2014 Winter Newsletter

NEWSLETTERMY

Do you have type 2 diabetes? If so, let me tell you one thing: you have never had more tools in your toolbox! There are now nine different classes of oral medications to help treat type 2 diabetes. The newest medications in the oral class are called SGLT-2 inhibitors (Invokana and Farxiga). These agents are once a day medications that are effective at not only lowering glucose and A1c levels, but they also help you to lose weight. 2014 will be a year when you will learn about the best

combinations of these oral medications, some of which will be combined in the same pill with the benefit of only one copay!

More insulin pumps and newer, more effective insulin formulations will be introduced that are specifically designed for people with type 2 diabetes. Lastly, there will be progress on what I feel is one of the most important classes of medications for people with type 2 diabetes, the GLP-1 receptor agonists,

Winter 2014 Volume 46

2014 Is Going To Be A Great Year (continued on page 2)

Dr. Edelman’s Corner

Hello PWD (people with diabetes) and welcome to 2014. I have a very strong feeling that it will be a great year for all of us living with

diabetes! There is no question that there has never been a better time to have diabetes.

There Has Never Been A Better Time To Have Diabetes: 2014 Is Going To Be A Great Year!

INSIDE

Join Our Online Research RegistryPage 3

Dietary Supplements and Diabetes Page 4

Getting Back in Control Page 6

Cold Weather Recipe Page 7

Keep Your Smile Page 8

Question of the Month Page 9

Living Well - FitBit Page 10

Know Your NumbersWeR1Page 11

Diabetes MED TalkPage 12

also called incretins. Victoza, Byetta, and Bydureon are the currently available incretins. These are injectable agents, however, several companies are working on longer-acting formulations with better delivery devices. Bydureon is already given only one time each week, but there will be once a month formulations and, potentially, a once a YEAR application! This class of agents is the most potent in terms of lowering the blood glucose levels, as well as leading to significant weight loss. They also work well with the oral medications and insulin. In fact, one of the developments that looks very promising is the combination of basal insulin plus one of the above incretin agents mixed together in the same pen.

Do you have type 1 diabetes? If so, let me tell you that smarter glucose meters are on the horizon. Glucose meters will eventually be able to help you calculate insulin doses based on the individual information you input (insulin sensitivity factor or correction factor and insulin to carbohydrate ratio). In addition, your glucose meter will be able to learn and remember experiences you’ve had in the past, which will help make insulin dosing and blood glucose management much easier and automatic. Type 1’s can also look forward to smaller and more precise insulin pumps that have dual chambers, one for insulin and one for glucagon, with connectivity to a CGM device. CGM devices will get even more accurate and, hopefully, will be able to display blood glucose data on your cell phone.

2 My TCOYD Newsletter, Vol. 46

Board of DirectorsSteven V. Edelman, MD Founder and Director, TCOYD

Sandra Bourdette Co-Founder and Executive Director, TCOYD

Edward BebermanChristine BeebeAudrey FinkelsteinS. Wayne KayMargery PerryDaniel Spinazzola

Contributing AuthorsJanice Baker, MBA, RD, CDE Jennifer BraidwoodSteven Edelman, MDCandis M. Morello, PharmD, CDEWilliam Polonsky, PhDAndrew Valine, 2nd Year Student, PharmLarry Verity, PhD, FACSM

TCOYD TeamSteven V. Edelman, MD Founder and Director

Sandra Bourdette Co-Founder and Executive Director

Jill Yapo Director of Operations

Michelle Day Director, Meeting Services

Michelle K. Feinstein, CPA Director of Finance and Administration

Jennifer Braidwood Manager, Outreach and Continuing Medical Education

David Snyder Manager, Exhibit Services

Robyn SemberaAssociate Manager, CME and Outreach

MyTCOYD NewsletterEditor: Jennifer BraidwoodAssistant Editor: Robyn Sembera Design: Hamilton Blake Associates, Inc.

MyTCOYD Newsletter is offered as a paid subscription of Taking Control Of Your Dia-betes. All material is reviewed by a medical advisory board. The information offered is not intended to constitute medical advice or function as a substitute for the services of a personal physician. On the contrary, in all matters involving your health, TCOYD urges you to consult your caregiver. ©2014 All rights reserved.

2014 Is Going To Be A Great Year (continued from page 1)

SpecialAcknowledgements

Steven Edelman, MDFounder and DirectorTaking Control Of Your Diabetes

This data will then be stored on a cloud server where it can be analyzed for trends and patterns.

