I always liked to exercise but was never consistent. I used to go to the gym once a year… to pay my dues! A few years ago I finally made a commitment to do aerobic activities 4-5 times a week. I got into cycling, thanks to my good friend Phil Southerland, and now I am addicted. I either go to a spin class at my health club, ride my old spin bike at home or ride

along the San Diego coastline and other bike trails. I often cycle with friends to shoot the breeze and, of course, stop at our favorite Starbucks turn-around rest stop. Cycling has become a lifelong change that is now part of my weekly routine and I love it. This is the key…you have to really like or love or become comfortable with the changes and make them part of your life.

Winter 2013 Volume 42

New Year’s Resolutions (continued on page 2)

Dr. Edelman’s CornerDr. Edelman’s Corner

We all do it! As the New Year comes around, we make promises to ourselves and our loved ones about eating better, exercising more,

losing weight, checking our glucose more, getting our A1C down, etc., etc., etc. Eighty percent of yearly health club memberships are sold in the first 10 days of January and by mid-February very few of those folks are still visiting their new gym. Most of us need to figure out what kind of real and PERMANENT changes we can realistically make for the long term.

NEWSLETTERMY

New Year’s Resolutions: For 3 Weeks…or Lifelong Changes?

I Want a New DrugPage 3

Breaking Free from DepressionPage 4

Question of the Month Page 5

The Jerry Lund StoryPage 6

Know Your NumbersPage 9

Novel Test to Determine Future Risk of Type 2Page 10

Product TheaterPage 11

INSIDE

SpecialAcknowledgements

For years and years, another New Year would come around and I would state confidently each time that I was going to cut out mac and cheese, nachos, french fries, red meat and all desserts, including warm bread pudding with a scoop of vanilla ice cream on top (my favorite). These promises to myself pretty much only worked for a few weeks; then I felt like a failure and a whimp when I broke them.

To be honest, I also expected many of my overweight patients to cut out the things they loved and lose weight upon my medical command and, of course, that didn’t work any better for them than it had for me!

I finally figured out that we are not what we eat but how much we eat! I have lost 14 pounds over the past two years by reducing my portion size while still eating what I really like, including, on occasion, warm bread pudding and vanilla ice cream. The recommendation of reducing caloric intake and maintain-ing good portion control is now the main suggestion I give to my patients. Weight loss is damn hard and we do not yet have any magic bullets to reduce weight, however, we do have tools such as the old and new oral medications (Belviq and Qsymia), Symlin, GLP-1 agents (Bydureon and Victoza) and bariatric surgery. I know we all have to figure out what works best for us on an individual basis but, for me, I now like to order my own appetizer or salad and share a main dish, or visa versa. I love looking at the dessert menu and ordering the best one with four spoons or forks…even if I am

alone! (Just kidding about that one!)What about my diabetes

management? I am the first to admit that I have had lifelong difficulties getting my A1C under 7% without excessive hypoglycemia. As a person living with type 1 diabetes for 42 years and as a diabetes specialist, I am the first to recognize that we all have barriers that keep us from reaching our metabolic

goals. It is tough to not get down on yourself when the labs come back abnormal or higher than you wished or were

striving for. When talking to myself (not out loud in public), or my patients, I try to figure out the toughest issue causing the problem and then address it head-on. As I have learned from my good buddy Bill Polonsky of the Behavioral Diabetes Institute, your A1C is just a number and not a reflection of being a good or bad person. Remember, reaching our goals is not a sprint, but rather, a marathon. Hang in there and try not to get discour-aged if you are not where you want to be in terms of your diabetes control. Get help and support from your loved ones or caregiver and remember, they could be the same person!

Take control and let 2013 be different in terms of making not just short-lived resolutions, but rather lifelong changes...changes that you embrace, enjoy, crave and become part of your daily routine.

Even if it is only one small permanent change, make it for a lifetime. I am excited for you!

2 My TCOYD Newsletter, Vol. 42

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

Sandra Bourdette Co-Founder and Executive Director, TCOYD

S. Wayne Kay

Margery Perry

Terrance H. Gregg DexCom, Inc.

Daniel Spinazzola DRS International

Contributing AuthorsJennifer BraidwoodSteven Edelman, MD Juan Pablo Frias, MDSusan Guzman, PhD Robert LewisJeremy Pettus, MDWilliam Polonsky, PhD, CDE

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

Antonio Huerta Director, Latino Programs

Jennifer Braidwood Manager, Outreach and Continuing Medical Education

Jimm Greer Manager, Social Media

David Snyder Manager, Exhibit Services

Robyn SemberaAssociate CME Manager 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 Diabetes. 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. ©2013 All rights reserved.

