diabetesblood glucose levels that are. higher than normal, but not high enough gestational diabetes or having delivered a. baby greater than nine pounds. …
diabetes care
What to Tell Family and Friends About
By Evan Benjamin, MD, FACP
Checked for Diabetes
More than 6 million of the 20 million people who have diabetes in the United States, according to the American Diabetes Association ADA, dont yet know it because they havent had their blood glucose levels checked Another 54 million Americans are estimated to have prediabetes–blood glucose levels that are higher than normal, but not high enough to be called diabetes If you have diabetes, your close family members are at higher risk of getting diabetes With nearly one-fifth of Americans over 60 having diabetes, you likely have friends with diabetes According to the ADA, people who have certain risk factors for diabetes should have their blood glucose levels checked, also called being screened for diabetes Learn the risk factors for diabetes that can be changed and those that cannot Also find out which of your loved ones should be screened for diabetes or pre-diabetes
Getting
Have your family members talk with their health care providers to discuss if they should be screened for diabetes
SHOULD YOUR LOVED ONES BE SCREENED FOR DIABETES?
The ADA recommends screening to detect
diabetes and pre-diabetes in individuals who are over the age of 45, particularly those individuals with a Body Mass Index BMI greater than 25 The ADA also recommends that screening be considered for those who are younger than 45 years of age and are overweight if they also have another risk factor, such as a first-degree relative parent or sibling with diabetes, a member of a high-risk ethnic group or a history of gestational diabetes or having delivered a baby greater than nine pounds Have your family members talk with their health care providers to discuss if they should be screened for diabetes
DIABETES YOU
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diabetes care
The Numbers for Blood Glucose to Diagnose Pre-Diabetes and Diabetes
Blood Sample Fasting 2 hours after eating Any time of day Normal levels less than 100 mg/dL less than 140 mg/dL Prediabetes levels more than 100 and less than 126 mg/dL more than 140 and less than 200 mg/dL Diabetes levels more than 126 mg/dL more than 200 mg/dL Symptoms of diabetes and casual plasma glucose 200 mg/dL
It is more likely for a person with pre-diabetes and/or early onset type 2 diabetes to have a normal fasting plasma glucose but a higher than normal 2 hour
blood glucose A diagnosis of diabetes has to be confirmed with blood glucose measures taken on two different days with a measure of fasting plasma glucose, 2 hours after eating or casual any time of day plasma glucose
Risk Factors for Diabetes You Risk Factors for Diabetes You
Cannot Change
ly history of diabetes If a parent or sibling has diabetes, a persons risk of developing type 2 diabetes is higher than if a more distant relative aunt, uncle, grandparent has diabetes
Can Change
ng overweight is the most important risk factor that you can do something about While weight loss can be difficult, it is possible The good news is that small amounts of weight loss, just 10 to 20 pounds, can make a big difference Someone is considered obese if he or she weighs more than 20 over their ideal body weight One tain ethnic groups, including American easy way to determine what a healthy weight for you may Indians, Hispanics and African-Americans, are at be is to calculate your BMI A BMI over 30 indicates severe higher risk for developing type 2 diabetes Many of obesity and puts you at much higher risk for developing these ethnic groups not only have genes that may be diabetes The risk
for diabetes depends not only on your linked to type 2 diabetes, but they have also total weight, but how you carry your weight Researchers undergone more rapid changes in their lifestyles over have found that having more fat within your abdomen the past 100 years American Indians are twice as likely middle section is a more significant risk factor than to develop diabetes than the general public Africancarrying fat in your thighs The so-called appleshaped Americans are between 15 to two times more likely to person is at higher risk for developing diabetes and heart have diabetes than Caucasians, and Hispanicdisease than the pearshaped person Americans, particularly Mexican-Americans, also are at higher risk for developing type 2 diabetes cal inactivity is an additional risk factor that can be changed Increasing physical activity helps to ng had gestational diabetes diabetes prevent diabetes by helping with weight loss and making during pregnancy Diabetes during pregnancy the bodys insulin work more efficiently Experts occurs in about 3 of all pregnancies It usually recommend getting at least 30 minutes of physical activity disappears after pregnancy However, women who three to
five times every week However, you still need to have had gestational diabetes are at higher risk for consult with your health care provider before increasing developing type 2 diabetes later in life your physical activity
1Fami
1Bei
2RaceCer
3Havi
2Physi 3Hi
risk of developing diabetes increases as you age When you are over the age of 45, the risk of diabetes increases every year
4AgeThe
gh blood fats, such as triglycerides, not only make you a higher risk for heart disease, but also may be associated with a higher risk of having diabetes Proper nutrition that keeps fat and cholesterol in balance is important to help lose weight and have lower fats in your blood
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DIABETES YOU
2006 Unilever
47 less sugar 100 clinically proven
than original Slim Fast With exercise, the Slim Fast plan is proven to help people with diabetes lose weight successfully and is designed with protein and fiber, which contribute to hunger control
Slim Fast is clinically proven to help people lose weight, including those with Type 2 diabetes Our Optima and High Protein bars and shakes are lower in sugar, a perfect 180 to 220 calories, and specially designed to help control
hunger
diabetes care
whats new
