News and Views From the Field of Diabetes Management Integrated Diabetes Services Those with insulin-dependent diabetes will need to inject fast-acting …
Summer, 2002
Control Solutions
News and Views From the Field of Diabetes Management
Gary Scheiner MS, CDE Regina Taddeo MA, RD, CDE Bret Boyer, PhD -
Integrated Diabetes Services
Integrated Diabetes Services
Control Solutions is published by Integrated Diabetes Services, the
diabetes self-care specialists Day, evening and weekend consultations are
available for all ages Services include:
Basic diabetes education Blood sugar tune-ups
Insulin pump therapy Weight management
Nutrition counseling Exercise planning
Preventive health Psychotherapy
610-642-6055
300 E Lancaster Ave, Suite 111
Wynnewood, PA 19096
wwwintegrateddiabetescom
2000, Gary Scheiner , MS, CDE
Its Watch Time
The Glucowatch Biographer is here But will it meet expectations?
April 15 is a dreaded day of taxation for most, but a possible day of
liberation for diabetics Thats because on April 15, 2002, Cygnus
Corporation officially released the
Glucowatch Biographer to the public
Heres the rundown:
Primary Assets
The watch is a little bigger than a standard wristwatch and is worn on the
top or bottom of the forearm On the bottom side of the watch where it
contacts the skin is a disposable sensor with adhesive gel that is good
for up to 12 hours of testing The watchs sensors do not actually pierce
the skin Instead, a mild electric current from a AAA battery pulls
glucose molecules to the skin surface
With a fresh sensor in place, the watch takes 3 hours to warm-up Then,
the user must calibrate the watch by checking their blood sugar with a
meter and entering the value The watch can then provide readings every 20
minutes for up to 12 hours The readings obtained by the watch are
reasonably accurate but lag 20-30 minutes behind the blood glucose value
In other words, a watch reading at 2:00 pm corresponds with a blood sugar
level at 1:30-1:40 pm
The watch permits the user to enter events, such as meals and exercise, to
correspond with the downloadable glucose readings The user can also set
the watch to alarm if it exceeds high and low blood sugar thresholds
Alarms will also sound if the watch senses
perspiration or a rapid blood
sugar drop
The watch is not meant to replace your blood glucose meter or to be used
all the time It CAN be useful in special testing situations, such as
checking basal rates for pump or Lantus users, overnight detection of
hypoglycemia, sick day management, checking for after-meal blood sugar
spikes, on travel days or in high-stress situations Personally, I found
the watch useful for seeing how high my blood sugar rose after eating
certain types of foods
Itemized Deductions
For starters, there is the out-of-pocket cost The watch sells for 595
plus the cost of the sensors, and Cygnus is just beginning to make some
headway in terms of insurance reimbursement
Another problem is skin irritation The electric current produced by the
watch is not painless The sensation can range from a mild tingling to a
moderate stinging Luckily, the sensation tends to become less severe the
longer you wear it Redness and itching are common at the watch site
Those with highly sensitive skin may develop blisters or moderate-to-severe
inflammation If your forearm is hairy, you will also have to shave the
site
Logistically, the unlit screen, lack of
water-resistance, and three-hour
warm-up period can be somewhat inconvenient
Perhaps the greatest detriment is continuity During the 12-hour testing
period, the watch may skip a number of readings due to interference from
temperature changes, rapid shaking, and perspiration Overall, I found
that the watch skipped 20-30 of the readings during typical usage, and
rarely worked during even mild amounts of exercise On the bright side, it
is comforting to know that the watch will not provide readings that may be
inaccurate
Check With Your Accountant I mean Diabetes Educator
So, now you know what the watch is all about Just as tax laws are
constantly changing, the watch is likely to go through its share of
modifications Already, plans are underway to make the warm-up period
shorter, to lessen the effects of perspiration on the readings, and to
provide readings every 10 minutes
If you are interested in learning more about the watch, contact Cygnus by