Steven Edelman, MDFounder and DirectorTaking Control Of Your Diabetes

New Year’s Resolution (continued from page 1)

Weight loss is damn hard and we do not yet have any magic

bullets to reduce weight...

Taking Control Of Your Diabetes 3

Take a look at the figure below for what I call the “diabetes scorecard”. You can see that type 2 diabetics have many different classes of medications to choose from while type 1s only have insulin and pramlintide. You may be wondering what pramlintide is, and I’ll get to that in a second. I also included the date when the drugs became available. Insulin was discovered in 1921, and then there was a huge gap until 2005 when the FDA approved pramlintide (trade name Symlin), the only other medication approved for type 1 diabetes.

The point of showing you this figure is not to cause some inter-disease rivalry or

I Want a New Drug!Other medications for type 1 diabetes beyond insulin

By Jeremy Pettus, MD

resentment between different types of diabetics, but just to bring your attention to the lack of alternative medications for type 1s. The good news is, this is changing! Let’s start by talking briefly about Symlin, and then talk about what is coming down the road.

Symlin is a synthetic version of the hormone amylin. Amylin is a

hormone that is made by the beta cells of the pancreas, the same cells that make insulin. In healthy people, amylin is released with insulin into the blood stream when we eat. It works by slowing down the speed at which our stomach empties food, tells the liver to temporarily stop producing glucose, and reduces our overall appetite. Together, these mechanisms make us eat less and help to regulate our blood sugar after eating. Since types 1s generally don’t have any beta cells, not only are we deficient in insulin, but we are deficient in amylin, too. Symlin was approved in 2005 to use along with insulin in type 1 diabetes. Large clinical trials have shown that injecting Symlin at mealtimes can lower your A1C (generally about 0.5%), cause you to lose a little weight, and lower your total insulin dose. The downsides of the medication are that it is a separate injection before each meal and can cause nausea. If you haven’t heard about the medication, I would start by getting some informa-tion online at https://symlin.com and asking your healthcare provider if it might be worth trying.

Matching Patient with a Protocol As both a patient and a physician,

I have had a good amount of exper-ience with Symlin. In the right patient, it can work wonders. However, as I mentioned above, it requires 3-4 extra injections a day and the effects on lowering your A1C are there, but not that robust. That being said, Symlin has demonstrated that other medications can effectively be used to

If you have type 1 diabetes, you must have wondered to yourself at some point why there seems to be a new drug available for

type 2 diabetes everyday, but those of us with type 1 are stuck with just insulin. Insulin is literally a lifesaver for people living with type 1 diabetes, but despite our advances with insulin therapy, the majority of patients do not reach an A1C goal of less than 7%. Furthermore, insulin can lead to weight gain, hypoglycemia, and its variable absorption can be extremely frustrating. Sure, curing the disease entirely would be great, but I think most of us would be happy with another medication that could help make living with the disease a little easier.

Living Well

New Drug (continued on page 8)

Classes of Drugs AvailableType 2 DiabetesBiguanides (metformin)Thiazolidinediones (TZDs)Alpha-glucosidase inhibitorsSulfonylureasDipeptidly peptidase - 4 inhibitors (DPP-4 inhibitors)GLP-1 agonistsBile Acid SequestrantsDopamin AgonistsPramlintideInsulin

Type 1 DiabetesInsulin (1921)Pramlintide (2005)

Breaking Free from

But there is good news: This article will help you understand depression and how it may be linked to diabetes. By learning these ten important facts, you take an important step toward feeling good again.

So hang in there! You CAN overcome depression, handle diabetes more successfully and feel much, much better again.

1. Depression and Diabetes: Why This is a Big Deal.

Depression is painful all by itself, but depression and diabetes together is a dangerous combination. Having diabetes increases the chances of having a significant problem with depression, and depression can make it difficult to manage diabetes effec-tively. Scientific research has shown that depressed people are more likely to skip medications, get little exercise, have an unhealthy diet, and have difficulty managing their weight.