Youve likely heard the saying that laughter is the best medicine Well, studies have shown that people who laugh certainly feel better about life and the circumstances they are in People with positive attitudes generally enjoy life more, but are they any healthier? The answer is often yes Optimists are more likely to overcome pain and adversity in their efforts to improve their medical treatment outcomes For example, optimistic coronary bypass patients generally recover more quickly and have fewer complications after surgery than do patients who are less hopeful
By Alan Braverman
the power of positive thinking
A recent report from the American Association of Clinical Endocrinologists has confirmed that people with type 1 diabetes who have more positive attitudes toward their illness enjoy better mental and physical health The researchers noted the stress of living with diabetes requires great adjustments, even more so than the lifestyle changes demanded by its treatment They found that these people with diabetes were more concerned about possible future complications than about taking their injections or limitations in their current
lifestyle
reduce stroke risk with fruits veggies
The next time someone offers you a fruit or a veggie–eat up It turns out that fruits and vegetables can help prevent stroke Researchers looked closely at eight studies involving more than 257,000 people in Europe, the United States and Japan Their findings, published recently in the medical journal,
The Lancet, show a clear connection between increased consumption of fruit and vegetables and reduced stroke risk The researchers said that increasing our intake to more than five servings of fruit and vegetables a day can reduce the risk of stroke by 26 percent,
compared with the risk when we eat fewer than three servings The researchers also said the high levels of potassium, folate, fiber and antioxidants in fruits and vegetables all help to contribute to their health-boosting qualities
red grapefruit may lower heart disease risk
If you like eating grapefruit, you will be happy with what researchers in Israel have recently discovered In a study published in the Journal of Agricultural and Food Chemistry, a team from Hebrew University in Jerusalem found that eating a red grapefruit every day may reduce blood fats and protect
against heart disease Grapefruits and other citrus fruits are known to contain large amounts of antioxidants This new study is the first to look at different grapefruit types and their influence on people with high blood cholesterol and significantly lowering hardening of the the level of arteries Both play triglycerides major roles in heart disease The researchers found that grapefruit, regardless of its color, helped to lower LDL or bad cholesterol But only a diet supplemented with red Jaffa grapefruits was effective in
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DIABETES YOU
nutrition
Oats and Other Foods To Boost Your Health
By Janis Roszler, RD, CDE, LD/N
What do oats and garlic have in common?
They could help start a great casserole, but the real answer is far more exciting:These foods may help reduce your risk of heart disease, heart attack and stroke High blood LDL cholesterol and triglyceride levels increase the risk of heart disease, heart attacks and strokes This risk is even greater if you have diabetes Cholesterol is a soft, fat-like substance that can clog arteries and interfere with the flow of blood It comes in two forms: LDL bad cholesterol, which clogs the arteries with plaque and HDL
good cholesterol, which helps remove the bad cholesterol from the arteries Some researchers believe that the bad cholesterol also may injure the blood vessels when it changes from a liquid into a solid inside the blood vessels When this happens, the cholesterol expands and tears the arteries walls Healthy food choices, regular physical activity and medicines if needed can help you meet the cholesterol and tryiglyceride goals set by the American Diabetes Association In addition to following a healthy lifestyle and taking medicine as directed, you also can get added help in reaching your heart-healthy goals from some commonly found foods and supplements
DIABETES YOU
Oats
Many studies show that eating oats and other whole grain foods with fiber offers significant heart-healthy benefits A study published in the American Journal of Clinical Nutrition 2003 showed that people who consumed whole grains in place of refined grains had a lower risk of developing coronary artery disease To include oats in your day, sprinkle some into meatball or meatloaf recipes, bake them into muffins and cookies or enjoy a tasty bowl of hot oatmeal at breakfast
Garlic contains a substance called allicin
that helps encourage a moderate, short-term reduction in total cholesterol, LDL bad cholesterol and triglyceride levels, as demonstrated in studies published in a variety of scientific journals Raw, roasted, dried or powdered garlic can be added to many recipes, including soups, sauces, salad dressings and vegetable dishes If you take a garlic supplement and will be having a surgical procedure, be sure to discontinue the supplement prior to the surgery It can thin the blood, which could cause healing problems
Garlic
Flaxseed
Flaxseed, the subject of numerous studies, contains Omega-3 fatty acids, which may help reduce triglyceride levels and improve HDL levels Ground flaxseeds can be baked into muffins or breads or sprinkled onto breakfast cereal or lowfat yogurt Whole seeds can be used, as well, but the benefits are the greatest when the seeds have been crushed or chewed well
Fish Oils
Oily fish, such as salmon, mackerel, lake trout, herring, sardines and albacore tuna, contain two beneficial Omega-3 fatty acids These may help reduce the risk for heart disease and blood vessel cardiovascular disease Fish oil capsules usually have more concentrated doses of the fatty acids EPA
and DHA This may help reduce triglyceride levels and may enhance the effectiveness of statin drugs that are used to improve cholesterol levels There are many fish oil products available at Walgreens All of us want to stay healthy It is nice to know that many common food items and supplements found in your kitchens and/or Walgreens pharmacies can help you achieve that goal
Holiday 2006 27
EASY TO USE
CONVENIENT ACCURATE DOSING
Q A
11125
105
10
THE CONFIDENCE OF LANTUS THE CONVENIENCE OF A PEN
SOME QUESTIONS AND ANSWERS ABOUT
Your Medicare Drug Benefit
WHEN IS THE MEDICARE PART D PRESCRIPTION DRUG PLAN ENROLLMENT PERIOD?
