Vitamin D?
Vitamin D is a fat-soluble vitamin, with two types: the naturally
occurring cholecalciferol (vitamin D3) and the synthetic ergocalciferol (vitamin D2). We get vitamin D3 from the sun and vitamin D2 from foods. When sunlight or ultraviolet radiation hits the skin, cholesterol is converted to vitamin D3, while vitamin D2 is synthesized from plants. Regardless of the source of vitamin D, its activation in the body is dependent on normal liver and kidney function, therefore people with liver or kidney problems may be susceptible to low vitamin D levels.
Vitamin D is an important regulator of calcium and phosphorus absorption from the gastrointestinal tract and calcium re-absorption in the kidneys. The action of vitamin D results in higher levels of calcium in the blood, which increases bone growth and maintains bone health. Without enough vitamin D, the body cannot absorb dietary calcium. Since calcium is necessary for bone health, low calcium results in weak bones and increases the risk of developing osteoporosis.
How is Vitamin D Associated with Diabetes?
Studies suggest that vitamin D deficiency may be associated with hyperglycemia (high glucose), insulin resistance, high blood pressure, obesity and abnormal lipid profile, also known as “metabolic syndrome.” People with metabolic syndrome are at higher risk for developing diabetes. Studies suggest a possible relation-ship between low levels of vitamin D,
metabolic syndrome and diabetes. The exact way vitamin D affects
diabetes is not known. However current research suggests vitamin D may act on the pancreas to increase insulin synthesis and secretion, which correlates with lower blood glucose levels. Studies have found that higher levels of vitamin D are associated with better glucose tolerance as well.
Furthermore, vitamin D may also play a role in regulating systems involved in blood pressure and choles-terol, resulting in lower blood pressure and cholesterol levels. In addition, a recent review article evaluated studies looking at the role of vitamin D in cardiovascular disease, diabetes mellitus and metabolic syndrome. High levels of vitamin D decreased the risk of having cardiovascular disease by 33%, type 2 diabetes mel-litus by 55% and metabolic syndrome by 51% compared to lower levels of vitamin D. Further studies are needed to determine if this relationship is causal and to identify the optimal dose of vitamin D supplementation.
Currently, the American Diabetes Association (ADA) does not recom-mend vitamin D supplementation in patients with diabetes without under-lying deficiency. Vitamin D deficiency can be determined by a blood test.
Good Day Sunshine!Vitamin D and Diabetes
Vitamin D is a hot topic in diabetes research right now, and not just because of the recent sunny, warm weather. Research suggests that vitamin D, or “the sunshine vitamin,” may play a role in regulating insulin secretion, managing blood pressure and creating a better lipid profile. In fact, higher levels of vitamin D may decrease the risk of developing certain diseases, such as diabetes or heart disease. Interested yet? Read on to learn more about this innovative research in the field of diabetes.
Very few foods naturally contain vitamin D. The best sources include:
By Candis M. Morello, Pharm D, CDE, FCSHP and Sarah A. Bajorek, PharmD Candidate 2011
Candis M. Morello, pharm D, CDE, FCShp, Associate professor of Clinical pharmacy at UCSD Skaggs School of pharmacy and pharmaceutical Sciences and Clinical pharmacist at VASDhS
Sarah A. Bajorek, pharmD Candidate 2011 at UCSD Skaggs School of pharmacy and pharmaceutical Sciences
oily fish (salmon, tuna, mackerel) Beef liver Cheese
Egg yolksorange juice*Milk*Cereals*
* Fortified with vitamin D
Ask Your Pharmacist
Taking Control Of Your Diabetes 5
Suggested Daily Doses of Vitamin D
Vitamin D can be acquired from sun exposure, diet or supple-mentation. Most people obtain their vitamin D needs through sun exposure. Five to 30 minutes of sun exposure on the arms, legs and back during peak hours (10 am to 3 pm) at least twice weekly can generate all the vitamin D we need. However, the skin’s ability to produce vitamin D is diminished with age (65 years and older), skin pigmentation (darker pigmentation require longer sun exposure) and sunscreen use.