2. Why is Depression So Much More Common for People with Diabetes?

Getting depression doesn’t mean you are crazy nor does it mean you have a weak mind. The major factors that contribute to depression are

By William Polonsky, PhD, CDE and Susan Guzman, PhD

your genes, the amount of stress in your life, and how you think about yourself and your future. And having diabetes makes depression even more likely. There are two reasons why this is so:

u The psychological influence. Managing diabetes takes attention and effort, and this can be burdensome. It can feel like you have been given a full-time job: a job that you didn’t apply for, don’t want, and can’t quit.

u The biological influence. Certain common medications (like beta blockers) and other diseases (like hypothyroidism) can sometimes cause symptoms of depression or make it worse. Chronic pain (such as pain due to neuropathy) as well as sleep problems can also contribute to depression. In addition, chroni-cally high blood glucose levels may worsen depressive symptoms.

3. Getting Help for Depression is Worth the Effort.

Too many people never seek treatment for depression. As a result,

they suffer with depression unneces-sarily and for far too long. Depression is unlikely to go away all by itself; this is not because you are weak or haven’t tried hard enough. Even if you have tried some treatment in the past and it didn’t work, don’t give up. There are a number of new therapies that might help you now.

4. As a First Step, Talk to Your Doctor.

There are many different ways to treat depression, but which one is best for you? Talking to your doctor should be your first step. By working together with your doctor to identify the causes of your symptoms, he or she can help you select the best treatment for you.

5. Antidepressants Can Help, But They Are Not Perfect.

No one is happy about taking additional medications, especially if you feel like you are already taking too many. But antidepressant medica-tions have helped millions of people to recover from depression and regain their lives.

When prescribed an antidepressant, your dose may need to be changed over the first several months, and it may take 4–6 weeks before you start feeling better. And these drugs aren’t foolproof. In almost half of all cases, the first antidepressant that is tried doesn’t really help. But don’t despair; there are many kinds of antidepressant drugs and this just means you may need to try a second drug, or even a third, before you get real benefit.

6. Cognitive-Behavioral Therapy (CBT) Can Help.

There are many forms of counseling, but only one, CBT, has been consis-tently shown in scientific research to

4 My TCOYD Newsletter, Vol.334 My TCOYD Newsletter, Vol. 42

Taking Control

Depression is like a black hole. It can take the joy out of life, drain your energy and

motivation, and cause you to feel hopeless and worthless. Even worse, depression can make the tasks required to manage diabetes seem much more difficult and, therefore, may seriously hurt your long-term health.

What You Need to Know and Do

Taking Control Of Your Diabetes 5

What is the best way to fine-tune basal rates on an insulin pump? AspecialthankstoallofourFacebookfanswhosentinquestionsforDr.Edelman!

Answer: Fine-tuning the basal rate on your pump and your basal dose of Lantus or Levemir is very important. The basal insulin dose, whether given via an insulin pump or an injection of Lantus or Levemir, is meant to keep your blood sugar values perfectly level or flat between meals, overnight and during periods of fasting. If your blood sugar (BS) levels go up during fasting, your basal rate or dose of basal insulin is too low. If your BS goes down, your basal rate or basal insulin dose is too high.

The best way to test your basal insulin dose is to have a continuous glucose monitor (CGM), a device that gives you a BS reading every five minutes, day and night. On your ‘test’ day, skip breakfast, fast until the afternoon and follow your BS values. If you do not have a CGM device you will need to test your BS frequently, every 60 to 90 minutes, and record them. If you think you will die of hunger, have an early breakfast, making sure you take the proper amount of fast-acting insulin to control your post meal BS and then watch your values until dinner. On a different day, have an early dinner and do not eat a thing until the next morning. With this technique you will be able to assess your basal rate or your basal insulin dose. You will also see if you need a secondary basal rate. You may need to do this on more than one occasion in order to really confirm your basal insulin needs. As a general rule of thumb, 50% of your total daily dose of insulin should be the basal component.

Question of the MonthBy Steven Edelman, MD

help people overcome depression. CBT is based on our understanding that depression causes you to notice only the negative things going on in life. These are automatic forms of thinking that you may not even notice you are doing.

By helping you to see how depression is causing mistakes in how you think, CBT allows you to view challenging situations more clearly and learn how to respond to them in a more effective way.

7. Good Sleep and Regular Exercise: The World’s Cheapest Antidepressants.

Most of us don’t get enough restful sleep OR exercise, and those with depression are even less likely to be getting enough.