ASK YOUR DOCTOR FOR YOUR FREE OPTICLIK PEN OR GO TO WWWOPTICLIKCOM
OptiClik is a reusable insulin delivery device insulin Pen for use with a 3-mL Lantus cartridge U-100
Q A
See Important Safety Information for Lantus on next page
November 15 through December Walgreens Pharmacists can 31, 2006 is the open enrollanswer any questions you may ment period have about Medicare Prescription Insurance, plus they can provide you with a FREE, personalized report that WHY IS THIS IMPORTANT will tell you which plans cover your FOR ME? current medications So if
youre This is the only time you will signing up for the first time or your be able to sign up for a plan, medication needs have changed and or switch to a new plan if you are youre looking to switch plans, this not happy with your current plan report can provide you with inforIf youre already signed up for a mation you need to help you make a plan, keep a look out in the mail decision in October for your plans Annual Notice of Change This notice WHAT PLANS DOES includes information regarding WALGREENS ACCEPT? specific changes in Medicare and Walgreens accepts all major plan benefits, plan premiums and Medicare prescription insurance plan rules effective January 1, plans 2007
Q A
HOW CAN WALGREENS HELP ME WITH MY MEDICARE PART D NEEDS?
Q A
2006 sanofi-aventis US LLC
USAGLA060217
28
Holiday 2006
DIABETES YOU
Ken Kleba, go-kart buff, Lantus patient since 2003
Individual results may vary
HIS PASSION: GOING FULL THROTTLE HIS POWER: LANTUS 24-HOUR INSULIN
LANTUS
ONCE-DAILY, 24-HOUR INSULIN
Ken loves to put the pedal to the metal He also takes Lantus insulin as part of his diabetes therapy Lantus is the only once-daily, 24-hour insulin with no pronounced peak And it works
steadily all day and all night, so Ken is free to go off to the races
Important Safety Information Prescription Lantus is for adults with type 2 diabetes or adults and children 6 years and older with type 1 diabetes who require long-acting insulin for the control of high blood sugar OptiClik is a reusable insulin delivery device insulin Pen for use with a 3-mL Lantus cartridge U-100 DO NOT DILUTE OR MIX LANTUS WITH ANY OTHER INSULIN OR SOLUTION It will not work as intended, and you may lose blood sugar control, which could be serious Do not change your insulin without talking with your doctor The syringe must not containany other medication or residue You should not use Lantus if you are allergic to insulin Lantus is a long-acting insulin you inject just once a day, at the same time each day As with any insulin therapy, possible side effects may include blood sugar levels that are too low hypoglycemia; injection site reactions, including changes in fat tissue at the injection site; itching and rash; and allergic reactions Rare but serious side effects may occur Tell your doctor about all other medicines and supplements you are taking because they can change the way insulin works
See additional important information on the next page
Ask your doctor how Lantus can fit into your total diabetes treatment, which may include diet, exercise, oral medications, and mealtime insulin
2006 sanofi-aventis US LLC USAGLA060231
Ask your doctor about 24-hour Lantus, available for use in the OptiClik pen
1-866-4LANTUS wwwlantuscom
Brief Summary of Prescribing Information February 2006
Rx Only
LANTUS
insulin glargine [rDNA origin] injection
LANTUS must NOT be diluted or mixed with any other insulin or solution INDICATIONS AND USAGE LANTUS is indicated for once-daily subcutaneous administration for the treatment of adult and pediatric patients with type 1 diabetes mellitus or adult patients with type 2 diabetes mellitus who require basal long-acting insulin for the control of hyperglycemia CONTRAINDICATIONS LANTUS is contraindicated in patients hypersensitive to insulin glargine or the excipients WARNINGS Hypoglycemia is the most common adverse effect of insulin, including LANTUS As with all insulins, the timing of hypoglycemia may differ among various insulin formulations Glucose monitoring is recommended for all patients with diabetes Any change of insulin should be
made cautiously and only under medical supervision Changes in insulin strength, timing of dosing, manufacturer, type eg, regular, NPH, or insulin analogs, species animal, human, or method of manufacture recombinant DNA versus animal-source insulin may result in the need for a change in dosage Concomitant oral antidiabetes treatment may need to be adjusted PRECAUTIONS General: LANTUS is not intended for intravenous administration The prolonged duration of activity of insulin glargine is dependent on injection into subcutaneous tissue Intravenous administration of the usual subcutaneous dose could result in severe hypoglycemia LANTUS must NOT be diluted or mixed with any other insulin or solution If LANTUS is diluted or mixed, the solution may become cloudy, and the pharmacokinetic/pharmacodynamic profile eg, onset of action, time to peak effect of LANTUS and/or the mixed insulin may be altered in an unpredictable manner When LANTUS and regular human insulin were mixed immediately before injection in dogs, a delayed onset of action and time to maximum effect for regular human insulin was observed The total bioavailability of the mixture was also slightly decreased compared to
separate injections of LANTUS and regular human insulin The relevance of these observations in dogs to humans is not known As with all insulin preparations, the time course of LANTUS action may vary in different individuals or at different times in the same individual and the rate of absorption is dependent on blood supply, temperature, and physical activity Insulin may cause sodium retention and edema, particularly if previously poor metabolic control is improved by intensified insulin therapy Hypoglycemia: As with all insulin preparations, hypoglycemic reactions may be associated with the administration of LANTUS Hypoglycemia is the most common adverse effect of insulins Early warning symptoms of hypoglycemia may be different or less pronounced under certain conditions, such as long duration of diabetes, diabetes nerve disease, use of medications such as beta-blockers, or intensified diabetes control see PRECAUTIONS, Drug Interactions Such situations may result in severe hypoglycemia and, possibly, loss of consciousness prior to patients awareness of hypoglycemia The time of occurrence of hypoglycemia depends on the action profile of the insulins used and may, therefore, change
