CHILDREN’S DIABETES FOUNDATION AT DENVER — SPRING 2003

2002 BRASS RINGLUNCHEON* RAISESOVER $200,000!

The Brass Ring Luncheon held at theDenver Marriott City Centeron Tuesday, November 5, 2002 raisedover $200,000 with proceeds from theevent benefiting both the Children’s

Diabetes Foundation and the Denver NuggetsCommunity Fund. Nordstrom presented theirFall/Winter 2002 Collection to an eager audience ofmore than 800 of Denver’s most prominent citizens.

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The fabulous Silent Auction, co-chaired by Lisa Corley, SallyFrerichs and Gretchen Popelured most of the guests to thehotel early, anxious to keep aneye on the item they mostdesired. The Auction featured aunique collection of rare andextraordinary treasures thanksto the efforts of countlessvolunteers and generous donorsand raised $37,000. Gratitudeis also expressed to the AuctionCommittee: Ginny Adler, JillAdler, Dianne Bartlett, GleneenBrienza, Sharon Cooper, NancyCowee, Pat Crofts, Chris Foster,Susan Greenwald, SharonKamen, Julie Kucera, PatLansing, Irene Leyva, Suzy Love,Kim Myers, Kindall Pope, JanRosen, Amy Sage and CarolSchlessman and to AuctionAdvisors Helen Hanks and GailJohnson.

After the Auction ended, guestsentered the ballroom to awaitthe start of the luncheon andfashion show. To pen Chair GailJohnson’s words, “Ed Greene,what a cutie” just couldn’t havebeen better as Master ofCeremonies. We so appreciatehis involvement in thecommunity and we wereprivileged to have him join us.

Chairwoman Gail Johnsonwelcomed guests and sharedfrom her heart the devastatingeffects of diabetes on the morethan 4,000 children and youngadults and their families treatedat the Barbara Davis Center.Gail said, “How can we not feelgood about being here today,knowing that our hard-earneddollars are benefiting childrenso that one day no child willneed suffer the ravages of thisdisease.” She then introducedDamien Clark, a Barbara DavisCenter patient. Damien had theaudience in tears as he read apoem he had written in which hespoke about how he feels about

diabetes. His poem spelled out“Human Pin Cushion,” which hesaid, is “what I really feel likeevery day!” Guild PresidentHelen Hanks said, “This eventreminds me of the Oscars - somany to thank, so much to say,and so little time.” She stressedthat during her presidency, shehas honored the staff of CDFand would continue to do sotoday by reading the names ofthe greatest non-profit supportanywhere. In closing, Helenstated, “It is impossible to standup here and see all of you andnot feel that we will conquerthis disease – diabetes.”

The Guild would like to extendheartfelt thanks to the followingindividuals/businesses formaking the Brass RingLuncheon a tremendoussuccess: The Denver NuggetsCommunity Fund, a fund of theRobert R. McCormick TribuneFoundation for their ongoingsupport; Nordstrom, for all theyprovided and a fabulous fashionshow; The Denver Marriott CityCenter; Premier Sponsors.Allan & Margot Frank; AngelSponsors Warren & HelenHanks, George & Gail Johnson,Arnold & Connie Pohs andRichard Saunders; CorporateTable Sponsors: The DenverBroncos – Annabel Bowlen, FirstAmerican State Bank – Jay &Kristina Davidson, Great WestLife – William & YvonneMcCallum, Guaranty Bank andTrust; Platinum Sponsors: Walt& Georgia Imhoff, SharonMagness and David Margolis;Gold Sponsors, Forest OilCorporation – David &MaryAnne Keyte, ProfessionalBuilding Solutions – Scott &Cherie Axelrod; Brass Sponsors,Colorado State Bank, MichaelBurns, Denver TechnologicalCenter, Peter & Cathy Culshaw,First Bank, Ron Tilton and WellsFargo Bank.

Many thanks to: Bill and YvonneMcCallum, Kick-Off Hosts; MartyJensen, Kick-Off Chair; GlennJanssen, Photographer; KurtYoungren and Jacob CreekAustralian Wines.

BRL Chair Gail Johnson, Master ofCeremonies Ed Greene and 2002 GuildPresident Helen Hanks

A new addition to the 2002Brass Ring Luncheon was thePatron Reception, which washeld the evening prior to theevent. More than 250 patronsand sponsors were invited. Onhand to greet guests as theyarrived were Sharon Whiton Geltand Linda Bowen Scott,Reception Co-Chairs.

There could not have been amore perfect setting than thelovely home of Bob and ChristiAustin. The Guild of theChildren’s Diabetes Foundationis most grateful to the Austinsfor their generosity and support.This evening was the perfectopportunity to thank our topsponsors and majorcontributors.

* “An event of Children’sDiabetes Foundation at Denverand the Denver NuggetsCommunity Fund, a fund of theMcCormick Tribune Foundation.”

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BrassRingLuncheon

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The Brass Ring LuncheonAuction Committee would liketo express our heartfeltappreciation to the followingbusinesses and individualswho gave unselfishly gifts tothe Silent Auction.

PREMIER DONOR:

Mile High Tours, Denver, CO

DONORS:

Adam’s Mark Denver Hotel, Denver, CO

Jill Adler, Aurora, CO

A Head of Our Time Salon, Denver, CO

A Head of Our Time Salon & Tanning Spa,Denver, CO

Alice’s Tapestries, Denver, CO

American Furniture Warehouse, Englewood, CO

Amirob Architectural Designs, Denver, CO

Ampersand, Castle Rock, CO

Jane Anderson, Englewood, CO

Archiver’s The Photo Memory Store, HighlandsRanch, CO

Dr. Max and Dianne Bartlett, Denver, CO

Bombay Company, Aurora, CO

The Bookies, Denver, CO

Boutique Judaica, Denver, CO

brandis b., Denver, CO

The Broadmoor, Colorado Springs, CO

Broadway Center for Plastic Surgery, P.C.,Englewood, CO

Brown Palace Hotel, Denver, CO

Build-A-Bear Workshop, St. Louis, MO

CADE Clinique, Denver, CO

Cara Mia Medical Day Spa, Parker, CO

Carlisle, Greenwood Village, CO

Carmine’s on Penn, Denver, CO

City Park Golf Course, Denver, CO

Colorado Athletic Club, Englewood, CO

Colorado Ballet, Denver, CO

Colorado Heart and Body Imaging, Denver, CO

Colorado Avalanche Hockey Club, Denver, CO

Cooks Fresh Market, Greenwood Village, CO

Bob Cooney, Denver, CO

Copperfalls Aveda Day Spa, Castle Rock, CO

Tom, Lisa, Alex & Spencer Corley,Westminster, CO

CQESS, Morrison, CO

Pat Crofts, Denver, CO

Nancy Davis, Los Angeles, CA

The Denver Athletic Club, Denver, CO

Denver Center for the Performing Arts,Denver, CO

Denver Nuggets Community Fund, Denver, CO

Denver Marriott City Center, Denver, CO

Denver Wholesale Florist, Denver, CO

Denver Zoological Foundation, Denver, CO

Diz’s Flower Shop, Denver, CO

The Downtown Day Spa, Santa Fe, NM

Bridgett Dungan, Evergreen, CO

Chet Dymek, Colorado Springs, CO

Dr. Terry W. Egert, Denver, CO

Frieda Eisenbarth, Golden, CO

Eme Inc., Englewood, CO

Ethan Allen, Aurora, CO

The Firebird Group, Inc., Louisville, KY

Framed De Art II, Denver, CO

Chris Foster, Aurora, CO

Franciscan Estates, Scottsdale, AZ

Russ & Sally Frerichs, Denver, CO

Fresh Fish Company, Denver, CO

Gallery One of Cherry Creek, Denver, CO

Gateway Mazda, Aurora, CO

Great American Country, Englewood, CO

The Guild

Gumbo’s Louisiana Style Café, Denver, CO

Linn Gunsberg, Edgewater, CO

Todd Helton, Denver, CO

Hemingway’s, Denver, CO

The Historic Starkey Mansion, Denver, CO

Hotel Boulderado, Boulder, CO

Hotel Monaco, Denver, CO

Hyatt Regency Tamaya Resort & Spa, SantaAna Pueblo, NM

India’s Restaurant, Denver, CO

Interstate All Battery Center, HighlandsRanch, CO

Jackson Hole Resort Lodging, Teton Village, WY

Diane Jensen, Englewood, CO

Jordan Marie Baby Boutique, Denver, CO

Sharon Kamen, Denver, CO

Keystone Resort & Conference Center,Keystone, CO

King Soopers, Denver, CO

Melly Kinnard, Englewood, CO

Mike Lansing, Morrison, CO

Le Delice, Inc., Denver, CO

Leventhal, Brown & Puga, P.C., Denver, CO

Irene Leyva, Denver, CO

Limeade™, A Lilly Pulitzer Signature Store,Denver, CO

Linny’s Cookies, LLC, Englewood, CO

Dr. Carl Lipe, Aurora, CO

Suzy Love, Englewood, CO

Dr. Juliann Lyons, Denver, CO

Loews Denver Hotel, Denver, CO

Macaroni Grill, Englewood, CO

Max Hair and Retail Center, Englewood, CO

Judy McNeil, Englewood, CO

The Melting Pot, Louisville, CO

Michael Jultak, Inc., Denver, CO

Mizuna, Denver, CO

Monaco Inn, Denver, CO

Morton’s Steakhouse, Denver, CO

9NEWS, Denver, CO

Nordstrom

NPR, Inc., Denver, CO

Occasions by Sandy, Englewood, CO

Dr. John Offerdahl, Littleton, CO

OshKosh B’Gosh, Northglenn, CO

Palomino Restaurant, Denver, CO

Panera Bakery Café, Boulder, CO

Papillion Designs, Greenwood Village, CO

Perry Park Country Club, Larkspur, CO

PetSmart, Denver, CO

Photography by: Russell M. Smoak, Denver, CO

Gretchen Pope, Denver, CO

Kindall Pope, Denver, CO

R Stafford, Aurora, CO

Regal Entertainment Group, Knoxville, TN

RE/MAX International, Greenwood Village, CO

Remington’s, Denver, CO

Jan Rosen, Englewood, CO

Russ Berrie & Company, Denver, CO

Amy Sage, Highlands Ranch, CO

Salon Mercedez, Englewood, CO

Season’s Basket Company, Wheat Ridge, CO

Seven 30 South, Denver, CO

Sharon Cooper Associates, Ltd., Englewood, CO

Simply Faux Walls!, Parker, CO

Sky Vodka, Denver, CO

Slip on Pocket, LLP, Centennial, CO

Marietta Smit, Denver, CO

Sol, Denver, CO

Solera, Denver, CO

Katie Stapelton, Denver, CO

Frank Stevens, Denver, CO

Dr. Adrienne Stewart, Denver, CO

Stone Bridge Companies, Englewood, CO

Thomas L. Stone, M.D., Englewood, CO

Tallgrass Aveda Day Spa & Salon, Denver, CO

Taylor’s Sprinkler systems, Parker, CO

Susan Tracy, Greenwood Village, CO

Target, Boulder, CO

Target, Broomfield, CO

Target, Denver, CO

Target, Parker, CO

Tiffany & Co., Denver, CO

Undercover Spa, Denver, CO

University of Colorado Hospital Gift Shop,Denver, CO

Vail Cascade Resort & Spa, Vail, CO

Venice Italian Restaurant, Greenwood Village, CO

Venus Swimwear, Jacksonville, FL

Vitamin Cottage Natural Grocers, Englewood, CO

Walkers, Denver, CO

West Southwest Gallery, Denver, CO

The Wizard’s Chest, Denver, CO

Wolfgang Puck Café, Denver, CO

Y Cross Ranch, Horse Creek, WY

Yoga Ventures, Parker, CO

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NEWS FROMTHE BDCCLINICALDIVISION

— Marian Rewers, M.D., Ph.D.Clinical Director

Last year was another busy one for the Clinical Division of the BDC that saw

3,122 patients and their familiesduring over 10,000 visits. Thisrepresents a 13% increase from2001. About 10% of patientvisits were for research studiesonly, similar to the previousyears. The figures in chart Ashow annual number of visits(bars) and number of newpatients (line) that we accepted.As you can see, both have grownsteadily. The BDC merger withThe Children’s Hospital groupheaded by Dr. Klingensmith in1994 and the addition of Dr.Jackson’s Eye Clinic in 1997naturally added a lot of newpatients. However, since 1997the Clinic has grown by another38%. This has been both aneffect of Colorado’s populationgrowth and our willingness andability to grow. Last year, weaccepted 583 new families,including quite a few who losttheir health insurance andothers whose providers askedthem to leave.

We are making every effort tomake certain that the BDC isnot simply growing, but that thequality and efficiency of ourservices are also increasing.Helping to ensure that we reachour goals are the excellenthealthcare providers who workat the Center, including 15practicing physicians, 13nurses, four dietitians, twosocial workers, five pediatricendocrinology fellows and anumber of auxiliary staff andclinical research assistants.

New FacultyDr. Robert (Rob) Slover, Associate Professor of Pediatrics, re-joined the BDC staff in August

2002 after completing a three-year church service in Korea.Many of his former patients arerejoicing with us at Rob’s return.Recently, he agreed to becomeDeputy Director of PediatricClinic as well as taking theleadership of our outreachactivities. Under the leadershipof Dr. Klingensmith, Rob willsearch for ways to make ourservices at the UCHSC locationeven more user-friendly andefficient. Since November, Dr.Slover and DeAnn Johnson,R.N., B.S.N., have been seeingour regular patients on Tuesdaysat a satellite southeast Denverfacility on County Line andBroadway. In the near future, hewill explore a possibility ofopening another satellite clinicin Broomfield. Dr. Slover’sresearch interests are veryclosely related to these activities– he is excited to study thehealth outcomes of differentoutreach services that we areoffering.

Dr. Raymond Gutin joined the Young Adult Clinic staff starting from one day a week in April and

gradually increasing to threedays a week in October. Dr.Gutin is an excellentendocrinologist who spent mostof his recent professional careerworking for the Presbyterian/St.Luke system in Denver. We areexcited to have Ray with us!

In November, Philip Weintraub, Associate Professor of Psychiatry, started seeing

BDC patients at our main clinicon Friday afternoons. Whilemany of our patients needevaluation and some needtreatment for depression,anxiety, ADD and other mentalhealth issues, Dr. Weintraub cansee only approximately 12children or young adults permonth. The intention is to offerthis service primarily to thosewho have nowhere else to go,but a one-time evaluation maybe possible for even fullyinsured patients. Dr. Weintraubworks very closely with RitaTemple-Trujillo and Ellen Fay-Itzkowitz – our trustedpsychosocial staff, as well aswith diabetes doctors at theBDC.

Dr. Paul Wadwa, AssistantProfessor, will be joining thePediatrics staff in August 2003.Paul is now finishing hisendocrinology fellowship inCincinnati. He will be supportedby a faculty development awardfrom the National Institutes ofHealth – a unique fundingmechanism that was initiallyawarded to only the four bestpediatric diabetes programs inthe U.S. This has been possibledue to the hard work of Dr.

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Klingensmith who received thisfunding for five years to traintwo faculty and three fellows(each can be supported for upto three years). The incomingfellows Drs. Aristides Maniatis,David Maahs and Jill Simmonsare already excellentpediatricians who elected forcareers in pediatricendocrinology/diabetes. We areexcited to see them addingdepth to our current corps ofexcellent fellows – Drs. KristenNadeau and Jennifer Barker –they will be doing mostlyresearch during the third year oftheir training.

On a sad note, Dr. Juan Friaswho joined us in the fall of 2001is leaving the BDC and movingto San Diego to pursue a careerin the R&D division of a drugcompany. He will be missed bythe Clinic team and by over 370patients that he’s helped here.Many thanks and good luck,Juan! In addition to Dr. Frias,last fall the Pediatric Clinic saidgoodbye to Dr. Sharon Zemelwho moved to Pittsburgh to becloser to her family on the EastCoast.���ChallengesSpace – about a year ago theClinic received nearly 7,000square feet of space withinwalking distance (five minutes)from the current building. TheBDC Annex at Hale Parkway andClermont hosts the TranslationalResearch Unit, a number of ourresearch projects and groupteaching sessions. With theaddition of the Hale Annex andSE Denver Outreach, the mainfacility is a bit less crowdedthan a year ago. But space willremain at a premium until atleast mid-2005 when weanticipate the move toFitzsimons. Countless hours ofplanning effort over the pastyear have brought us to thepoint where most of the

architectural design issues ofthe new building have beensolved and now we arediscussing location of telephonejacks and carpet colors.However, further growth will bepossible only if there is anincreased efficiency of ourservices. Simple growth byadding personnel and space isnot a solution, because ourcurrent level of service, whileexcellent, is not fullyreimbursed.

Electronic BDC - inFebruary, we moved to a newversion of our electronic medicalrecord that uses professionalSQL Server software andpowerful hardware. Despite twoyears of development, we arestill improving the new systemand, more importantly, learninghow to use it most efficiently toshorten visits at the BDC andstay in touch with our patientsbetween the visits. The newsystem (called PP3) is giving ushope that in a year or two wecan go completely “paperless” indocumenting our services,provide our patients easy accessto their electronic records,enhance our Internet-basedteaching resources and reachout using telemedicine topatients living close and far

from the Center. I am writingthis report from San Antonio,participating in the annualmeeting Towards ElectronicPatient Record (TEPR ’03). Thisis a large convention ofhealthcare users and vendors ofe-health hardware and software.Jeremy Figal, BDC softwaredeveloper, and I are trying tofigure out what is alreadyavailable that would make theBDC a better place and what ison the horizon two to five yearsfrom now.

In summary, the ClinicalDivision of the BDC has growntremendously. The numbers ofpatients and visits does not tellthe whole story. Technologicalprogress has brought newinsulins, insulin pumps, metersand continuous glucosemonitoring systems. We arecontinuously updating ourteaching methods and materialsto keep up with these changesand to make the lives of ourpatients easier. Whilestruggling sometimes withinsufficient space and resources,we look forward to 2005 whenwe hope to cut the ribbonopening the new BDC at Fitz –house of our dreams.

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HIPAA – WHATIT MEANS TOYOU AND YOURCARE— Georgeanna J. Klingensmith, M.D.

