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EMPOWER.2011.SUMMER

In This Issue:Checking in with Diabetes Care 1News You Can Use 1Insulin & CGM Use Improves HbA1C 2 Fact or Fiction 2 Do I Use Food to Cope? 3Counting Carbohydrates 3Lifestyle Works 4Nutritious and Delicious 4Diabetes National Events 5Health Links 6Letter From the President 7

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We provide same day delivery that meets your needs – our strong commitment to high quality care is supported by our accreditation from The Joint Commission for both durable medical equipment and respiratory services.Christopher and JustinShipping and Delivery Team

Summer 2011, Volume XXIV

©2011 Robin Pedersen, BLN Employee

See Page 4 To read more about “Lifestyle Works”

Summer brings with it relaxation, more outdoor activities and travel

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How can you make the most of your visit to your diabetes doctor?

Bring completed glucose journal

Bring results of your last eye exam

Be prepared to discuss any changes that occurred in how your feet look

Tell your doctor about any new symptoms since your last visit

Be prepared with a list of your medications you currently take, other doctor’s visits, etc. This enables your doctor to make an informed decision about how and if to change your diabetes plan of care.

Ask what are the results of your last tests & exams, such as your hemoglobin A1c, cholesterol (LDL and HDL), and triglyceride levels and write them down. This enables you to see trends and make adjustments with your diabetes care provider to your diabetes care plan.

Ask if you are up to date on all of your immunizations (such as flu and hepatitis)

Whether you’ve had diabetes for 2 years or 20, it’s a good idea to regularly perform self check activities to make sure that you’re still on track with your diabetes care. Successful diabetes care involves a series of daily activities that puts you in charge of your health for a lifetime. The 7 Self-Care Behaviors™ are recommended by diabetes health care professionals and supported by research to help individuals with diabetes who follow them stay healthy everyday.

In this issue, we review one of the 7 Self-Care Behaviors which is ways to eat healthfully for a lifetime. This does not mean going on a diet or even following instructions on a sheet of paper. Developing healthy eating habits is an evolving process that takes time with life long benefits.

There is no such thing as “good” food and “bad” food. It is more important to understand and practice the following concepts until they become habit:

Portion control

Eat small meals regularly throughout the day

Balanced meals means carbohydrates, proteins and fats are balanced

Selecting foods high in dietary fiber like fresh vegetables, whole grain breads, rice and pasta and beans and legumes will help your weight and blood glucose readings

Mindful eating involves focusing on the activity of eating

Following your hunger and satiety cues so that you eat when you are truly hungry and know to stop before you are uncomfortably full (take the quiz on Page 3)

Know your weight goal

Knowing how certain foods affect your blood glucose level will help you achieve your target glucose levels everyday

What is an example of a balanced meal that will help me maintain or lose weight and achieve my blood glucose levels?

Carbohydrate is the nutrient that most affects blood glucose, and there are different ways to count them. The simplest technique is the Plate Method that is a useful guide when you are first learning to control your carbohydrate intake.

UseNewsYou Can

“Checking in with Diabetes Care” continued on Page 6

Checking in with Diabetes CareEating Healthfully for a Lifetime

2

Insulin Pump and Continuous Glucose Monitor Use Improves HbA1c

A blood over 200 when you first wake up is normal when you have diabetes.

This early rise in blood sugar is also called the Dawn phenomenon. Levels of certain hormones that help us wake up and that help regulate metabolism rise early in the morning. This natural rise in these hormones also causes an increase in blood sugar. If this happens to you more than twice a week, let your health care provider know so that adjustments can be made to your medication.

People who write down their blood sugars exhibit better blood glucose control than those who do not.

Similarly to those who keep a food journal, reliable studies show that writing down blood glucose levels helps improve blood glucose management and levels. Researchers postulate that it could be an instant accountability issue – a visual reminder of the person’s blood sugar levels.

Exercising when your blood glucose is 250 mg/dl will lower it.

At this point hormones in your body that typically lower blood sugar are low because the hormones that oppose these to raise blood sugar are high. Your body is receiving the message that it is in a ‘starvation’ state so exercising will only increase these hormones further. It is recommended that the blood sugar be around 150 mg/dl before resuming physical activity.

