The number of hospitalizations where diabetes was the diabetes have decreased from 2000 to 2004, the number of hospitalization for diabetes, as well as …
Diabetes Care
Cataracts occur more often and at a younger age in people with diabetes Glaucoma: Glaucoma is the result of a buildup of pressure in the eye Over time, this damages the optic nerve–the eyes main nerve The damage first causes loss of peripheral vision–sight from the side The treatment is daily eye drops This lowers the pressure Glaucoma occurs more often and at a younger age in people with diabetes Detect any problems early and treat them quickly
Eye Care Products Covered Under a Health Care Flexible Spending Account
STEPS TO TAKE INCLUDE: 1 Know the risk factors for type 2 diabetes Get diagnosed as early as possible Its known that diabetic retinopathy starts to develop about seven years before people are diagnosed with type 2 diabetes 2 Keep your blood glucose as close to normal as possible 3 Keep your blood pressure in good control 130/80 Take blood pressure medicines if you need them 4 Do not smoke 5 Have an eye exam every year This can be done by an eye doctor, either an optometrist or ophthalmologist Let the doctor know you have diabetes Make sure he or she does a dilated eye exam This test shows if your retinas are healthy or not Also, make sure you are
checked for cataracts and glaucoma 6 If your eye doctor finds a problem take the steps he or she suggests to treat the problem
Learn more about diabetes at wwwwalgreenscom/diabetes
I
n mid-2003 the Internal Revenue Service IRS began allowing employers who offer health benefits to their employees and other family members covered by the health plans to set up a Health Care Flexible Spending Account FSA An FSA allows employees to pay for some medical costs that are above and beyond what is covered by the employers health plan This means that you can use pre-tax dollars money that is set-aside and you are not taxed on to buy everyday medicines that your health care providers suggest you use Most employers limit the amount you can put into an FSA to 3,000 Examples of over-the-counter OTC medicines that people with diabetes use which can be applied to an FSA include: aspirin, insulin and smoking cessation medicine Many of the FSA-allowed OTCs are available at Walgreens An example of OTC supplies that cant be applied to an FSA are dietary supplements such as vitamins and herbs When it comes to eye care, youll be pleased to learn that you can apply the cost of some of these to your FSA
Heres a partial list: eye glasses co-pay or deductible contact lenses co-pay or deductible eye exam co-pay or deductible contact lens solutions saline solution
There is an end-of-year deadline for people who participate in FSA programs If the FSA isnt emptied by the end of the year, any money left in those accounts is given up You you have until March 31 to file for reimbursements
24
Holiday 2004
I
DIABETES YOU
Use your flexible spending account dollars before years end
No matter what your eye irritation
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CONSUMER: Limit one coupon per purchase specified Any other use constitutes fraud Void if copied, transferred or expired RETAILER: We will pay you for the face value of this coupon, plus 8 handling, if submitted in compliance with the Warner-Lambert Coupon Redemption Policy, available upon request Void where prohibited, taxed, or restricted by law Cash value 1/100 Mail coupons to: Warner-Lambert, PO Box 880142, El Paso, TX 88588-0142
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Date Name of Medication Strength Directions for Use Circle Time of Day Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Type of Insulin Breakfast Dose Lunch Dose Afternoon Dose Dinner Dose Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime Lunch Dinner Bedtime
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Coping
from 13 countries The results were used to identify critical gaps in health care for people with diabetes If you have been living with diabetes for a number of years, DAWNs findings will not surprise you The study found that more than half of the people with diabetes felt stressed and anxious about
their health These feelings were expressed both by people with type 1 and type 2 diabetes, regardless of where they lived The results also showed that people want more help from their health care providers in dealing with the emotional side of diabetes live better with diabetes See the Assess Your Relationship quiz on page 15 If your provider does not seem interested in how you are feeling about your diabetes, then you may want to find another provider Look to other people with diabetes or to a diabetes educator to steer you toward a health care provider who is interested in you as a whole person and is not just interested in your numbers If you do not want to or cannot change providers, you can find other sources of emotional support, such as: family or friends; someone who is a good listener; others who share the same concerns you have, such as members of a diabetes support group Support groups offer the chance to talk with other people who are having many of the same struggles you are A diabetes educator in your area can be a good place to start when you look for a support group Your American Diabetes Association office also may be able to offer resources for support call
800-DIABETES If a support group does not appeal to you or is not available, there are many books published by the American Diabetes Association and others that address these important issues If you find that your feelings are overwhelming and interfere with your enjoyment of life, you may benefit from counseling, medication or both Your provider or diabetes educator can help you find a counselor in your area who understands diabetes There are also other resources that may be available to you Many employers offer work site assistance programs, and many religious organizations offer this type of counseling There may also be community-based resources available Do not be afraid to ask for help Even the strongest people sometimes need help to manage a difficult illness like diabetes
By Martha Funnell, MS, RN, CDE
T
here is plenty of research about the effects of diabetes on health But few studies have addressed what people want when it comes to their health care The Diabetes Attitudes, Wishes and Needs study DAWN was a large international survey taken of doctors, nurses and people with diabetes The purpose of the study was to learn what people believe, want and need to manage