All of these advances will help drive the development of the artificial or bionic pancreas, which is advancing at a very fast pace. Think of going about your day, doing anything you want, including eating anything you want, at any time! The trio of a pump, CGM and computer algorithms will keep your blood sugar in a narrow range without your input, or better yet, without you having to think about your diabetes at all. Amazing! It is not a cure but a darn good substitute until a cure comes along.

Lastly, those of us with type 1 will start to see more research and clinical experience with other therapies for type 1 diabetes that were originally developed for type 2 diabetes, including drugs like Victoza and Bydureon (GLP-1 agonists), as well as the newest class of oral medication SGLT-2. Both of these classes help to lower glucose levels, reduce fluctuations and help with weight loss. It took over 90 years to come up with something other than insulin to help type 1’s!

From all of us at TCOYD, we wish you a very healthy, happy and productive 2014! Remember that you are your own best advocate. Be smart

and be persistent. There truly has never been a better time to have diabetes.

Taking Control Of Your Diabetes 3

TCOYD in Motion

The TCOYD Research Registry is the newest way to get involved

in the ever-evolving world of diabetes care! Not only are you playing a personal role in assisting with the advancement of diabetes management strategies, you could also be compensated for your time and effort.

Here’s how: When you join the registry, you will be asked a little bit of information about yourself (like your name, gender, type of diabetes you have, and the medications you are taking). Then you will be contacted about potentially interesting online diabetes studies as they arise. You are not committing to anything by joining the registry; you are just giving TCOYD permission to inform you about studies that you might find interesting. Most studies will have an enticing incentive that will properly compensate you for your dedicated time and effort.

All of TCOYD’s diabetes research studies are being developed in collaboration with the Behavioral Diabetes Institute in San Diego, which is also a not-for-profit organization. These studies focus primarily on behavioral management and the psychosocial side of living

with diabetes. Most of these studies include web-based, online surveys and telephone interviews, and do not focus on medical management. By participating in one or more of these future studies, you will be assisting TCOYD in the process of discovering new information that may be valuable to many other individuals with diabetes. Additionally, the information gathered will be published in professional journals and shared with other healthcare providers at professional meetings. Registry members will not be identified in any way in these papers and none of the information collected will be used for commercial purposes.

To learn more about the registry and sign up, log on at tcoydresearchregistry.com. Registry information is confidential and

will not be shared or sold to any third party. Remember, signing up only means that you are giving TCOYD permission to inform you about future studies that may be of interest to you. YOU decide which projects, if any, you might like to participate in when an invitation arrives. Also, you can expect only a few invitations each year, so you won’t be receiving lots and lots of emails and you can withdraw from the registry at any time.

So please log on to our registry site at tcoydresearchregistry.com and learn more. We hope that you will consider playing a part in another big step toward better care and management strategies for people with diabetes.

Join Our Online Research Registry

Join the TCOYD Research Registry today by visiting

www.tcoydresearchregistry.com and answering a few

simple questions.

By William Polonsky, PhD


4 My TCOYD Newsletter, Vol.334 My TCOYD Newsletter, Vol. 46

When it comes to controlling diabetes, the most important

remedies are eating healthy, being involved in physical exercise, monitoring blood glucose, and the proper use of FDA approved medications. Over the past decade, a few studies have evaluated how dietary supplements affect people with diabetes. But what exactly are dietary supplements? Dietary supplements are substances such as vitamins, minerals, herbal products, and other nutrients that are used to complement the diet. They aren’t considered “drugs” by the regulatory agencies. However, just because they aren’t labeled as “drugs” doesn’t mean they can’t have significant affects on your body, both good and bad. Since they aren’t stringently regulated like FDA approved medications, the dietary supplement business has boomed and is now over a $100 billion dollar market. It is important to remember that there are many supplements on the market today that have no medicinal benefits and, in certain circumstances, can cause some harmful effects.

If you have diabetes and you are considering adding a dietary supplement to your current medication regimen, it’s important to ask yourself two questions:

“How can dietary supplements affect my treatment?” and “Are they worth using?”