The recommended dietary allowance for vitamin D has not been established. The recommended adequate intake (RAI) may not be enough in persons with osteoporo-sis risk factors or low exposure to sunlight. See Table 1 for the RAI for vitamin D supplementation. A vitamin D supplement can be taken without regard to meals. Since the Federal Food and Drug Administration does not regulate supplements, be sure to choose one with a “USP” certified seal on the bottle, which means the manufacturer followed standards of the US Pharmacopoeia. Vitamin D is also used in higher doses for the prevention and treatment of osteo-porosis since it increases absorption of dietary calcium. For adults 50 years or older the recommended dose is 800-1000 IU daily.
Possible Adverse Effects of Vitamin D: How Much Is Too Much?
Vitamin D is usually well toler-ated at the recommended doses.
However, high intake of vitamin D can raise blood levels of calcium, which can cause changes in mental status and heart rhythms. Early symptoms of excessive vitamin D intake are nausea, vomiting, consti-pation, weakness and weight loss. Since vitamin D is fat soluble, excessive amounts of it may be stored in fatty tissue for longer periods of time, increasing the risk of toxicity.
People with sensitivities to vitamin D or its analogues should not take vitamin D. Since vitamin D increases blood calcium levels, it should be used cautiously in patients taking cardiac glycosides (e.g. digoxin) or thiazide diuretics (e.g hydrochlorothiazide or HCTZ). In addition, people with a history of high blood calcium, calcium-contain-ing kidney stones or malabsorption syndrome should not take vitamin D. As always, talk to your physician before starting any new medications or supplements.
The Bottom LinePeople with diabetes may be
at an increased risk for low levels of vitamin D, possibly predispos-ing them to glucose intolerance, high blood pressure and abnormal lipid profiles. Ask your primary care provider to test your vitamin D levels
to see if supplementation is right for you. More studies are needed to determine the exact relationship between vitamin D supplementa-tion and diabetes in people without vitamin D deficiency. Either way, head outdoors and enjoy small doses of sunshine to start boosting your vitamin D levels!
Did You Know? A serum vitamin D level of less than 15 ng/mL is considered inadequate for bone and overall health.
Another hurdle is obtaining regulatory approval to conduct these trials. The JDRF has worked closely with the investigators and the FDA to make this hurdle as small as pos-sible. Clinical studies are ongoing at all of the consortium’s research sites.
The main limitation in the current systems is not the brains, but the time lags associated with current sensors and pumps. This makes the whole system sluggish. Future work will include novel delivery methods for faster insulin action (spreading agents, monomeric, intradermal, intraperitoneal and inhaled insu-lins) and improvement in sensor accuracy.
The first product will probably not be a fully functioning closed-loop system. It will be a step-wise approach starting with advanced hypoglycemia predictions, which will temporarily suspend insulin delivery then moving on to meal and exercise detection and then to overnight control and finally to full control.
Closing the Loop (continued from page 3)
Table 1: Recommended Adequate Intake (RAI) for Vitamin D Age RAI0-50 years 200 IU*51-70 years 400 IU71+ years 600 IU *IU, International Units
6 My TCOYD Newsletter, Vol.33
On average, Americans dine out approximately four to five times per week. Whether it is breakfast, lunch or dinner, these meals can add up in calories, fats, saturated fats and sodium content. Many people find themselves fighting weight gain, high cholesterol, heart complica-tions, diabetes and more and are wishing that they had healthier menu options when it comes to eating out. For those living with diabetes it can be especially demand-ing when trying to choose restau-rants with healthy alternatives. This is the basis for the Healthy Dining Program and the HealthyDining-Finder.com website.
Started by Anita Jones-Mueller, MPH and Esther Hill, PhD in 1990, Healthy Dining was inspired by the fight against obesity and the chal-lenges presented when trying to maintain a healthy diet while on the go. At the time, Esther’s son had been diagnosed with type 2 diabetes, and the family found it increasingly difficult to know what they were
getting nutritionally when eating at restaurants. Both Esther and Anita decided to join forces to address this ever-growing problem. They began approaching restaurants and offering to identify healthy dishes on their menus and the caloric, fat and satu-rated fat contents involved.