diabetes more effectively We need to pay more attention to the psychosocial aspects of diabetes, and through DAWN, hopefully we are closer to this change, said Pierre Lefèbvre, president of the International Diabetes Federation DAWN was conducted in 2001, with responses submitted by more than 5,000 people with diabetes and 3,800 health care professionals
28 Holiday 2004
WHAT THESE RESULTS MEAN First, it means that if you have had feelings of anger, frustration, fear, sadness or guilt about having and caring for diabetes, you are not alone Knowing that these feelings are common may help you feel more comfortable talking about them with your family, friends and health care providers Second, the results of the study are a good reminder to health care providers to pay attention to these important issues You have the right to expect your health care provider to ask you about how you are coping with your diabetes Sharing this information with your health care provider is just as important as any other part of your health care, such as having a foot exam or looking at your blood glucose monitoring record Quality diabetes care is more than just the numbers and the medicines It also means
caring about you as a person THE SUPPORT YOU NEED If your provider does not ask about the emotional side of things, feel free to bring it up You are not wasting your providers time by raising these issues Sometimes having your provider listen carefully to you for only a short time can make a world of difference You have the right to ask for what you need in order to
I
DIABETES YOU
You comfort
want
Ideal for insulin syringe and pump users
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In BDTM Lancet Device when compared to 28 gauge lancets in other lancet devices Data on file at BD NOT FOR EMERGENCY OR MEDICAL INFORMATION BD, BD Logo and all other trademarks are property of Becton, Dickinson and Company 2004 BD
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Terms Conditions: Limit one monitor per consumer Offer cannot be combined with any other offer Offer valid only in the USA BD reserves the right to discontinue program at any time This offer is invalid for consumers whose prescription claims are reimbursed by 1 any governmental program, including, without limitation, Medicaid and Medicare, or 2 any third-party payer or health plan in the states of MA, MI, MN, or RI This offer is also invalid where prohibited by law, and is not available to clubs and groups or organizations Claims submitted to private insurers should fully reflect all discounts, rebates or other reductions in price Consumer: Present this coupon to retailer at time of purchase Coupon good for up to 7499 off the purchase price of one BD LogicTM Blood Glucose Monitor when you purchase one 50-ct box of BDTM Test Strips Consumer pays applicable sales tax Available while supplies last Retailer: No rebate allowed Coupon is limited to 7499 for BD LogicTM Blood Glucose Monitor, or the amount paid, whichever is less plus 8 cents provided you and your
consumer have fully complied with the terms of this coupon Cash value 1/20 of one cent Reproductions and/or alternations of this coupon will not be accepted Send valid coupons to: BD, PO Box 880294, El Paso, TX 88588-0294 You may have an obligation to report the coupon value on any third-party claim form you file of the third-party payor may impose other restrictions on this offer Pharmacist complete the following: I certify that I have received this coupon from an eligible consumer, have dispensed the BD LogicTM Blood Glucose Monitor 207763 as indicated, and have not submitted, and will not submit, a claim for reimbursement to the consumer or any third-party payor I certify that my participation in this program is consistent with all applicable state laws and any obligation, contractual or otherwise, that I have as a pharmacy provider Pharmacists Signature:
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Feature
Diabetes Educators AADE, and supported by Merck Co, Inc It might come as a surprise to some of us that someone like Dick Clark, who has always
appeared to be in excellent shape, especially for his age, developed diabetes He is the perfect example of someone who is relatively fit and doing things the right way as far as taking care of himself, can still be at risk So, everyone needs to watch themselves–not just people who are severely overweight or who have other similar health issues
By Jonathan Jarashow
F
30
rom the generation that grew up watching the popular American Bandstand to their children who faithfully watch Dick Clarks New Years Rockin Eve, countless Americans have come to view Dick Clark as a trusted voice and spokesperson Luckily for the diabetes community,
Holiday 2004
Clark, who lives with diabetes, has joined wholeheartedly in a national public education campaign to warn others of the relationship between diabetes and heart disease Diabetes: Know the Heart Part is the message being spread by the campaign, sponsored by the American Association of
DIABETES DIAGNOSIS Clark was diagnosed with type 2 diabetes around 10 or 11 years ago Like many, he didnt have any real symptoms when he went for his annual physical His doctor went through the usual routine and blood tests and, much to his surprise, Clark
found out he had diabetes In relating the story, Clark reports that it was not an overly dramatic moment in his life It wasnt startling It was surprising, because I didnt have any family history, and I thought I was in great shape, Clark shares I wasnt having any symptoms I guess that happens to a lot of people But on the other hand I was warned that it was a very serious condition and you shouldnt just take it lightly Still, Clark didnt immediately lose the ten pounds that the doctor told him he needed to lose After all, he thought he was in decent shape And certainly, he looked fine I wasnt mindful of my intake of food; I didnt pay a lot of attention to that As long as I kept reasonably within the guidelines, and despite the doctors saying, You gotta lose weight, I didnt Ive done it now and I feel better about it I think thats an important step What was the turning point that caused him to get serious about
I
DIABETES YOU
Feature
losing weight? I wasnt really diligent until news came out that 2/3 of people with diabetes die of a heart attack or stroke–then I got diligent is, and I do it as an obligation The results of sticking to this new healthier lifestyle? I like the loss