Omega-3 Fatty AcidsOne of the most popular

supplements is the omega-3 fatty acids. These fatty acids cannot be made by our bodies, but are found in fish and certain plants. Besides supplements, adequate amounts of omega-3’s can be found in two servings of fatty fish, such as salmon or mackerel. Vegetable sources include walnuts, flax seed, avocado, and olive oil. The American Heart Association claims that up to three grams of fish oil per day can significantly reduce the risk of a cardiovascular disease event (like a heart attack). This occurs because omega-3’s can help lower triglycerides up to 40%, decrease platelet aggregation, and slow atherosclerosis (arterial wall thickening) in as little as two months. They may also help with dry skin, depression, rheumatoid arthritis, and many other conditions. Mild side effects from these supplements could include fishy taste or breath, nausea, or upset stomach. They may also increase the risk of excessive bleeding if taking more than three grams per day.

Omega-3 fatty acids are considered safe and could help with the cardiovascular risks often associated with diabetes, without affecting blood glucose or insulin sensitivity. Be sure to discuss your cholesterol levels and overall risk for heart disease with your caregiver before deciding to use this supplement.

Vitamin D

Vitamin D is a fat-soluble vitamin associated with calcium regulation. The body absorbs Vitamin D from the sun, but advanced age, sunscreen use, or darker skin may hinder the amount of Vitamin D absorbed by the body. Vitamin D deficiency can be associated with insulin resistance, hyperglycemia, high blood pressure and obesity. This may be due to Vitamin D’s involvement with insulin production and sensitivity. Potential side effects from taking Vitamin D supplements may include nausea, vomiting, and diarrhea, however, these are uncommon. Be sure to talk with your doctor about assessing your Vitamin D levels. He or she can order a simple blood test along with your usual labs, to determine if your Vitamin D level is low and supplementation is necessary.

Dietary Supplements And Diabetes: Are They Worth It?

If you have diabetes and you are considering adding a dietary

supplement to your current medication regimen, it’s important

to ask yourself two questions, “How can dietary supplements

affect my treatment?” and “Are they worth using?”

By Candis M. Morello, PharmD, CDE, FASHP and Andrew Valine, 2nd Year Student Pharm.

Dietary Supplements And Diabetes: Are They Worth It?


Dietary Fiber Dietary fiber is indigestible

food parts from plants and is associated with lowering glucose levels, increasing insulin sensitivity, and preventing type 2 diabetes. Dietary fiber lowers the glycemic index of food. In other words, it slows the glucose absorption of other ingested food. In theory, this slower absorption could lead to lower postprandial (after meal) blood glucose and lower A1c concentrations. A popular fiber supplement is psyllium husk, a natural seed that contains fiber. Fiber can also be found in whole grains, nuts, legumes, fruits, and certain vegetables. The average person only gets half of the recommended daily amount of 20-35 grams. Possible side effects include gas, bloating, constipation, and upset stomach. Increasing fiber by small amounts (about five grams more per day) and slowly getting to 20-35 grams each day should help reduce any negative effects. If you do decide to add fiber supplements, take other medications, including warfarin and digoxin, an hour before or two hours after a fiber supplement to avoid decreased absorption of these drugs. Adding fiber to the diet is beneficial for regular bowel movements and some studies suggest that fiber may help to prevent colon cancer.

Alpha Lipoic Acid ALA is an antioxidant, that

helps prevent cell damage in the body. ALA may also have a modest effect on peripheral neuropathy

pain (nerve pain associated with diabetes). Neuropathy pain theoretically occurs when blood glucose levels are uncontrolled for many years. Those uncontrolled glucose levels eventually produce harmful free radicals, causing cell damage. ALA has the potential to neutralize these free radicals. Studies suggest 600 mg of ALA per day could reduce neuropathy pain up to 50% in as little as three to six weeks. Dietary sources include spinach, broccoli, and potatoes. However, these only contain very small amounts of ALA. Supplement side effects may include upset stomach, headache, and skin rash. These are more likely to happen at doses greater than 600 mg. The bottom line is, this supplement may be useful for helping neuropathy pain associated with diabetes, but it has not had a major impact in this area. It is important to discuss the use of FDA approved medications for neuropathy, as well as supplements such as ALA, with your caregiver before taking anything that is sold over the counter.

ChromiumChromium is an essential trace

element for metabolism, meaning the body needs a small amount to properly digest and utilize food. Although studies have related Chromium supplementation with decreased blood glucose, its effectiveness remains inconclusive. In addition to supplements, Chromium can also be found in meats, broccoli, teas, and whole-

wheat foods. Possible side effects include headache, skin irritation, sleep problems, stomach upset, and mood changes. Don’t take Chromium supplements if you have liver or kidney damage and be aware chromium may cause hypoglycemic events if taken with diabetic medications. The evidence for Chromium is very limited for diabetes. There are many studies that conclude there are no beneficial effects of a Chromium supplement.