This initial idea rapidly grew into 19 editions of the Healthy Dining books for major Southern California regions. Additionally, in 2007, the organization launched its website, HealthyDiningFinder.com. The website encompasses various restaurants from fast food establish-ments to family restaurants and includes several dishes from each res-taurant that fit certain nutritional criteria.
“We approach res-taurants and encourage them to participate in our program. We explain the benefits of identifying healthy menu items, no matter the size of the
restaurant,” says Erica Bohm, M.S., who serves as the Vice President and Director of Strategic Programs at Healthy Dining.
Over the years, the database and locales of Healthy Dining Finder have grown significantly. Restaurant chains such as McDonald’s, Panda Express and Chili’s are represented, as well as local establishments who want to participate in the program. Menu items with up to 750 calories, 25 grams of fat, 8 grams of saturated fats and 2000 mg. of sodium are highlighted on the website under each restaurant’s page. Some people are surprised by the choices and why they are among the healthier categories.
“There are so many people who identify healthy foods by certain buzz words, such as ‘fresh’ or ‘organic.’ However, even items such as salads sometimes contain a lot of dressing or cheese and may have unexpectedly high levels of calories, fat, saturated fat or sodium,” says Bohm.
For people living with diabetes, healthy dining choices can be espe-cially difficult to determine. Certain menu items, such as foods high in fats and carbohydrates, are typi-cally labeled “no-no’s,” as are foods high in caloric value. Knowing
In the United States, dining out has become a staple of our culture. With the hustle and bustle of juggling family, work,
extracurricular activities and everything else that life throws our way, it is becoming increasingly difficult to prepare healthful meals on a daily basis.
By Julia Baron
LivingWellLivingWellthe Key to Dining out the Smart Waythe Key to Dining out the Smart Way
By Julia Baron
Taking Control Of Your Diabetes 7
Here are some quick tips for those looking to improve their current diets:1. Do a personal inventory of the foods
you enjoy that are healthy, such as fish or chicken. Find menu items that incorporate these ingredients, that are also low in fat, carbohydrates and calories, yet provide protein, vegetables and whole grains.
2. Don’t look at eating healthy as a sacrifice. Stick with the healthy foods you already enjoy and find dif-ferent meals to work with. There are many benefits to eating well, includ-ing better control of your diabetes!
3. Try using less oil, butter, salt, etc. Moderation is key!
Health Educator Erica Bohm is VP & Director of Strategic Partnerships for Healthy Dining. She coordinates restaurant enrollment and promotes the Healthy Dining program and website to the public and media. She develops strategic partnerships within the restaurant industry and with the many “stakeholders”—employers, health agencies, and others—who publicize HealthyDiningFinder.com to their populations as part of wellness initiatives.
The A1c test is one of the most important laboratory procedures
to inform people with diabetes about their overall glucose control.
Want to test your knowledge? Take the TCOYD A1C quiz below!
a. Less than 6%b. Less than 6.5%c. Less than 7%d. Less than 7.5%
Answers:1.) The A1c value gives an estimate of what the average blood glucose value has been over the past 2 to 3 months. Glucose binds to the red blood cells (RBCs) in our bodies, which have a life of about 2 to 3 months. At any time, we can measure the percentage of glucose bound to RBCs and then compare the values to normal individuals. Those living with diabetes who have moderate to poor control of their disease have a higher per-centage of glucose bound to these RBCs, and therefore, have a higher A1c level.
2.) The A1c test provides information on the average blood glucose value and does not give any information on the mag-
nitude of the post meal or postprandial blood glucose values. Testing with glucose meters or continuous glucose monitoring devices can tell us more about the typical glucose excursions that occur throughout the day in response to food, exercise, stress and other variables that can poten-tially affect our numbers.
3.) The goal for A1c values must be individualized. In general, we aim for less than 7%. Keep in mind, there are many factors that should influence your particular goal including, but not limited to: age, heart disease, hypoglycemia or low glucose unawareness. It is important that you discuss these issues with your caregiver.
Do You Know Your A1c and What It Means?
the importance of these factors is key in choosing healthier courses and eating them in moderation. Sometimes, this can be off-putting for people who are used to eating certain foods and are not as willing to change their diet.
“Limiting carbohydrates, calories and fats is key in controlling diabetes. Information is power. With the infor-mation on the website, people with diabetes can choose the choices that are right for their particular dietary regimen,” says Bohm.