of weight–it makes me feel more energetic It invigorates me to be thinner cynical, about celebrity involvement in diabetes awareness Its suddenly now something we feel free to talk about and bring to the publics awareness To him, celebrities who must manage their diabetes also have the added responsibility of being mindful to use their potential to help educate others Recognizable people can be of service and say, Yeah, Im a diabetic and this is what Im doing about it Along these lines, Clark stresses the goal of education in the Diabetes: Know the Heart Part campaign I would say our prime goal is for people who have diabetes to find out more about the significance and connection to heart disease Find out what that means–become knowledgeable For more information on the Diabetes: Know the Heart Part campaign, visit the website wwwknowtheheartpartcom or call 800 224-4089 to get a brochure
PORTION CONTROL IS KEY Simply cutting down on portion sizes became the key to helping get the weight off I restricted my diet I was going to try the Atkins diet, and the no-carb diet But the doctor said, Dont bother with all that stuff–just leave something on the plate Cut down on the portions
When you serve food at home, eat a lot less The doctors advice did the trick You know, my wife and I were used to serving up twice as much as we needed and cleaning the plate But he doesnt do that anymore, even when out at a restaurant Now, I leave something behind, and its working I shouldnt say its the only way to lose weight, but its certainly the most sensible way, because you can keep a well-rounded intake of all kinds of foods, but just cut down the volume Then the result will inevitably happen Like the rest of us who have observed him over the years, Clark had assumed he was in good health Ive had the advantage of seeing myself on television–if not daily, very frequently–and you always are aware of what you look like, and I thought I was staying in pretty good shape But a coat can hide your gut Its not difficult to pick up an extra 10 pounds and hide it The other key factor to Clarks self-care is his activity routine, which he takes seriously now, even though it is not his favorite part of the day I spend about 20 minutes every day doing activities like stair climbing and using 15pound weights Ive got the television on, to try to make the time go faster, but, he admits,
its not fun But I know how important it
NO NEED TO SKIP A BEAT Clark also maintains a very positive attitude about living with diabetes Diabetes, he remarks, is one of those [health-related] things in life over which you pretty much are in control And diabetes has not gotten in the way of his career, which is still extremely active He continues to move forward with new projects, such as plans in the works to possibly bring back American Bandstand, for example Im one of the fortunate people–it hasnt affected my lifestyle or my work habits Diabetes has become part of my routine Clark is one of many celebrities with diabetes who have begun to talk very publicly about it Mary Tyler Moore, Halle Berry and Della Reese are all now, or have been, involved in national awareness campaigns related to diabetes But Clark isnt surprised, or
Learn more about diabetes at wwwwalgreenscom/diabetes
DIABETES YOU
I
Holiday 2004
31
Diabetes Care
Diabetes
Heart Health
D
Q
A
iabetes You recently spoke with Virginia Zamudio, RN, MSN, CDE, president of the American Association of Diabetes Educators Zamudio is a registered nurse and a certified diabetes educator She traveled with Dick Clark
nationwide as part of the Diabetes: Know the Heart Part campaign We asked her about the connection between diabetes and heart disease, as well as tips for better managing diabetes
Whats the connection between diabetes and heart disease?
When a person has diabetes, if their blood sugar is elevated, it actually damages the inside lining of the blood vessels and the arteries The blood vessels become thicker, and they become less elastic Then blood cannot flow through in a normal fashion This sets the person up for a higher risk for heart disease and stroke So, someone with diabetes has more of a risk of having heart disease, as well?
Q A
How can people with diabetes deal with these challenges on their own? the same If you take the steps to take care of the diabetes, its going to also help you reduce your risk for heart disease
Q A
Yes A person who has diabetes and has never had a heart attack is at the same level of risk as someone without diabetes whos already had a heart attack Thats even if their cholesterol is normal So of course managing blood sugar is important, but its also important to take other steps to reduce the risk for heart disease, like understanding what the
target numbers are for blood pressure, cholesterol and blood fats We know that for blood pressure, people with diabetes need to try to achieve a number below 130/80 and need to work to get that LDL bad cholesterol down to less than 100
32 Holiday 2004
People living with diabetes certainly arent on their own But, it is a self-managed disease Its the decisions that the person with diabetes is making every day that really make the difference in the long run At the same time, the partnership with their health care providers is important because they may need medication, and the physician can help them monitor the situation I think the important message is that people go to their health care provider and initiate a conversation about whats right for them based on their individual situation Everyone is different and may have a different set of risk factors Theyve got to know where they stand individually and do whatever it takes to reach their goals Where can people get the information they need to best manage their diabetes?
Q A
What are some of the ways people can manage their diabetes?
Q A
I recommend that people work with a diabetes educator to learn how to adjust their
lifestyles to meet their goals, whether it is blood glucose goals or reducing their risk for heart disease, which are actually one in
Physical activity is a great way not only to manage blood glucose, but it also helps to manage or reduce the risks for high blood pressure hypertension So, physical activity is good all around Its going to help with a lot of different problems Of course, nutrition is really important For people to reduce their risk of heart disease they need to have a well-rounded diet including fruits, vegetables, whole grains, low-fat meats and low-fat dairy–and everything in moderation They need to really work with their health care providers– specifically dietitians–to help them build a meal plan thats going to help them reach their dietary goals
Learn more about diabetes at wwwwalgreenscom/diabetes
I
DIABETES YOU
If you have diabetes,
Are you sure your current medication is covering you at mealtime?