when the treatment regimen or timing of dosing is changed Patients being switched from twice daily NPH insulin to once-daily LANTUS should have their initial LANTUS dose reduced by 20 from the previous total daily NPH dose to reduce the risk of hypoglycemia see DOSAGE AND ADMINISTRATION, Changeover to LANTUS The prolonged effect of subcutaneous LANTUS may delay recovery from hypoglycemia In a clinical study, symptoms of hypoglycemia or counterregulatory hormone responses were similar after intravenous insulin glargine and regular human insulin both in healthy subjects and patients with type 1 diabetes Renal Impairment: Although studies have not been performed in patients with diabetes and renal impairment, LANTUS requirements may be diminished because of reduced insulin metabolism, similar to observations found with other insulins see CLINICAL PHARMACOLOGY, Special Populations Hepatic Impairment: Although studies have not been performed in patients with diabetes and hepatic impairment, LANTUS requirements may be diminished due to reduced capacity for gluconeogenesis and reduced insulin metabolism, similar to observations found with other insulins see CLINICAL PHARMACOLOGY, Special
Populations Injection Site and Allergic Reactions: As with any insulin therapy, lipodystrophy may occur at the injection site and delay insulin absorption Other injection site reactions with insulin therapy include redness, pain, itching, hives, swelling, and inflammation Continuous rotation of the injection site within a given area may help to reduce or prevent these reactions Most minor reactions to insulins usually resolve in a few days to a few weeks Reports of injection site pain were more frequent with LANTUS than NPH human insulin 27 insulin glargine versus 07 NPH The reports of pain at the injection site were usually mild and did not result in discontinuation of therapy Immediate-type allergic reactions are rare Such reactions to insulin including insulin glargine or the excipients may, for example, be associated with generalized skin reactions, angioedema, bronchospasm, hypotension, or shock and may be life threatening Intercurrent Conditions: Insulin requirements may be altered during intercurrent conditions such as illness, emotional disturbances, or stress Information for Patients: LANTUS must only be used if the solution is clear and colorless with no particles visible
see DOSAGE AND ADMINISTRATION, Preparation and Handling Patients must be advised that LANTUS must NOT be diluted or mixed with any other insulin or solution see PRECAUTIONS, General Patients should be instructed on self-management procedures including glucose monitoring, proper injection technique, and hypoglycemia and hyperglycemia management Patients must be instructed on handling of special situations such as intercurrent conditions illness, stress, or emotional disturbances, an inadequate or skipped insulin dose, inadvertent administration of an increased insulin dose, inadequate food intake, or skipped meals Refer patients to the LANTUS Patient Information circular for additional information As with all patients who have diabetes, the ability to concentrate and/or react may be impaired as a result of hypoglycemia or hyperglycemia Patients with diabetes should be advised to inform their health care professional if they are pregnant or are contemplating pregnancy Drug Interactions: A number of substances affect glucose metabolism and may require insulin dose adjustment and particularly close monitoring The following are examples of substances that may increase the
blood-glucose-lowering effect and susceptibility to hypoglycemia: oral antidiabetes products, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAO inhibitors, propoxyphene, salicylates, somatostatin analog eg, octreotide, sulfonamide antibiotics The following are examples of substances that may reduce the blood-glucose-lowering effect of insulin: corticosteroids, danazol, diuretics, sympathomimetic agents eg, epinephrine, albuterol, terbutaline, isoniazid, phenothiazine derivatives, somatropin, thyroid hormones, estrogens, progestogens eg, in oral contraceptives Beta-blockers, clonidine, lithium salts, and alcohol may either potentiate or weaken the blood-glucose-lowering effect of insulin Pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia In addition, under the influence of sympatholytic medicinal products such as beta-blockers, clonidine, guanethidine, and reserpine, the signs of hypoglycemia may be reduced or absent Carcinogenesis, Mutagenesis, Impairment of Fertility: In mice and rats, standard two-year carcinogenicity studies with insulin glargine were performed at doses up to 0455 mg/kg, which is for the rat approximately 10 times and for
the mouse approximately 5 times the recommended human subcutaneous starting dose of 10 IU 0008 mg/kg/day, based on mg/m2 The findings in female mice were not conclusive due to excessive mortality in all dose groups during the study Histiocytomas were found at injection sites in male rats statistically significant and male mice not statistically significant in acid vehicle containing groups These tumors were not found in female animals, in saline control, or insulin comparator groups using a different vehicle The relevance of these findings to humans is unknown Insulin glargine was not mutagenic in tests for detection of gene mutations in bacteria and mammalian cells Ames- and HGPRT-test and in tests for detection of chromosomal aberrations cytogenetics in vitro in V79 cells and in vivo in Chinese hamsters In a combined fertility and prenatal and postnatal study in male and female rats at subcutaneous doses up to 036 mg/kg/day, which is approximately 7 times the recommended human subcutaneous starting dose of 10 IU
0008 mg/kg/day, based on mg/m2, maternal toxicity due to dose-dependent hypoglycemia, including some deaths, was observed Consequently, a reduction of the rearing rate