Deep, restful sleep (typically 7–9 hours/night) is a process that restores the mind and body. When sleep is disrupted or inadequate over long periods of time, it can lead to increased tension, difficulty concen-trating, depressed mood, irritability and chronic fatigue. When fatigued, you are less likely to exercise. And when you are inactive, you may have more trouble sleeping. What a mess! You may end up in a downward cycle of inactivity and disturbed sleep, which can lead to depression.

Regular physical activity, such as brisk walking for 30 minutes/day (or whatever you are able to do), has been shown to reduce the symptoms of mild and moderate depression. Besides boosting mood, regular exercise can provide protection against heart disease while also lowering blood sugar, blood pressure and “bad” cholesterol levels.

8. Get Up and Get Out!Depression may cause you to

withdraw from your friends and family and become isolated. It may feel like you have lost your “get up and go”. You may even find it hard to get out of bed on some days, or to go outside. And all of this makes depression worse and worse. By breaking out of this pattern, even if it feels forced at first, you can begin to feel better again.

Take small steps to become re-engaged with life. Don’t sit around and just hope you will start feeling better some day. Get started now!

9. Deal With Your Negative Feelings About Diabetes.

Sick and tired of diabetes? Many people feel frustrated, scared, angry or overwhelmed. They may believe that they are “failing” at diabetes, that complications are inevitable, that nothing they try seems to work, or that they are alone with diabetes. Any of these can lead to “diabetes burnout” which can cause or worsen depression.

To address these feelings, there are a few things you must first know:

Depression (continued on page 12)

6 My TCOYD Newsletter, Vol. 42

There was nothing wrong with me. I woke up in the morning and I felt good, I felt okay, I felt healthy.”

As a kid, Jerry was pretty active, but always struggled a little with his weight. As he got older, he got married, became a Dad and then, two hip replacement surgeries later, things started to change. That “always husky” kid turned into a really overweight and sedentary adult. Like most of us, other things started taking priority, such as raising a family, being a spouse, and working a full-time job. Suddenly, surfing and playing baseball took backseats to things that seemed far more important, until they were no longer existent. Throughout the 70’s, 80’s and 90’s Jerry was on a diet rollercoaster. “I would gain some weight and think, ‘I should go on a diet for little while’ and then I would go on a diet and lose a bunch of weight. Then, a couple years later, I would gain all the weight back, and then some, so I would go on a diet again and lose a bunch of weight. Eventually, my daughter, Natalie, grew up and moved out on her own. I got divorced and over these last ten years I’ve been….alone. There was no one there to look in my cupboards, to see what I was eating. I mean, what’s any better than a great big cheeseburger, an ice cream cone, or a big fat piece of cake? Things were good.”

Eventually, Jerry met Sandy Bourdette, the Co-Founder and

TCOYD in Motion

We would like to invite our newsletter readers to join us

as we follow Jerry Lund, a 64-year- old man who, four months ago on September 26th, was diagnosed with type 2 diabetes. On that day, for the first time in his entire life, Jerry realized he was not just “husky”, or “a little overweight”, or that he needed to go on a diet for a little while. He realized he was extremely obese, a type 2 diabetic and things needed to change. So follow us, as we follow Jerry through his “awakening” as he calls it, and his journey through the next year of his life. We will feature Jerry and his story in each of our newsletters in 2013 as well as on our web site and social media pages.

Interview #1: November 10, 20126 ½ weeks since diagnosisCurrent Weight: 240 pounds26 pounds lost

“No one ever told me I was fat,” Jerry Lund said on November 10, 2012 during his first interview with TCOYD. “I thought I was a pretty happy and well-adjusted guy. I develop

clothing lines in the action sports industry and I have been doing that for most of my career. I live by the beach and I like to cruise around on my bike on the weekends. Growing up I loved to surf and play baseball. Sure, I was always a little husky as a kid but, up until about six weeks ago, I never ever thought I was fat or unhealthy. I was just me, ya’ know? And I was comfortable being me.

Day of diagnosis: September 26, 2012Starting Weight: 266 poundsFasting Blood Sugar: 180A1C: 9.0 BP: 180/110 Total cholesterol: 200 LDL: 129

...I was always a little husky as a kid, but, up until about six weeks ago, I never ever thought

I was fat or unhealthy.