Insulin coverage at mealtime and in-between time
Whenever you eat, your blood glucose level increases Normally your body would make more insulin to keep glucose levels where they should be People with diabetes may not have enough insulin after a meal, which
may cause a gap in the control of blood glucose levels Call or log on today to get FREE information about NovoLog Mix 70/30 you can discuss with your doctor NovoLog Mix 70/30 is for use in patients with diabetes to control high blood glucose You should know that NovoLog Mix 70/30 is Have you spoken with your doctor about: different from other insulin mixtures because it works fast So its important to take your Insulin coverage at mealtime? dose within 15 minutes of a meal Also, Easy and convenient dosing? check your blood glucose regularly Do not use Keeping up with the latest in diabetes care? NovoLog Mix 70/30 if your blood glucose is too low or if you are allergic to this Consider NovoLog Mix 70/30, which gives medication Low blood glucose is you the advantage of working quickly after the most common side effect you eat plus between-meals coverage Any change in insulin should be in a single insulin And ask about made cautiously and only under NovoLog Mix 70/30 FlexPen , medical supervision an easy, convenient way to deliver your insulin
See certificate for full details Please see additional important patient information on the following page NovoLog and FlexPen are
registered trademarks of Novo Nordisk A/S
Mealtime and in-between time
2004 Novo Nordisk Pharmaceuticals, Inc 127327R Printed in the USA September 2004
Patient Information for 10 mL vials, 3 mL PenFill cartridges and NovoLog Mix 70/30 FlexPen Prefilled syringe 100 Units/mL, U-100
This is a brief summary of important information about NovoLog Mix 70/30 It does not include instructions for using NovoLog Mix 70/30, and does not take the place of talking with your doctor about your medical condition or your treatment If you have any questions about NovoLog Mix 70/30 NO-voe-log-MIX-SEV-en-tee-THIR-tee, ask your doctor Only your doctor can determine if NovoLog Mix 70/30 is right for you Your pharmacist or doctor can provide more information about how to use NovoLog Mix 70/30, as well as information that is written for health professionals What is the most important information I should know about NovoLog Mix 70/30? WARNINGS THIS NOVO NORDISK HUMAN INSULIN ANALOG MIXTURE IS DIFFERENT FROM OTHER INSULIN MIXTURES BECAUSE IT HAS A RAPID ONSET OF ACTION THE RAPID ONSET OF ACTION MEANS THAT YOU SHOULD TAKE YOUR DOSE OF NOVOLOG MIX 70/30 70 INSULIN ASPART PROTAMINE SUSPENSION AND 30 INSULIN
ASPART INJECTION, [rDNA ORIGIN] WITHIN 15 MINUTES OF A MEAL ANY CHANGE OF INSULIN SHOULD BE MADE CAUTIOUSLY AND ONLY UNDER MEDICAL SUPERVISION CHANGES IN STRENGTH, MANUFACTURER, TYPE EG, REGULAR, NPH, ANALOG, SPECIES BEEF, PORK, BEEF-PORK, HUMAN, OR METHOD OF MANUFACTURE rDNA VERSUS ANIMAL-SOURCE INSULIN MAY RESULT IN THE NEED FOR A CHANGE IN THE TIMING OR DOSAGE OF NOVOLOG MIX 70/30 PATIENTS TAKING NOVOLOG MIX 70/30 MAY REQUIRE A CHANGE IN DOSAGE FROM THAT USED WITH OTHER INSULINS IF AN ADJUSTMENT IS NEEDED, IT MAY OCCUR WITH THE FIRST DOSE OR DURING THE FIRST SEVERAL WEEKS OR MONTHS What is NovoLog Mix 70/30? NovoLog Mix 70/30 is a mixed insulin analog similar to human insulin mixes used to treat diabetes The active ingredient in NovoLog Mix 70/30 is insulin aspart, which is made through biotechnology Another ingredient, protamine, is used to slow the absorption of the insulin analog by your body NovoLog Mix 70/30 comes in: 10 mL vials small bottles for use with a syringe 3 mL NovoLog Mix 70/30 FlexPen Prefilled syringe 3 mL PenFill cartridges for use with 3 mL PenFill cartridge compatible delivery devices 3 mL PenFill cartridge compatible delivery devices: NovoPen 3, Innovo,
and InDuoTM Who should NOT take NovoLog Mix 70/30? Do NOT take NovoLog Mix 70/30 if: Your blood sugar is too low hypoglycemia You are allergic to NovoLog Mix 70/30 or any of its ingredients Check with your doctor or pharmacist if you want information about the ingredients You are not planning to eat within 15 minutes of your injection Tell your doctor if: You have liver or kidney problems Your dose may need to be changed You are pregnant or planning to become pregnant It is not known whether NovoLog Mix 70/30 can cause any harm to the baby if it is taken during pregnancy You are breast-feeding or planning to breast-feed It is not known whether NovoLog Mix 70/30 is passed through in human milk, as is human insulin Many drugs, including human insulin, are present in human milk, and may affect the baby You take other medicines, including prescription and non-prescription medicines and herbal supplements Your NovoLog Mix 70/30 need may change if you take other medicines Be sure to mention if you take the following: oral hypoglycemic medicines medicines you take by mouth to treat non insulindependent [type 2] diabetes monoamine oxidase MAO inhibitors used to treat depression
