2010 Winter Vol 31

Volume 31, Fourth Quarter 2009

My wife, Ingrid, is a podiatrist specializ-ing in diabetes; my mother, Joyce, has beena school teacher for over 30 years; my sister,Susan, is an investigative reporter for theNew York Post; and my brother, Barry, is a clinical psychiatrist. While they work invaried fields, they are all superb educators,contributing to society’s knowledge base in different ways. In my address to a large group of diabetes

professionals from around the world, I toldthem my personal and professional storywith diabetes. I developed diabetes when Iwas 15 years old. I lost 20 pounds and hadthe classic symptoms of excessive thirst,

urination and tiredness. I remember beingyelled at by the other kids at the drinkingfountain because I took so long to quenchmy thirst. My teachers reprimanded me for falling asleep during class when I could barely keep my eyes open. As I think back on those days, they highlightthe importance of educating the publicabout diabetes and wiping out ignoranceand intolerance. I completed my professional diabetes

training at the Joslin Diabetes Center inBoston and it is there I learned that gettingPWD (people/person with diabetes) to put

Dr. Edelman’s CornerDr. Edelman’s Corner

(Educators, continued on page 2 )

Iwas honored this year by the American Diabetes Association withthe “Outstanding Educator in Diabetes” award. As I prepared my

acceptance speech, and attempted to thank as many people as I couldwho supported me in my journey, I came to the realization that we areall educators in our own way.

inTHISissue

ARE ALL EDUCATORSIN OUR OWN WAY ARE ALL EDUCATORSIN OUR OWN WAY

®

Dr. Edelman’s Corner

Taking Care of Your SkinKnow Your Numbers

To Carb or Not to Carb

The Treatment ofDiabetic Retinopathy

Question of the Month

Meditation–AComplimentary Therapy

GERD: Gastro-Esophageal RefluxDisease

Diabetes in Motion:Step Forward and Move Ahead

Where Would TCOYD BeWithout Philanthropy?

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64

78

9

11

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diabetes high on their priority list is akey component for long-term success.As a young faculty member at UCSDand the Veterans Affairs MedicalCenter, I spent a lot of time and energytrying to educate healthcare profession-als on how to take better care of theirpatients with diabetes. It was slowgoing. Diabetes care was not improvingfast enough at the community level andI started taking these crucial messagesdirectly to those who are most affectedby this condition, the people withdiabetes.Since the beginning

of TCOYD in 1995, wehave been pushing threemain themes and theyhave never lost theirimportance or magnitude:1. You have the main responsibilityfor taking control of your diabetes.

2. You are your own best advocate.3. Be smart and be persistent.Simply stating these themes is one

thing, but getting folks to takeownership of their health is another…that was, and continues to be, thechallenge. At that very first conference,I recognized how thirsty PWD were forinformation about their condition andthat much more needed to be done.I have always believed that presenting

real information infused with humor is a key component to informationretention and contributes to our overall success in making positivechanges. Another vital strategy is todirectly address the emotional barriersof diabetes, which opens our minds toabsorbing information by acknowledg-ing and addressing the commonality

and normality of feeling guilty, fearful,anxious, frustrated and depressed aboutour own diabetes or about the diabetesof a loved one. I have also come toappreciate that the type 3 diabetic (anyperson who lives with, or cares about,someone with diabetes) plays a critical

role in the ultimatesuccess of the PWDand,must be educated, too. The key message here is

that we must understandthat every one of us plays

a significant role in diabetes education,whether we are a person with diabetes, a type 3 diabetic, a health care profes-sional or a member of the generalpublic. Why? Because we must armourselves with the latest up-to-dateinformation, be sensitive to the manyemotional issues involved with diabetesmanagement and be able to share ourknowledge in an effective and individu-alized manner. We are all educators inour own way. We have the responsibil-ity, to ourselves and others, to keeplearning about living healthy, happy and productive lives with diabetes. The theme of this newsletter is ‘back

to basics’ and it features some of the bestarticles we’ve featured in past issues ontopics such as carbs, physical activity,meditation, your skin, eyes andstomach. Enjoy!

Steven Edelman, MDFounder and DirectorTaking Control Of Your Diabetes

Educators (continued from page 1)

2 MyTCOYD Newsletter, Vol. 31

SpecialAcknowledgements

MyTCOYD Newsletter is offered as a paidsubscription of Taking Control of YourDiabetes. All material is reviewed by amedical advisory board. The informationoffered is not intended to constitutemedical advice or function as a substitutefor the services of a personal physician. Onthe contrary, in all matters involving yourhealth, TCOYD urges you to consult yourcaregiver. ©2009 All rights reserved.