The Health Insurance Portability and Accountability Act(HIPAA) went into

effect April 14, 2003 with fullactivation by April 21, 2005. Tocomply with HIPAA, certainhealthcare practices will bechanging, including some at theBDC. As you may have noticed,there is no longer a “sign-in”sheet on the front desk, insteadwe are asking you to sign acard, which is then kept privateat the front desk. This is not achange in our “personalizedapproach to care,” but to satisfyHIPAA requirements to protectyour private health information.Some of our referring physicianshave interpreted HIPAA to meanthey are unable to share with usyour insurance referral number,the number of visits and theduration of the referral. Theybelieve they can only share thatinformation with you, whichthen requires that you obtainthat information and provide theBDC insurance coordinatorand/or our scheduling personnelwith that information. As youknow, we must have referralinformation in order for yourinsurance to pay for your care atthe Center.

You have been, or will be givenat your next visit, extensiveinformation about HIPAA; we arerequired to have you sign astatement that you have beengiven this information to read.In addition, we will request thatyou sign permission for theCenter’s professional staff andour collaborators to review yourBDC medical record for

purposes of research. Thisreview will be to determine ifyou/your child are eligible toparticipate in a specificresearch study. Some of theseresearch trials may be to studynew treatments, many will be toevaluate new blood glucosemonitoring systems, but most ofthe studies will be to look backto see how effective differenttreatment options have been inkeeping blood glucose levelsclose to target and preventingboth the short and long-termcomplications of diabetes. Partof our mission together is to findbetter ways to care for childrenand adults with diabetes; we canonly do that together throughresearch. By signing the“research permission,” you willbe helping, but you will not beagreeing to be in any researchtrial. Before being included in aresearch trial, a member of theCenter staff will contact you,explain the study you/your childmight be eligible for and ask you ifyou would like to participate. Ifyou agree to participate, you willbe asked to sign a specific consentform for that research study. Ifyou have any questions about thisform, please ask your doctor ornurse at your next visit.

HIPAA also affects how wecommunicate with you and yourprimary care physician. Sincemost families and many primarycare physicians do not havesecure (i.e., encrypted) emailsystems, transmission ofmedical information, includingblood glucose values, will not beable to be transmitted by non-secure email systems whenHIPAA is fully activated April 21,2005. Until then, only with yourpermission, we will continue touse email communications if yourequest this. We areinvestigating options to provideour patients with a secure emailaccess to the Barbara DavisCenter so that by April 21, 2005privacy of email communicationwill be assured.

The staff of the BDC has alwaysbelieved in the confidentiality ofyour medical information and wewill continue to do so. As we allbetter understand therequirements, we will let youknow other changes which maybe required for us to remain incompliance with HIPAAregulations.

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NEW TEENCLINIC NOWAVAILABLE ATBDC

— Susie Owen, R.N., C.D.E.— Philippe Walravens, M.D.

— Ellen Fay-Itzkowitz, L.C.S.W.— Gail Spiegel, M.S., R.D., C.D.E.

We are excited toannounce the formation of a new clinic available at the

Barbara Davis Center designedto meet the needs of your teen.In our work with children andteens we often hear aboutspecific, age-related challengesthat adolescents face when itcomes to managing theirdiabetes. As we all know,adolescence is a time oftransition and growth. It isnormal for adolescents to seekautonomy and independence andat times these changes inresponsibility can be frustratingand overwhelming for teens andparents. Our team hasdeveloped a Teen Clinic toaddress these specificchallenges.

We believe that our diabetescare team does a great job ofeducating parents at diagnosisand at routine visits, but wesometimes forget to re-educateour youth. One of the purposesof having a clinic dedicated toteens and teen issues is that wewill be better able to educateand encourage adolescents whoare learning to manage theirdiabetes. Sensitive issues suchas driving, alcohol use andsexual activity are importantissues but are difficult to tackleat routine visits with parentspresent. It is our goal that theTeen Clinic provides anatmosphere where teens feelcomfortable asking questions ofus and of one another. The Teen

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BARBARA DAVIS CENTERCONFERENCE ON CURRENTASPECTS OF DIABETES CARE:HONORING FATHERS WITHDIABETES

On May 3rd a luncheon and conference was held at the Westin Tabor Center in Denver in honor of the over 100 men with type 1 diabetes who have fathered children while receiving care at the Barbara Davis Center Young Adult Clinic. Dads and their families

enjoyed the buffet lunch, gift bags, entertainment by Mad Science,magic tricks performed by Dick Simon, balloons and face painting bySilly the Clown. A little of Las Vegas was brought to Denver asDeuces Wild gave the adults an opportunity to try their luck.

Special thanks to Aventis Pharmaceuticals, Eli Lilly and Company,Medtronic MiniMed, Therasense, Logimedix, Animas and Deltec fortheir support of this event. Everyone had a wonderful afternoon.

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Photos pages 6-9: kentmeireisphotography.com

Clinic will be unique in itsapproach, making youradolescent the focus of theirvisit.

Your adolescent will meet with aphysician and nurse and willhave access to social work andnutrition services as needed.We hope to create a quicker,more streamlined clinic visit,which we believe will be moreappealing to your child. Teenswill be invited to meet with theteam independently. Parentswill have the opportunity to jointheir child at the end of theirvisit, upon request. Weencourage parents to use thisforum as an opportunity to talkwith your teens about theirclinic visit. Ask them abouthemoglobin A1c results andinsulin dose recommendations.Ask your teens how you cancontinue to be involved in theircare in a way that is bothsupportive and useful.

There are appointmentsavailable for the Teen Clinic onJuly 18th and October 17th.Later dates will becomeavailable throughout the year.Please call Jan at the Center toschedule an appointment at(303) 315-6399. We lookforward to having you and yourteen become a part of thisexciting new Barbara DavisCenter experience.

OCULARCOHERENCETOMOGRAPHY

— William Jackson, M.D.

People with type 1diabetes are always at risk of developing dangerous

complications, including kidneyfailure, loss of limbs andblindness. The Eye Clinic at theBarbara Davis Center worksvery hard to stay on the cuttingedge of diabetic retinopathycare. One way that we aredoing this is with OcularCoherence Tomography (OCT),which offers high-resolutiontomograms (cross sections) ofthe retina and the optic nervehead.

This revolutionary technique hasbeen employed for themanagement of our diabetic

patients since July 2002. It isof particular value in diagnosingand following patients withDiabetic Macular Edema(swelling of the retinal center,i.e the area concerned withsharp and color vision). Thisnon-contact, non-invasive, 10micron resolution near infra–redtechnology permits “retinalbiopsies without surgery.” Onemicron is 1/1000 of amillimeter, or 1/2500 of an inch,or .000001 meter. This isamazingly sharp resolution. Itis quick, safe and very wellaccepted by our patients.

Because of this technology, weare able to track changes in ourpatient’s eyes, and in turnprevent them from the horriblecomplication of blindness.

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PLANNED GIVINGIt is very important that we assure the future of the clinical and research programs at the Barbara Davis Center for Childhood Diabetes as the patient population increases and research is more promising than ever before. Consequently, the Children’s

Diabetes Foundation has added a new dimension to the Brass RingFund – Planned Giving.

Planned Giving is a way for a donor to make a significant gift to anon-profit organization while receiving favorable tax and financialbenefits during his or her lifetime. A carefully “planned” gift tothe Children’s Diabetes Foundation can allow you to balance yourpersonal financial goals with your charitable interests.

Planned gifts come in various shapes and sizes, and all areimportant to the work of the Foundation and the Center. Whethera simple bequest provision, a charitable gift annuity or anindependently invested and managed trust, your gift will assurethat the Barbara Davis Center continues to be world-renowned forcare and research.

For additional information contact Sue Palandri at the Foundationoffice, 303-863-1200.

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QUESTIONS &ANSWERS

— H. Peter Chase, M.D.

Why do you keep pushing us to get our child’s hemoglobin A1clower?

The hemoglobin A1c (HbA1c) test is the most important test children with

diabetes have performed onthem on a regular basis. Thestandard of care is to have onedone every three months. Thetest tells us how often bloodsugars have been high everysecond of the day for the pastthree months. However, it isheavily weighted for theprevious one month.Approximately half of the testreflects the past month and theother half the two months priorto that.

The test is the main indicator of who needs to work harder toimprove their sugar control.Chapter 14 (page 151) of the

10th edition on the “PinkPanther™ & ©” book(Understanding Diabetes)discusses both the HbA1c testand the Diabetes Control andComplications Trial (DCCT).The DCCT showed thatintensively managed people withdiabetes could reduce the eye,kidney and nerve problems by76%, 39% and 60%respectively. The intensivelytreated adolescents had a meanHbA1c of 8.1% and the adults amean of 7.1%. Five studieshave suggested that if theHbA1c level is below 8% kidneyproblems from diabetes areunlikely. (The first waspublished by myself et al in theJournal of the American MedicalAssociation (vol. 261, 1155,1989).

Thus the question is “how do webreak the HbA1c barrier of 8%(or 7% for adults)?” There is noeasy answer to this question.The new Lantus® insulin andinsulin pumps now provide muchsafer and better control of nighttime and fasting glucoselevels. Many families now havefive or six morning sugars per

week below 180 mg/dl (or 150mg/dl for adults). An algorithmfor adjusting insulin dosages ison page 225 of the 10th editionPink Panther book. Writingdown the blood sugar resultsand faxing them weekly to yourdoctor or nurse if at least fourof the seven values are notbelow the age levels often helps.