calling 866-GLWATCH, or visiting their web site, wwwglucowatchcom The
watch is a prescription item, and you must pass a very basic test over the
phone before it will be shipped to you Training is provided So are a
warranty and
guarantee
Hey, its not perfect, but its still the best thing to ever happen on
April 15
Walk This Way
Come join the Integrated Diabetes Services Walk Team on Sunday, Sept 22
for a morning of food, fun, friendship, and fund raising among the fall
foliage at the JDRFs Walk To Cure Diabetes Our team will be sporting our
traditional red Stomp Out Diabetes shirts - free to all our team members
The walk features a 1-mile loop around Memorial Hall in beautiful Fairmount
Park Registration is at 9 am; our team photo is at 9:45, and the walk
starts at 10 Walk jog, bike, skip, or whatever as few or as many loops
as you like
Lets see if we can beat last years team mark of 90 walkers and over
11,000 dollars raised Everyone is invited to join our team, so give us a
call Team captain Christine Shubin will help you get registered and
provide you with everything you need to be part of the fun For more
information or to register, call Christine at 610 642-6055
New Product Focus: Lantus
After more than 40 years of dealing with the peaks and valleys of
intermediate-acting insulins, finally, an insulin is available that evens
the playing field
Lantus generic name glargine is an
insulin analog; its molecular
structure is slightly different from that of human insulin This slight
difference gives Lantus its unique absorption pattern: approximately 24
hours of action with no significant peak Lantus is designed to serve as a
basal insulin, covering the bodys own internal glucose production
Lantus offers a number of advantages over NPH, Lente and Ultralente
insulins It reduces the incidence of hypoglycemia by nearly 50,
especially during the night It only needs to be injected once daily
usually at bedtime, and it affords the user some added flexibility in
terms of meal times and sleep patterns
On the downside, because of its acidic nature, Lantus may sting slightly
and must not be mixed with any other kind of insulin Those with insulin-
dependent diabetes will need to inject fast-acting insulin with every meal
and snack when using Lantus And despite its peakless action, it does
not offer the kind of basal insulin fine-tuning afforded by insulin pumps
Nevertheless, Lantus is becoming increasingly popular among those with Type-
1 and Type-2 diabetes It is currently available only in vial form, but
the manufacturer Aventis Pharmaceuticals reports that a
pen version
should be available soon Lantus is FDA approved for use in ages 6 and up
For more information about Lantus, contact Integrated Diabetes Services
610-642-6055 or Aventis Pharmaceuticals 800-552-3656, or speak to your
physician
The Pump Room
Pumpers Picnic Aug 25th
Mark your calendars The third annual Pump Club of Greater Philadelphia
Barbecue/Picnic will be held on Sunday, August 25th, from 4-7 pm at the
home of the Calabros in Newtown Square, PA John Calabro and his parents,
Paulette and Sal, will once again host this fun-filled event, featuring
games, food and activities for the entire family Watch for more details
in the coming months
Summer Pumping
This time of year, I love listening to Martha Reeves and the Vandellas
singing: Summers here, and the time is right, for pumping in the heat
OK, maybe I botched the lyrics a bit But summer is here, and that means
we have to take a few extra precautions to ensure that our pumps are
working properly:
Wear your pump under clothing or in a light-colored case to protect it
from direct sunlight
Protect your backup insulin vial or pen from temperature extremes by
keeping it in a thermos or
cool pack
Check your infusion site for irritation or loose tape after swimming or
outdoor sports
For extra infusion set adhesion, try applying Skin Prep or antiperspirant
to the skin prior to inserting, or apply extra tape over the top
Change your cartridge and tubing more often than usual - at least once
every three days
When disconnecting outdoors, keep your pump and tubing wrapped up in a
wet towel to keep them cool and out of the sun
Consider cutting back on your basal rates and boluses Hot weather tends
to accelerate insulin absorption/action, and increased activity can make
us very sensitive to insulin for up to 24 hours
Is Seven Enough?