Medical Advisory BoardChair: Ingrid Kruse, DPMVeterans Affairs Medical Center

Alain Baron, MDCEO, Ethos Pharmaceuticals

John Buse, MD, PhDUniversity of North Carolina

Jaime Davidson, MDDallas, TX

Mayer Davidson, MDDrew University

Daniel Einhorn, MDDiabetes & Endocrine Associates

Robert Henry, MDVeterans Affairs Medical Center

Irl Hirsch, MDUniversity of Washington

Board of DirectorsSteven V. Edelman, MDFounder and Director, TCOYD

Sandra BourdetteCo-Founder and Executive Director, TCOYD

S. Wayne KayCEO, Response Biomedical Corp.

Margery Perry

Terrance H. GreggPresident & CEO, DexCom, Inc.

Daniel SpinazzolaPresident, DRS International

Contributing AuthorsSteven. V. Edelman, MDLorena Drago, MS. RD, CDN, CDEBill KingJoseph Nelson, MA, LPPaul E. Tornambe, MD, FACS, ASRSJanet Trowbridge, MD, PhDJames Wolosin, MD

TCOYD TeamSteven V. Edelman, MDFounder and Director

Sandra BourdetteCo-Founder and Executive Director

Jill YapoDirector of Operations

Michelle DayDirector of Meeting Services

Antonio HuertaDirector of Latino Programs & Exhibit Services

Roz HodginsDirector of Development

Alice HoweManager of Continuing Medical Education &Website Development

Julia LafranchiseCoordinator of Social Media & Program Support

MyTCOYD NewsletterEditors: TCOYD Team

Design: Hamilton Blake Associates, Inc.

[...we must all first realizethat every one of us

plays an important rolein diabetes education... ]

Taking Control of Your Diabetes 3

One of the major complaints peoplewith and without diabetes have is itchy skin. The bad news is that itchyskin can be an annoying and chroniccondition that, if left untreated, canlead to damaged skin from constantitching and rubbing. The good news is there are a variety of simplestrategies you can follow to “beat the itch.” First, know that your skin isthe body’s biggest immune organ andserves as a first line barrier against a

harsh environment. Helping your skinserve its barrier role and preventingpesky itch is as easy as this:1. Moisturize, Moisturize, Moisturize!

Frost yourself with moisturizer!2. Avoid hot showers, excessive sun,

synthetic clothing and powerfullychlorinated hot tubs and pools.Grease up!

3. Don’t scratch. Scratching leads to skin damage and, guess what?More itching.

Put down the back scratcher andpick up the moisturizer. Productslike Sarna and Eucerin CalmingCream can help sooth and relievethe itch. If prevention fails, yourdoctor can prescribe an antihista-mine or other medications designedto treat the itch, especially if it ispreventing you from getting rest.Finally, it is important to keep

in mind that intractable itching can be a sign of serious disease, such as liver or kidney problems oreven malignancies. So, if you havefrosted, hydrated and generallybabied your skin barrier and theitching persists, seek the advice of a medical professional.

There are a number of skin conditions that affect peoplewith diabetes. They have impressive polysyllabic names

like necrobiosis lipoidica, diabetic dermopathy and acanthosisnigrica and are best diagnosed and treated by a dermatologist.

By Janet Trowbridge, MD, PhD

Taking Care of theSkin You’re In

What is clear from this person’s logbook is that on a daily basis thenumbers jump from as low as 35 to as high as 478 mg/dl. What

must be so frustrating for this person is that there are no consistenttrends, which makes it almost impossible as a provider to make anyadjustments in the dose of insulin or oral medications. For example, ifthe morning pre-breakfast values were always high, then increasing thenighttime dose of medication would be appropriate; however, if 1/3 of the numbers are low, 1/3 are high, and thelast 1/3 are just right, then any adjustment would not be appropriate and could possibly be dangerous. What isamazing is that the A1c was 7.1%, indicating “great control”, but it is important to remember that the A1c is justan average and does not reflect the day-to-day ups and downs. Usually, in cases like this one, the person will need toimprove the consistency of his/her daily eating and exercise schedule in order to reduce the day-to-day fluctuations.

KnowYourNumbersBy Steven Edelman, MD


Carb, that four-letter word: Beware of using it, much less eating it. In

a blink of an eye, our world has becomea carb-free zone. Should people withdiabetes jump on the low-carb wagon?