By Steven Edelman, MD
Know Your Numbers
With six of his family members living with diabetes, Jerry wanted to make a significant impact and raise awareness for the disease.
“I want to serve as a resource for people living with diabetes and their families. Although I don’t have diabetes, it is a cause close to my heart,” says Jerry.
On October 30th, with the help of his family and team of supporters, Jerry plans to run 500 miles along the coast of California to raise money for the Iron Andy Foundation, a not-for-profit orga-nization dedicated to providing education and support for young people living with diabetes through special diabetes camps. Jerry met founder, Iron Andy (Andy Holder) at a race in Kentucky last year. He was immediately inspired by Andy’s dedication to young people living with diabetes.
Living well with type 1 diabe-tes himself, Andy knows first hand the challenges of controlling his condition and training for mara-thons and triathlons.
“He is such an inspiration. When I met him, I knew I wanted to be a part of what he was doing to help kids with diabetes. This is when I had the idea for Run the Coast,” says Jerry.
The Run the Coast race will begin on October 30th at the Golden Gate Bridge and end November 12th in downtown San Diego. Jerry will be joined by Team Iron Andy, which consists of: Andy Holder, Amy Gonsalves,
The sport of running requires dis-cipline, patience and dedication.
Training is tiring and time consum-ing, yet the results of tireless efforts are positive. For people living with diabetes, discipline, patience and dedication also play a significant role in controlling the disease and living a happy, healthy life. For Jerry and Jenifer Armstrong, both diabetes and running are integral parts of their day-to-day lives and have helped shape who they are.
Jerry and Jenifer are no ordi-nary couple. Jerry is a local police officer with a passion for ultrama-rathon running and Jenifer, a nurse and mother, has been living with diabetes for 24 years. Inspired by his wife’s determination and spirit, Jerry decided to dedicate his free time to his wife and son Jalen and becoming an advocate for diabetes.
8 My TCOYD Newsletter, Vol.33
RUNNING the Coast for Diabetes
By Julia Baron
“I want to serve as a resource for people living with diabetes and their
families...” –Jerry Armstrong[ ]Scott Jozefowski and John Moore, all living with type 1 diabetes; Monica Otero who is living with type two diabetes; and David Clark, Connie Dockendorf and Iso Yucra who are all friends and/ or loved ones of people with diabetes (type 3’s).
We wish the team the best of luck and we will see them at the finish line!
Want to Get Involved? You can help Team Iron Andy by making a donation or participating in either the Dean Karnazes Silicon Valley Marathon on October 31st or the Santa Barbara Marathon on November 6th. Both of these marathons will be opportunities to run with Jerry and Team Iron Andy during this two-week event.
For more information about Run the Coast and to donate, visit www.runthecoast.com.
Taking Control
Taking Control Of Your Diabetes 9
Most of us look forward to dessert after a meal—usually
after dinner. Desserts, being sweet, creamy and delicious, are some of our favorite comfort foods. Unfor-tunately, desserts are usually high in calories and low in nutrients. The trick is to save the rich desserts for truly special occasions and to make other desserts a nutritious part of your diet.
Making the Most of Dessert
Using Fruit for Dessert Fresh fruit that is in season is
a treat when dressed up with other nutritious additions. Try dipping it in non-fat vanilla yogurt, sprinkled with a little cinnamon. Another idea is to peel and chop apples or pears, sprinkle them with a teaspoon of sugar or other sweetener per cup of fruit, then microwave until tender. Stir in a few raisins or berries if you like, but don’t add water—the fruit creates its own syrup as it cooks. Enjoy the fruit warm by itself or sprinkle with a crunchy low-fat granola cereal to make a fruit crisp. You might also enjoy adding some chopped walnuts or sliced almonds, which adds fiber, protein and heart healthy fats.
Homemade Desserts
For puddings, icings and pie fillings, you can use non-nutritive sweeteners such as Splenda. Reduce the fat
content of dessert by using skim milk or other low-fat dairy products. Replace part of the oil with prune puree (use a jar of prune babyfood), applesauce or buttermilk.