beta-blocking agents used to treat certain heart conditions or high blood pressure angiotensin converting enzyme ACE inhibitors used to treat certain heart conditions or high blood pressure salicylates, including aspirin used to relieve pain or lower fever anabolic steroids and glucocorticoids oral contraceptives used for birth control diuretics such as thiazides used to treat high blood pressure or swelling [edema] thyroid hormones used to treat thyroid gland problems danazol used to treat endometriosis octreotide used to treat gigantism or other rare endocrine tumors sulfa antibiotics used to treat infections What should I avoid while taking NovoLog Mix 70/30? Alcohol, including beer and wine, may increase and lengthen the risk of hypoglycemia too low blood sugar when you take NovoLog Mix 70/30 Be careful when you drive a car or operate machinery Your ability to concentrate or react may be reduced if you have hypoglycemia Ask your doctor if you should drive if you have: frequent hypoglycemia reduced or absent warning signs of hypoglycemia What are the possible side effects of NovoLog Mix 70/30? Common side effects include blood sugar that is too low hypoglycemia
Hypoglycemia too little glucose in the blood is one of the most frequent problems experienced by insulin users It can be brought about by: 1 Missing or delaying meals 2 Taking too much insulin
3 Exercising or working more than usual 4 An infection or illness especially with diarrhea or vomiting 5 A change in the bodys need for insulin 6 Diseases of the adrenal, pituitary, or thyroid gland, or kidney or liver disease that is getting worse 7 Interactions with other drugs that lower blood glucose, such as oral taken by mouth antidiabetic medicines, salicylates for example, aspirin, sulfa antibiotics, and certain antidepressants 8 Drinking of alcohol What are the symptoms of mild to moderate hypoglycemia? These include sweating; dizziness; palpitation fast heart beat; tremor shakiness; hunger; restlessness; tingling in the hands, feet, lips, or tongue; lightheadedness; trouble concentrating; headache; drowsiness; sleep problems; anxiety; blurred vision; slurred speech; d 
epressed mood; irritability; abnormal behavior; unsteady movement; and personality change What are the symptoms of severe hypoglycemia? These include disorientation, unconsciousness, seizures convulsions, or death If
you develop serious hypoglycemic reactions, get medical help right away Without recognition of early warning symptoms, you may not be able to take steps to avoid more serious hypoglycemia Be alert for all of the various types of symptoms that may indicate hypoglycemia Patients who experience hypoglycemia without early warning symptoms should monitor their blood glucose frequently, especially prior to activities such as driving If the blood glucose is below your normal fasting glucose, you should consider eating or drinking sugar-containing foods to treat your hypoglycemia Mild to moderate hypoglycemia can be treated by eating foods or drinks that contain sugar Patients should always carry a quick source of sugar, such as candy mints or glucose tablets More severe hypoglycemia may require the assistance of another person Patients who are unable to take sugar orally or who are unconscious require an injection of glucagon or should be treated with intravenous administration of glucose at a medical facility You should learn to recognize your own symptoms of hypoglycemia If you are uncertain about these symptoms, you should monitor your blood glucose frequently to help you learn to
recognize the symptoms that you experience with hypoglycemia If you have frequent episodes of hypoglycemia or experience difficulty in recognizing the symptoms, you should consult your doctor to discuss possible changes in therapy, meal plans, and/or exercise programs to help you avoid hypoglycemia Common side effects include blood sugar that is too high hyperglycemia and diabetic ketoacidosis Hyperglycemia too much glucose in the blood may develop if your body has too little insulin Hyperglycemia can be brought about by any of the following: 1 Not taking your insulin or taking less than the doctor has prescribed 2 Eating much more than your meal plan suggests 3 Developing a fever, infection, or being under stress In patients with type 1 or insulin-dependent diabetes, long-lasting hyperglycemia can cause diabetic ketoacidosis DKA The first symptoms of DKA usually come on slowly, over a period of hours or days, and include feeling drowsy, flushed face, thirst, loss of appetite, and fruity odor on the breath With DKA, urine tests show large amounts of glucose and ketones Heavy breathing and a rapid pulse are more severe symptoms If uncorrected, long-lasting hyperglycemia or DKA can
lead to nausea, vomiting, stomach pains, dehydration, loss of consciousness, or even death Therefore, it is important that you obtain medical help right away Other possible side effects include the following: Serious allergic reaction Get medical help right away if you develop a rash over your whole body, have trouble breathing, a fast heartbeat, or sweating These are signs of a dangerous allergic reaction systemic allergic reaction These reactions are not common Reaction at the injection site local allergic reaction You may get redness, swelling, and itching at the injection site If you have serious or continuing reactions, you may need to stop using NovoLog Mix 70/30 and use another insulin Do not inject insulin into skin sites with these reactions No type of insulin should be injected into skin sites with these reactions Skin thickens or pits at the injection site, especially if the injection site is not rotated changed Vision changes that may require evaluation by an ophthalmologist medical doctor specializing in eye disease or changes in your eyeglasses or contact lens prescription Fluid retention or swelling of your hands and feet Low potassium in your blood hypokalemia