ConclusionYou need to be smart about

dietary supplements and be an informed consumer. Be knowledgeable about what you are buying at the vitamin store and consider the source of information. Ask yourself, “Did the supplement company do their own research or was it conducted by an objective independent research group?” Do not accept anecdotal information from your friend or the person working at the herbal remedy store. If you plan on taking supplements, investigate them thoroughly and discuss them with your caregiver. Most importantly, never substitute them for your prescribed medications unless clearly indicated by your doctor.

Submitted by Candis M. Morello, Pharm D, CDE, Associate Professor of Clinical Pharmacy at UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, Clinical Pharmacist at VASDHS.

Andrew Valine, 2nd Year Student Pharmacist at UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.

Ask Your Pharmacist


Two years ago, Ronald Kelly, a type 1 diabetic since the age

of seven, had begun to realize he had a major problem. An active sports enthusiast since childhood, Ronald always loved exercise but had begun having severe low blood sugar incidents after long periods of riding his stationary bike. “When I first started riding it was happening twice a week. Over time, the incidents weren’t as frequent but I was still having them. I would check my blood sugar often but I would be sitting in my La-Z-Boy® with my feet up and then the next thing you know, I was unconscious,” Ronald said.

Hypoglycemia unawareness is a condition in which a person with diabetes doesn’t experience the typical warning signs of hypoglycemia. Usually, when a person’s blood glucose drops, the body will attempt to raise it by releasing the hormones glucagon and epinephrine. Glucagon spurs the liver to release stored glucose into the bloodstream. Epinephrine signals the liver to produce more glucose and also causes the typical early

warning signs of hypoglycemia— sweatiness, shakiness and weakness. Ronald Kelly, like many others who experience hypoglycemia unawareness, skips these warning symptoms entirely and can easily lapse into severe hypoglycemia, becoming confused, disoriented or unconscious. “I would be at work and call the house and he wouldn’t answer and I would worry. Some days I would get home from work and he would be unconscious and I would have to revive him or call the paramedics,” said Sandra Kelly, Ronald’s wife. “I started to think it was only a matter of time before I would come home one day and he would be dead. One year, the paramedics had to come to our home ten different times.”

“It was the year 1997; I was watching some endocrinologist on TBS talk about diabetes care and management. I didn’t have an

endocrinologist at the time and there was something about this doctor that just stuck with me, so, I called his office, made an appointment to see him and he’s been my doctor ever since.” What Ronald didn’t know at the time was that his new endocrinologist, Dr. Steven Edelman, and his non-profit organization, TCOYD, would be able to offer Ronald something that would save his life years later when his hypoglycemia unawareness started getting out of control.

“About a year ago I had an appointment with Dr. Edelman and he had me feel this little transmitter thing on his stomach and I was like, ‘What the heck is that?’ He told me it was a CGM, or continuous glucose monitor. I didn’t think it would

TCOYD’s CGM Assistance Program

By Jennifer Braidwood

“I would be at work and call the house and he wouldn’t answer and I would worry. Some days I would get home from work and he would be unconscious and I

would have to revive him or call the paramedics.”

Giving Back


Fit To Eat

help me with my hypoglycemia unawareness because it doesn’t talk.” Ronald had begun to lose his vision at the age of 24 due to glaucoma and, by 1998, had completely lost sight in his left eye. With his right eye, he can still see movement and light; he can see the clock on the microwave, but not much of anything else. “Dr. Edelman said to me, ‘This is it, Ronnie. Even though this thing doesn’t talk, it is going to help you.’ He was the one who really pushed for me to get a CGM. I expressed my concern about the price and that I didn’t think I could afford it, but Dr. Edelman told me that his non-profit organization, TCOYD, had a CGM grant in place and could give CGM’s to individuals who really need it but had financial difficulties obtaining one.”

Within the last year, Ronald’s life has completely changed. His wife no longer worries about him when she’s at work. The paramedics have yet to be called and he hasn’t had one single incident of hypoglycemia unawareness since he got his new continuous glucose monitor. “It’s been such a great help in letting me know that my blood sugar is starting to fall. Once I hear that tone and feel the vibration, I check my blood sugar on my Prodigy and it tells me aloud what my number is. TCOYD has been so awesome, and I can’t thank them enough for everything they have done for me.”