However, no matter how health-ful or rich the dessert of choice is, portion control is always the major influence on how many calories you will be consuming. Using small cups or dishes, instead of larger bowls or plates and pairing up a very small portion of a rich desert or piece of candy with some fresh fruit can help maintain the calorie balance needed to achieve and maintain a healthy weight.
Fit to Eat
Question of the Month
1 cup canned pumpkin or
pumpkin puree
1 package (4-serving size)
sugar free nonfat vanilla
pudding
1 teaspoon pumpkin pie
spice1 ½ cups skim milk
By Steven Edelman, MD
I’ve never eaten a meal first thing in the morning, but my doctor tells me that with diabetes, I have to eat breakfast. I seem to end
up eating things that are bad for me, like a donut or Danish. What do you suggest I eat instead?
Eating a well-balanced breakfast in the morning is good for everyone, including those with diabetes. The breakfast does not have to be large, but having a morning meal does help with over eating at lunch. Pick a variation of meals that you enjoy that are also healthy and easy to prepare. Peanut butter on a toasted English muffin, oatmeal, a small bowl of cold cereal and low-fat yogurt are just a few examples. If you wake up early and do not feel like eating right away, take a “breakfast kit” to work and eat it a little later in the morning.
Easy Pumpkin Pudding
Mix all ingredients together.
Place in individual bowls or
glasses and chill until set.
Makes 4 servings. Each 2/3 cup
serving: 77 calories, 0 grams fat,
2mg cholesterol, 380mg sodium,
15 grams carbohydrate, 2 grams
fiber, 4 grams protein.
Making the Most of Dessert
10 My TCOYD Newsletter, Vol.33
Flying an airplane with type 1 diabe-tes hasn’t always been an option.
In fact, for years, no one in the world was allowed to operate an aircraft if they were living with the disease. For Douglas Cairns, this meant the end of his career as a pilot. Little did he know, it was only the beginning.
In 1986 at the age of 25, Douglas was diagnosed with type 1 diabetes. This came as a shock to him in more ways than one. At the time, he was a pilot in the Royal Air Force and was merely participating in a routine health screening when he received the news.
“I was devastated. They told me, ‘you have diabetes and you were a pilot.’ I didn’t know what to do,” says Douglas.
Shortly after being diagnosed, Douglas switched career paths. He moved to London where he was involved in financial asset manage-ment. From 1996-2002, he was based in Bangkok, Thailand where he was working to set up a joint venture. Although he was successful in his position, flying was still something he yearned to do.
In 1999, Douglas heard news
that the United States had a differ-ent system for pilots with diabetes—you could fly and maintain a pilots license if your blood glucose was under good control (100-300 g/dl) during flight. Finally, in 2003, Douglas took to the skies again for his first diabetes advocacy mission. His goal was to fly around the world for a project he called “Dia-betes World Flight” (DWF). In the process, he also managed to raise $26,000 for diabetes research.
“I was ecstatic! I got a twin engine aircraft and began DWF. I wanted to show people with diabe-tes what they can do, not what they cannot do.”
On his flight, Douglas was able to see the inequalities of various countries’ healthcare systems. He found that many people did not have access to basic diabetes care such as insulin or testing supplies.
Since Douglas’ first diabetes
So what’s next for Douglas?
On April 25th 2011, a record-setting flight to the North Pole (90 degrees north) called Diabetes Flight 90 (or Diabetes Polar Flight) is on the books. The temperature is predicted to be approximately -10º F. Now that’s cold!
flight, he has been able to accom-plish diabetes flight 48 which broke the existing record to land in all 48 contiguous states by 33 hours while raising over $27,000 for diabetes research; diabetes flight 50 by flying to all the states which also broke the existing record to land in all 50 states.
As of now, Douglas has no intentions of being grounded anytime soon. Flying is his passion and to be able to promote diabetes awareness in the process is a special achievement.
“Diabetes is controllable. I wont let it stop my from doing what I love and neither should anyone else,” shares Douglas.
He will be featured as a guest speaker at our upcoming San Diego conference on October 30th! Check tcoyd.org for details!