There are other possible side effects from NovoLog Mix 70/30 Ask your doctor or pharmacist for further information Tell your doctor or pharmacist if you have any other unwanted effects that you believe are caused by this insulin More detailed information is available on request For information about NovoLog Mix 70/30 contact: Novo Nordisk Pharmaceuticals, Inc 100 College Road West Princeton, New Jersey 08540 wwwnovonordisk-uscom 1-800-727-6500 Manufactured by: Novo Nordisk A/S DK-2880 Bagsvaerd, Denmark Manufactured for: Novo Nordisk Pharmaceuticals, Inc Princeton, NJ 08540 2002 Novo Nordisk Pharmaceuticals, Inc Novo Nordisk, NovoLog, FlexPen, Innovo, NovoPen and PenFill are trademarks owned by Novo Nordisk A/S InDuoTM is a trademark of LifeScan, Inc, a Johnson Johnson company Date of issue: November 18, 2002 126209
Diabetes Care
Keep blood glucose, blood pressure and cholesterol numbers as close to normal as possible Get regular check-ups from your health care team Get help to quit smoking if you are a smoker Be active most days Eat low-fat meals that are high in fruits and vegetables, and eat whole grain foods If you have diabetes, its important to talk with your doctor or
other members of your health care team about the link between diabetes and heart disease Use these questions as a guide for your next visit to your doctor: What are my ABC numbers and what are my ABC goals? How often should my ABCs be checked? What steps can I take to reach each of my ABC goals? Can taking medications such as aspirin, ACE inhibitors or statins help me reduce my risk for a heart attack or stroke? What are the symptoms of heart attack and stroke that I need to watch for? Do I need special testing to detect heart disease? Whats the best way for me to quit smoking?
W
hen most people think about the problems that result from diabetes, they usually think about blindness, amputations and kidney disease While these are serious diabetesrelated complications, there are other complications that can be deadly: heart disease and stroke In fact, as many as 65 percent, or 2-out-of-3, of deaths in people with diabetes are related to heart disease and stroke The American Diabetes Association ADA and the American College of Cardiology ACC are partners in an educational initiative called, Make the Link Diabetes, Heart Disease and Stroke The goal of the Make the Link initiative is
to encourage people with diabetes and their health care providers to work together to manage diabetes more comprehensively, to reduce risk factors that could lead to heart disease and stroke, and to remind
people that diabetes management goes beyond controlling just blood glucose One way for people with diabetes to reduce their risk for heart disease and stroke is to know their diabetes ABCs A is for A1C, a test that measures average blood glucose over the past two to three months B is for blood pressure, and C is for cholesterol The target ranges to keep in mind are: A1C less than 7 percent Check at least twice per year Blood pressure less than 130/80 mm/Hg Check at every doctor visit Cholesterol–LDL bad less than 100 mg/dL Check at least once per year But there are many ways to help break the link between diabetes, heart disease and stroke Even small changes can lower the risks Here are some suggestions:
Learn more about diabetes at wwwwalgreenscom/diabetes
The American Diabetes Association has developed a new Diabetes Survival Guide to give people with diabetes the information they need to help protect themselves from diabetes-related complications, such as heart disease and
stroke Call 800 DIABETES 1-800-342-2383 For more information about the link between diabetes, heart disease and stroke, visit wwwdiabetesorg/makethelink
36 Holiday 2004
I
DIABETES YOU
You know the importance of complete nutritionand so does Centrum
A recent report in a leading medical journal recommended that all adults should take a multivitamin every day Thats not surprising, because despite their best efforts to follow a healthy diet, most adults, even those with diabetes, fall short of getting the vitamins and minerals they need Taking a multivitamin every day as part of a lifestyle that includes a healthy diet and exercise is a simple way to help achieve significant health benefits And what is the 1 doctor and pharmacist recommended multivitamin brand? Centrum
Centrum and Centrum Silver provide you with scientifically advanced nutritional support specially formulated with antioxidants and other essential nutrients Taking a multivitamin as part of a healthy diet may help reduce the risk of certain chronic diseases, including heart disease The advanced formulas of Centrum, combined with a healthy lifestyle, do more for your health every day
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Centrum Always
complete From A to Zinc
2004 Wyeth Consumer Healthcare
THESE STATEMENTS HAVE NOT BEEN EVALUATED BY THE FOOD AND DRUG ADMINISTRATION THESE PRODUCTS ARE NOT INTENDED TO DIAGNOSE, TREAT, CURE OR PREVENT ANY DISEASE