occurred in the high-dose group only Similar effects were observed with NPH human insulin Pregnancy: Teratogenic Effects: Pregnancy Category C Subcutaneous reproduction and teratology studies have been performed with insulin glargine and regular human insulin in rats and Himalayan rabbits The drug was given to female rats before mating, during mating, and throughout pregnancy at doses up to 036 mg/kg/day, which is approximately 7 times the recommended human subcutaneous starting dose of 10 IU 0008 mg/kg/day, based on mg/m2 In rabbits, doses of 0072 mg/kg/day, which is approximately 2 times the recommended human subcutaneous starting dose of 10 IU 0008 mg/kg/day, based on mg/m2, were administered during organogenesis The effects of insulin glargine did not generally differ from those observed with regular human insulin in rats or rabbits However, in rabbits, five fetuses from two litters of the high-dose group exhibited dilation of the cerebral ventricles Fertility and early embryonic development appeared normal There are no well-controlled clinical studies of the use of insulin glargine in pregnant women It is essential for patients with diabetes or a history of gestational
diabetes to maintain good metabolic control before conception and throughout pregnancy Insulin requirements may decrease during the first trimester, generally increase during the second and third trimesters, and rapidly decline after delivery Careful monitoring of glucose control is essential in such patients Because animal reproduction studies are not always predictive of human response, this drug should be used during 
pregnancy only if clearly needed Nursing Mothers: It is unknown whether insulin glargine is excreted in significant amounts in human milk Many drugs, including human insulin, are excreted in human milk For this reason, caution should be exercised when LANTUS is administered to a nursing woman Lactating women may require adjustments in insulin dose and diet Pediatric Use: Safety and effectiveness of LANTUS have been established in the age group 6 to 15 years with type 1 diabetes Geriatric Use: In controlled clinical studies comparing insulin glargine to NPH human insulin, 593 of 3890 patients with type 1 and type 2 diabetes were 65 years and older The only difference in safety or effectiveness in this subpopulation compared to the entire study population was an
expected higher incidence of cardiovascular events in both insulin glargine and NPH human insulin-treated patients In elderly patients with diabetes, the initial dosing, dose increments, and maintenance dosage should be conservative to avoid hypoglycemic reactions Hypoglycemia may be difficult to recognize in the elderly see PRECAUTIONS, Hypoglycemia ADVERSE REACTIONS The adverse events commonly associated with LANTUS include the following: Body as a whole: allergic reactions see PRECAUTIONS Skin and appendages: injection site reaction, lipodystrophy, pruritus, rash see PRECAUTIONS Other: hypoglycemia see WARNINGS and PRECAUTIONS In clinical studies in adult patients, there was a higher incidence of treatment-emergent injection site pain in LANTUStreated patients 27 compared to NPH insulin-treated patients 07 The reports of pain at the injection site were usually mild and did not result in discontinuation of therapy Other treatment-emergent injection site reactions occurred at similar incidences with both insulin glargine and NPH human insulin Retinopathy was evaluated in the clinical studies by means of retinal adverse events reported and fundus photography The numbers of retinal
adverse events reported for LANTUS and NPH treatment groups were similar for patients with type 1 and type 2 diabetes Progression of retinopathy was investigated by fundus photography using a grading protocol derived from the Early Treatment Diabetic Retinopathy Study ETDRS In one clinical study involving patients with type 2 diabetes, a difference in the number of subjects with 3-step progression in ETDRS scale over a 6-month period was noted by fundus photography 75 in LANTUS group versus 27 in NPH treated group The overall relevance of this isolated finding cannot be determined due to the small number of patients involved, the short follow-up period, and the fact that this finding was not observed in other clinical studies OVERDOSAGE An excess of insulin relative to food intake, energy expenditure, or both may lead to severe and sometimes long-term and life-threatening hypoglycemia Mild episodes of hypoglycemia can usually be treated with oral carbohydrates Adjustments in drug dosage, meal patterns, or exercise may be needed More severe episodes with coma, seizure, or neurologic impairment may be treated with intramuscular/subcutaneous glucagon or concentrated intravenous
glucose After apparent clinical recovery from hypoglycemia, continued observation and additional carbohydrate intake may be necessary to avoid reoccurrence of hypoglycemia DOSAGE AND ADMINISTRATION LANTUS is a recombinant human insulin analog Its potency is approximately the same as human insulin It exhibits a relatively constant glucose-lowering profile over 24 hours that permits once-daily dosing LANTUS may be administered at any time during the day LANTUS should be administered subcutaneously once a day at the same time every day For patients adjusting timing of dosing with LANTUS, see WARNINGS and PRECAUTIONS, Hypoglycemia LANTUS is not intended for intravenous administration see PRECAUTIONS Intravenous administration of the usual subcutaneous dose could result in severe hypoglycemia The desired blood glucose levels as well as the doses and timing of antidiabetes medications must be determined individually Blood glucose monitoring is recommended for all patients with diabetes The prolonged duration of activity of LANTUS is dependent on injection into subcutaneous space As with all insulins, injection sites within an injection area abdomen, thigh, or deltoid must be rotated from
one injection to the next In clinical studies, there was no relevant difference in insulin glargine absorption after abdominal, deltoid, or thigh subcutaneous administration As for all insulins, the rate of absorption, and consequently the onset and duration of action, may be affected by exercise and other variables LANTUS is not the insulin of choice for the treatment of diabetes ketoacidosis Intravenous short-acting insulin is the preferred treatment Pediatric Use: LANTUS can be safely administered to pediatric patients 6 years of age Administration to pediatric patients 6 years has not been studied Based on the results of a study in pediatric patients, the dose recommendation for changeover to LANTUS is the same as described for adults in DOSAGE AND ADMINISTRATION, Changeover to LANTUS Initiation of LANTUS Therapy: In a clinical study with insulin naïve patients with type 2 diabetes already treated with oral antidiabetes drugs, LANTUS was started at an average dose of 10 IU once daily, and subsequently adjusted according to the patients need to a total daily dose ranging from 2 to 100 IU Changeover to LANTUS: If changing from a treatment regimen with an intermediate- or