A TCOYD

Extreme

Diabetes Makeover:

The Jerry Lund

StoryBy Jennifer Braidwood

A TCOYD

Extreme

Diabetes Makeover:

The Jerry Lund

Story

Taking Control Of Your Diabetes 7

Executive Director of TCOYD, at a summer wedding. They became friends and soon found themselves spending weekends together, chatting on the phone, and really getting to know one another or, as Jerry likes to say, “someone in my life started bugging me.” That someone was, in fact, Sandy, who started to push Jerry and ask him questions about his health, such as, when was the last time he saw his doctor or had a physical; it started making things uncomfortable for him. “See, the only other person in my life who had asked me those things or bugged me about what I was eating or how much I weighed was my ex-wife, Michelle.

She and I once had this argument about my weight. She asked me how much I weighed and I lied to her. She wanted me to get on the scale and prove it, prove I weighed what I said I weighed. I thought it was ridiculous. I never got on that scale. Sandy started ‘nagging’ me in that same way. I didn’t want anyone question-ing me. I was happy the way I was. I didn’t want to change, but most importantly, I didn’t want to face the number on the scale. Looking back now, I know I was in denial. I thought my weight was someone else’s problem and not my own. I didn’t have a problem with my weight, Michelle did, and now Sandy did.”

For six months Sandy and Jerry

kept up their friendship while Sandy attempted to help Jerry get on the right track and to see a doctor. It had been 7 years since his last physical exam. “Then, one night, everything changed. I was on the phone with Sandy and she asked me how I was feeling about a doctor’s appointment I said I had made. I had lied. I hadn’t made an appointment and I had no intention of making one. I remember it being a really awkward conver-sation. There was a lot of silence, maybe she knew I was lying. I told her I felt good about the supposed appointment, and told her to quit bothering me about it. Then the conversation ended. I thought it was all over, I probably wouldn’t talk to her again.”

This is where everything changed for Jerry. He picked up the phone, called Sandy back and confessed he had been lying about making the appointment. “It took another person to convince me to take a really good look at my life and what I was doing to it. Everything changed with that phone call. She had pushed me so hard over the last six months and she never gave up. I didn’t want to be pushed, but that’s what it took. It took someone not giving up on me. I made the appointment the next day.”

Jerry was diagnosed with type 2 diabetes shortly after his doctor’s appointment. For the next few weeks he spent countless hours every night reading all he could about diabetes care and management. “Before, I would ignore anything that had to do with weight or health because, in my reality, I thought I was fine. I wasn’t fine. Now, I can’t stand not to

read anything about diabetes care or weight management.”

Jerry began to make small changes after that initial doctors appoint-ment. He started going to bed earlier and waking up earlier, eating better foods, and getting about 20 minutes of exercise every night after work. “I am going to do this every day. I am not going to skip a day. I communi-cate with my doctor a lot, over text or email. I told him that I was losing weight and you know what he said? He said, ‘that’s a good start.’ He’s right, it’s a good start. I have a long way to go.”

Interview #2: December 26, 20123 months since diagnosisCurrent weight: 220 pounds46 pounds lostFasting Blood Sugar: 93A1C: 6.3BP: 150/90Total cholesterol: 156 LDL: 99

We caught up with Jerry again the day after Christmas and asked him how his last six weeks have been and what has changed. “You know, I am starting to realize a lot of things. There are these things I used to worry about I thought were normal worries because they were such an ingrained part of my life. I would worry about a seatbelt on an airplane not fitting around me. I would worry

Jerry Lund Story (continued on page 8)

I didn’t want to face the number on the scale.

Looking back now, I know I was in denial.

8 My TCOYD Newsletter, Vol. 408 My TCOYD Newsletter, Vol. 42

help patients with type 1 diabetes and has really opened the door for a renewed interest in alternative therapies. So what else is coming?

GLP-1 Agonists You may have heard of drugs

called GLP-1 agonists. Currently, three drugs in this class are available for patients with type 2 diabetes: Byetta, Victoza, and Bydureon. They are also injections and are given anywhere from twice a day to once per week. In type 2s they have some similar effects as amylin in that they can lower your A1C and actually cause some weight loss. Recently, some small clinical trials have shown that these medica-tions may have a beneficial effect in patients with type 1 diabetes as well. Furthermore, a good number of patients living with type 1 diabetes have already started taking these medications in an “off-label” fashion, meaning that these medications are not yet officially approved for use in type 1 diabetes. The real advantage to these medications is that the injections are less frequent. We don’t know exactly how well these medications work or if they are more effective than Symlin, however, the manufacturers are pursuing more trials in patients living with type 1 diabetes. The goal is to show their efficacy and get them FDA approved for treatment.

