In this issue

Islet TransplantationDiet and Weight LossCoping with Diabetes - Managing ChangeA Guide for Healthy Diabetic FeetDiabetes Oral Medications Living with Type 2 diabetesEmergency PreparationDiabetes Education: What is it really?

BC Endocrine Research Foundat ion i s a non-profit charitable foundation dedicated to promoting research and education efforts in several important areas of endocrinology and metabolism.

These areas include diabetes, hear t d isease, thyro id disease, hypertension and dyslipidemia, osteoporosis, ovarian hormone therapy, menopause and women’s health. As physicians we see the need for this research in our everyday practices as we assist patients in making informed health decisions. In addition, the need for education in the maintenance of optimal health has never been more important, as effective strategies are available for both prevention and treatment of most health problems.

PRESIDENTT.G. Elliott, MBBS, FRCPC

VICE-PRESIDENTD.M. Thompson, MD, FRCPC

DIRECTORSM.A. Dahl, MD, FRCPCK.G. Dawson, MD, PhD, FRCPCM.A. Fung, MD, FRCPCJ.M. Kong, MD, FRCPCJ.C. Prior, MD, FRCPCS.M. Sirrs, MD, FRCPC

Advisory Council Kurt BrockAnne FiddickSheila GairLinda LightDarlene Marzari SECRETARYEric G. Norman, PhD

www.bcendocrineresearch.com

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QUARTERLY CONTENTS

An Update from the Islet Transplantation Program ................................. 3Diet and Weight Loss .............................................................................. 4Coping with Diabetes - Managing Change ................................................. 6A Guide for Healthy Diabetic Feet ........................................................... 8Diabetes Oral Medications ...................................................................... 9Living with Type 2 diabetes ..................................................................... 10Emergency Preparation .......................................................................... 10Diabetes Education: What is it really? ................................................... 11

From the Editor

Welcome to our second Live Well with Diabetes newsletter. Our initiative continues to move forward with this second issue along with major changes to the website at www.livewellwithdiabetes.com. We are currently working on a complete French version as well as a number of multi-cultural segments for the website. The DVD is now available at all the pubic libraries in the lower mainland. Please visit the website and let us know what you think. Your input is appreciated as it will help us to create a more dynamic initiative that better suites the needs of the diabetes community. We hope you find something of interest to you in this issue.

SincerelyEric Norman

Volunteers Needed For Research StudyPregnancy and the Regulation of Ghrelin

A Newly Discovered Hormone that Stimulates Appetite

We are currently conducting a research study on a newly discovered hormone called ghrelin. It is closely associated with glucose and insulin concentrations. Ghrelin is produced mainly by the stomach and is also present in the placenta. We have shown that in the rat, ghrelin gene expression is much more abundant in the fetal pancreas compared to the fetal stomach, raising the possibility that it could participate in the maturation of the insulin-producing cells in the fetal pancreas.

Ghrelin stimulates appetite and may play a role in the diabetes of pregnancy (gestational diabetes) and in the development of diabetes in babies born to mothers with gestational diabetes.

It is recognized that children of mothers who have had gestational diabetes have an increased risk of developing insulin resistance, impaired glucose tolerance and type 2 diabetes later in life. We hypothesize that in the gestational diabetic mother, high glucose and insulin levels will cause a decrease in circulating ghrelin compared to mothers without gestational diabetes.

The study involves 2 tests if you have diabetes, and 3 tests if you don’t have diabetes. Each visit will take 2 hours and after each test you will receive cash reimbursement for your time.

If you are pregnant, with or without diabetes and are interested in participating in this study, please contact us for more information (Dr Elaine Tham; phone: 604-875-2345 ext 5114, email: etham@cw.bc.ca, or Dr Jean-Pierre Chanoine; phone 604-875-2624, email: jchanoine@cw.bc.ca).

statistically significant further decrease to 4.05 after islet transplantation. This means that on average the treated group had fewer highs and lows with respect to blood glucose management.

Fewer Severe Low Blood Sugars Some patients previously reported severe hypoglycemia prior to islet transplantation. Of the 17 patients in the islet transplantation program, 11 reported severe hypoglycemia before entering the Medical Care Program, 7 continued to experience severe hypoglycemic while in the Medical Care Program, and none have reported severe hypoglycemic after islet transplantation. Insulin Requirements Of the 17 patients transplanted, 14 were able to stop taking insulin for a period of time, but currently only 6 patients are off insulin and the others have returned to taking a smaller amount of insulin compared to their pre-transplant requirements to keep their glucose levels controlled. Three patients were never able to stop taking insulin, although the amount of insulin they require has decreased.