Let me help you unravel the carbohydrate knot:u Carbohydrate is the nutrient in

foods that raises blood glucose themost. People with diabetes needto budget their carbohydrateintake. “Carb Budgeting” doesnot mean “Carb Bankruptcy”.You will still be able to eat carbs.

u The amount and type of carbo-hydrate eaten determines how highblood glucose will rise after a meal.

u Carbohydrates begin to raise bloodglucose levels 15 minutes after a meal.

Carb Counting–3 Simple Steps:1. Carb Oh Carb: Where ArtThou? Look in your refrigerator. Canyou identify which foods have carbohy-drates? It is perhaps easier to count thefoods that do not have carbohydratesthan those that do. Carbohydrates arefound in:u All breads, cereals, legumes (beans),

starchy and root vegetables, pastaand rice

u All fruits and fruit juicesu All vegetablesu Milk, yogurt, cottage cheeseu Sweets, candy, cakes, cookiesu Ketchup, barbecue sauce,

balsamic vinegarCarbohydrates are not found in: u Meats, poultry, fishu Eggsu Oils, margarine, mayonnaise,

and other fats

2. How Many Carbs?Find out how many carbs are in thefoods you eat. For example, 4 ounces of orange juice has 15 grams of carbohy-drates and 1 cup of raw broccoli has 5grams of carbohydrates. Although bothfoods have carbohydrates, they don’tcontain the same amount. Somethingelse to remember when counting carbsis that size does matter. For example, a1-ounce bagel has 15 grams of carbohy-drates, while a 4-ounce bagel has 60grams. Bagels, like other foods, havegrown almost 100% since their marketdebut. You don’t have to learn the carbohydrate content of every existingfood, just the ones you commonly eat. Helpful resources:www.calorieking.com,www.diabetes.org, www.eatright.orgwww.diabeteseducator.org

3. How Many Carbs Do I Need?Find out from your Certified DiabetesEducator how many carbohydrates youcan have at every meal to maintainyour blood glucose levels as close tonormal as possible. In general, menneed from 60-75 grams of carbohydratesper meal while women need from 45-60grams of carbohydrate per meal. Thetotal amount depends on your age,gender, activity level, medications/insulin, height and weight.

Carbohydrate Tips:u Glycemic Index (GI) – This tool

measures the effect of carbs on bloodglucose levels during digestion. Acarbohydrate that digests quickly,like white bread, has a higherglycemic index than a carbohydratethat digests slowly, like barley. The

To Carb or Not to

Carb?That is The

By Lorena Drago, MS, RD, CDN, CDE

Question

Lorena Drago, MS, RD, CDN, CDE is aregistered dietitian, certified diabeteseducator and Hispanic EducatorSpecialist. She is the author of thebook titled, “Beyond Rice and Beans:The Caribbean Latino Guide to EatingHealthy with Diabetes”. Lorena alsoworks as a consultant, conductinglectures, self-management workshopsand diabetes patient education formanaged care organizations,businesses and individuals.www.lorenadrago.com

Lorena Drago, MS, RD, CDN, CDE is aregistered dietitian, certified diabeteseducator and Hispanic EducatorSpecialist. She is the author of thebook titled, “Beyond Rice and Beans:The Caribbean Latino Guide to EatingHealthy with Diabetes”. Lorena alsoworks as a consultant, conductinglectures, self-management workshopsand diabetes patient education formanaged care organizations,businesses and individuals.www.lorenadrago.com


higher the GI, the faster glucoseenters the blood stream. Low GIfoods have a value lower than 55.

u The GI is affected by manyfactors, such as cooking time andthe presence of fat. For example:u Boiled spaghetti cooked for

5 minutes - GI 34. u Boiled spaghetti cooked for

10-15 minutes - GI 40. u Potato chips - GI 75 u Baked potato - GI 93

u For more information aboutGlycemic Index, visitwww.snac.ucla.edu/pages/resources/handouts/HoGlycemic.pdf

u Sugar Free Foods? – You pick a cookie. The nutrition labelclaims 20 grams of carbs, 0 gramsof sugar and 10 grams of sugaralcohols. Too good to be true or creative accounting? u All carbohydrates are not

created equal. Glycerin, polydextrose, dietary fiber and some sugar alcohols havenegligible effects on blood

glucose levels.u Word of caution: Maltitol,

one type of sugar alcohol, may impact blood glucoselevels in some individuals.Sugar alcohols may also cause gastrointestinal distress.

u Remember, Low-carb does not equate Low-cal.