The second emphasis has to beon blood sugars after meals.This is usually the time of daywhen blood sugars are highest.Food changes to blood sugar in10-15 minutes. Humalog® andNovolog® start to act in 10-15minutes. This means that someinsulin should be taken PRIORTO the first bite of food (theexception is the toddler whodoes not eat consistently). Theway to check if the dose ofinsulin for the meal is correct isto do a blood sugar level twohours after the meal. If the pre-meal dose was correct, mostvalues will be below 180 for achild or below 150 for adults. Ifvalues are not below this level,the dietitian, nurse or doctor areavailable to help make changes.The 10th edition of the PinkPanther book is the first editionto suggest the need for routinelychecking blood sugars “twohours after each meal once ortwice weekly” (page 50). Iusually ask my families to putstars in their log books by thevalues two hours after meals soI can easily identify them.

Obviously, there are many moreaspects to breaking the HbA1cbarrier of 8% (7% for adults).Getting blood sugars in thedesired range in the fastingstate and two hours after mealsis a good start. Approachingdiabetes as a family disease,with everyone in the familyhelping, is one of the otherimportant aspects. The familyneeds to keep working until thebarrier is no longer a barrier!

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LIVINGOVERSEASWITH TYPE 1DIABETES –ONE FAMILY’SSTORY

— Barbara Bendrick

The past year and a half has been anadventure in world travel for our family, with

my husband’s job sending usfirst to Taipei, Taiwan and thento Dubai in the United ArabEmirates. Our 7-year olddaughter, Jacqueline, has livedwith type 1 diabetes for overfive years. If we have learnedanything while living overseaswith diabetes, it is to preparefor the worst, and then to enjoylife and not allow diabetes toslow us down!

When my husband firstapproached me to say that hewanted to interview for aposition in Taipei, Taiwan, myinitial reaction was, “We can’t –Jacqueline has diabetes!” We’dalways enjoyed taking ourholidays overseas, but living in aforeign country and dealing withdiabetes on a daily basisseemed too overwhelming tome. How could I keepJacqueline’s diabetes undercontrol living outside of theU.S.? My husband gentlyreminded me that people havetype 1 diabetes in every countryaround the world. Hadn’t westressed to Jacqueline that sheshouldn’t allow diabetes toprevent her from enjoying life?What better way to prove this toher and to ourselves? We madea list of pros and cons and Ireluctantly agreed that he couldinterview for the job. Sureenough, a few weeks later, I wasresearching the availability of

diabetes supplies in Taiwan andwe were planning our move.

We contacted the manufacturersof each of the diabetes itemsthat Jacqueline used – insulin,syringes, blood glucose meters,etc., to find out the availabilityof products in Taiwan. We alsorequested a waiver from ourinsurance company whichallowed us to purchase a 12-month supply of everything weneeded for Jacqueline’s diabetescare so that we wouldn’t have tofigure out the pharmacy systemin a foreign country right off thebat. Dr. Klingensmith, DeAnnJohnson and Gail Spiegel weremy support system, making surethat we knew how to use theGlucagon® if Jacqueline got sick,making sure that I wascalculating my supply needscorrectly, etc. With the Internet,it was comforting to know thatthey were only an email away.

Taiwan is a very denselypopulated (23 million people),but beautiful country. Taipei,the capital, is situated at thenorth end of the island and is amodern city with high-risebuildings, an extensive subwaysystem and many westernamenities. The population islargely middle-class and welleducated. The spoken languagein Taiwan is Mandarin and,

unfortunately for us, English isnot only rarely spoken butalmost never written on signagearound town. Our first weeks inTaipei were a huge adjustmentculturally. I started looking fordiabetes supplies in pharmacieswith no luck. Then I tried to callhospitals to ask aboutendocrinologists and I couldn’treach an English-speakingoperator! The knot in mystomach started to grow.

As it turned out, Jacqueline’sschool held most of the answersto my diabetes questions. BeforeJacqueline started classes atthe Taipei American School, wevisited the school nurses to goover our diabetes routine. Therewere two English-speakingnurses at the school and wewere relieved to learn that therewere two other students at theschool with type 1 diabetes.Their parents recommendeddoctors and a hospital and gaveus the ins and outs of life withdiabetes in Taiwan. Alsothrough contacts at the school,we soon met the representativesfor Johnson & Johnson and EliLilly and were invited to attenda Medtronic MiniMedpresentation on insulin pumps.

Because the rate of type 1diabetes is so much lower inTaiwan than in the U.S., we were

10 10

T

Winners Circle

Jacqueline Bendrick with Diabetes Nurse Educator Nibal Al Sabban andPediatrician Dr. Ian Jefferson

D11

not able to find anendocrinologist who focusedsolely on pediatric diabetes. Wefelt fortunate, however, to meetDr. Dau-Ming Niu at Veteran’sGeneral Hospital. At our firstmeeting with him, he presentedus with a draft of a translationhe was finishing. It turned outto be the Chinese translation ofDr. Peter Chase’s Pink Pantherbook! He accepted Jacquelineas his patient and we were soonmoving toward puttingJacqueline on an insulin pump.While Taiwan carried most ofthe latest technology in terms ofinsulin pumps and blood glucosemeters, Jacqueline’s biggestdisappointments were that therewas no HbA1c machine (blooddraw from the arm!), no Emla®

cream and a three-hour wait fora blood draw.

With the help of Dr. Niu and hisstaff, we learned how to saysome key diabetes phrases inMandarin – “I have diabetes”and “Where is the hospital?” aswell as how to recognize theChinese characters for“carbohydrate” on food labels inthe grocery stores, since therewas no English labeling onlocally packaged food. To helpwith carbohydrate counting ofChinese foods, I was given apicture book with the carbcounts and portion sizes shownnext to the photos. I also hadJacqueline’s Medic Alertbracelet engraved in Chinese incase paramedics weren’t able toread English.

Through the MiniMedrepresentative and the doctor,we learned the ins and outs oflocating diabetes supplies inTaiwan. Similar to buyinggroceries in Taiwan, there is nosuch thing as one-stop shoppingfor diabetes supplies – youtravel one place for one itemand another place for the nextitem. There also is no private

health insurance, only agovernment sponsored plan.But a Taiwanese with diabetes iseligible not only for agovernment health card, butalso for coverage under a“chronic condition” plan, whichallows patients to get syringesand some insulin at a very lowprice. Most diabetes suppliesare purchased at the hospitals.Other supplies, such as bloodglucose meters and strips, hadto be purchased at medicalsupply stores, which differedfrom pharmacies. In Taipei, onehospital carried Lilly insulin,while another, across town,carried Novo insulin. Fast-acting insulin, such as Lispro(Humalog), was not coveredunder the national health plan,and could only be purchasedthrough MiniMed’s distributor.Most people with diabetes,therefore, were on the two orthree-shots per day regime,using Regular and NpH, sincethese supplies were coveredunder the health plan.Taiwanese insulin pump usersalso don’t receive assistancefrom their health plan for theinsulin pump or any of its supplies.At the time we left Taiwan, thenumber of people on an insulinpump was less than 100.

Sponsored by hospitals, therewere several support groups foradults and children with type 1diabetes; some were calleddiabetes “clubs” where otherdiabetes items (like glucosetablets and sugar-free products)not found in the hospitals,pharmacies or medical supplystores could be purchased.There were also diabetes campsfor children as well as familycamps just as in the U.S.Unfortunately, as I found outsitting through a three-hourinsulin pumpers’ support group,the meetings are in Mandarin,not English, so it is hard for aforeigner to break in to the

Taiwanese diabetes supportcircle.

Living outside of the U.S. servedas a reminder to have a set ofdiabetes supplies handy to grabin case of emergency, as well asa back-up plan for periods ofelectrical failure. Taiwan issubject to frequent earthquakesand we swayed through our first6.9 earthquake during our 2nd

month in the country. Previousearthquakes had left parts ofTaiwan without electricity forweeks. Taiwan also gets hitwith typhoons on a seasonalbasis and there is no evacuationplan. Residents tape up thewindows and ride the storm out.Again, typhoons had leftresidents without electricity andwater for weeks in previousyears. As we heard horrorstories, we started to worryabout our insulin supply. Wepondered buying a generator oreven a cooler that would pluginto the car lighter. We endedup storing large blocks of ice inour freezer as a minimal back-up plan. Whenever we left thecountry on vacation, we gaveour insulin to a “babysitter.”Nothing would be worse thancoming back after a week awayto find the electricity off and theinsulin warm! I kept extradiabetes supplies in the schoolclinic and insulin in theirrefrigerator as another back-up.Luckily, we never had to grabthe emergency supplies duringour time in Taiwan.

At the end of 2002, we weretransferred from Taiwan toDubai in the United ArabEmirates (UAE). Taiwan and theUAE are quite a contrast fromone another in many ways. Thepopulation of the UAE isapproximately 2 million vs. 23million in Taiwan; the emirate ofDubai sits on the edge of a hugedesert, while Taiwan is a greenand lush island. Most of the

�[

year Dubai is warm and dry,while Taiwan has seasonaltemperature changes butremains humid 12 months out ofthe year. While we are stilllearning our way around Dubai,in many ways, living here ismuch easier than in Taiwan.English is widely spoken and allsigns are labeled in both Arabicand English. The UAE is also avery wealthy country, and assuch, has access to the latesthealthcare and technology thatEurope and the U.S. have tooffer.