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An Update from the Islet Transplantation Program Dr. Michelle Fung MD, FRCPC

The Islet transplantation program is a program run jointly with the Best Medical Therapy Program for type 1 diabetes. It is being conducted at Vancouver Hospital. The aims of the study are to determine the effect of islet transplantation on glycemic control, complications related to diabetes, and quality of life, compared to Best Medical Therapy. The ResearchAll patients are cared for first by the Best Medical Therapy Program prior to transplantation. Best Medical Therapy includes a run-in period of routine diabetes care, contact with the diabetes nurse by phone or fax twice a month for insulin adjustment, and follow-up appointments with an endocrinologist. The standard of care of type 1 diabetes includes intensive glycemic control with target A1c < 7%, blood pressure control to target blood pressure < 130/80, treatment for high cholesterol to target LDL cholesterol <2.5 mmol/L and total cholesterol to HDL ratio <4, and an ACE inhibitor therapy (blood pressure medication) for microalbuminuria (protein in the urine). Pat ien ts a re se lec ted when a donor pancreas from a deceased individual becomes available for islet transplantation. Not all donor pancreases are used fo r i s le t transplantation as some are used for whole pancreas transplantation, often in combination with a kidney transplant. Of those pancreases that are available for islet transplantation, the pancreas is processed by Dr. Ziliang Ao in the Ike Barber Lab. Islet cells are isolated from the pancreas. If the islet count in the final preparation is considered adequate for transplantation, the islet transplantation team and BC Transplant society are notified, and a patient is selected, contacted and admitted to Vancouver Hospital usually that evening for preparation. The transplantation procedure occurs the following morning in the interventional radiology department of the hospital under local anesthetic. Patients are generally able to leave hospital one or two days after the procedure.

An immunosuppression protocol is used in islet transplant recipients in order to prevent the body from rejecting the transplanted cells. Patients are followed for their immunosuppression in the solid organ transplant outpatient clinic by Dr. R. Jean Shapiro and Dr. P. Keown.

The Results as of May, 200552 patients have been enrolled in the Best Medical Care Program, and of those 52 patients, 17 patients have received an islet transplant. The remaining patients continue to be followed in the Medical Care Program. The average duration of follow-up has been 18 months in the Medical Care Program and 13 months for those in the islet transplantation program. Better Blood Sugar Control The average A1c for all patients before entering the Medical Care Program was 7.6%. The most recent average A1c for those in the Best Medical Care Program is 7.0% compared to 6.5% in those who have received an islet transplant. Fewer Highs and Lows The MAGE score is another measure we made with respect to metabolic control in patients with diabetes. It stands for Mean Amplitude of Glycemic Excursion, and is a reflection of how much the blood glucose increases or decreases throughout the day. The lower the MAGE score, the less severe the swings in blood glucose. The average MAGE score prior to entry into the Best Medical Care Program was 8.38, with a subsequent decrease to 7.48 while in the Best medical Care Program and a

The British Columbia Islet Transplant Program

We are looking for people with Type 1 diabetes to participate in a research study that is trying to determine who will benefit from islet transplantation compared to standard medical care. The study is taking place at the Vancouver Coastal Health Research Institute.

To be eligible, you mustHave type 1 diabetes Have some degree of retinopathy (eye damage) Have some protein in the urine Have no heart disease Be a resident in BC

For more information, contactDr. David Thompson or Sharon Kozak at 604 875 5997

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Diet and Weight LossEric Norman Ph.D.

Am I overweight? Use the adjacent BMI equation (or visit www.livewellwithdiabetes.com/tools.aspx) to determine your BMI based on your height and weight. If yours is greater than 25 then you are overweight and if greater than 30 you are considered obese and should consider trying to lose some weight. Obviously how much overweight you are determines how much you should lose.