Thinking Outside the Box In addition to the GLP-1

drugs, other classes of medications may have promise in type 1 diabetes. A new class of drugs called SGLT-2 inhibitors work in the kidney by actually causing patients to waste sugar into the urine. The kidney normally is very good at reabsorbing all the sugar in the body, however, by causing a patient to urinate out some of the sugar in the blood, you can lower your blood sugar and potentially lose a little weight. This is a great example of “thinking outside the box” in diabetes as this would be the first therapy to focus on the kidneys. Clinical trials in type 1 diabetes are now underway.

Looking to the future, I believe we will see more therapies for patients with type 1 diabetes become available within the next five years. Such medica-tions would help to fill a major gap in treating people living with the disease. Make sure to check in with your healthcare provider at regular intervals, not only for your routine diabetes care, but to see if there have been new devel-opments in this area. And don’t forget, Symlin is available now, so if you haven’t heard of it, do some research and talk to your doctor about whether it would be right for you.

Jeremy Pettus, MD, is an endocrinology fellow at the University of California, San Diego and living with type 1 diabetes.

about not finding a parking spot close enough to a store’s entrance and I would worry about walking down a set of stairs because eventually I would have to walk back up them. I find myself not worrying about that kind of stuff anymore.”

Jerry is now exercising 25 minutes every day after work and for two hours per day on the weekends. He has gone from a size 46 waist to a 40 and from a XXXL shirt to an XL. “Lucky for me I have diabetes because that is really my main source of motivation to keep active and healthy.”

Jerry’s more active lifestyle has allowed him to have an easier day-to-day life, from working a trade show to lifting boxes at his place of business to walking up a flight of stairs. Jerry says that the physical aspect of his life is being returned to him when he didn’t even know it was missing in the first place. We asked Jerry what motivates him to keep going and he wasn’t ashamed to say, “I look good! I look in the mirror and I like what I see and I know in another six weeks I’m going to like it even more. But my main goal is to get back on my surfboard, to surf again. I haven’t surfed in 10 years. My knees

Jerry Lund Story (continued from page 7)

New Drug (continued from page 3)

“I look good! I look in the mirror and I like what I see

and I know in another 6 weeks I’m going to like it even more.

Taking Control Of Your Diabetes 9

By Steven Edelman, MD

Know Your Numbers

This 42-year-old male with type 2 diabetes is working really hard to control his diabetes. He

is testing four times a day without missing a single time and his numbers look excellent. It seems as though he is totally in control.

However, there is something definitely wrong with this picture. The numbers do not vary much and there are too many numbers that are exactly the same or end with zero or five, which is mathematically not likely. In addition, there is no food or blood on the logbook, which is pretty common given the circumstances of when and where blood sugars are tested. This person had a HbA1c of 15%, indicating that his average blood sugar level is in reality 250 to 350 mg/dl!

So, what’s the deal? Unfortunately, after a little questioning, I figured out that he was just making up these numbers since he either did not test at all or was afraid or ashamed to tell me his real numbers.

I cannot stress how important it is to realize that having bad blood glucose levels does not mean you are a bad person or that you are an utter failure at controlling your diabetes. Falsifying your glucose values does only two things: it hurts you and doesn’t allow your caregiver to assist you with adequate and proper care. When it comes to diabetes management we must all overcome the emotional barriers of dealing with “bad numbers”. It’s a little tough, but in the long run, you are much better off giving real numbers, even if they aren’t what you were hoping for.

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feel better, my legs feel better. I’m not carrying around 46 pounds anymore and that is pretty amazing. I wonder what it’s going to be like when I’m not carrying around 80 pounds anymore.”

The main thing that Jerry wanted us to know during this interview was that he wasn’t on a diet any more and he wasn’t on an exercise plan anymore. “See, diets and exercise plans are so temporary. You go on a diet but eventually you go off of it. I have realized that this is not a diet, this is just the way I eat now and exercise is part of my life now. It’s a lifestyle modification, a lifestyle makeover!” Side note: At TCOYD we like to call it an Extreme Diabetes Makeover!

We asked Jerry to share one final thought before we ended the interview. “One thing I have learned from Sandy and from Dr. Edelman, it’s not what you eat but how much you eat. Eventually, I will be able to enjoy an occasional ice cream cone, or a cheeseburger. I’m not ready for that yet, but I’ll get there.”