The rate of type 1 diabetes inthe Middle East is estimated tobe similar to that of the U.S.,but over 20% of the UAEpopulation is said to have type 2diabetes and the rate is quicklyrising. Diabetes supplies areeasy to find here and many typesof blood glucose meters can beseen in the windows ofpharmacies in every shoppingcenter.

As in Taiwan, the school nursesat the American School of Dubaiwere our introduction to thehealthcare system. The nursesdirected us to the AmericanHospital of Dubai, a five-yearold facility that has a pediatricendocrinologist on staff. Dr. IanJefferson was recruited by theAmerican Hospitalapproximately two years agofrom the U.K. Together with aDiabetes Nurse Educator, NibalSabban, they treatapproximately 50 children withdiabetes. Like Jacqueline, manyof the children come fromforeign countries, as thepopulation of Dubai is estimatedto be over 80% foreigners.Jacqueline was thrilled to learnthat the hospital has both anHbA1c machine and Emlacream. The wait for her lastblood draw was only fiveminutes.

The American Hospital of Dubaisponsors a type 1 diabetessupport group on a quarterlybasis. The meetings are held inEnglish and well attended.Some families drive severalhours from neighboring emiratesfor the support group meetings.Our first meeting reinforced theidea that diabetes crosses allpolitical boundaries, as wechatted with families from Syria,Iran, the Philippines and India,as well as UAE nationals. Mostchildren are on two to threeinjections each day mixingHumalog and a long-actinginsulin (NpH or Ultralente).Some use the Regular/NpHcombination. What we learnedfrom this meeting though, is thatmany families don’t takediabetes control as seriously aswe do. We spoke with severalpeople whose children only testblood sugar once a day! Wealso seemed to be one of only afew that understoodcarbohydrate counting. Mostfamilies either pay for diabetessupplies out of pocket or withthe assistance of privateinsurance. At the moment,there are less than 10 peopleusing insulin pumps in the UAE,according to MiniMed’srepresentative, and Jacquelineis the only child.

Life here, although fairlycharmed, is not withoutchallenges. In contrast to theU.S. and Taiwan, most locallyproduced food is not labeledwith nutritional or ingredientinformation. We’ve learnedthrough trial and error that even“plain” yogurt may actually besweetened. Carb counting is achallenge here! Also, by thetime May rolls around each year,the high temperature in Dubaiaverages over 105 degrees everyday. We’re told thattemperatures will exceed 120degrees in June through August.The humidity, which is around

20% during the winter, rises toalmost 100% as summerapproaches. Since Jacqueline iswearing an insulin pump, I’vebeen watching closely to seewhat happens to the insulin inthe heat (she’s using Novolognow). In fact, because thetemperature is so hot, duringrecess, students tend to go intothe air-conditioned library,rather than playing outside onthe playground. PE classes areinside an air-conditioned gym orin the swimming pool. So thusfar, we haven’t experienced anyheat related difficulties with thepump, other than a few skinrashes around the infusion site.However, the desert itselfpresented new challenges withthe pump that I’d never had tothink about before. Sand iseverywhere here, theplayground, our backyard,parking lots, etc., and sandstorms are a common winteroccurrence here. Living inDubai is truly like living in themiddle of a sand box. Jacqueline,like any 1st grader, thinks this isgreat and she loves to dig in thesand. But when she startedcoming home from school withsand inside her pump I began toworry. I resorted to putting thepump in a plastic bag and theninto the pump case in order tokeep sand out.

Each new destination that we’vetraveled to has presented newwonders and new challenges.We don’t know how long thisopportunity to live and workoverseas will last but we aremaking the most of it. We knowthat until there is a cure fordiabetes, we will always have toplan for and accommodatediabetes when we travel. But thepast year and a half hascertainly given us the confidenceto know that as long as we stayon top of diabetes, we can enjoythis opportunity to see theworld. And we are!

12

Winners Circle

QUILT ARTIST

Chelsea Dyke has been seen at the BDC since her diagnosis in 1995 at age 11.

Thanks to the friendly anddedicated staff at the Center shehas realized that diabetes willnot get in the way of her dreamof becoming a quilt artist.

As a thanks to Barbara Davisand the Center, Chelsea and hersister Kashia, designed andmade a twin size quilt with 15

photos of the Center, the Davis’and of course children, that wasauctioned off at the Brass RingLuncheon on November 5th.

If you are interested in apersonal photo quilt or atraditional quilt you can contactChelsea and her family atCustomized Quilting EmbroiderySewing Services (CQESS) 303-979-7168 in Morrison,Colorado.

13

Tips for Living/Traveling With DiabetesOutside the U.S.

* Bring more diabetes supplies than you think you'll need. Factorin possibilities such as illness (possible quarantines) temperaturechanges, humidity, and political turmoil. Don't count on being ableto find the supplies you need at your destination.

* Contact diabetes supply distributors/manufacturers to knowwhere you can find supplies in the country you are traveling to ifyou need them. Ask for names and telephone numbers of localrepresentatives in that country.

* Try to locate a recommended hospital and/or endocrinologistbefore you go.

* Devise a plan to accommodate utility failures, which are dailyoccurrences in many countries.

* Consider having your medical ID bracelet engraved to say"insulin-dependent diabetes" in the language of your host country.

* Talk with your endocrinologist before you travel to work outinsulin adjustments during your flight to accommodate timechanges.

*See www.childrenwithdiabetes.com for a chart on how to say “Ihave diabetes,” “Where is the hospital?” and “Where is thepharmacy?” in many languages.

* Bring a conversion chart between mg/dl and mmol/dl since mostcountries use mmol/dl in measuring blood glucose. (Dr. Chase'sUnderstanding Diabetes, Appendix i)

C

Max Anger wrote thefollowing poem prior to

beginning his insulin pump atage 9. He does wonderful onthe pump (HbA1c = 7.2) andhas fewer lows then when onshots. He (along with hisdad) has enjoyed diabetescamp and Max is now

learning to snowboard ratherthan ski. Way to go Max!

THE PUMPThe pump will change me

forever.

No more shots.

I will eat lots.

I will eat little.

I will eat whenever I want.

The pump will change meforever.

I will play.

I will jump.

I will race.

I will run whenever I want.

The pump will change meforever.

I will count carbs.

I will divide by thirty orfifty.

I will command my pump.

And I will never worryagain.

The pump will change meforever.

å

The following letter was sent toDr. Chase from a grateful parentof one of our ski tripparticipants.

A BIG FATTHANK YOU!

“Her legs are shaky and I don’t think she can ski” said the instructorat the Keystone

Ski School just two hours afterSamara’s lesson started. Heobviously didn’t understand thatSamara was having a low bloodsugar reaction.

It was such a frighteningexperience for my daughterSamara who’s had juvenilediabetes for six years. Shecame down the slope shakingand sad. It truly broke my heartto see her looking so defeated.That’s not like her I thought.She is a very athletic anddetermined girl. But that day,diabetes took over and hung likea dark cloud in the sky. Thatday she swore that she wouldnever ski again.

…Well, that was until we signedher up for the Children’sDiabetes Foundation ski trips toWinter Park. By her third trip,Samara came home with a sparkin her eyes, cheerful and self-confident. She couldn’t stoptalking about how much funshe’d had, the slopes she skiedand the great instructors…diabetes was not an issueanymore. There were trainedprofessionals to keep it undercontrol while Samara focused onlearning to ski, having fun andmost importantly, being a kid.

Samara now can’t wait to hit theslopes again. “I love skiing!”she claims.

We owe the Children’s DiabetesFoundation and all the peoplewho dedicated their money andtime a “big fat” THANK YOU!You helped instill the love ofskiing in my daughter Samara –a gift that she’ll keep for life!You made a true difference! Hatsoff to you!

From the Heart,

Monia Swaans

14

Winners Circle

DOES YOUR COMPANY HAVE AMATCHING GIFT PROGRAM?

There are over 1,000 companies in the United States who have matching gift programs for their employees who make charitable contributions. Matching gift contributions can double your donation’s power while helping programs of the

Barbara Davis Center and the Children’s Diabetes Foundation.

Please be sure to check our website(www.childrensdiabetesfdn.org) or with your company’spersonnel or Human Resources department to see if they offerthis wonderful chance to double, and even sometimes tripleyour contribution.

If you would like to make a donation online from our websiteand your company does match gifts, please print the emailconfirmation receipt that you will get after you make youronline donation and submit it to your company.

T

WEBSITE ADDRESSESMake sure to keep these addresses handy!

www.ChildrensDiabetesFdn.org

www.BarbaraDavisCenter.org

H

����

15

ENDOWED CHAIR FOR THE CLINICAL DIRECTOR

AT THE BDCName ____________________________________________________

Address __________________________________________________

City _____________________________ State ______ Zip __________

Amount ___________________________________________________

Gift in Honor of:

Name ____________________________________________________

Address __________________________________________________

City _____________________________ State ______ Zip __________

Amount ___________________________________________________

(Make checks payable to “Children’s Diabetes Foundation”)Please return your contribution with this form to:

Children’s Diabetes Foundation777 Grant Street, Ste 302

Denver, CO 80203

BDC is looking

for volunteers.