With the holidays behind us, we’re still dealing with cooler weather and indoor cooking. It never hurts to have more ideas for healthful,

convenient dishes for the busy workweek, as well as weekend activities!This recipe is versatile enough to please everyone and is full of heart

healthy vegetables, flavorful spices, fiber and lean protein. The chili can also be made in large quantities and frozen into single or larger serving containers to take to work or have on hand for a day when you don’t feel like cooking. Pair this up with a green salad and whole grain bread for a satisfying and easy meal.

By Janice Baker, RD, CDE

1 1/3 lb lean ground turkey1 tablespoon olive oil½ teaspoon ground cinnamon1 tablespoon ground cumin1 tablespoon chili powder½ teaspoon ground black pepper1 small onion, finely chopped (vegetables and garlic can be chopped in food processor)4 cloves garlic, minced (easy tip - use jarred minced garlic)

In large heavy bottom pot, brown turkey with olive oil, add cinnamon, cumin, chili powder, and pepper and cook for an additional 3 minutes. Add onions, garlic, red bell pepper, and water, allow to cook on medium heat until everything starts to soften (about 5 minutes). Stir in tomato paste, allow to cook for 2-3 minutes then add bay leaves, salt, and 3 cups of broth, bring to a boil, reduce to simmer, partially covered (lid ajar), for 1½-2 hours, until reduced to a thick consistency. Lastly, add kidney beans and remaining ½ cup of stock and heat thoroughly. Remove bay leaves before serving.

1 small red bell pepper, finely chopped2 tablespoons water4 oz tomato paste2 bay leaves½ teaspoon salt (optional)3 1/2 cups low sodium chicken stock/broth1 15oz can, drained kidney beans, rinsedGarnish: Top each bowl of chili with a sprinkle of green onions and 2 teaspoons low fat cheese or non-fat sour cream.

Turkey Chili (makes 8 cups) 4 servings 2 cups per serving(recipe can be doubled for larger quantities)

Per Serving: Calories: 387 • Carbohydrates: 23g • Total Fat: 18g Saturated Fat: 4g Cholesterol: 117mg • Fiber: 6g • Protein: 36g • Sodium: 628mg • Carb Choices: 1.5

experts believe the connection between diabetes and oral health is a two-way street; diabetes makes mouth problems more likely and, in turn, serious gum disease can make managing diabetes more difficult.

Warning SignsHow can you tell if you have a

problem? If your gums are red, sore, bleeding, or swollen, you might have gum disease. Gums that seem to have pulled away from the teeth, loose teeth, persistent bad breath, an irregular bite, and dentures that don’t fit well are other signs. Karimbux warns that symptoms can seem minor. “You may notice a little bleeding, your teeth may be a little loose—but many people are often surprised to learn that these are signs of gum disease,” he says. In fact, it’s not uncommon for the dentist to be the first healthcare provider to diagnose diabetes, especially in people who don’t have other risk factors for gum disease. Researchers at Columbia University College of Dental Medicine in New York City were able to identify people with undiagnosed diabetes who were unaware of their condition. In the study, published in the

Diabetes can affect your body from head to toe—including your mouth. By simply having diabetes your risk for dental problems

is more likely, but that risk is much greater if you have uncontrolled blood glucose and if you smoke, says Rita Kalyani, M.D., an assistant professor in the endocrinology division at Johns Hopkins University in Baltimore. You can prevent complications by knowing the risks and practicing prevention—every day. “I tell people that if they take good care of their teeth and gums, come in for regular cleanings, and do their best to control their diabetes, they can avoid serious problems,” says Nadeem Karimbux, D.M.D., associate professor and assistant dean for dental education at Harvard School of Dental Medicine in Boston.