Two new pumps have been brought to the US market in recent months
The Paradigm is the first waterproof pump from MiniMed/Medtronic It is
smaller and lighter than earlier models, and features fast programming
through simple pull-down screens A new DC motor enables quiet insulin
delivery and rapid electronic priming The Paradigm runs on a standard AAA
battery, but the battery must be changed every couple of weeks While the
Paradigms cartridge is limited to 160 units of insulin after priming, it
has a
special adaptor that makes it easier than ever to de-bubble
Special versions of MiniMeds Quik-Set, Sof-Set and Silhouette are
available for use with the Paradigm
SOOIL Development Co, a firm with 22 years of insulin pump experience, has
introduced an innovative new pump, the DANA Diabecare II The DANA pump is
a very small, lightweight pump but with heavyweight features including dual
microprocessors, a DC motor with basal delivery every four minutes,
hourly basal settings, rapid bolus and electronic priming, icon-based
programming and a waterproof design DANA also features a series of
sophisticated setup options that permit pre-set bolus amounts specific for
each meal and a reminder-to-eat signal 30 minutes following bolus
delivery Presently, the DANA pump can only be used with SOOILs hard-
needle, disconnectable infusion set However, a soft infusion set is
expected before the end of the year For more information, please call
Burmans Home Health Care at 610 876-6000
NovoLog Approved for Pump Use
The US Food and Drug Administration FDA has approved NovoLog insulin
aspart for use in insulin pumps Manufactured by Novo Nordisk, NovoLog is
the first and only insulin analog
approved by the FDA for use in pumps
NovoLogs action is similar to that of Humalog insulin lispro, but with a
somewhat longer action curve 4-5 hours and a more concentrated peak
action time 40-50 minutes following infusion Conversion from buffered
Regular or lispro to NovoLog is usually on a unit-for-unit basis
News You Can Use
New Treatment for Neuropathy
A significant amount of research and empirical data supports the use of the
antioxidant alpha-lipoic acid also known as thioctic acid to slow or
reverse the progression of diabetic
neuropathy Oral dosing at 1800 mg/day for 4 to 7 months has been shown to
improve nerve conduction and reduce cardiac autonomic neuropathy Thioctic
acid is generally safe, inexpensive, and readily available without a
prescription However, as with any supplements, check with your physician
before giving it a try
Burn It Up, Keep It Off
Researchers involved in the National Weight Control Registry reported that
dedication to exercise is a common factor among people who are successful
at achieving and maintaining weight loss Among people who have lost at
least 30 pounds and kept it off for more than a year, the average weekly
calorie
expenditure through exercise is 2700 calories - equivalent to
walking 60-90 minutes daily Most commercial weight-loss plans recommend
burning 1500 calories weekly through exercise The take home message: It
is possible to keep weight off permanently, but it may require high levels
of activity on an ongoing basis
Caffeine and Blood Sugars
Ever wonder why your blood sugar rises after drinking a cup of coffee -
even when using artificial sweetener? Its probably due to the caffeine
Intravenous administration of caffeine was found to reduce insulin
sensitivity the degree to which insulin lowers blood sugar by 15
Caffeine produced an increase in epinephrine adrenaline, free fatty acids
and blood pressure The solution: either take extra insulin with your
coffee, or switch to decaf
Travel Alert
Traveling with insulin, syringes, lancets and other diabetes supplies
requires some advance planning - especially with the new security measures
at US airports To prove that you have diabetes and need to carry these
types of supplies, ask your pharmacist to place one of the pharmacys
preprinted labels on your box of insulin The label should include your
name and type of insulin to
be given Do the same with your blood glucose
test strips Bring the boxes with you as proof of medical necessity A
prescription or letter from your doctor may not be considered adequate
proof due to forgery concerns
Lose Weight the RIGHT Way
Downsizing With Diabetes is a 10-week weight loss program designed
specifically for people with diabetes It combines individualized
treatment with group interaction and support Each session includes an
exercise component and dietary tips that aide in the pursuit of weight loss
and maintenance The program focuses on healthy eating, behavior change,
physical activity and blood sugar control The sessions are led by
Certified Diabetes Educators Regina Taddeo a registered dietitian and
Gary Scheiner an exercise physiologist
Our next program will begin on July 15th, with another set to start in the
fall Classes are held at Integrated Diabetes Services on Monday evenings,