To learn more

please contact

the BDC

at

303-315-8796

rBOOK ORDER FORM

Name _____________________________________________________________________________________________

Address ____________________________________________________________________________________________

City/State/Zip ______________________________________________________________________________________

Phone (Day) _____________________ Phone (Eve) _____________________ Email _____________________

Understanding Diabetes $18 per copy (includes shipping and handling) ______ Quantity

Managing and Preventing Diabetic Hypoglycemia (Video) $20 per copy ______ Quantity

A Book for Coloring and Learning About Diabetes $5 per copy ______ Quantity

A First Book for Understanding Diabetes (Spanish) $7 per copy ______ Quantity

Kid’s Cupboard - Chock Full of Treats for All Ages $10 per copy ______ Quantity

Make checks payable to: The Guild – CDF at DenverVisa, MasterCard and Discover accepted.

All orders must be paid in full before delivery. Costs include shipping and handling. Allow 1 to 3weeks for delivery.

Canadian and Foreign Purchasers: Please include sufficient funds to equal U.S. currency exchangerates and international postage.

For additional information call 303-863-1200 or 800-695-2873 or visit www.ChildrensDiabetesFdn.org

Mailing address: The Guild of the Children’s Diabetes Foundation777 Grant Street, Suite 302Denver, CO 80203

16

TIFFANYWEDDING DAYCELEBRATION

The Children’s Diabetes Foundation was the beneficiary of “A Tiffany

Wedding Day Celebration” heldon February 2nd at the PinnacleClub in downtown Denver. Theevent, hosted by Tiffany & Co.and sponsored by ColoradoExpression Magazine, Confettimagazine and The Denver Post,was attended by more than 200guests who enjoyed a completeafternoon of extraordinaryjewelry designs, inspiring tablesettings and bridal registryinformation from Tiffany & Co.Auer’s presented a formal bridalfashion show including men’sfurnishings from Boss HugoBoss store, floral designs byJudy Stevenson & Company andhair and make-up by JasonLinkow of Metafolics. Inaddition to the glorious fashionsthere were also planningsuggestions from weddingconsultant extraordinaire NancyChase, a tasting of gourmet farefrom the Pinnacle Club, weddingcake displays and samplingsfrom Gateaux, a videographydemonstration by Mares VideoProduction, professionalphotography ideas from GeraldSchuster Photography anddisplays from ColoradoExpression and Confettimagazines.

TGuild Guide

GUILD OFFICERS FOR 2003INSTALLED AT ANNUAL MEETING

The Denver Country Club was the site for the 2003 Annual Meeting on January 21st. The Denver Nighthawks, a local Jazz band brought in by Helen Hanks thrilled the guests with their jazz performance.

After the conclusion of the Nighthawks performance, Helen Hanks,2002 Guild President, called the meeting to order and spoke abouther term. She thanked all Guild members for their support duringthe year and chronicled the activities and events with which TheGuild was involved during 2002. She ended her speech by thankingeveryone for the honor and privilege of serving as Guild Presidentand expressed that she feels her life has been enriched by theexperience. Helen then presented Dr. John Hutton and Dr. Ron Gillwith contributions from The Guild totaling $90,000.

Following the presentation of the check Helen introduced, 2003 GuildPresident, Diane Sweat who introduced the new slate of officers andspoke about her term as new Guild President.

T

2003 EXECUTIVE BOARD:President: Diane Sweat

Treasurer: Judy McNeil

Recording Secretary: Lyn Schaffer

Corresponding Secretary: Gina Abou-Jaoude

President-Elect for 2004: Bonita Carson

Treasurer-Elect for 2004: Chris Foster���

Judy McNeil, Chris Foster, Lyn Schaffer, Gina Abou-Jaoude, Bonita Carson and Diane Sweat

DIANE SWEATSPOTLIGHTSPROFOUNDNEEDS ATANNUALMEETING

I am honored to serve as the President of The Guild of the Children’s

Diabetes Foundation for thecoming year. I have watchedthis organization grow andmature since joining nine yearsago, and have seen howimportant The Guild is inhelping the patients and familiesof the Barbara Davis Center.For nearly a quarter century,The Guild has raised money inthe fight against diabetes, andthe need is as great as ever.

But instead of trying to tell youhow important the Center is tochildren with diabetes, I want tointroduce to you, two peoplewho have lived with juvenilediabetes for nearly 10 years.They have seen first-hand howour efforts have improved theirlives, and the lives of thousandsof other young people who haveType I, or juvenile diabetes.

This is Britni Bunn and hermother, Susan Rice. Britni isnow 13, and was diagnosed withType I diabetes as a 3-year-oldin 1993 when she and hermother were living in Clint, TX.They moved to Colorado in Julyof 1996, so Britni could receivetreatment from the BarbaraDavis Center for ChildhoodDiabetes. The doctor she sawthen, and the doctor shecontinues to see every threemonths, is Dr. Peter Chase.

Britni regulated her diabetesthrough as many as fourinjections of insulin a day until

April of 2001, when she beganusing the MiniMed 508 insulinpump. The pump wasunobtainable by young childrenuntil recently, because theshort-acting insulin used inpumps now—which is easier toregulate—wasn’t available.

In December, Britni upgraded tothe Paradigm pump. This newpump is smaller and waterproof,which was important to Britnibecause she is a competitiveswimmer. She can get exactingamounts of insulin even whenshe’s in the middle of a race.

But all of this moderntechnology doesn’t come withouta cost. And it’s a big cost,because expenses of thisdisease are prohibitive for thosefamilies with no insurance.

Britni’s first pump cost $5500.The Paradigm pump, which shehas now, is about $6000.Depending on the needs of theindividual child, supplies runfrom $200-$400 per month.They include some of the thingsyou see here: test strips,infusion sets, reservoirs, IVpreps for cleansing and, of

course insulin, which must berefrigerated. Britni’s pump uses180 units of insulin every twodays.

I’ll let Britni and Susan tell youhow Britni is doing with her newpump, and what the BarbaraDavis Center has meant to bothof them:

Susan shared the emotionalstruggle she and her daughterendured in their attempts to findcomprehensive diabetic care forBritni. Before the two of themleft their Texas home forColorado, Susan had littleprofessional guidance fromqualified diabetic professionals.Moving to Denver to ensure top-flight care from the BarbaraDavis Center changed both oftheir lives, and Susan said thatthey’ll be forever grateful toeveryone involved with theCenter.

Before we adjourn the meeting, Iwant to remind you that the2003 Guild membership driveis underway.

Kindall Pope and ChristyHanson, daughters of long-timesupporters Gretchen Pope andJan Rosen, are the membershipchairmen for 2003. Their goalis to conduct a membershipcampaign that will increasemembership by at least 10%,which would bring the numberof Guild members to nearly 300.

In this, The Guild’s 25th year,Kindall and Christy would loveto count you as a member if youhaven’t already joined. Pleaseunite with all of us in thequest to eradicate thisubiquitous disease.

Note: As of this printing, the2003 membership of TheGuild stands at 351 members.Thank you all!

17

Guild G

uide

I

2003 Guild President, Diane Sweat

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18

2003 BRASSRINGLUNCHEON*KICK-OFF AHUGE SUCCESS

East/West Partners of Riverfront Park hosted a fabulous kick-off reception

for the Children’s DiabetesFoundation’s 2003 Brass RingLuncheon (BRL) at a premierproperty, set at the RiverfrontTower Penthouse. Gourmet FineCatering and Syd Sextonprovided a splendid array ofTuscan-style cuisine. TangyBuchanan, this years BRLChairman, thanked kick-off

chairs Dianne Eddolls, VictoriaFrank and Roselyn Saunders andthe sponsors. Tangy announcedto a delighted crowd that Tiffany& Co. will be the PresentingSponsor and that the fashionshow will feature Fall designs byworld-renowned fashion houseESCADA and be produced byDick Auer of Auer’s.

The Brass Ring Luncheon willtake place on Tuesday, October28, 2003 at the Denver MarriottCity Center. For moreinformation please contact SusieHummell at the Foundationoffice (303) 863-1200.

* “An event of Children’s DiabetesFoundation at Denver and the DenverNuggets Community Fund, a fund ofthe McCormick Tribune Foundation.”Guild Guide

GUILD MISSION STATEMENTThe Guild of the Children’s Diabetes Foundation at

Denver raises funds for clinical and research programsfor the Barbara Davis Center for Childhood Diabetes.

The Guild promotes diabetes awareness and education;assists families in need; provides continuing educationscholarships and sponsors social activities for children

and their families.

Dick Auer and Stephanie Kelley Victoria Frank, Roselyn Saunders, Tangy Buchanan and Diane Sweat

Frieda & Dr. George Eisenbarth with Gretchen Pope Event Chair Tangy Buchanan withDouglas Kerbs of Tiffany & Co.

E

19

CARBCOUNTING ANDDIABETES

— Markey Swanson, R.D., C.D.E.

Do you count carbs? If you answered yes, then think again. Carb Counting is

when you determine how muchcarbohydrate you are consumingso that you can determine howmuch insulin you need for it.But that’s not all! If your bloodsugar is too high, you must alsodetermine how much additionalinsulin you need to take toreturn your blood sugar level tothe specified target range. Ifyou think about it, this is exactlywhat your body would do if itcould. Your pancreas wouldsecrete the appropriate amountof insulin needed for thecarbohydrate foods that you eatin order to keep your bloodsugar stable. Since yourpancreas won’t do that, youmust THINK about what dose ofinsulin to take.