A multi-center study that was published in the New England Journal of Medicine in 2010 is the first randomized study of a large number of persons with type 1 diabetes that compared insulin pump therapy with an integrated continuous glucose monitor (sensor therapy) to multiple daily injections (MDI). The study is also the first to study the use of sensor therapy in children (7 to 18 years of age).

All 495 study participants were shown how to count carbohydrates and to download their blood glucose readings for each visit at 3,6, 9, and 12 months. After 1 year in the study overall hemoglobin A1c (HbA1c) had decreased from 8.3% to 7.5% in the insulin pump group and 8.1% in the MDI group. Adults in the insulin pump group had a reduction of 1 percentage point in HbA1c compared to 0.4 percentage point in the MDI group. Children in the insulin pump group had a reduction of 0.4 percentage point in HbA1c and an increase of 0.2 percentage point in the MDI group. All of these results were statistically significant. Increased frequency of sensor use was associated with a greater reduction in HbA1c level. Individuals wearing the sensor at least 80% of the time demonstrated a 1.2% decrease in their HbA1c level. There was no difference in weight gain between the the insulin pump group and MDI groups. There was no difference in hypoglycemic events between the two groups whether their HbA1c was less than 7% or above 7.1%. Children in the insulin pump group who had a HbA1c less than 7% did not have a higher rate of hypoglycemia.

These results demonstrate the benefits of insulin pump and sensor therapy in reducing HbA1c levels. Many large studies have demonstrated the clinical significance of just a 1% reduction in HbA1c level reduces microvascular complications by 37%, myocardial infarction risk by 14%, and risk reduction of any diabetes related complication or death by 21%.

Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. Bergenstal RM et al. N Engl J Med 2010;353:311-20.

FACTFICTION?

or

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Do I Use Food to Cope?

Carbohydrate counting is an important skill to learn that will keep your blood

sugars on target.

In this example, a 1 cup serving of cereal (A) contains 25 grams of

carbohydrate (D). You would add this number to any other carbohydrates you might have at that same meal.

So if you also have 1 cup of milk, this contains 12 grams of carbohydrate. Your total at that meal so far is 37

grams of carbohydrate. Add to this 1 small 6 inch banana, that has 15 grams

of carbohydrate.

Your total for this meal is:25+12+15 = 52 grams of carbohydrate. Most adults require between 30 to 60 grams of carbohydrates at each meal.

Weight maintenance is more than just choosing healthy foods and controlling your portions and carbohydrates. Our eating habits are affected significantly by factors such as our environment, coping skills and our state of mind. Eating has been recognized as a coping mechanism when confronted with stressful situations, or as an attempt to modulate one’s mood. Using food in either of these ways will sabotage weight management attempts. It is important that one understand if one uses food to cope and what triggers it. Recognizing these factor(s) are important steps to successful weight management.

Take the short quiz below to find out if you use food as a coping mechanism:

1. I can usually work out a solution to my problems. Yes No 2. Other people influence how I handle problems. Yes No 3. I eat when I am upset with myself. Yes No 4. I have control over my life. Yes No 5. I feel the need to make others happy. Yes No 6. I can control my eating when I am upset with myself. Yes No 7. I am capable of dealing with stressful situations. Yes No 8. I eat when I am anxious. Yes No 9. I am confident I can control my eating when I am frustrated. Yes No 10. I worry about what people think of me. Yes No

How to score:

Mark A each time you answered yes to questions 3, 8 and/or no to 6, 9 Mark B each time you answered no to questions 1,4 or 7 Mark C each time you answered yes to questions 2, 5 or 10

Count your total A, B and Cs. Your highest score determines whether factors in your environment cause you to eat or if you use eating to cope. If you have a higher score for A questions, then you use eating as a coping mechanism in response to emotions or stressors. If you scored higher for B questions, then your ability to cope and your perception of control (or lack of) causes overeating. And if you scored higher for C questions, then outside influences and stressors result in negative moods that trigger eating. Of course you can also have a combination of any of the above if you score higher in more than 1 category.

The important point to take away from this is that recognizing what triggers the eating behavior is part of working towards a solution. Building and enhancing skills as alternatives to eating are steps that will result in permanent change in eating habits and weight management. Your doctor can help you with the appropriate health care professional who can guide you in these changes.

The Eating and Appraisal Due to Emotions and Stress (EADES) Questionnaire: Development and Validation. Ozier AD, et al. JADA 2007;107:619-628.