Risk of Associated Disease According to BMI and Waist Size

18.5 or less Underweight18.5 - 24.9 Normal25.0 - 29.9 Overweight30.0 - 39.9 Obese40 or greater Extremely Obese

Body Mass Index can be calculated using pounds and inches with these equations

BMI = ( Weight in Kilograms

BMI= ( Weight in Pounds

(Height in meters) x (Height in meters)

) (Height in inches) x (Height in inches)

) X 703

Weight and Weight LossChanges in body weight are a function of the number of calories consumed relative to the number of calories burned. It is true that there are genetic factors involved but the calories in and out equation still holds true. Careful not to place blame or use genetics as an excuse, but rather consider the positive steps you can take to change your situation if you are overweight. Educate yourself on the nutritional and calorie values of various foods and make wise choices. Try to get a variety of foods in your diet and eat healthy portion sizes. Use the Canada Food Guide as a starting point with an emphasis on plenty of fresh vegetables and whole grains. Try not to eat just because you are bored or are watching television.

It is far better to lose weight slowly. Losing weight at a slow rate allows the body to adjust to the change and you are far more likely to the keep the weight off for the long-term. Develop weight loss routines that you can sustain as a permanent part of your daily life. If you are overweight even a small weight loss in the amount of 5% of your body weight can make a difference with respect to decreasing insulin resistance, improving blood glucose control and lowering blood pressure. If you weigh 100 kg (220 lbs) this means you only need to lose 5 kg (11 lbs) in order to obtain some benefit. That doesn’t mean you can’t lose more if you want to, but start with a smaller goal that you can realistically achieve. It is important to keep in mind that while a well balanced diet is important physical activity is equally important. Physical activity can help you to lose weight and feel better with more energy. It will also improve blood glucose management and cardiovascular fitness.

Glycemic Index One of the best things that anyone can do, regardless of whether they have diabetes or not is learn about the Glycemic Index (GI). There are a number of books available that discuss Glycemic Index. Simply put, Glycemic index is a measure of how quickly the blood sugars rise after eating a specific type of food. Certain foods are known to raise the blood glucose levels more quickly than others and knowledge of the differences can help you to better manage your blood sugars. Since the condition of diabetes impairs the body’s ability to effectively maintain proper levels of glucose in the blood it is important to make informed food choices that can reduce the speed at which carbohydrates from a meal reach the bloodstream as glucose.

Calories in food come from three main macronutrients and include proteins (meat, fish, chicken, eggs), fats (oils, margarine, mayonnaise, etc) and carbohydrates (grains, fruits, vegetables, dairy sweets). While fats and proteins are essential for growth and repair of tissue, it is the carbohydrate foods that provide us with much of the fuel that we burn for energy.

The GI is measured for a single type of food but in the real world the typical meal is a combination of foods composed of not just carbohydrates but also fat and protein along with fiber and micronutrients. The interaction of these foods in the digestive tract can alter the rate of digestion and absorption. The GI is still a valuable guide, however, when trying to estimate and reduce the GI of a whole meal, which should be the goal of everyone with diabetes.

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One of the best ways to do this is to focus on a relative scale of high, medium and low in terms of the GI indices. Rather than memorize a whole bunch of numbers, learn to identify those foods or combinations of foods that result in healthy and higher blood glucose readings after the meal or snack. Use your meter to help you figure out the effects of different meals on your glucose reading. Think of a food type or a meal in terms of low (slow to digest and raise glucose), medium and high (quick to digest and raise glucose) on the GI scale. Learn from your experiences and get a sense of which foods and portion sizes allow you to best manage your blood glucose levels.

SummaryIf you have diabetes this information may provide an additional tool to help you manage blood sugars more effectively. We are all different so test your blood sugars regularly and learn which foods and combinations work for you. This doesn’t mean that you should sit down before each meal with a calculator trying to determine the GI of your meal to the nearest decimal point. The GI is simply a guide to help you understand and more accurately estimate the impact of a meal on your blood sugars. Use this information to help you make appropriate food selections.

How is the glycemic index (GI) determined? Typically the reference point against which all other foods are measured is pure glucose since that is the final product of carbohydrate digestion that enters the blood. When pure glucose is eaten the rate at which this glucose enters the blood is designated a GI value of 100. All other foods have a GI value expressed as a percentage relative to this glucose standard.

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Food, Weight and Diabetes ManagementAn interview with Nina Hirvi of Nutrition Works a dietitian specializing in diabetes carewww.nutritionworks.org

What are your first words of advice to an individual who is newly diagnosed with type 2 diabetes?Managing diabetes is not just about “Cutting out sugar”, that’s not really enough. Most important is “limiting” sugars, but spacing your meals out through the day. Remember that 1 cup of brown rice has the same sugar as 9 tsp of sugar. So if and when you eat carbohydrates, it’s best to eat 1 cup/meal rather than 3 cups all at once.