There are 2 primary methods ofCarb Counting:

Constant Carb Meal Plan andInsulin Sliding Scale: Usingthis method, you eat the sameamount of carbohydrate at eachmeal and snack and use a scale(based on your blood sugarlevel) to determine the amountof short-acting insulin you musttake.

Insulin/Carb Ratio and BloodSugar Correction Factor:Using this method, you take aspecific amount of short-actinginsulin for a specific number ofgrams of carbohydrate. Inaddition, you will add a specifiedamount of short-acting insulin toadjust your blood sugar by acertain number of mg/dl (orpoints.)

In order to Carb Count, severalsteps are required.

Step 1: Determine foodsources of carbohydrate.Let’s start by using the FoodGuide Pyramid.

The food groups from the FoodGuide Pyramid that are majorsources of carbohydrate areStarch, Fruit, Milk andSweets.

The food groups of Meat & MeatSubstitutes, Green Vegetablesand Fat do not contain much, ifany, carbohydrate and do notneed to be counted. That doesnot mean that they are notimportant foods and sources ofnutrients, they just don’t havesignificant carbohydratecontent. (Please include them inyour diet but do not includethem when counting grams ofcarbohydrate.)

Step 2: Determine how muchcarbohydrate is in the foodyou are eating.

The Food Guide Pyramidcarbohydrate groups contain

approximately 15gms ofcarbohydrate per serving. Theserving size that is recommendedmay or may not be the servingsize that you normally consume,it is simply the amount of thatfood which contains 15gms ofcarbohydrate. This is intendedto help you quantify how muchcarbohydrate that you areconsuming. If your serving sizeis the same as the amount notedfor the carbohydrate foodgroups on the Food GuidePyramid, it contains 15gms ofcarbohydrate. If your servingsize is double the amount notedon the Pyramid, then it hasdouble the amount of carbohydrate,or 30gms, and so on.

You may alsodetermine theamount ofcarbohydrate ina food choice bylooking at theNutrition Factslabel.

Nutrition N

ews

D

FOOD GUIDE PYRAMID

N u t r i t i o n F a c t sServing Size 1 Slice (34g/1.2oz)Servings Per Container 20Amount Per Serving

Calories 90 Calories from Fat 10% Daily Value*

Total Fat 1g 2%Saturated Fat 0g 1%Polyunsaturated Fat )gMonounsaturated Fat 0.5gCholesterol 0mg 0%Sodium 160mg 7%Total Carbohydrate 15g 5%Dietary Fiber 2g 8%Sugars 2gProtein 4g

20

Again, serving size isimportant. Check the servingsize (1 slice) on the label andthen travel down the label to theboldface type that reports TotalCarbohydrate. The totalnumber of grams ofcarbohydrate for that portion islisted as the first number afterTotal Carbohydrate (15gms).This is the number of grams ofcarbohydrate in a single serving.If you are eating 2 or 3 servings,you will need to double or triplethe number of grams ofcarbohydrate listed for oneserving.

There are additional resourcesto aid you in determining thecarb content of various foods. Acouple of suggestions:

The Complete Guide to CarbCounting by Hope Warshaw,R.D., C.D.E. and KarmeenKulkarni, M.S., R.D., C.D.E.

The Doctor’s Pocket Calorie, Fat& Carbohydrate CounterAvailable at:www.calorieking.com

Step 3: Determine the insulindose you need for thecarbohydrate that you areconsuming and your bloodsugar value.

If you are using a ConstantCarb Meal Plan and InsulinSliding Scale, the insulinsliding scale is designed tomanage a specific amount ofcarbohydrate for a specificblood sugar level, not more orless. Therefore, the amount ofinsulin you take - as determinedby your blood sugar value - canbe pre-determined.

As you can see below, 11 unitsof short-acting insulin is theappropriate amount for theblood sugar level of 232mg/dl.The meal is consistent with theamount of carbohydrate for theprescribed insulin dose or90gms of carbohydrate. If themeal contained morecarbohydrate than 90gms thesliding scale would not beaccurate.

As an example, one ounce ofchips is roughly a small handful.You got a little carried away andhad three handfuls of chips.This is NOT 15gms ofcarbohydrate, but more like45gms! That makes the totalcarbohydrate for the meal equalto 120gms, not just 90gms.There is not enough insulincalculated into the sliding scalefor 120gms of carbohydrate, sothe next time you test yourblood sugar level, you will verylikely have a high number.

If you are using an Insulin/CarbRatio and Blood SugarCorrection Factor, you mustdetermine the carb content ofyour meal and how much insulinis needed to cover that amountof carbohydrate. You will alsoevaluate your blood sugar priorto eating. This will allow you tomake a decision about howmuch insulin you may need toadd to correct your blood sugar -to return your blood sugar totarget range if it is too high.

Nutrition News

Let’s look at a fictitious blood sugar and sample meal to determine the short-acting insulin doseusing a Constant Carb Meal Plan and Insulin Sliding Scale:

Blood sugar=232mg/dlSliding Scale for 90gms of Carbohydrate:

<100mg/dl............. 8 units 101-150................ 9 units151-200................ 10 units201-250................ 11 units251-300................ 12 units>300..................... 13 units

Meal: Carb ContentSandwich

2 slices bread 30gms1 slice each, meat and cheese 0gms

1oz. chips 15gms1 small apple 15gms8oz. glass of milk 15gms2 chocolate sandwich cookies 15gms

Total Carbohydrate 90gmsTotal Insulin 11units

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Using the example above, yourblood sugar prior to eating is250, and you really want yourblood sugar to be at a moreappropriate level - 150. Theblood sugar correction is 1 unitof short-acting insulin per each50mg/dl (points) your bloodsugar is over the target of 150.Since your blood sugar is 250and you really want a bloodsugar of 150, you would give 2units of short-acting insulin.One unit would drop the bloodsugar from 250 to 200 and thesecond unit would drop theblood sugar from 200 to 150.These 2 units are given only to“correct” your blood sugar.

Once you determine how muchshort-acting insulin is needed to“correct” your blood sugar, adecision must be maderegarding how much short-acting insulin you need to addfor the carbohydrate you areconsuming. Per the example,your ratio is 1/10 (1 unit ofshort-acting insulin for each10gms of carbohydrate.) Howmuch insulin do you think youneed for this meal? If youanswered 9 units—you areabsolutely correct!!

But you’re not finished yet. Youmust add the two numberstogether to get the appropriateshort-acting insulin dose. Thetotal dose needed to correct theblood sugar and allow for thecarbs in the meal is 11 units ofshort-acting insulin.

You have arrived at the sameinsulin dose using two differentmethods of calculation. Bothmethods consider blood sugarvalue and amount ofcarbohydrate consumed.

When dosing insulin, it isimportant to remember thatindividual insulin needs vary.Your carb amount and insulinsliding scale or insulin/carbratio and blood sugar correctionare determined specifically foryour needs. There are no magicnumbers!

The most important thing toremember when you aremanaging your diabetes is this:

Carb Counting allows flexibilityand a feeling of being able tocontrol your diabetes, not theother way around! You candetermine what and how muchyou choose to eat and adjust

your insulin accordingly. Thisaffords better diabetesmanagement on YOUR terms!

If you are interested in learningmore about Carb Counting,please call the BDC to makereservations for the next CarbCounting Class or ask to see adietitian at your next visit!

Let’s look at a fictitious blood sugar and sample meal and determine the short-acting insulin doseusing an Insulin/Carb Ratio and Blood Sugar Correction Factor:

Blood sugar correction: 1 unit per each 50gm/dl > 150Blood sugar 250

(250mg/dl–150mg/dl=100mg/dl; 100mg/dl÷50=2units) =2units

Meal Carb ContentSandwich

2 slices of bread 30gms1 slice each, meat and cheese 0gms

1oz. chips 15gms1 small apple 15gms8oz. glass of milk 15gms2 chocolate sandwich cookies 15gms

Total carbohydrate (1 unit/10gms is 90gms÷10) 90gms = 9 units Total Insulin(2units+9units) 11 units

LEMON BREEZE —Tammy Miller

INGREDIENTS:8 ounces nonfat lemon chiffon yogurt5 large frozen strawberries1/4 to 1/2 cup skim milk

DIRECTIONS:Combine ingredients in blender; blend on high until smooth.Pour into glasses and serve immediately.

NUTRITION INFORMATION PER SERVINGNumber of Servings: 2Serving Size: 6 ounces or 3/4 cupCalories: 95Carbohydrate: 17 gramsProtein: 7 gramsFat: 0 grams

r

DAY AT THEROCKIES“Day at the Rockies” provided750 BDC patients and theirfamilies with a fun-filled, freeday at the ballpark. Thechildren were able to attend apre-game tailgate party andenjoy goody bags from our manysponsors which included: All-Ways Valet, Aramark Corporation,Colorado Rockies Baseball Club,Deep Rock Water Company, Fifty50 Foods, Frito-Lay, ImperialHeadwear, The Pepsi BottlingGroup, Stretch Island Fruit andRobinson Dairy. Thank you toall of the volunteers who workedat the pre-game party and aspecial thank you to ChairmanSally Newcomb for organizingthis grand slam of an event.