Taking Control

The ConnectionBlood glucose affects your saliva;

if blood glucose is too high, bacteria can thrive in your saliva. Over time, the bacteria can erode protective tooth enamel, leading to tooth decay. In addition, the bacteria can make you prone to thrush (a fungal infection of the mouth and tongue), chronic bad breath, and gum disease. Uncontrolled blood glucose also makes mouth infections more difficult to heal. “Smoking increases all of these effects,” Karimbux says. Smokers over age 45 with poorly controlled blood glucose levels are almost five times more likely to have severe gum disease than people without diabetes, according to the

National Institute of Diabetes and Digestive and Kidney Diseases. Smoking also appears to restrict blood flow to the gums, which hampers healing gums if they become infected. If left untreated, gum disease can lead to tooth and bone loss—making it tough to chew and to eat a healthful diet. Many

This article is provided by Diabetic Living Magazine

Smokers over age 45 with poorly controlled blood glucose levels

are almost five times more likely to have severe gum disease than

people without diabetes, according to the National Institute of Diabetes and Digestive and

Kidney Diseases.

July 2011 Journal of Dental Research, they examined 530 at-risk people and correctly identified prediabetes and diabetes by the number of missing teeth and percentage of deep periodontal pockets. (Patients were officially diagnosed later with a fasting blood glucose test).

Next StepsThe simplest strategies to

prevent problems are already familiar; brush after every meal with a soft toothbrush and floss twice a day. By removing bacteria, you lower your risk of serious gum issues. Also, if you have dry mouth—a common condition for people with diabetes—ask your dentist about over-the-counter rinses and toothpastes and drink plenty of water.

By Steven Edelman, MD


Iam a 58-year-old woman and I was just diagnosed with type 2 diabetes. I have been worried sick about how it will affect

my life in terms of health and longevity. My grandmother died of diabetes at a young age after she had an amputation and a heart attack. My doctor also discovered my blood pressure was too high and my cholesterol levels were not in a healthy range. I am now on several new medications. I have started to change my diet and I am now exercising a few times a week. I’m scared I’m going to die soon. How many good years do you think I have left?

Answer: It turns out for people like you, getting diagnosed with type 2 diabetes probably saved your life and will ultimately lengthen your life!

Think of it like this; by getting diagnosed with diabetes, you will not only start to eat better and exercise more, but now your abnormal blood pressure and cholesterol levels are being addressed. These are very serious conditions that if left undiagnosed and untreated, will lead to heart attacks, strokes and other complications like blindness, kidney failure and amputations. There is really only good news here. If you were not diagnosed with diabetes, not only would your life style not be very healthful, but you would also be walking around with elevated blood pressure and cholesterol levels, which typically have no symptoms. Getting diagnosed with diabetes may have seriously saved your life.

A special thanks to all of our Facebook fans who sent in questions for Dr. Edelman!

Question of the Month

Get tips on how to thrive with diabetes and delicious diabetes friendly recipes at DiabeticLivingOnline.com

Next issue of Diabetic Living goes on sale February 11, 2014

like MyFitnessPal and SparkPeople and can be a way to have greater communication with friends. Lastly, with this FitBit tracking device, you can link to “Everymove.org” and potentially get more out of your tracking device!

There are several different types of FitBit devices available today, including: FitBit Zip Activity Tracker, FitBit One, FitBit Flex, and the FitBit Force. Each of these FitBit devices is somewhat different. However, all of them offer an opportunity for the user to be fully engaged in a more healthy lifestyle.

Specific information on FitBit devices can be found on their website [http://www.fitbit.com]. For people with diabetes, we know

By Larry S. Verity, PhD, FACSM

Anyone with diabetes knows that monitoring your blood glucose

levels is only one of the many facets of good control. It’s also incredibly important to stay on top of your overall health, which includes establishing and maintaining a good diet and exercise regimen.

One of the newest technology crazes to have reached the market that will help get your diet and exercise regimen on track in the New Year is called FitBit. FitBit is much more than a pedometer — it’s sometimes referred to as “a pedometer on steroids.” You might be asking yourself, what is this “FitBit” thing and why is it so good? Well, FitBit uses advanced accelerometer technology (calculating movement in 3-D) that allows users to count steps, stairs, and track exercise times. FitBit can also monitor how long you have slept and how often you woke up during night.