If someone is overweight do you make any special recommendations?People who are overweight know they are overweight so I don’t make a point of telling them they need to lose weight. I make sure that people know the connection between waist-size and health risk (high blood pressure, diabetes, high lipids). In order for people to lose weight, they have to ingest fewer calories - easiest way to tackle this - double to triple your vegetable intake and make your grains as high in fibre as possible (NO white stuff) - high fibre foods are more filling so you are satisfied with less. Also, try to be aware of when you eat for reasons other than hunger (i.e. boredom, depression, anxiety) and strategize around that. Lastly, successful weight loss doesn’t happen without regular activity.

If someone with diabetes is normal weight do you make any different recommendations?Not really - I teach the same stuff about carbohydrate and fats - everyones’ needs are the same, except that in order to lose weight, you have to take in less food, or use up more through activity.

Is there any food that someone with diabetes can’t eat or should avoid?Granola - dipped in fat and rolled in sugar and Chinese buffet restaurants!! Just kidding, even that won’t cause your head to spin. BUT, you have to be pretty smart MOST of the time!

Is three square meals per day still appropriate for people with diabetes?The more frequently we eat, the better - less stress on the body, less chance to get crazy hungry and eat too much of the wrong thing, and it’s better for cholesterol levels. BUT, it’s not realistic for most of us to eat every 2 hours. It’s an individual thing - 3 meals/day works well for most people, UNLESS they can actually eat 6 SMALL meals a day.

Any words of wisdom that you think may provide some guidance for those struggling with diet?Little changes make a lot of difference over the long term!! Make sure you plan to have some successes along the way by not setting your goals too high (the smaller the goal, the better).

For weight loss, if you eat 100 calories less everyday, you will lose 1 pound/month or 12 pounds a year, or 24 pounds over 2 years!!! That’s only reducing by 1 slice of bread a day, 1/2 cup rice, 1 ounce of beef, 2 tsp added margarine, or 1/4 cup of half and half in your coffee.

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The diagnosis of diabetes represents a major change in the life of that person as well as the lives of family members and friends. Change is a fundamental part of our life and progress as humans. Change happens, be it the change of seasons, growing up from a child to an adult or the evolution of technologies and tools enabling us to do our work. The diagnosis of diabetes can be one of those changes and as a chronic disease it is permanent and must be dealt with. Everyone will deal with it differently, but accepting change as a normal part of life is very important to managing diabetes and preventing potential health complications. Adapting to change associated with diabetes is very much a question of attitude. You can be an active participant in your care and be positively affected or you can deny that changes are happening and bet on the outcome…so change or be changed.

We all tend to get into a “comfort zone” and are afraid to change our settings because we have developed habits and built all sorts of values to protect our comfort zone. In doing so, we often become attached to our comfort zone and, if it is lost or taken away, it can be traumatic. This can happen with the diagnosis of diabetes as many new behavior patterns must be adopted and old ones abandoned. Having diabetes means that you need to plan your meals, increase physical activity, and take medication. It will seem difficult at the beginning, but step by step you will learn how to manage the changes in your life.

Learning how to manage diabetes and a changing lifestyle is a major change. Managing change that is caused by diabetes is similar to any other change in our life that we did not anticipate or plan for. To effectively manage change, it is worthwhile to familiarize yourself with the different stages that people go through during a major life transition. Each stage is associated with varying emotions as well as the opportunity to learn and take action. Keep in mind that not all people go through the same phases.

Managing Change

Coping with Diabetes

ho , Anger, and iltWhen a change is first experienced there is a reaction of shock or surprise. This can initially make a large demand on our energies. This can lead to quiet withdrawal or extrovert demonstrations. Also during this phase individuals lose focus and feel dazed. The shock then could give way to anger. It is perfectly normal to feel this way at times, but you won’t help yourself by remaining angry and hostile all the time. Try talking to family members, friends or others with diabetes to get these feelings out. Consider directing the energy you’re using on anger to something positive by volunteering for diabetes organizations. You might also feel guilty and ask yourself, why do I have diabetes? Have I done something wrong? The answer is no. We know that the vast majority of the tendency to diabetes is genetically transmitted. Therefore, rather than blame yourself for where you are at, it is better to think of what you can do to control your diabetes and make your health better.