SKIINGPROVIDESPURE JOY

The 2003 Winter Park ski trips were pure joy this season for the children of the

Barbara Davis Center, rangingfrom the ages of 8-18. Withseveral ski trips scheduledthroughout the months ofJanuary and February, the kidswere more determined than everto experience the best skiseason yet. With our childrenwanting to gain more skiing orsnowboarding skills, they werearmed with determination whiletaking instruction from theWinter Park ski staff.

This year we would like toexpress our sincere appreciationto Peter Gottlieb, Sandy Hoops,Clark Kulig, Monica Lee, KristenNadeau, Carolyn Tibbetts andTobias Zahn all of the BarbaraDavis Center for attending ourski program. Without theirsupport and assistance, the skiprogram would not be possible.A HUGE thank you goes out toour magnificent Chairmen DonMorrell and Rebecca Opalinskiand to the many parentvolunteers who helpedchaperone this year’s ski trips.Thank you to all of the childrenwho participated in the skiprogram and we anticipateseeing you all again next year!!!

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Carousel Days

IMPORTANT NOTICE!If you wish to have your name removed from our Newsnotes mailing list, please fill out the following form and return it to:

Children’s Diabetes Foundation777 Grant Street, Suite 302Denver, CO 80203

Name __________________________________

Address ________________________________

City ___________________________________

State _________ Zip ____________________

I

A child reaching for the brassring on a carousel is symbolicof the most important goal ofthe Children’s DiabetesFoundation — a cure. Your con-tribution on behalf of a loved onewill make a difference. It willsupport treatment programs toassist children with diabetes inleading healthier lives; and it willfund research to help CDF “catchthe brass ring” by finding a cure.

Mark an anniversary, birthday,special occasion; express appreci-ation or make a memorial tributein honor of someone special witha contribution — for any amount— to the Children’s DiabetesFoundation at Denver. We nowaccept gifts online.Donations are tax deductible. Tax ID #84-0745008

Enclosed is my Contribution of $ ___________________In memory of ______________________________________Or in honor of _____________________________________Occasion _________________________________________

Please send acknowledgements to:(Amount of gift will not be mentioned)

Name ____________________________________________Address __________________________________________City __________________ State ________ Zip ___________

FromName ____________________________________________Address __________________________________________City __________________ State ________ Zip ___________

NEWSNOTES is published twice ayear by the Children’s DiabetesFoundation at Denver. We wel-come your comments. If you would like to submit an article or a letter to NEWSNOTESsend information to:

Children’s Diabetes Foundation at Denver777 Grant Street, Suite 302Denver, CO 80203

Hilary Sheldon Christine LernerEditors

Cindy BartonGraphic Designer

Dorothy HarringtonAssociate Editor

Know the symptoms ofChildhood Diabetes:• Loss of weight• Extreme thirst• Excessive irritability• Frequent urination

Children’s Diabetes Foundation at Denver777 Grant Street, Suite 302, Denver, CO 80203

303-863-1200, 800-695-2873, www.ChildrensDiabetesFdn.org

Printed on Recycled Paper

The BrassRing FundRemember a loved one ––Help CDF “Catch the Brass Ring”

EXECUTIVE BOARD:Mrs. Marvin Davis, ChairmanRichard S. Abrams, M.D.Jules Amer, M.D.Miss Amy DavisMs. Dana Davis Mrs. Nancy Davis-RickelMrs. Janet ElwaySteven Farber, Esq.Mr. Gerald S. GrayMrs. A. Barry HirschfeldM. Douglas Jones, Jr., M.D.Richard D. Krugman, M.D.Dean, School of Medicine, University of Colorado HealthSciences CenterMr. Arnold C. PohsEx-officio Member:George S. Eisenbarth, M.D., Ph.D.Executive Director, Barbara Davis Center for ChildhoodDiabetes, University of Colorado Health Sciences Center;Professor of Pediatrics and Medicine, University of ColoradoSchool of Medicine

SCIENTIFIC ADVISORY BOARD:Richard S. Abrams, M.D.Associate Clinical Professor of Medicine, University of ColoradoSchool of Medicine; Rose Medical Center, DenverJules Amer, M.D.Clinical Professor of Pediatrics, University of Colorado School ofMedicine; Partner, Children’s Medical Center, DenverM. Douglas Jones, Jr., M.D.Professor and Chairman, Department of Pediatrics, Universityof Colorado School of Medicine; Pediatrician-in-Chief, TheChildren’s Hospital, DenverBrian Kotzin, M.D.Professor of Immunology, University of Colorado School ofMedicine; National Jewish Center for Immunology andRespiratory Medicine, DenverAké Lernmark, M.D., Ph.D.Robert H. William Professor, Department of Medicine,University of Washington School of Medicine, SeattleAli Naji, M.D., Ph.D.J. William White Professor of Surgery, Hospital of University ofPennsylvania, Philadelphia

Gerald Nepom, M.D., Ph.D.Scientific Director and Director of Immunology and DiabetesResearch Programs, Virginia Mason Research Center, SeattleWilliam V. Tamborlane, M.D.Professor of Pediatrics, Yale University School of Medicine, New Haven, Connecticut

ADVISORY BOARD:Mrs. Alan AngelichMr. and Mrs. Rand V. AraskogMrs. John AylsworthMr. Michael BoltonMrs. Joseph BroughtonMrs. Franklin L. BurnsSir Michael CaineThe Honorable Ben Nighthorse Campbell,

U.S. Senate, ColoradoMs. Natalie Cole Mr. Phil CollinsMr. Lodwrick M. CookMrs. John CoweeMr. and Mrs. Robert A. DalyMrs. Thomas P. D’AmicoMr. Tony DanzaThe Honorable Gray Davis, Governor of CaliforniaThe Honorable Diana DeGette,

U.S. House of Representatives, ColoradoMr. Neil DiamondMr. Placido DomingoMiss Donna DouglasPresident and Mrs. Gerald R. FordMr. David FosterMrs. Joseph FranzgroteMrs. Sally FrerichsMr. Kenny GMr. David GeffenMr. Merv GriffinMrs. Warren HanksMr. Bob HopeMs. Whitney HoustonMrs. Walter ImhoffMrs. Olé T. JensenMr. and Mrs. John H. JohnsonMr. Quincy Jones

Mrs. Michael JultakDr. Henry A. KissingerMrs. Robert KniselyMs. Sherry LansingMr. Jay LenoMrs. Suzy LoveMr. Paul MarcianoMiss Dina MerrillMr. Myron M. MillerMr. Roger MooreEvelyn and Mo OstinThe Honorable and Mrs. Bill Owens,

Governor and First Lady of ColoradoSir Sidney PoitierMrs. Calvin PopePresident and Mrs. Ronald ReaganMr. Lionel RichieMrs. Sheldon RogerMr. Kenny RogersMiss Diana RossMr. George SchlatterMs. Maria Shriver and Mr. Arnold Schwarzenegger

Alan and Sandra SilvestriMr. Steven Spielberg and Ms. Kate Capshaw

Mrs. Robert J. StewartMrs. Diane SweatMrs. Robert TuckerMrs. Thomas N. TuckerMiss Joan van ArkMrs. Peter WeingartenMrs. Luanne WellsMs. Barbera Thornhill and Mr. Gary L. Wilson

Mr. Henry WinklerMr. Stevie Wonder

FOUNDATION:Christine Lerner, Executive DirectorSue Palandri, Program Director

������������

Nonprofit Org.

U.S. POSTAGE

PAIDDenver, CO

Permit No. 1752

Children’s DiabetesFoundation at Denver, CO

777 Grant Street, Suite 302Denver, CO 80203

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WATCH YOUR MAILBOX FOR UPCOMING INFORMATION ON THEHIGH HOPES TRIBUTE DINNER TO BE ANNOUNCED SOON.

THE 2003 BRASS RING LUNCHEON*WHAT: The Brass Ring Luncheon & Fashion Show

to benefit the Children’s Diabetes Foundation & the Denver Nuggets Community Fund, a fund of the Robert R. McCormick Tribune Foundation.

WHEN: Tuesday, October 28, 2003

WHERE: Denver Marriott City Center

WHO: Presenting Sponsor, Tiffany & Co.Show Produced by Richard Auer of Auer’sFeaturing ESCADA – Fall Collection

WHY: To raise funds to provide emotional and financial assistance in times of exceptional need and to insure that the health needs of the patient are met.

TICKETS: For premier seating, please get your checks in early. CHECKS MUST BE MADE PAYABLE TO: BRASS RING LUNCHEON

Platinum – tickets are $250 each and include a listing inthe program, priority seating, pre-event PatronReception, a special patron gift and complimentary valetparking

Gold – tickets are $150 each and include a special goldpatron gift and complimentary parking & shuttle service

Brass Ring – tickets are $75 each and includecomplimentary parking & shuttle service

Contact Susie Hummell at the Foundation office for more information 303-863-1200BSPONSORSHIPS:

Title Sponsor: $15,000Premier Sponsor: $10,000Major Sponsor: $ 7,500Angel Sponsor: $ 5,000Corporate Sponsor: $ 3,000

* “An event of Children’s DiabetesFoundation at Denver and the Denver

Nuggets Community Fund, a fund of theMcCormick Tribune Foundation.”