long-acting insulin to a regimen with LANTUS, the amount and timing of short-acting insulin or fast-acting insulin analog or the dose of any oral antidiabetes drug may need to be adjusted In clinical studies, when patients were transferred from once-daily NPH human insulin or ultralente human insulin to once-daily LANTUS, the initial dose was usually not changed However, when patients were transferred from twice-daily NPH human insulin to LANTUS once daily, to reduce the risk of hypoglycemia, the initial dose IU was usually reduced by approximately 20 compared to total daily IU of NPH human insulin and then adjusted based on patient response see PRECAUTIONS, Hypoglycemia A program of close metabolic monitoring under medical supervision is recommended during transfer and in the initial weeks thereafter The amount and timing of short-acting insulin or fast-acting insulin analog may need to be adjusted This is particularly true for patients with acquired antibodies to human insulin needing high-insulin doses and occurs with all insulin analogs Dose adjustment of LANTUS and other insulins or oral antidiabetes drugs may be required; for example, if the patients timing of dosing, weight
or lifestyle changes, or other circumstances arise that increase susceptibility to hypoglycemia or hyperglycemia see PRECAUTIONS, Hypoglycemia The dose may also have to be adjusted during intercurrent illness see PRECAUTIONS, Intercurrent Conditions Brief Summary of Prescribing Information January 2006 sanofi-aventis US LLC Bridgewater, NJ 08807 Country of Origin Germany wwwlantuscom 2006 sanofi-aventis US LLC OptiClik is a registered trademark of sanofi-aventis US LLC LAN-FEB06-B-Aa
feature article The Sopranos Star
Aida Turturro
Standing Up To Diabetes
By Alan Braverman
ida Turturro is known to millions as Janice Soprano from the HBO series, The Sopranos What people dont know is that she has struggled with diabetes for a number of years Now she is sharing her personal story and speaking out to encourage those who have been diagnosed with or are atrisk for diabetes to get in control of the condition to avoid life-threatening complications Aidas diagnosis could not have come at a more difficult time It was 2001 and her father had recently died Her mother was sick Aida knew diabetes ran in her family, but still, she was surprised when she learned, after a routine examination,
that she had diabetes Her reaction? I just didnt pay attention to it There was too much going on It took two years until Aida actually paid attention to her diabetes She was lucky enough to have a health care provider who sat her down
A
and explained, in no uncertain terms, what would happen to Aida if she continued to ignore her condition In hindsight, I realize how crazy I was being, she explained I was being snappy I was tired all the time I had these emotional highs and lows, and it seemed like I was always crying Aida learned that these emotional ups and downs were just one small part of not managing diabetes If she continued to neglect it, diabetes would seriously affect her life and health So, for about three years now, Aida has been taking insulin to help manage her diabetes She takes her insulin four times every day and checks her blood glucose levels at least as many times, if not more At first I would check my blood all the time, Aida reports But now that I got the hang of it and know how my body reacts, Im down to about four times each day While the insulin she takes plays
It took two years until Aida actually paid attention to her diabetes She was lucky enough to
have a health care provider who sat her down and explained, in no uncertain terms, what would happen to Aida if she continued to ignore her condition
DIABETES YOU
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feature article
a leading role in keeping her diabetes under control, Aida is also careful about what she eats and how she exercises Living in the New York City area and shooting The Sopranos in New Jersey, in addition to all her traveling and other commitments, Aida admits that its sometimes hard to stick with a strict regimen of diet and physical activity Nonetheless, she usually has a cup of oatmeal or a protein shake for breakfast On the weekends, shell sometimes have eggs Lunch usually consists of vegetables and a protein Dinner is similarly healthy The trick, for me, is to eat a little bit throughout the day, so I dont get too hungry and end up doing something Ill later regret If Im on the set, Ill make sure to ask catering not to put out tempting foods I need to avoid reports Some people just get it and jump right in and start managing their diabetes Then there are people who are more like I was: in denial The response shes been getting tells Aida shes doing a good thing by talking about
diabetes As diabetes becomes much more prevalent in America, shes finding more and more people who want to learn about the right way to manage diabetes Im lucky enough to be on a show that allows me to speak to people and have them listen, she says Im no doctor, but that doesnt make what I have to say any less important Aida admits that she has good days and bad days Some days she feels that her weight and glucose are under control Other days arent as positive After all, diabetes is hard work to manage Nonetheless, she is eternally upbeat about bringing her message to the masses I wish we could get everyone on board, like an AA meeting, Aida shared Kids, especially, need to know the importance of eating right and living a healthy lifestyle Aida Turturro has appeared on stage and screen as many different characters, but no doubt her most famous role to date is that of Tony Sopranos sister, Janice, on The Sopranos The daughter of a well-known painter and sculptor her dad and a television film editor her mom, Aida was bitten by the acting bug at a young age Fresh out of college in 1984, Aida nabbed her first film, True Love, opposite Anabella Sciorra While she worked her day job
organizing and cleaning houses, she landed parts on Broadway including a 1992 revival of A Streetcar Named Desire starring Alec Baldwin and Jessica Lang and in movies ranging from What About Bob? 1991 to Woody Allens Manhattan Murder Mystery 1993 Other film credits include Martin Scorseses Bringing Out the Dead, John Turturros Romance and Cigarettes and Illuminata, and Allens Celebrity When The Sopranos is not in production, she continues to hone her craft by appearing on stage and in independent films