DenialIn this phase, individuals begin to behave as though the change is not present. ‘I don’t have diabetes’ or ‘I just have a touch of diabetes’ are typical responses. Denial is a significant obstacle to managing diabetes as it prevents you from taking good care of your health. Denial can be dangerous. It is normal to deny things that frighten us. Accept this initial fear, experience it and then move on. Fear and worry will not change your circumstance. People with diabetes can have a normal life; you are not less than anyone else. You are not alone. If there are ten people in a room then two of them probably have diabetes and most likely two others have it and don’t know. There are more than 170 million people with diabetes worldwide.

Trblent TimeThis phase is accompanied with a significant drop in the individual’s energy levels, along with mixed feelings of blaming oneself and others for one’s suffering, panic, dread, helplessness and apathy. This is a critical stage if you have diabetes. First, eliminate the blame. You are not responsible for your disease and some things are out of your control. You are responsible for your health however, and many tools are available to help you manage diabetes effectively. Secondly, be sure to keep talking to family and friends. Get out and visit. Think of all the good things in your life and take it one day at a time as you work on managing your blood sugars in this new phase of your life.

Testing and ExperimentingIn this phase people will try different ways to accept and cope with the change. This may be the first time positive energy is expressed, as the individual starts to let go of negative feelings associated with the change. The goal in coping with diabetes is acceptance. This allows you to feel good about yourself and to move forward with the management of your disease. It is normal for old feelings of guilt, anger or fear to surface. Gather strength and think about what allowed you to accept diabetes the first time. Do not pressure yourself. Think positively, set small goals, keep faith and maintain a sense of humor.

Disovery and LearningDuring the exploration phase there is a feeling of chaos or disorganization as individuals try to work out what the future might mean for them. There is a lot of uncertainty and stress associated with this phase, particularly among those who have a need for order and structure. Others find it an exhilarating time and a spark to their creativity, as they look for ways to get the most from the future. As you learn more about your diabetes you’ll realize that much of the information is a guide and you will have your own unique experiences. Experiment and learn what works best for you. This is true for emotional well-being as well as blood sugar control.

AeptingNow you are ready to move on. You learned what diabetes is, how you can manage it and what works for you. Remember, diabetes management is a life-long process. You will need to always test your blood sugar level and consult with your healthcare team to re-adjust your diabetes management activities. Don’t expect that you will know everything about diabetes or how to manage it right away. It takes time but you must start right away. You can live a long happy life with diabetes.

From a support perspective, be patient and learn how to support people with diabetes. An effective means of supporting people is to accept how they feel and to not try to persuade them that they should feel differently. Remember, when offering support, it is mostly about them not you.

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Depression can be a serious problem for people with diabetes. Symptoms of depression include feelings of helplessness or hopelessness, loneliness, lack of self-esteem, fatigue, irritability and changes in sleep patterns or eating habits. If you experience any of these symptoms, get help. Your doctor or diabetes educator can refer you to counselors with experience in helping people with diabetes.

A UIDE FOR HEALTHY DIABETIC FEETBy Dr. Shenin Mohamed, PodiatristWest Vancouver Foot Clinicwww.westvanfootclinic.com

EVERYDAY you should do the following:

You should examine your feet everyday to look for cuts, sores, blisters, redness, etc. if you notice anything of that nature, and it doesn’t heal in a day or two, notify your podiatrist at the West Vancouver foot clinic, immediately. If you have trouble seeing or bending down, ask someone to help you, or use a mirror to help you see better.

Wash your feet daily with lukewarm water and mild soap. Dry in between your toes carefully and thoroughly with a soft towel.

Don’t soak your feet – this will make your skin too dry.

If you have dry skin on your feet, use a moisturizing lotion to prevent cracking – but NEVER use lotion or cream between your toes, as this will lead to infection.

If you have corns or calluses, DO NOT cut them, don’t use corn plasters or liquid corn callus remover – they can damage your skin. See your podiatrist, who will trim them for you and recommend options you can do at home.

Keep your toenails trimmed. Trim them with toenail clippers after you have washed and dried your feet. Trim the nails following the shape of your toes, and smooth them with an emery board or nail file. Don’t cut into the corners of the nail, which could trigger an ingrown nail, leading to infection. If your nails are very thick, yellow or you have difficulty seeing or bending over, have your podiatrist trim them for you on a regular basis.