Putting It All TogetherEating a meal is not just about

identifying and quantifying carbo-hydrate foods. Fats and proteins arealso part of your meal. Discuss withyour registered dietitian how muchfat and protein you should includein your meals. I always tell mypatients to watch their p’s and q’s(portions and quality) Be mindful of your portions and select highquality carbs, proteins and fats.A healthy and realistic eating

plan is a work in progress that needs fine tuning to keep your blood glucose numbers in check!

Carb Count Food Serving Size

15 grams per serving Fruit and fruit juice 1 small fruit or 4 ounces juiceStarches: bread, cereal, 1 ounce bread, 1/2 cup cooked rice, pasta cereal, 2/3 cup cold cereal,

1/3 cup cooked rice or pasta

Starchy vegetables: ½ cup corn, peas

12 grams per serving Milk 8 ounces

Yogurt 6 ounces

5 grams per serving Non-starchy 1/2 cup cooked or 1 cup rawvegetables: spinach, carrots, broccoli

TCOYD Diabetes Makeover Project

Introducing our reality baseddocumentary style video series!Our ‘TCOYD Diabetes Makeover’will introduce five people withdiabetes who have a strong desireto get their diabetes under goodcontrol to a ‘Dream Team’ ofdiabetes care professionals who willoffer them regular guidance andpractical advice as they work tocontrol their disease and live anormal life. Video crews will followtheir progress, both as individualsand as a group, for 5 months. Wewill visit with them at home, withtheir families and during their dailylives, including their visits with the‘Dream Team’. Watch our TCOYDwebsite for the announcement ofour cast of people with diabetesand the identity of our ‘DreamTeam’ of diabetes professionals.We will film from January throughJune. The show will be posted onour website, as well as ourTCOYDtv YouTube channel, 3 segments a week for 26 weeks,beginning in May.

Stay tuned!

New in 2010

MOST PEOPLE WITHDIABETES GO BLIND

BECAUSE THEY ARE SEENTOO LATE. Most cases of diabeticblindness are preventable. If presenttreatment techniques are institutedappropriately, and in a timelyfashion, most people with diabetesshould be able to enjoy lifelongvision. The tragedy today is thatmany people with diabetes still don’tget to our attention until significantretinopathy has developed. The general rule of thumb is that

those who develop diabetes inchildhood should have their eyesexamined the first time at about age 13 (puberty), and those whodevelop diabetes after age thirteenshould have an eye examinationpromptly after the diagnosis is made.Women who develop gestational

diabetes, or diabetes that is firstdiagnosed during pregnancy, shouldalso have a retinal examination.Pregnant women with diabeticretinopathy must be monitored more closely during the pregnancy.Medical management of blood

sugar, blood pressure and lipids, dietand exercise, remain the best meansto prevent, delay, and minimize thechances of developing significantdiabetic retinopathy. In the mid-

1970’s the National Eye Instituteconducted many clinical trials thatclearly defined when and how tobegin treatment for those whodevelop diabetic retinopathy. Thoseguidelines have not changed, and iffollowed, will significantly decreasethe incidence of severe visual loss.

Retinopathy ManagementLaser photocoagulation still

remains the corner stone for themanagement of both background(mild) diabetic retinopathy and proliferative (severe) retinopathy. To properly

determine theextent ofdiabeticretinopathy acomplete eyeexamination is performed with color photographs of the retina. A diagnostic test, optical coherencetomography (OCT) is also routinelyused to determine if there is damageto the retina or the back of the eyefrom diabetes. OCT is a veryaccurate picture of the eye. Itpermits much higher resolution of the macula. The OCT study ispainless, takes a few minutes toperform, and requires no injections.The OCT can determine swelling

before it is clinically apparent, andmay influence the decision to treatwith laser earlier than might bedetermined by other tests alone.If laser treatment fails, an

operation called a vitrectomy isperformed. During this operation the vitreous jelly inside the eye is removed (don’t worry, like theappendix, the vitreous has no usefulfunction and just causes trouble).The abnormal blood vessels are alsoremoved and/or cauterized. We haveperformed vitrectomy since the mid-1970’s. The instruments have been

greatly refined andthe operation ishelpful in mostcases. Vitrectomysurgery is asignificant operation

with some risks but, when indicated,the benefits of vitrectomy far out-weigh the risks. This operationshould only be performed by aRetina Specialist, an M.D. who has taken at least one year (andusually two years) of extra subspe-cialty training in Retinal andVitreous Disease. You may locate a Retina Specialist in your area by going to the American Society of Retina Specialists web site:www.retinaspecialists.org