RETAILER: Send this coupon to Wyeth Consumer Healthcare, PO Box 880130, El Paso, TX 88588-0130 for reimbursement at face value plus 8 handling if submitted in compliance with the Wyeth Consumer Healthcare Redemption Policy, available upon request Any other use constitutes fraud Void if reproduced, transferred, or where taxed, prohibited or restricted by law Customer pays sales tax Cash value 1/100 of 1 LIMIT ONE COUPON PER PURCHASE 2004 Wyeth Consumer Healthcare
1 OFF
452388
MANUFACTURERS COUPON
EXPIRES 9/30/05
Recipes
Pechugas de pollo al limón pimienta con pasas y semillas de girasol
Quick Holiday
COUSCOUS WITH CURRANTS AND WALNUTS
Couscous is a staple of the people from northern Africa It is flour-coated semolina, the same ground durum wheat used to make the flour for pasta INGREDIENTS /2 /2 1 1 2 /3 3 1 /2 1 /2
1 1
Boneless chicken breast halves are quick-cooking and economical, and with the right seasonings they can turn a simple dish into a special main
course INGREDIENTS
2 4-ounce skinless, boneless chicken breast halves,
/4 1 /4 1 /4 1 /8 1 11/2 2 1 1 1 /2
1
pounded thin teaspoon garlic salt optional teaspoon lemon pepper seasoning teaspoon crushed dried oregano teaspoon crushed red pepper flakes, or to taste tablespoon olive oil tablespoon balsamic vinegar tablespoons dark raisins tablespoon dry-roasted sunflower seeds tablespoon chopped parsley for garnish optional fresh lemon, cut into wedges, for garnish optional
COOKING INSTRUCTIONS Rinse the chicken breast halves and pat dry with paper towels Start a charcoal or gas grill, or preheat the broiler Sprinkle the chicken breasts with garlic salt if using, lemon pepper, oregano and red pepper flakes Grill the breasts, 4 to 6 inches from the mediumhigh heat source, for 4 minutes per side, until no longer pink inside cut to test Transfer to two plates and keep warm Meanwhile, in a small pan, bring the olive oil, vinegar, raisins and sunflower seeds to a full boil over high heat for 30 seconds Immediately spoon the mixture over the chicken breasts and sprinkle with parsley, if desired Serve with the lemon wedges, if desired, to squeeze over all Makes 2 servings
teaspoon
ground cinnamon teaspoon ground cumin tablespoon dried currants teaspoon reduced-calorie margarine cup instant couscous tablespoons chopped fresh parsley teaspoon crushed dried thyme tablespoon chopped walnuts
COOKING INSTRUCTIONS Place 1 cup of water in a pot with a cover Add the cinnamon, cumin, currants and margarine, and bring to a boil Stir in the couscous, parsley and thyme Cover the pot, remove from the heat and let stand for 5 minutes Fluff with a fork and sprinkle with the walnuts Serve immediately Makes 2 servings
NUTRITION INFORMATION PER SERVING
249 calories 36 calories from fat 27 g protein 10 g total fat 15 g saturated fat 12 g carbohydrate 1 g dietary fiber 66 mg cholesterol 78 mg sodium Exchanges: 4 very low-fat protein, 1 carbohydrate 1 fruit
38 Holiday 2004
NUTRITION INFORMATION PER SERVING
257 calories 14 calories from fat 9 g protein 4 g total fat 02 g saturated fat 50 g carbohydrate 3 g dietary fiber 0 mg cholesterol 18 mg sodium Exchanges: 3 carbohydrate 3 bread/starch
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DIABETES YOU
Recipes
Easy Recipes
Judías con hierbas
Budín de pan tradicional
Crisp on the top and creamy inside, this old-fashioned treat is a welcome dessert any time of year You
can make it with dried cherries, as weve done here, or raisins, dried blueberries or chopped dried apricots INGREDIENTS 1 1 1 /2 1 /2 1 /2 1 /8 1 /2 1 /2 2 butter-flavored cooking spray cup cubed day-old French bread toasted if bread is fresh cup skim milk teaspoon reduced-calorie margarine teaspoon grated orange zest tablespoon chopped dried cherries no sugar added teaspoon vanilla extract teaspoon ground cinnamon teaspoon sugar substitute, or to taste tablespoons egg substitute
Cooking baby vegetables quickly and then flavoring them with your favorite herbs changes them from ordinary to special Serve them hot, at room temperature or chilled in a salad INGREDIENTS ounces young green beans, stem ends removed, olive oil cooking spray 1 scallion white part plus 1 inch of green finely chopped 1 clove garlic, minced, or 1/8 teaspoon garlic powder 1 /2 1teaspoon fresh chopped tarragon, thyme, or basil, or 1/4 teaspoon dried freshly ground pepper to taste 1 teaspoon white wine vinegar COOKING INSTRUCTIONS Bring a saucepan of water to a boil and add the beans Simmer until crisp-tender, about 3 minutes Drain well and return to the saucepan Lightly coat the beans with cooking spray Toss
with the scallion, garlic, herbs and pepper Sprinkle with the vinegar and serve at once Makes 2 servings 8
COOKING INSTRUCTIONS Preheat the oven to 375F Lightly coat two 2-cup soufflé dishes with cooking spray Divide the bread cubes between the prepared dishes In a small saucepan, combine the milk and margarine Scald the milk Remove from the heat and stir in the orange zest, cherries, vanilla extract, cinnamon, sugar substitute and egg substitute Pour over the bread cubes Place the soufflé dishes on a baking sheet since the mixture may bubble over Bake for 20 minutes, until the top is crisp and a knife inserted in the center comes out clean Serve warm Makes 2 servings
NUTRITION INFORMATION PER SERVING
147 calories 13 calories from fat 9 g protein 2 g total fat 06 g saturated fat 23 g carbohydrate 1 g dietary fiber 2 mg cholesterol 274 mg sodium Exchanges: 11/2 carbohydrate 1/2 non fat milk, 1 bread/starch