with a pre-class 1-on-1 orientation scheduled at your convenience A 1-on-
1 follow-up is included after the classes are completed
The fee for the program is 270, with special consideration given to those
with limited financial resources Each participant may bring only
one
partner, as class size is limited If you are interested in registering
for one of our upcoming classes, please call Regina Taddeo at 610-642-6055
Patient Spotlight:
Adam Murauskas
In this special edition of patient spotlight, we feature an essay written
by Adam Murauskas, a recent graduate of Christiana High School Adam will
be attending the University of Delaware this fall to study electrical
engineering He is a member of the National Honor Society and received a
University of Delaware Scholarship award for his outstanding academic
achievements, which included a GPA of over 40
Adam is no geek, although he claims to love calculus His first loves are
skateboarding and his girlfriend Lyndsay not necessarily in that order,
and his senior class elected him to deliver the keynote speech at their
graduation ceremonies
Adam is also a resourceful young man He once repaired a broken computer
cable in my office with nothing more than a paper clip and some chewing gum
MacGyver, look out More importantly, he managed to survive a senior
year filled with AP courses, yet lowered his HbA1c to 66
After reading Adams college application essay, youll know why everyone
from his
mother to his friends to his diabetes team has the utmost
confidence that Adam Murauskas is going to make a real difference in this
world Best of luck in college
Adams College App Essay
Indicate a person who has had a significant influence on you, and describe
that influence
When asked who has been a significant influence in my life, I could
unequivocally say my mother, or my older brother Josh Personally, I would
find it more interesting and informatory to hear about who has been the
most significant influence on me, because this person, for me, does not
quite qualify as a mentor or a role model It seems that ninety-nine out of
a hundred people credit a family member with being the most significant
influence in their lives, but that is exactly what makes this person so
unique
I met him when I was eight years old It was on the eighth day of April,
eight years ago, as a matter of fact I will never forget the distinct
impression he left on me that day He certainly opened my eyes to some new
things Although, I sometimes wish that we had been introduced under more
amiable circumstances, because I think we have a long road ahead of us
He is undoubtedly unlike any other person I
have ever met before, which is
most likely the reason why we didnt get along in the beginning He isnt
exactly what I would call a talkative fellow, but after some time together,
I learned to understand him just fine He was a bad kid, so I developed a
habit of checking on him several times during the course of each day I
didnt think it was very funny that everyone called him a juvenile
Believe it or not, this kid taught me all about responsibility
I got the impression that he never really knew his parents, since he
abhorred the subject, but on that account he had acquired an admirable
understanding of how to be self-reliant He explained the real value of
money to me, and consequently encouraged me to find a job, despite my young
age In light of my new understanding of money, I opened a couple of
banking accounts Soon enough I was buying my own food and clothes, saving,
and budgeting my money It was a quality learning experience I was then
able to apply my newly refined reasoning ability to scholastic matters I
also found myself acting more ethical than my peers in certain situations
My ability to hold in-depth conversations with adults, and strangers
indicated a growth in people
skills and maturity I recognized the
succession of mental developments in myself, ensuing from a friends
advice
He and I became inseparable We went to school together, worked together,
played together, and who knows what else? I remember times when he woke me
up in the middle of the night just to shoot the breeze I can never be
totally sure of what to expect from him Our relationship has its highs and
lows, just like anyone elses, really Every so often, he gets me all
nervous for no reason, but that never lasts for more than a half of an hour
or so Other times, he makes me feel insignificant, and Ill be angry with
him for a couple days
Everybody has seen or at least heard of this kid, but there is a
surprisingly meager quantity of people who actually know him personally
That doesnt bother me too much What bothers me is his bad reputation
People pity me because I hang out with him all of the time, but they dont
seem to comprehend that he has been an immense positive influence for me
If not for him, I certainly would not be the person that I am today