DIABETES YOU
On her tour, Aida is touching on several key points:
Acknowledging the severity of diabetes It can harm you if left uncontrolled Getting educated about diabetes Being knowledgeable will control the fear of being diagnosed Staying in control of blood glucose levels through diet, physical activity and medication Checking glucose AND A1C levels regularly Glucose tests let you know your levels at that moment, while A1C is an indication of glucose levels over time Speaking with your health care providers about effective ways to manage blood glucose levels Establishing a support system to help you through difficult times Friends and relatives can be crucial to helping
you manage diabetes
32 Holiday 2006
Aida advises the people she talks to about diabetes to just walk You dont need a trainer All you need is a pair of sneakers and maybe a pedometer
In terms of physical activity, Aida makes sure to get moving almost daily Working with a trainer who supervises her overall physical activity plan, she goes bike riding, hiking, does yoga and as much aerobic exercise as possible But, she says, physical activity doesnt have to be an expensive proposition Aida advises the people she talks to about diabetes to just walk You dont need a trainer All you need is a pair of sneakers and maybe a pedometer The important thing to remember, she advises, is not to get discouraged Aidas been talking to people all around the country on a tour sponsored by sanofiaventis makers of Lantus So far, shes been to Los Angeles, New York City, Chicago, Boston, Philadelphia and Atlanta The concept behind the tour is to communicate to people who have diabetes how serious it is and the importance of taking care of it as soon as you are diagnosed Im amazed at what Ive seen, Aida
RE
MMEN CO by D
people with
DIABETES
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We love our new meters For tests at home or on the go, nothing gives you all-in-one convenience with the least pain like the ACCU-CHEK Compact Plus system A drum of 17 preloaded strips fits inside the meter Outside is a detachable lancet device proven least painful Find out more by calling 800-858-8072
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diabetes care
Blood Glucose Meters Available at Walgreens
Meter Box Meter Memory
365 tests, 14- 30day avg Walgreens TrueTrack 365 tests, 14- 30day avg Walgreens Prestige IQ 50 tests Less than 10 sec Small 1 L
Two-step testing with smallest disposable blood glucose testing system available Vial of 50 test strips with meter built right on top No coding Allows for alternate site testing Large screen with bold symbols Easy-to-use Comfort Curve strip guides finger to target area for easy blood application Rubber grip for easier handling 10-50 sec Medium 4 L Easy three-step testing Large screen Easy-to-handle strips Affordably priced Data uploading capability
Test Time
10 sec
Sample SizeL
Small 1 L
Features Comments
Easy two-step testing with fast results Capillary-action test strips with small sample needed Affordably priced Data uploading capability Allows for alternate site testing
Walgreens Sidekick Disposable 480 tests, 26 sec 7-, 14- 30-day avg Accu-Chek Advantage 500 tests, 7-, 14- 30-day avg Accu-Chek Aviva 300 tests, 7-, 14- 30 day avg Accu-Chek Compact Plus 100 tests, 30 sec 14-day avg 5 sec 5 sec
Medium 4 L
Very Small 06 L
Easy to handle and use, with two simple steps Large, wide test strip fills quickly and easily Over 150 quality checks to detect and prevent unreliable results Allows for alternate site testing No strip handling Seventeen strips are contained in a drum,
which is loaded into the meter Attachable lancet device that uses Softclix lancets Automatic coding Allows for alternate site testing Simplified testing with no coding required Ten individual strips in one easy-to-load disc Allows for alternate site testing
Small 15 L
Small 25 L
Ascensia Breeze 240 tests, 15 sec 14-day avg Very Small 06 L Test and go The only single-strip system with no coding required Corrects for common errors to ensure accuracy Sip-in test strips Allows for alternate site testing
Ascensia Contour 250 tests, 14-day avg FreeStyle Flash
L microliters
DIABETES YOU
7 sec
Very Small 03 L
Worlds smallest meter Gives accurate and precise results with the worlds smallest sample size Test light and backlight display Allows for alternate site testing
Holiday 2006
35
diabetes care
Meter Box Meter Memory
250 tests, 14-day avg
Test Time
5 sec
Sample SizeL
Very Small 03 L
Features Comments
Gives accurate and precise results with the worlds smallest sample size Easy to read, with largest reading of any meter Easy to hold Four programmable alarms remind you when to test Allows for alternate site testing Large, easy-to-read display Automatically draws blood into
test strips and shows if there is enough blood for an accurate reading Compact size and weight Allows for forearm testing Before and after meal averages can help show the effects of food on blood glucose Two-way scrolling buttons Backlight makes it easy to read and operate Allows for alternate site testing Easy to use Simple three-step testing Very small meter Sleek design that is easy to handle Large, easy to read display Get just the number you want
FreeStyle Freedom 150 tests, 14- 30day avg OneTouch Ultra 500 tests, 7-, 14- 30-day avg OneTouch Ultra2 50 tests 5 sec Small 1 L 5 sec Small 1 L 5 sec Small 1 L
OneTouch UltraMini 3,000 tests, 14- 30day avg OneTouch UltraSmart 450 tests, 7-, 14- 30 day avg Precision Xtra
L microliters
5 sec
Small 1 L
Automatically organizes results into onscreen charts and graphs so that you can see patterns and trends Easy blood application Allows for alternate site testing
5 sec
Very Small 06 L
Simple two-step testing, with easy blood application Just insert strip, add blood and test begins Large, easy-to-read display Measures both blood glucose and blood ketone
Choosing Your Meter
Some features to look for:
COST Find out what meters
and strips your health plan covers Check the prices of both of these items before you make your purchase Look for trade-in and rebate offers EASE OF USE Items to consider: Can you easily handle the meter and strips? Does it have features such as automatic calibration, and a large, easy-to-read screen?