The Treatmentof DiabeticRetinopathy:Past, Presentand Future By Paul E. Tornambe, MD, FACS, ASRS

[ I believe that within the nextfive years we will continue to

reduce the incidence ofblindness from diabetes... ]


Future TherapyAs Yogi Berra said, “The future

isn’t what it used to be!” New pharmacologic treatments to bothprevent diabetic retinopathy andtreat diabetic retinopathy are on the horizon. Most of these treatments are

directed toward a protein calledvascular endothelial growth factor,or ‘VEGF’, which causes bloodvessels to leak (as with backgrounddiabetic retinopathy), or whichcauses new, weak, abnormal bloodvessels to grow into the eye (prolif-erative diabetic retinopathy). Theseanti-VEGF treatments come in pillform, but some require an injectioninto the vitreous cavity. We arehoping that these drugs maysomeday be available in an eye drop form! These drugs will likely not

take away the need for the laser or vitrectomy altogether, but mayreduce the amount of laser neededand decrease the number of eyesrequiring vitrectomy surgery.I believe that within the next

five years we will continue to reducethe incidence of blindness fromdiabetes and maintain and, evenrestore vision, in significantly moreeyes than we do today. But, it stillrequires that we diagnose diabeticretinopathy in a timely fashion. In five years people with diabetes

will still go blind if we get to themtoo late!

Dr. Tornambe is a past president of theAmerican Society of Retina Specialists(A.S.R.S.) and is in private practice withoffices in Poway and La Jolla, California. www.retinaconsultantssandiego.eyemd.org

nswer: Unfortunately, yes. I have a number of patients with bothtypes of diabetes. Type 1 diabetes is an autoimmune condition wherethe body’s antibodies attack the insulin producing cells in the pancreasand destroy insulin production. Type 2 diabetes is an insulin resistantcondition where the body produces insulin, but can’t use it effectively.The causes of each condition are very different and can occur togetherin one individual. Typically, people are diagnosed with type 1 diabetesfirst, but over time, they can start to develop the metabolic syndromethat is so common in type 2 diabetes. Metabolic syndrome, which isstrongly associated with insulin resistance and type 2 diabetes, consistsof a group of cardiovascular risk factors, such as abnormal cholesterollevels, elevated blood pressure, tendency to have blood that clots easily(hypercoaguable state), and abdominal, or central, obesity. Having astrong family history of type 2 diabetes will also increase the likelihood.If you think about it, type 2 diabetes is very common in our society, soif you have type 1 diabetes, and also have the risk factors for gettingtype 2 diabetes, you may find yourself with both. Managing type 1 andtype 2 diabetes at the same time involves replacing the missing insulinby injection or insulin pump, and adding oral medications to enhancethe effectiveness of the administered insulin. Because of insulinresistance, people with type 2 diabetes in addition to type 1 diabetesfrequently require more insulin than those with type 1 alone.

Can someone have both type 1 and type 2 diabetes? Iwas diagnosed with type 1 diabetes 25 years ago as achild. Both of my parents have type 2 diabetes and I’mwondering if I can get that, too.

Question of the Month

By Steven Edelman, MD

A

Silver

Gold

Platinum TCOYD Corporate Sponsors

Ibelieve meditation is a practice that can benefit anyone. I started

meditating when I was a sophomore in college some 35 years ago. I foundthe practice to be a powerful calminginfluence. The type of meditation Ipracticed years ago was known asvipassana or insight orientedmeditation. At the time,Transcendental Meditation wasbecoming quite popular, soI took the training for thatand began practicing twotimes per day as theyinstructed. This was alsoquite calming and gave me a type of rest that is rather unique to

this practice. These were veryhelpful tools in my young

adulthood, when life was verybusy and there was not much

importance placed on living mindfully.Unfortunately, however, I fell off thecushion. One day for no good reason, I quit meditating. It was about twelve years ago at

a conference called the NationalInstitute for the Clinical Application of Behavioral Medicine that I heard JonKabat-Zinn speak about the research hehad done using a program he developedwhich incorporated MindfulnessMeditation as its central component.The program was offered to patients atMass General Hospital. These patientshad chronic pain, depression, anxiety,diabetes, migraines, and any number of other conditions which had beenresistant to conventional treatment.The results he presented were astoundingly successful.