His name is Diabetes
Movie Trivia: Panic Room
In the action/suspense thriller Panic Room, Jodie Foster plays a woman
whose
daughter has Type-1 diabetes and experiences a severe hypoglycemic
episode while trapped in an impenetrable safe room I give the movie
for its creative storyline, but only for its technical accuracy in
regards to diabetes See how many diabetes-related flaw you can find in
the movie; my answers are given below
1 Blood sugar drops low despite eating pizza and drinking regular Coke
for dinner last I checked, those are loaded with carbs
2 The girl takes Regular insulin by injection, despite the fact that her
dad is a pharmaceuticals honcho she would be taking an insulin
analog, or using a pump
3 The stress of having the house overrun by burglars sends her blood
sugar down stress makes blood sugars rise
4 Following a hypoglycemic near-seizure, she recovers without eating
anything, and is stable enough to request glucagon from one of the
burglars she would normally be unconscious
5 Despite having no instructions and no experience with glucagon, the
burglar has no problem drawing up and injecting it on the first try
even with experience, glucagon is complex to administer
6 She asks the burglar to inject the glucagon
into her abdomen it is
meant to be given in the thigh, arm or buttocks
7 The glucose watch worn by the girl works perfectly fine even when
she is sweating heavily the Watch as we know it does not work with
perspiration
8 Before her blood sugar drops, the blood sugar is steadily in the 70s
through most of the night high-fat food should make her blood sugar
rise through the night
Calendar of Events
Integrated Diabetes Services: Programs are FREE and held at the IDS office
unless noted Call 610-642-6055 for info
Insulin Pump Club of Greater Philadelphia - for anyone who uses or is
interested in insulin pumps Barbecue/picnic at Calabro estate in
Newtown Square, Sunday August 25th, 4-7 pm; support/educational
meeting at Friends Central School in Wynnewood, Weds Dec 4, 7:30-9
pm
Parents Support Group - Networking education for parents of
children with diabetes Wednesdays: July 10 and Oct 2, 7:30-9 pm
Neuropathy Association - Support/education group for people with
peripheral neuropathy Wednesdays: Aug 7 and Nov6, 7:00-8:30 pm
Good Nutrition Seminars - Support group and
lecture series on a
variety of dietary topics, Saturdays: July 6, Aug 3, Sept 7, Oct 5,
Nov 2, Dec 7, noon-1 pm
Great Expectations - Pregnancy support group for women with Type-1 or
gestational diabetes Saturdays: July 13, August 17, Sept 14, Oct
12, Nov 9, Dec 14, noon-1 pm
Downsizing with Diabetes - 10-week weight loss program begins July 15;
group sessions held Monday evenings from 7-8:15 There is a fee for
this program Pre-registration and orientation required
Setebaid Services: Call 866-SETEBAID for info
Harrisburg Diabetic Youth Camp - for children ages 8-15, in Millville,
PA, June 16-22
Camp Setebaid - for children and teens ages 8-17, in Shickshinny, PA
Ages 8-10: Aug 6-10; Ages 9-12: Aug 11-16; Ages 13-17: Aug 5-10
Whitewater Rafting Teen Weekend - in White Haven, PA Luzerne County,
NE PA, Sep 20-22
American Diabetes Association: For program info call 610-828-5003 PA;
302-656-0030 DE
Diabetes Camp - at Camp Green Lane, PA, Aug 18-24 Contact Fran
Hackett
Sugar Free Kids Weekend Retreat - at Camp Arrowhead, Lewes, DE, Sept
7-8
Meissner
Chevrolet Phila 500 - at Philadelphia Park, PA, Sept 22
Contact Shannon Maki
Americas Walk for Diabetes - Tyler State Park Newtown, PA, Sept
29; Memorial Hall Fairmount Park Philadelphia, PA, Oct 6; Fort
Washington State Park Fort Washington, PA, Oct 6; Rockford Park
Wilmington, DE, Oct 6; Ridley Creek State Park Media, PA, Oct 13
Diabetes Ball - at Wyndham Hotel in Wilmington, DE, Nov 16
Juvenile Diabetes Research Foundation: For program info call 610 664-
9255
Walk to Cure Diabetes - at Memorial Hall Fairmount Park, Great
Valley Corp Ctr Chester Cty, Hatboro/Horsham High School
Montgomery Cty, and Tyler State Park Bucks County Sept 22
Registration at 9 am, walk at 10
Ride to Cure Diabetes - Biking adventure 31, 62 or 100 miles in
Death Valley, CA Oct 24-27
Way To Go
Congratulations to the following patients:
Ryan Ayares, for being named a Gloucester Co Fire Academy Junior
Firefighter
Greg Auerbach, for lowering his HbA1c from 82 to 74
Rosyln Cowen, for lowering her HbA1c by 2 points and dropping 29 lbs
Karen Eason, for the birth of her daughter, Aubrey Leigh
Asaf Gans, for taking 3rd place in
the Parallel Bars at the regional Junior
Olympics
Irene Gross, for her engagement to Craig Burns
Adam Murauskas, for his best-ever HbA1c of 66
Frank Polsenberg, for a year free of severe hypoglycemia
Fred Ross, for lowering his HbA1c from 95 to 64
Sonia Seifert, for taking 2nd place in the Pennsylvania Miss Classic Woman
of the Year
Karen Walsh, for lowering her HbA1c from 92 to 71
Source:integrateddiabetes.com