Diabetes Need Not Keep You GroundedDiabetes Need Not Keep You Grounded
“I was devastated. they told me, ‘you have diabetes
and you WERE a pilot.’ I didn’t know what to do.”[ ]
By Julia Baron
Taking Control
Taking Control Of Your Diabetes 11
A significant multi-year gift has been made by Arline and Ted Greene to further TCOYD’s Latino programs. This initiative
supported by the Greene’s spirit of generosity will enable TCOYD to take a much-awaited step to translate our Taking Control of Your Diabetes book into Spanish, making it available to the thousands of Spanish speaking people who are living with diabetes. This effort has been long overdue and will incorporate the important TCOYD messages of education, motivation and self-advocacy, while making every effort to ensure the messages are culturally appropriate to the Hispanic/Latino population.
This book will be a welcome addition to the resources made available at all TCOYD confer-ences across the nation, online and to diabetes professionals who are working to reach the Spanish speak-ing population. The Greenes are no strangers to diabetes and the Latino culture. Ted is the co-founder and former CEO of Amylin Pharmaceu-ticals, a biotech company dedicated to providing new treatments and therapies for people living with diabetes. He currently serves on the board of directors for Tandem Diabetes Care—a company com-mitted to creating diabetes products that enable a flexible lifestyle. In addition, he is also chairman of Satiogen Pharmaceuticals where he is co-inventor of several novel concepts for treating diabetes and obesity.
Arline is has type 2 diabetes and has a personal understanding of what it means to live well with the disease. Her father passed away
due to complications associated with the disease. He was instru-mental in helping educate Hispanic students, so in his honor, she set up the Alberto Radillo Scholarship fund at Santa Ana College in 2001. To date, she has helped 92 Hispanic students majoring in math and science with tuition and book fees, and currently, four of these students are attending medical school. Ted and Arline have been avid support-ers of health causes for most of their lives, as well as programs aiding students of Latino descent. This
Giving Back
was a natural step in their decision making process of where to direct their giving. “When we learned of the Latino program fostered by TCOYD, we could not help but jump in and offer our support to lend a hand to this vulnerable population. TCOYD is definitely making a differ-ence in the area of diabetes patient education, and Ted and I are pleased to be a part of this initiative,” Arline says of their recent commitment. We thank them for their endless generosity toward our organization and the Latino community.
TCOYD Corporate Sponsors
Platinum
Gold
Silver
By Roz Hodgins
Ted and Arline Greene: Lending A Hand to the Latino Diabetes Community
To learn more about giving, please contact: Roz Hodgins TCOYD Director of Development
1110 Camino Del MarDel Mar, CA 92014 (858) 792-4741 Ext. 20 or toll free: (800) 998-2693email: [email protected]
12 My TCOYD Newsletter, Vol.33
Finally, the moment we have all been waiting for! TCOYD’s
newest project, Extreme Diabetes Makeover, will premiere online at TCOYD.org and RealAge.com on September 27th to viewers around the world. This cutting-edge series takes reality programming where it has never gone before—into the lives of the 26.2 million Americans living with diabetes, documenting the challenges they face while battling this chronic condition.
Tune in as we follow 7 unique
individuals, all living with diabetes, who have two things in common: poor control of their diabetes and the desire to improve their condition. Watch them work with a “Dream Team” of diabetes experts over a 22-week period as they battle their emotions, test their limits and explore new ways to manage their condition.
Join us as we show the world
what it means to take control of your diabetes!
For schedules, bios, trailers and more, visit www.tcoyd.org or www.RealAge.com
TCOYD Conferences & Health Fairs 2010-2011 Schedule
2010 September 25 Des Moines, Iowa October 30 San Diego, California November 13 Native American Program, Oklahoma
2011 February 12 Santa Rosa, California March 5 Honolulu, Hawaii March 6 Kona, Hawaii April 2 Tucson, Arizona May 21 Albuquerque, New Mexico June 11 Albany, New York September 10 Amarillo, Texas October 1 Tampa, Florida November 12 San Diego, California TBA Native American Program TBA SoCal Latino Programs
NonprofitOrganizationU.S. Postage
PAIDSan Diego, CAPermit No 1
Taking Control Of Your Diabetes1110 Camino Del Mar, Suite “B”Del Mar, CA 92014 | www.tcoyd.org