When I got home I worked withsome other professionals to offer thesame program in our clinic. Theprogram was called the MindfulnessBased Stress Reduction and RelaxationProgram, known as the MBSR program.There are now hundreds of theseprograms around the country and can be found by looking online; just Google MBSR.

I believepeople whohave diabetescan benefitfrom this

program or other forms of meditation ina number of ways. The relaxation thatcomes from meditation is worth theeffort all by itself. We are all challengedby worry and stress. Meditation gives a ‘time-out’ from our usual challengesand offers an opportunity to practice atechnique of settling the mind and bodythrough the simple activity of focusedbreathing. After practicing meditationregularly, the attitudes of patience,acceptance, non-judging, and letting gobecome part of your daily experience.This practice helps stave off anxietyand depression. If you have lived withdiabetes for a long period of time, youmay appreciate how important theseattitudes are in living day-to-day withthe unpredictability diabetes brings. I hope you will consider givingmeditation a try as complimentarytherapy. Check out the following resource:

Full Catastrophe Living by Jon Kabat-Zinn

Joe Nelson is a licensed psychologistad certified sex therapist in GoldenValley, Minnesota. The issues of thosehe sees for psychotherapy includeadjusting to the diagnosis of diabetesas well a depression and anxiety.You can contact Joe Nelson [email protected].

A Complimentary Therapy By Joseph Nelson, MA, LPED

ITAT IO

N [ I believe people who havediabetes can benefit from thisprogram or other forms of

meditation in a number of ways.]

M8 MyTCOYD Newsletter, Vol. 31


Feeling the BurnFor most people, GERD is simply

a mild nuisance condition that leads to heartburn after large mealsor overindulging. For others, it canbe a very serious condition leading to complications such as ulcers,bleeding, and even cancer. Thestomach normally secretes acid thataides in the first stages of digestion.

Although the lining of the stomachis resistant to the damaging effects ofacid, the esophagus is not, and evensmall amounts of acid regurgitationcan injure the lining causing painand ulceration. A one-way valveknown as the lower esophagealsphincter is located between thestomach and the esophagus. It isdesigned to allow food and fluid to enter the stomach and preventbackflow into the esophagus; unfor-tunately, this valve frequentlymalfunctions and allows acid refluxto occur. The most commonsymptom that occurs is a burningfeeling in the chest called heartburn(even though there is no relationshipto the heart itself). Other symptomsmay include chest pain, regurgitationof fluid, nausea, vomiting, anddifficulty swallowing. If acid backs up all the way to the throat, then“extra-esophageal” symptoms mayoccur. These include sinus irritation,hoarseness, laryngitis, worseningasthma, and even pneumonia.Although the lining of the

stomach is resistant to the damagingeffects of acid, the esophagus is not,and even small amounts of acidregurgitation can injure the liningcausing pain and ulceration.

Hiatal HerniaMany people with GERD will

also be diagnosed with hiatal hernia.This occurs when the opening in the diaphragm through which theesophagus passes enlarges and thestomach slides upward into the chest. The “sliding” hiatal herniapredisposes the individual to acid

reflux. Unlike other hernias, hiatalhernias usually do not need to berepaired surgically.

How Do You Know?A diagnosis of GERD is often

made solely on the treatment ofsymptoms and treatment can bestarted right away. In some cases,further testing is necessary. A barium swallow or upper gastroin-testinal x-ray may be advised. Upperendoscopy is a more accurate testthat allows the physician to pass aslim tube with a digital camera onthe tip into the mouth, esophagus,stomach, and intestine (undersedation of course!). This providesthe detailed information regardingthe tissue lining these various organsand also allows biopsies to be taken.In some cases, measurement ofesophageal acid exposure over a 24-hour period may be advised.

What Can You Do?Treatment of GERD first entails

lifestyle modifications. These includeweight loss (if you are overweight),smoking cessation, avoidance ofeating 3 or more hours before goingto bed at night, and elevation of thehead of the bed 6 to 8 inches. A dietthat is low in fat and spices may bebeneficial and, of course, one shouldavoid any foods that tend toprecipitate symptoms. Control ofdiabetes is especially important ashigh blood sugars may slow down the rate at which the stomachempties, leading to worseningGERD. In addition, if diabetes is

Gastro-esophageal reflux,or GERD, is a very

common condition thataffects up to 20% of thepopulation in America. If youhave diabetes this problemmay be even more commonand more severe. Whenblood sugars are elevated anddiabetes is poorly controlled,the stomach does not emptyproperly leading to anincreased frequency of reflux,heartburn, and indigestion.