A

B

C

D

E

Reading Nutrition Labels

Carbohydrate Counting 101

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Savory Quinoa Salad(Makes 4 Servings)

2/3 cup uncooked quinoa1-1/2 cups small broccoli florets

2 small plum tomatoes, cut into cubes1/3 cup (1-1/2 ounces) low-fat crumbled

feta cheese2 tablespoons fresh lemon juice3 teaspoons extra virgin olive oil

1/2 tablespoon fresh parsley1/2 tablespoon fresh mint

1/4 teaspoon salt (optional)1/8 teaspoon black pepper

Cooking Instructions1. Cook quinoa according to package

directions omitting any salt or fat; cool to lukewarm

2. Steam or boil broccoli until just tender3. Combine quinoa, broccoli and feta4. In small bowl whisk lemon juice, olive oil,

parlsey, mint, black pepper and salt (if added), and pour over salad; toss gently

Nutrition FactsCalories 189Total fat 8 gSaturated fat 2 gProtein 7 gCarbohydrate 23 g

Cholesterol 9 mgFiber 4 gSodium 151 mg

If you are traveling on the road or by air, you want to be prepared and have a travel kit and ask the right questions so that you will have peace of mind during your vacation. Airline travel particularly requires more planning because you have less control and are dealing with stricter security rules.

Scott is a 48 year old man with type 2 diabetes who is using an insulin pump and continuous glucose monitor. He is planning to visit one of his children who lives on the west coast, and is anticipating that he has to call the airport to find out about how the latest security measures affect taking his insulin pump/cgm and medications on a plane. He has already

had his doctor’s appointment and has taken his prescriptions for his testing supplies, insulin and glucagon to be filled at his pharmacy.

Scott calls the airline and asks them the following questions:

Q: Can I wear my insulin pump and cgm through the metal detector? A: Yes, these should not trigger the alarm or damage the devices.

Q: What happens if I go through the full body scanners?A: These include x-rays so you will have to remove the insulin pump

and cgm. These cannot go through the x-ray machine. You may choose to avoid removing these devices by requesting an alternative screening process such as a visual inspection of your pump and a full-body pat-down.

Q: Can I take my lancets, infusion sets and syringes on the plane? A: Yes. Lancets and syringes must be capped, and the glucose meter

Summer brings with it relaxation, more outdoor activities and travel

DeliciousNutritious

Eating healthy doesn’t mean you have to sacrifice great taste!

&

“Lifestyle Works” continued on Page 5

Lifestyle W rksThis section of emPOWER highlights small lifestyle changes that over time result in empowerment and better health.

5

must have the manufacturer’s name imprinted in the meter. All of these are fine when accompanied by insulin.

Q: What about the restriction on liquids? Will that be a problem with my insulin and glucagon?

A: No. Make sure the pharmacy’s label clearly indicates that it is insulin, and keep the glucagon in its original container. Pack these in a clear bag. People who have diabetes are permitted to carry water, juice, gels or liquid nutrition on the plane.

You will want to carry insulin on board, not in baggage that is checked in where it could be exposed to extreme temperatures.

The airline representative also recommends to Scott that he arrive at the airport at least 2 to 3 hours before his flight and to have all prescriptions for the above items on his person. Although it is not required, it could make easier the screening process. She also recommended carrying a memo or card (see below) that alerts the screeners that he has diabetes.

Please note there have been reports that travelers with diabetes who wear insulin pumps have been subjected to additional screening that included comprehensive hand and explosive check of all of the traveler’s carry-on baggage. The American Diabetes Association is currently working with the TSA to clarify this policy. If you have been discriminated against because of your diabetes, request assistance from ADA’s Center for Information and Community Support at 1-800-342-2383.

TSA Memohttp://www.diabetes.org/assets/pdfs/know-your-rights/public-accommodations/tsa-notification-card.pdf

Diabetes Identification Cardhttp://www.diabetes.org/assets/pdfs/know-your-rights/public-accommodations/tsa-communications-card-memo.pdf

Continued from Page 4

Lifestyle W rksThis section of emPOWER highlights small lifestyle changes that over time result in empowerment and better health.

American Diabetes AssociationTM National Events:

Tour de CureA ride, not a race, with routes designed

for everyone from the occasional rider to the experienced cyclist. Whether you ride

10 miles or 100 miles, you will travel a route supported from start to finish with rest stops, food to fuel the journey and

fans to cheer you on!