36 Holiday 2006
SPEED Some meters provide results in as little as five seconds PORTABILITY Is your meter small and light enough to carry with you? SAMPLE SIZE Meters with a smaller sample size 1 L or less allow you to use a thinner lancet This can mean less pain for your fingers ACCURACY Make sure you understand how to use your meter properly in order to get an accurate result
RESULTS UPLOAD Most meters allow you to upload results from your computer and analyze them electronically ALTERNATE SITE TESTING This feature allows you to take blood from a site other than your fingers, such as your palm, forearm, upper arm, calf or thigh MEASURING BLOOD KETONES This gives you better information and control on sick days
DIABETES YOU
Blood Glucose Log Sheet
Blood Glucose Mon Breakfast After Breakfast Lunch After Lunch Dinner After Dinner Bedtime Notes: Extra readings, special events,
illness, activities, etc
Tues
Wed
Thurs
Fri
Sat
Sun Reference Chart Before Breakfast Before Meals Two hours after meals Average Target Blood Glucose Levels 90130 mg/dL 90130 mg/dL 180 mg/dL or less Your Blood Glucose Goals
work with your doctor to establish your blood glucose goals MEDICATION TABLE Name of Medication Strength Directions for Use Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Circle Time of Day Lunch Lunch Lunch Lunch Lunch Lunch Dinner Dinner Dinner Dinner Dinner Dinner Bedtime Bedtime Bedtime Bedtime Bedtime Bedtime
LEARN MORE ABOUT DIABETES AT
Doctors Phone Number
Walgreens Pharmacy Phone Number
wwwwalgreenscom/diabetes wwwLillyDiabetescom
Remember to call 1-800-WALGREEN for your nearest Walgreens location or visit our website at wwwwalgreenscom/findastore
diabetes care
Stay on Track by Keeping Track
By Martha Funnell, MS, RN, CDE
There is no question that there is a lot to do when you have diabetes Paying attention to what you eat, being physically active, checking your blood glucose and keeping up with several different medications all take time and effort To make life easier, many people with diabetes choose meters with memory to
keep track of their blood glucose readings making for one less thing to worry about This type of meter can be very helpful Although writing down your blood glucose levels yourself and keeping a blood glucose log sheet, like the one on the opposite page, or a logbook, can be very useful, as well Here are some ideas about how log sheets or a logbook can help you keep your blood glucose levels on track
DIABETES YOU
WHY ARE YOU CHECKING YOUR BLOOD GLUCOSE LEVELS?
People monitor their blood glucose levels for different reasons For some, it is simply because their health care professional advised them to do so But you are the one who has diabetes You are the one who has to care for it day in and day out Blood glucose monitoring gives you the facts you need to make informed choices
WHAT DO THE NUMBERS MEAN?
It is hard to use the information if you do not know what the numbers mean It helps to set a target range for your blood glucose level Some people use the targets set by diabetes experts and others use their own targets Either way,
There are certain times that a logbook is especially helpful For example, when you start a new medication, when your readings are higher or lower than
usual for a few days or when you are ill or under more stress than usual
Holiday 2006 39
diabetes care
you need to know where you are aiming so you SO WHY NOT KEEP A LOG? There are several reasons that people choose can make the results meaningful to you not to write down their blood glucose records HOW CAN YOU USE THE RESULTS? If any of these ring true for you, perhaps the One way to use the results is as a clue for what hints listed below will help you to think is happening with your diabetes management differently No matter what the reading, think about why I dont know what the numbers mean your blood glucose level is where it is Did you The table found on the log sheet on page 38 eat less or exercise more than usual? Are you can give you some ideas about target ranges stressed? Are you coming down with a cold? Remember, not every blood glucose reading Have you been paying more or less attention to will be in your range It is what happens most your diabetes? Thinking about why your result of the time that counts is what it is helps you to better understand My provider does not look at the results your body and your diabetes It is hard to look at several months worth of numbers
and try to make sense out of them LOOK FOR PATTERNS You might try to show your health care Another way to use your results is to look for provider your blood glucose levels for the week patterns or times when your blood glucose before your visit If you choose to do this, make level is often in or out of your target range If sure you check your blood glucose at least two your blood glucose is not in your target range to four times a day and at different times so at certain times on most days, then it is likely you have a full picture of a day Your health you need a change in your treatment plan If care provider can use this record, plus your A1C this is the case, do not wait until your next and the readings in your meter to get a good visit Call your health care provider to let him idea of how your treatment is working or her know what is happening There may be My provider just yells at me about a simple solution You can learn to make the results changes in your insulin dose based on these patterns as well and it is easier to see these Be proactive Tell your health care provider what you think is going on and why This can patterns in a log sheet or logbook help start a discussion
that can lead to a solution, rather than bad feelings CHECK YOUR WORK Blood glucose testing can help you see how your medications, meal planning and physical activity affect your blood glucose level It is easy to get discouraged when you are working hard and the mirror or scale do not reflect those efforts You may be able to see changes in your glucose levels before you can see changes in your weight Also, you can get information right away about how different foods or exercises affect your blood glucose level That helps you know how to plan and what to expect the next time Writing it down makes it easier to remember Its too frustrating It is frustrating when the numbers do not seem to change or reflect your efforts Keep in mind that your blood glucose reading is just a number It is not a judgment of you, your efforts or your character It is simply information Keeping this in mind will also help you to be honest with yourself as you write down your results and think about why they are what they are
Blood glucose testing can help you see how your medications, meal planning and physical activity affect your blood glucose level
HOW KEEPING TRACK CAN HELP YOU
There are certain times
that a log sheet or logbook is especially helpful For example, when you start a new medication, when your readings are higher or lower than usual for a few days or when you are ill or under more stress than usual The main reason to keep a log is to help you take charge of your diabetes Your meter gives you the power to manage your diabetes A log sheet or logbook helps you use that power to your best advantage
DIABETES YOU
GETTING PREPPED
Looking back over your blood glucose log sheets or logbook is a good way to get ready for your visit with your health care team Your results can give you ideas about questions to ask or concerns to raise Showing your logbook to your health care professionals also helps them make decisions about your treatment
40 Holiday 2006
Source:msmr.org