(GERD, continued on page 11 )

GERD: GASTRO-

ESOPHAGEALREFLUXDISEASE

By James Wolosin, MD

The key to sticking with anexercise program is to find an

activity you like. You do notnecessarily have to go to the gym toexercise. You can go dancing or takea dance class. You can take up oneof the many martial arts such asAikido, Karate, Tae Kwon Do or TaiChi. If an organized activity is just

not for you, find other ways to getmoving. Take the stairs instead ofthe escalator. Park at the farthestparking space in the parking lotinstead of driving around andaround looking for the one locatednearest to your destination. Do youlike to shop? Take a walk aroundthe mall. Do you like animals?

So you have diabetes andeverything is “OK.” When your

family or friends ask, you answer,“Yeah, I’m good, thanks for asking.”But is “good” good enough? Are youfooling yourself and everybody elsearound you? Many of us withdiabetes fall into this trap; it’s like acocoon of denial that we choose tolive in, protected from the invasionof interest from those around us.Active control is a better way to live with diabetes.People who intensively manage

their diabetes reduce the risks, orprevent the risks, of diabetes compli-cations. These people, much likesuccessful people anywhere, sharemany of the same traits: u Great working knowledge and

an insatiable quest for moreinformation to better manage and treat their condition.

u The optimistic belief in theirability to cope well with theircondition for the long haul.

u The ability to review data, trendsand patterns with clarity andadjust accordingly.

u The ability to honestly andeffectively communicate withthose who care about them, andwith those who can help them.

u An active lifestyle, keeping mindand body in motion.

u The willingness to exercise, whichbenefits the body and the psyche.

u Healthful eating habits. Mostpeople who are successful realizethe keys to their success are well-planned, balanced meals, andlimited over-indulgence.

u Good, sound, sleep techniques.The body needs rest, relaxationand sleep. A troubled soul cancause difficult sleep patterns andpoor rest can lead to lower self-esteem and a lack of attention todetail.

My wife is a nurse and I sometimesthink she knows a little too much

about diabetes. But, without her inmy life, I realize that I would not beas healthy and safe as I am today. Inthe past, I would sit in my cocoonand tell her, “I am fine; don’t worryabout me; I just checked myself andI’m 118” (lie). Why did I act thisway? The less I tell people, the less Ihave to face what I know is not thebest for me. I can continue to goforward without clarity and accept alevel of care and a quality of life thatis not healthy, safe, or best for mybody, mind and soul.Today, with a greater knowledge

of where I am and what I need to do to survive, stay healthy, and live a great life with diabetes, I amconfident in my approach to achievea higher quality of life. Take eachday and work to make improve-ments. Follow the lead of otherswith a proven path to success. Lookclosely at yourself and choose abetter path. Take the active steps to change and move forward to thegood life with diabetes. Love yourselfand respect those around you whocare about you.

Diabetes in Motion:Step Forward and Move Ahead!

Exercise Isn’t Just For The Gym

Bill King has been living with type 1 diabetessince October, 1984. Bill works with AnimasCorporation, is a board member of the DiabetesExercise and Sports Association (DESA), andtravels the country motivating people to keepactive in the balance of life with diabetes.

By Bill King


Volunteer to walk the dogs at yourlocal SPCA or animal shelter. Areyou just too busy or just don’t feellike leaving the house? Put on somelively music and dance while youcook dinner or vacuum the house.Do push-ups, sit-ups, leg-lifts or walkin place during the commercials ofyour favorite show. Get creative.Have fun. Make yourself a priority.Get moving. Feel better!


GERD (continued from page 9)

poorly controlled for many years,intestinal nerve damage can occur,leading to worsening problems with stomach emptying as well as abnormal movement of theesophagus itself.Numerous medications are

available for the treatment ofGERD. Antacids, such as Maalox,Mylanta, Tums and Gaviscon, mayprovide relief for mild heartburn. H2 blockers are a group ofmedicines that decrease acid outputfrom the stomach and are effectivefor treatment of mild GERD. Theseare available over the counter andby prescription. H2 blockers includeTagamet, Zantac, Pepcid, and Axid.Proton pump inhibitors, or PPI’s, are

a stronger group of medicines thatsuppress stomach acid secretion to a greater degree and are moreeffective in healing ulcerations of the esophagus associated withGERD. These include Prilosec (now available over the counter at a very reasonable price), Prevacid,Aciphex, Protonix, Nexium, andZegrid. All of these medications are safe to take long term. For thosepatients who do not do well withmedications, an effective surgicalprocedure called fundal plicationmay be considered. Minimallyinvasive endoscopic procedures are available to stop GERD, buttheir long-term effectiveness isuncertain and many consider these

to still be experimental.GERD is a very common

and treatable condition with thepotential for serious complications if undiagnosed and untreated. It isespecially important to control yourblood sugar well because high bloodglucose may have a negative impacton GERD over both the short andlong term. It is important to speakwith your physician if you arehaving persistent symptoms.