Last year, more than 50,000 cyclists in 80 Tour events raised nearly $17 million

to support the mission of the ADA: to prevent and cure diabetes and to

improve the lives of all people affected by diabetes.

Step Out® Walk to Stop DiabetesSM

Last year more than 130,000 walkers from around the country joined in the

fight against diabetes knowing that together we can Stop Diabetes. Each step they took and every dollar they raised helped the American Diabetes

AssociationTM provide community based education programs, protect the rights

of people with diabetes and fund critical research for a cure.

School Walk for DiabetsAn educational school fundraising

program that promotes healthy living, school spirit and community

involvement.

While raising money for the American Diabetes Association, students learn

about diabetes and the importance of making healthy choices including eating

nutritional foods and exercising every day. The money raised through School

Walk for Diabetes helps to fund diabetes research, education and advocacy in

support of the mission of the American Diabetes AssociationTM.

For more information, please visit the American Diabetes Association® web site at http://www.diabetes.org/

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As pictured below, half of your plate is filled with at least 1 cup of non-starchy vegetables such as lettuce, cucumbers, peppers, broccoli, celery or carrots. Fill the other quarter with 3 to 4 ounces (size of a deck of cards) of a lean protein like chicken, turkey, fish, lean pork or beef. The last quarter contains between 2 to 4 servings (between ½ to 1 cup) of a carbohydrate like rice, pasta, potatoes or a starchy vegetable such as corn, peas or legumes/beans. Depending on your target carbs for that meal, you can also add 1 serving of fruit (like 1 small apple or 1 cup of cut melon) or 1 cup 1% milk.

Diabetic supply needsBetter Living Now

1- 800-854-5729www.BetterLivingNow.com

Educational information about diabetesAmerican Diabetes Association

1-800-Diabetes www.diabetes.org

American Dietetic Association www.eatright.org

Juvenile Diabetes Foundation www.jdrf.org

Joslin Diabetes Centers www.Joslin.org

WebMD www.WebMD.com

Bayer Care Diabetes www.bayercarediabetes.com

Abbott Diabetes www.abbottdiabetescare.com

Nutrition food factsNutri-Facts

www.nutri-facts.comFastFoodNutrition.org

www.fastfoodnutrition.orgNutrition.gov

www.nutrition.govNutritionData

www.nutritiondata.comCalorieKing

www.calorieking.com

Recipe ideasAll Recipes

www.allrecipes.comADA Virtual Grocery Store

vgs.diabetes.orgHealthy Meals Resource

healthymeals.nal.usda.govMyRecipes

myrecipes.comContinued from Page 1

The Plate Method -- 1 cup or more of non-starchy

vegetables, 30 to 60 grams of carbohydrates and 3 ounces of meat, poultry, f ish nuts/seeds,

or meat replacements.

Checking in with Diabetes CareEating Healthfully for a Lifetime

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A Letter From The President Dear Valued Friends and Customers,

Summer is a time of fun and relaxation. Another school year has come to a close. For those of you with kids, this means ‘sleep’ overs, sleep away camp, local camp, a family vacation or just a number of planned fun outdoor activities. Unfortunately, diabetes does not take a vacation. However, by following a few simple steps to take care of your diabetes you can enjoy the dog days of summer!

Our staff of health care professionals recommend you do the following over the summer months:

Remember to take your medications as prescribed, and be familiar with any side effects Between the warmer weather and increased activity make sure you drink plenty of fluids Carry fluids and carbohydrate-containing snacks with you Increased activity means lower blood sugars so make sure you test your blood sugars before and after activityFor extended period of activity such as a long hike, check your blood sugar during the activity Make sure you have enough diabetes testing supplies and medication Keep your insulin and supplies in a cool place at home and when traveling Insulin pump and continuous glucose monitor users who are traveling by plane can check ada. org for the latest travel advisories Insulin pump users may need a stronger adhesive, or change their infusion sets and cartridges more frequently on warmer days Always put on your suntan protection including lip balm Take proper care of your feet by wearing comfortable shoes and keeping them dry and protected

Please visit our web site at www.BetterLivingNow.com to shop for all your summer time needs. We would all like to wish you a very happy and fun summer!

Warm Regards,

Daniel S. Pope and Family

www.BetterLivingNow.com • 1-800-854-5729 • info@BetterLivingNow.com

Daniel Pope