Tune in next quarter to find out how Jerry is doing! You can also meet Jerry on our web site and our YouTube page, TCOYDtv. Click and watch his first video, “A TCOYD Extreme Diabetes Makeover: The Jerry Lund Story”.

10 My TCOYD Newsletter, Vol. 42

Today, over 26 million adults in the United States have diabetes, and

approximately 80 million —one of every 3 people over age 20—have “prediabetes,” a condition where glucose levels are above normal but not yet at a level to diagnose diabetes.

Prediabetes is a “red flag” for healthcare providers and patients, because it signals a higher risk for future development of type 2 diabetes and other medical conditions, such as heart disease.

The good news is that the onset of type 2 diabetes can be prevented, or at least significantly delayed. This can be accomplished through increased physical activity, good nutrition, weight control and, if needed, medication. The bottom line is that healthy living can prevent or delay the onset of type 2 diabetes and reduce the risk of heart disease and many other conditions!

The first step in the prevention of type 2 diabetes is knowing whether or not you have prediabetes. This is usually done by testing your fasting blood glucose level or your A1C (measure of glucose levels over a 2-3 month period). Do you know what your fasting glucose or A1C is?

With these values in hand, your healthcare provider can determine whether or not you have prediabetes or diabetes. The American Diabetes

Association currently recommends that everyone be screened for diabetes and prediabetes starting at age 45, and if you are overweight and have other risk factors for diabetes, such as high blood pressure, abnormal cho-lesterol or a family history of type 2 diabetes, testing should begin before age 45. Check out the ADA’s website for full recommendations about screening http://www.diabetes.org/dia-betes-basics/prevention/pre-diabetes/. You should definitely know whether your glucose levels are normal, in the prediabetes range or in the diabetes range. If you do not, talk to your healthcare provider soon!

For persons with prediabe-tes there is a relatively new blood test called the PreDx® test (Tethys Bioscience, Emeryville, CA). This test estimates your risk of developing type 2 diabetes within the next five years. The PreDx test measures seven substances in your blood (called biomarkers) that are associated with the development of type 2 diabetes, not just glucose alone. Results of these biomarkers, which measure inflammation as well as fat cell and

By Juan Pablo Frias, MD

glucose function, are combined with age and gender to produce a personalized score between 1 and 10 that indicates your likelihood of progressing from pre-diabetes to type 2 diabetes within five years. The lower your PreDx score, the lower your risk of developing type 2 diabetes within five years. The higher your PreDx score, the higher your risk of future type 2 diabetes.

Your healthcare provider can use the information provided by the PreDx test along with other clinical information to determine the best diabetes prevention plan for you.

Periodic retesting with PreDx can also be used to monitor the impact of your diabetes prevention plan, and guide changes in your prevention strategy. Research has shown that a drop in PreDx score in response to lifestyle changes reflects a reduction in the risk for developing type 2 diabetes. If there is no change or an increase in the PreDx score with your diabetes prevention efforts, adjustments in your plan can be made to help achieve better results.

Unlike so many devastating diseases, type 2 diabetes can be prevented or at least delayed. A PreDex test can give you a more complete picture of how quickly you might be moving toward a diagnosis of type 2 diabetes.

As Dr. Edelman says in the most recent edition of his book Taking Control of Your Diabetes, “The best way to prevent the terrible complications of diabetes is to prevent diabetes in the first place.” Know your risk and take control! For more information about the PreDx test, you can visit http://www.tethysbio.com/.

Juan Pablo Frias, MD, is the Director of Medical Affairs for Tethys Bioscience, Inc.

Use of a Novel Test to Determine Future Risk of Type 2 Diabetes

Taking Control Of Your Diabetes 11

16 ounce can tomatoes

1 medium onion, cut up

1 can of drained black beans

1/2 cup of frozen corn

2 clove garlic

4 tablespoons snipped cilantro

1/2 teaspoon sugar

8 cups chicken broth

1 1/2 lbs chicken breast cut up

2 or 3 *chipotle peppers and

little adobo sauce

Garnish with: Quest Blanco or

jack cheese

Chef Roberto’s

Tortilla Soup of Love

Chopped avocados

Tortilla chips

Fresh cilantro

Fresh lime

Cooking Instructions

1. In a stockpot combine chicken broth, diced

chicken, undrained tomatoes, onion, garlic,

cilantro, and sugar. Cover and bring to a boil.