FitBit users have the ability to sync their device to a smartphone (iPhone or Android), as well as to a PC or Mac computer, both

of which allow the user to access mobile and online tools. Whether using a smartphone or computer, users are able to view a free online “dashboard” (visual display of all information uploaded) and obtain an overall snapshot of all accomplishments—daily exercise performed and physical activities, as well as food consumed. FitBit devices also provide feedback and motivational comments to help users track their daily progress. The FitBit device can help individuals track more information about their health beyond step counting and distance traveled, including heart rate, blood pressure, AND blood glucose throughout the day. As a matter of fact, those with diabetes have the ability to record their A1c (%). Along with journal-keeping, monitoring of body weight, and goal-setting, the FitBit device has significant advantages over just monitoring step counts with a pedometer! The FitBit device has a “social media” element to it, too! Through tracking calorie intake, the FitBit can be synced with apps


Living Well

A New “Gizmo” For People With Diabetes

Taking Control Of Your Diabetes Is Generously Supported By:

Platinum Corporate Sponsors

Silver Corporate Sponsors

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Platinum Foundation Support

By Steven Edelman, MD


Know Your Numbers

George is a 46-year-old man with a history of being overweight, along with high blood pressure and abnormal cholesterol levels. His mother, brother,

sister, and two paternal uncles have type 2 diabetes. He came to my office to ask what he can do to prevent diabetes.

I gave George a loaner glucose meter so he could track his blood glucose levels. I asked him to test occasionally during the following week before breakfast and a few hours after dinner. George made an appointment to see me one week later. The results of his logbook are below.

As you can see, his before-breakfast numbers range from 98 to 123 mg/dL. The official ranges for fasting blood glucose levels (before food in the morning) are less than 100 for your typical individual without diabetes and over 126 for people with diabetes. If your blood glucose values are over 100 but below 126, you may have what we call pre-diabetes.

George’s after-meal values go as high as 198 mg/dL. The post-meal glucose values for people who do not have diabetes are less than 140; however, people who have diabetes typically have after-meal values of 200 and higher. Again, George’s values are very close to those of someone who has diabetes.

What it comes down to is George’s values are not normal, but neither are they within the diabetes range. He clearly has pre-diabetes. I recommended a good dietitian and exercise physiologist to slowly begin practical lifestyle changes that will help him avoid developing full-blown diabetes.

After we see how his blood glucose does with lifestyle modifications, I will make sure George is aware of medication options and see if he wants to be aggressive about attempting to prevent diabetes. The bottom line is that each person at risk needs to be dealt with on an individual basis.

Be sure to check out TCOYD’s newest exciting initiative

called WeR1, an online platform that will allow professionals with type 1 diabetes to connect. Sign up today at www.wer1diabetes.org and learn more about this exciting new collaborative in the next edition of our newsletter.

A Place Where Diabetes Professionals With Type 1 Can Connect

the monitoring of daily physical activity and caloric intake are important. Through the use of a FitBit device, you can monitor and track trends over days, weeks, and months to get a better understanding of how you are doing when it comes to reaching your goals.

Start off the New Year with a FitBit and get moving!

Submitted by Larry S. Verity, PhD, FACSM, Associate Dean of Academic Affairs College of Health and Human Services San Diego State University

NonprofitOrganizationU.S. Postage

PAIDSan Diego, CAPermit No 1

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

Stay connected to TCOYD, visit www.tcoyd.org

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 Conferences & Health Fairs 2014 Schedule

February8 NativeAmerican, Pala,California March8 Sacramento,California April12 Honolulu,Hawaii May17 Raleigh,NorthCarolina June7 Washington,DC September6 Missoula,Montana September27 DesMoines,Iowa October18 Amarillo,Texas November8 SanDiego,California


Do you want more of Dr. Edelman? If so, be sure to check out the

new online radio and podcast channel called Diabetes MedTalk. This new series is a weekly ten-minute talk-show hosted by Dr. Steven Edelman. Each week, Dr. Edelman will engage key opinion leaders, educators, primary care physicians and other specialists in practical discussions on the latest areas of diabetes care.

With Dr. Edelman’s blend of

smarts, humor, and experience living with diabetes himself, you will certainly gain valuable insights and enjoy a rich and engaging discussion every week. Best of all, the channel is free with registration and accessible on all digital platforms: web, mobile and tablets, anytime, anywhere!

What makes Diabetes MedTalk so great is that you can personally listen to Dr. Edelman have

important discussions with his peers and learn their tips and tricks about the most cutting-edge diabetes care and management strategies. While Diabetes MedTalk is geared more towards the medical professional, it is certainly available to anyone who wants to engage and learn more about the conversations going on in the medical community. If you are a medical professional, you can also submit questions to be answered and discussed on-air, as well as participate during the show by adding in your own comments and opinions.

We hope that you will take a moment to listen and engage with this new series. Register now at www.diabetesmedtalk.com.

Documents

2014 Winter Newsletter