Don’t go barefoot – not even indoors. Always wear socks, stockings or nylons with your shoes to help avoid blisters and sores. Choose soft socks made of cotton, wool, or a cotton- polyester blend, which helps keep your feet dry. Avoid mended socks or those with seams that can rub and cause blisters.

Don’t wear shoes with high heels or pointed toes. They can create pressure, which might contribute to bone and joint disorders as well as diabetic ulcers.

Don’t wear open toed shoes or sandals with a strap between the first toes. They increase the chance that you will injure your toe.

When you buy new shoes, be sure your feet are properly measured and that the shoes are properly fitted. Over time your feet can change shape and size so it is important to have them measured at each new shoe purchase. Shoes should fit both the length and width of your foot, with enough room for your toes to wriggle freely.

Your new shoes should be sturdy and comfortable. They should have leather or canvas uppers, which breathe to keep your feet from getting sweaty. Avoid vinyl or plastic shoes, because they will not stretch or breathe.

When you get new shoes, break them in gradually to prevent blisters.

Always shake your shoes before you put them on. Even a little pebble in your shoe can lead to problems.

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Diabetes Oral MediationsPeople ask when is the time to start medication for diabetes? The time to start medication is when despite good efforts at diet and exercise your blood sugar is above the target your doctor has set for you. Then it is time to start on medication. People with type 2 diabetes tend to have two problems: they don’t make as much insulin as they need and the insulin they do make is less effective in allowing glucose to enter the cells of their body.

There are four groups of drugs which work in different ways to lower blood glucose levels:

Drugs that increase insulin production. This group includes two classes of drugs: Sulfonylureas and Meglitinides. Trade names for these drugs are Glyburide (diabeta), Amaryl, GluconormDrugs that decrease insulin resistance (Thiazolidinediones). This class of drugs makes the body cells more sensitive to insulin. Trade names for these drugs are Actos and AvandiaDrugs that decrease glucose production by the liver (Biguanides). A trade name for this drug is Metformin.Drugs that slow the absorption of glucose from the digestive tract (Alpha-glucosidase inhibitors). Trade names for these drugs are Prandase, Miglitol.

Therapies for type 2 diabetes are varied and will change over time as the disease progresses. Insulin resistance, insulin production and excessive liver glucose production all change over time and require adjustments in your diabetes therapy. In general it is normal for the disease to progress and require more or different therapy. The nature of the diabetes therapy will determine the degree of risk for low blood sugars. Biquanides and Thiazolidinediones do not cause excessively low blood sugars.

Using diabetes mediations wiselyIn general, diabetes medications are safe and work well. But like any other drug, they must be used with care. All diabetes pills can interact with other medicines. Because of the chance of medication interactions, you need to tell your doctor about all medicines you are taking. While you’re taking diabetes pills, you should check with your doctor before starting anything new -- even over-the-counter items.

Review your diabetes therapy and decide which therapy applies to you. Knowing what your risk is for low blood sugars helps you to take the necessary precautions for safety and also helps you manage your blood sugars effectively. Ask your doctor about any potential side effects.

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Copyright © 2004 by Lippincott Williams & Wilkins. Clinical Drug Therapy:Rationales for Nursing Practice, 7th Edition by Anne Collins Abrams.

Emergeny PreparationYou never know when some type of emergency will happen. It doesn’t have to be a tidal wave or a hurricane. It may be you have to leave town suddenly to visit a sick relative or friend. Perhaps you get injured and are confined to the house. Since you never know when an emergency might happen you should always be prepared with respect to your diabetes therapy and other medications or health related therapies. You should always have at least 1 month’s supply of:Diabetes medications

Blood glucose test stripsInsulin if you are taking itNeedles or syringes for insulin injection if requiredBlood Pressure and Cholesterol medications if prescribedOther medicationsSome food and water including carbohydrate for low blood glucose treatment

Having these supplies on hand is important for several reasons:Effective management of your blood glucose levels ensures that your diabetes management remains optimalSafety: You should be aware of and able to treat in case your blood glucose levels go low, especially if you are drivingManaging all aspects of your health, not just your diabetes is importantOften it is impossible to get all these things together at the last minute so be prepared

Being prepared is part of taking responsibility for your own health management.