2. Simmer for 20 minutes.

3. Add chipotle peppers, corn, black beans and a

little adobo sauce. Bring to simmer cover and

finish cooking for about 20 minutes.

In the Market for a New Meter?The OneTouch Verio IQ Might Be The Perfect Fit For You!

What’s great, and not to mention innovative, about the OneTouch®

Verio™IQ is that it’s the first meter with PatternAlert Technology. The PatternAlert system looks for, you guessed it, patterns! If the meter notices patterns of high or low blood sugar levels it will alert you —right on the screen. Once the meter has discovered a pattern, you can use the Tools for Life OneTouch® Verio™IQ

Pattern Guide to help you zero in on possible causes of the highs or lows.

The OneTouch® Verio™IQ also has a nice bright color display, 750-test memory, color-coded alerts and intuitive navigation, so it’s pretty easy to get the meter to do what you want it to do without having to read and understand a huge user manual. It’s even fluent in Spanish. It’s also really useful when you are trying to

Product Theater

By Jennifer Braidwood

Have you been thinking about upgrading your meter? With so many different options it can

sometimes be hard to find one that is the perfect fit for you. However, if you are interested in having a meter that sheds some serious light on exactly why you are having highs and lows then you might want to consider the OneTouch®Verio™IQ.

test in dark or dimly lit conditions because the top of the meter and color screen both light up. It stores and displays 7-, 14-, 30-, and even 90-day blood sugar averages thanks to an epic ability to remember your last 750 results. It also stores up to 50 pattern messages, which is great infor-mation to help with your adjustments.

From the first screen on, OneTouch®Verio™IQ delivers results, alerts and messages brilliantly on its big, bright LCD display. It even color-codes your pattern messages, red for high and blue for low, so you can tell what they are at a glance. An eco-conscious rechargeable battery that only needs to be charged about twice a month is also pretty convenient.

When selecting a meter, make sure you get one that works well for you and your lifestyle. If you have a meter that is pretty simple but it keeps you on track with your diabetes management, that’s great. You may not need all the bells and whistles. However, if you are looking for something a little more advanced, the Verio™IQ may be the right meter for you.

12 My TCOYD Newsletter, Vol. 34

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P A I DSan Diego, CAPermit No 1

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

Visit us online at www.tcoyd.org

u Diabetes is an important part of your life, but it doesn’t have to run your life.

u You are not a bad person because you developed diabetes. It is not your fault. You are not “bad” because you didn’t exercise today or because you ate more than you intended last night.

u It is important to measure diabetes progress in a realistic manner. You can never be perfect with your diabetes care, nor do you need to be. So measure your progress with your results (for example, A1C, blood pressure and cholesterol), not your day-to-day behavior.

Remember, don’t let blood sugar readings determine your self-esteem. Blood sugar results may be important, but they are neither “bad” nor “good.” They are just information.

u Make sure you have a specific and doable plan for action. If you just have a vague sense that you should be “exercising more” or “checking blood sugars more often,” you might believe you are never doing enough. To start, pick one action that might have a positive impact on your diabetes. Be specific.

u Don’t do diabetes alone. Talk to your doctor or enroll in a diabetes education program to get the support you need, learn about the

powerful benefits of good diabetes care, and understand how to fit diabetes into your life without blame or shame.

Yes, you can feel more confident and in control of your diabetes. And you can feel better again. To learn more about how to do so, and read the extended version of this article, visit www.behavioraldiabetes.org.

William Polonsky, PhD, CDE is a clinical psy-chologist, the Founder and Chief Executive Officer of the Behavioral Institute, and an Associate Clinical Professor at the University of California, San Diego

Susan Guzman, PhD, is a clinical psychologist and is the Co-Founder and Director of Clinical Services of the Behavioral Diabetes Institute a non-profit orga-nization devoted to the emotional side of diabetes.

Depression (continued from page 4)

TCOYD Conferences & Health Fairs 2013 Schedule

February 23 Tucson, Arizona March 23 Santa Clara, California April 27 Honolulu, Hawaii April 28 Kauai, Hawaii May 18 Savannah, Georgia September 21 Worcester, Massachusetts October 12 Omaha, Nebraska November 2 Albuquerque, New Mexico November 23 San Diego, California Date/Location TBD Native American

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