James Wolosin, MD, is a practicing gastroen-terologist at the Sharp Reese-Stealy MedicalGroup in San Diego, CA. He is activelyinvolved with clinical research and thedevelopment of new medications for thetreatment of intestinal problems.

Is it worthwhile to search for a physical activity thatyou enjoy? You bet it is. Regular exercise offers analmost endless list of physical and emotional benefits:u Improves blood sugar controlu Helps you meet your weight goalsu Lowers your risk for heart diseaseu Strengthens your bones, heart and cardiovascular systemu Improves strength, flexibility, and enduranceu Improves circulation and flexibilityu Improves your sleepu Heightens self-esteemu Reduces feelings of depression, stress and anxietyu Helps you feel relaxed, fit and healthy

Conference 2010 Sat. May 22, 5pm – Sun. May 23, 5pm

Marriott Center City, Raleigh, NCSat. May 22 ◆ 9am - 5pm ◆ Raleigh Convention Center, Raleigh, NC

DIABETESTAKING CONTROL OF YOUR

CONFERENCE & HEALTH FAIR

NonprofitOrganizationU.S. PostageP A I DSan Diego, CAPermit No 1

TCOYD Conferences & Health Fairs 2010 Schedule

February 6 Augusta, Georgia February 27 Sacramento, California March 20 Kalispell, Montana April 24 Honolulu, Hawaii April 25 Kauai, Hawaii May 8 New Orleans, Louisiana May 22 Raleigh, North CarolinaSeptember 11 Providence, Rhode IslandSeptember 25 Des Moines, Iowa October 30 San Diego, California TBA Native American Program

Taking Control Of Your Diabetes1110 Camino Del Mar, Suite “B”Del Mar, CA 92014 | www.tcoyd.org

Tel: (800) 998-2693 (858) 755-5683 Fax: (858) 755-6854

®


TCOYD is a not-for-profit 501(c)3charitable educational organization.

Philanthropy has enabled TakingControl Of Your Diabetes to meet

the needs of the growing population ofpeople with diabetes for 15 years. Thanksto people like you, our not-for-profitorganization has grown from its first yearof hosting just one TCOYD educationalconference for people with diabetes andtheir loved ones, to 111 conferences heldnationwide with more than 150,000people attending.

Your support helps to further ourefforts by allowing TCOYD to offerconferences at a reduced rate, far belowthe actual cost of $175.00 per attendee.

Through your generosity we have been able to expand our outreach to theLatino community, a population severelyimpacted by diabetes, and offered in

Spanish at locations selective to thispopulation. Additionally, TCOYD’stelevision and radio programs open up aworld of diabetes education to thousandswho never have the opportunity toattend a Taking Control conference.

Since 2006 we have been able tosupport the increased demand for ourunique education programs for healthcareprofessionals, hence providing the latestdiabetes information to doctors andnurses who in turn assist the patient with knowledge of how to better care for themselves.

Without your support, TCOYD would not be able to continue ouroutreach to the diabetes community.Your commitment is important to us and I consider your personal involvement

the lifeblood of Taking Control Of YourDiabetes—thank you!

TCOYD is pleased toannounce that Roz Hodginshas joined our staff asDirector of Development. Roz is well acquainted withTCOYD, and the world ofdiabetes, as she served as Director ofDevelopment at The Whittier Institute forDiabetes at ScrippsHealth from 1996-2002.Most recently she was Director of Major Giftsand Foundation/ Corporate Relations at TheScripps Research Institute. Roz will bring apersonal touch to the fundraising experience bycreating relationships with our donors, helpingthem understand that their contributions andsupport are the lifeblood of making a difference in those people seeking to take control of theirdiabetes.

To learn more about giving, please contact: Roz Hodgins TCOYD Director of Development1110 Camino Del Mar Del Mar, CA 92014 (858) 792-4741 Ext. 20or toll free: 1-800-998-2693email: [email protected]

Where Would TCOYD BeWithout Philanthropy?

By Roz Hodgins

Documents

2010 Winter Vol 31