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Living with Type 2 diabetesApproximately ten years ago I was diagnosed with type 2 diabetes. At the time I did not feel well and was not sure why. I knew that my vision was blurred but did not even think of the possibility of it being diabetes. I was 37 years old. It turns out I was having blood glucose levels in the high twenties. The diagnosis left me with three choices. I could say to myself that I’m okay and just continue on with life or I could simply listen to my doctor and do whatever he or she says. Alternatively, I could learn as much as possible about diabetes and with the help of my doctor and other diabetes specialists I could come up with a plan to manage my diabetes to the best of my ability. For me personally I felt that the latter was the best approach. What it means is that I’m an active part of my own healthcare team and am in the position to make informed decisions about my healthcare. It is MY health after all so I need to be in charge and take responsibility for myself.

The first step in my plan was to acknowledge and accept the fact that I have Type 2 diabetes. Next was testing my blood glucose level frequently and recording everything I eat and do and how it affects my glucose levels. Although I had the option to eat everything in moderation, I chose to stop eating sweet foods and even things such as sushi which I did not realize would affect my blood glucose. Now that I am better able to manage my diabetes, I eat almost everything but in moderation. The key was testing how my body would react to different foods. To help control my blood glucose, my doctor suggested that I take 2.5 mg of Diabeta (glyburide) once a day. It worked well, however I was always cautious of being hypoglycemic and kept glucose tablets with me all the time.

With managing my lifestyle, healthy eating and regular physical activity I was able to lose approximately 8% of my body weight. At that time, after 6 years with diabetes, my doctor agreed with me to stop the medication. I had consistent A1c readings less than 6.5%. Recently the A1c drifted up and as hard as I tried I couldn’t get it under control. I decided at that point that I would start oral diabetes medications again. After 4 years of managing my diabetes without medications it was a big decision for me. I could get discouraged or I could take charge of the situation with the tools available. I discussed it with my diabetes doctor and we decided that the most important thing was blood sugar management and preventing long-term complications. Therefore I started Metformin, a diabetes medication, and now have my A1c under control again. I will continue to monitor my blood sugars and do whatever is required to ensure they are well controlled.

I am also human though and there are times when I find my diabetes management feels like it is too much work. Other days the blood sugar readings are high no matter what I do. Sometimes I feel very discouraged about the whole process. Two important messages here. One is that nobody is perfect. The other is that you need to learn that diabetes like life is constantly changing and you too will have to learn new ways to manage the disease. You will also have to search for the motivation, especially during the difficult times. You can manage your diabetes as long as you are willing to learn and to try. We are all different and what worked for me may not work for you. As in life our journeys are all different so don’t be afraid to try different approaches until you find the one that works for you. Do not give up. There is a solution for everyone.

Diabetes Edation: What is it really?By: Kris Swenson, RN, CDEDiabetes Management & Training Centers, Inc.Phoenix, Arizona USA

You can learn about diabetes and it’s care everywhere these days. TV, radio, books, internet. There is no shortage of information telling people what they should do and what they should know. But, sadly, many people with diabetes continue to be frustrated and live with health challenges even though we know so much more than we ever have before. And our medical tools are better than they’ve ever been. So what’s the problem? Why doesn’t all this information seem to be making a difference?

Well, let’s think about it. When did you learn how to do something very difficult or complicated? What was it that helped you do something successfully? Was it the book that came in the box with the bike that taught you how to stay upright? Was it the instruction book that came with your computer? Probably not. Would you fly on a plane where the pilot passed a test about facts in a book? Or would you rather get on board with a pilot and crew that not only read the book, they actually practiced the skills, learning from their efforts, both good and bad, how to fly a plane safely?

The same is true of learning and practicing successful diabetes management. Good, scientific information is invaluable to you, the diabetes manager. But the most important part is taking this information and putting it into practice. And that is what inspired us to write this book and video.

We started with the 15 most common topics filled with myths and misinformation followed by the “truths” and straight facts on the subjects.

After you’ve read the myths and truths, the most important part of the entire book will be found on page 78-79. It’s a blank piece of paper for recording YOUR life with diabetes. The foods you enjoy eating and the blood sugars before and after each meal. It’s with this kind of information, you will begin to see patterns and be better able to apply the diabetes information to you. And, even more important, you can change the course of your diabetes to ensure a safe, healthy journey. If you think this book and/or video would be helpful to you, visit www.diabetestraining.com to order your copy.

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Myth: It's my falt that I have diabetes.Myth: Taing Inslin means I have failed.Myth: A person an have a toh of diabetes.Myth: People with diabetes shold eat sgar free foods.