Reprinted with permission from The Joslin Diabetes Quick and Easy Cookbook Simon Schuster, NY Copyright 1998 by Frances Towner Giedt, Bonnie Sanders Polin and Joslin Diabetes Center All rights reserved
NUTRITION INFORMATION PER SERVING
39 calories 3 calories from fat 2 g
protein 1 g total fat trace saturated fat 9 g carbohydrate 4 g dietary fiber 0 mg cholesterol 8 mg sodium Exchanges: 2 vegetable
DIABETES YOU
I
Holiday 2004
39
Care for your family, take care of yourself
Together, ACCU-CHEK products and Eucerin wish you a healthful holiday season
2004 Roche Diagnostics All rights reserved 388-23534-0804 ACCU-CHEK and LIVE LIFE WELL FIT IN are registered trademarks of a Member of the Roche Group Beiersdorf Inc 2004 EUCERIN is a registered trademark of Beiersdorf Aktiengesellschaft
Meter Comparison
Blood Glucose Meters Available at Walgreens
Meter Box Meter Picture Picture Memory
365 tests, 14- 30day avg
Walgreens TrueTrack
Test Time
10 sec
Sample Size
Small 1 L microliters
Features Comments
Easy two-step testing with fast results Only a small sample is needed Large, easy-to-read screen Affordably priced
365 tests, 14- 30day avg
Walgreens IQ
10-50 sec
Medium 4 L
Easy three-step testing Large screen Easy-tohandle strips Affordably priced Allows for downloading data to the Internet
200 tests, 7- 14day avg
Accu-Chek Active
5 sec
Small 1 L
No buttons to press Meter turns on when you insert test strip Portable design Allows for
alternate site testing
Accu-Chek Advantage
480 tests, 7-, 14- 30-day avg
26 sec
Medium 4 L
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 No strip handling Strips 17 are contained in a drum, which is loaded into meter Automatic coding Allows for alternate site testing
100 tests, 8 sec 7-day avg
Accu-Chek Compact
Small 15 L
100 tests, 14-day avg
Ascensia Breeze
30 sec
Small 25 L
Effortless handling and testing with no coding required Ten individual strips in one easy-to-load disc Allows for alternate site testing The only single strip system with no coding required Automatically draws blood into strip and corrects for common errors to ensure accuracy Allows for alternate site testing Can track insulin doses Comes with lancing device that uses 33-gauge lancets–the thinnest yet
240 tests, 14-day avg
Ascensia Contour
15 sec
Very Small 06 L
250 tests, 7- 14day avg
BD Logic
5 sec
Very Small 03 L
250 tests, 14-day avg
FreeStyle
15 sec
Very Small 03 L
Gives accurate and precise results with the worlds smallest sample size Simple to use with large, easy-to-read
display Allows for alternate site testing
DIABETES YOU
I
Holiday 2004
41
Meter Comparison
Blood Glucose Meters Available at Walgreens
Meter Box Meter Picture Picture Memory
250 tests, 14-day avg
FreeStyle Flash
Test Time
7 sec
Sample Size
Very Small 03 L
Features Comments
Worlds smallest meter Gives accurate and precise results with the worlds smallest sample size Just 3 inches in height and weighs only 14 oz Allows for alternate site testing Easy to use, with less blood, which helps avoid retests Large display and easy-to-handle test strips
75 tests
45 sec
Medium 5 L
OneTouch Basic
150 tests, 14- 30day avg
OneTouch Ultra
5 sec
Small 1 L
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 alternate site testing Automatically organizes results into onscreen charts and graphs so that you can see patterns and trends Easy blood application Allows for alternate site testing Allows for testing of ketone levels, which acts as a sign of diabetic ketoacidosis DKA Easyto-read display with backlighting and glow-inthe-dark case Touchable test strips
OneTouch
UltraSmart
3,000 tests, 14- 30day avg 450 tests, 7-, 14- 30-day avg
5 sec
Small 1 L
10-20 sec Small 15-25 L
Precision Xtra
Choosing Your Meter
EASE OF USE Some meters are more difficult to handle than others Also, see if you can read the results from the machine easily The screens on some meters are larger than others ALTERNATE SITE TESTING If you want to get blood from a site other than your fingers, make sure the meter you buy is approved for whats called alternate site testing RESULTS UPLOAD Most meters allow you to upload results to your computer and analyze them electronically SPEED Some meters provide results in five seconds Thats the quickest test around If you check your blood glucose several times per day, you may want a quick test ACCURACY It is important for you to know that the meters are not as precise as the results of blood tests taken at the lab Your meter is likely to measure your blood glucose within 20 percent of your usual lab test numbers This is considered the acceptable range PORTABILITY If you carry your meter with you, which is what most people do, make sure it is small and portable
42
Holiday 2004
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DIABETES YOU
Important News for Medicare
Shoppers
Walgreens now accepts assignment on OneTouch products
Americas Selling Meter
The Convenience You Want
Lower out-of-pocket cost No waiting for reimbursement
Find out more
Ask your pharmacist
Walgreens accepts assignment on any of these OneTouch brand products
Combined Blood Glucose Monitoring and Insulin Dosing System
UltraSmart
TM
Blood Glucose Monitoring System
Basic
As Easy as 1-2-3
Blood Glucose Monitoring System
Glucose Testing and Insulin Dosing in One
Meter and Electronic Logbook in One
SmartButtonsTM SmartButtons Make Your Entries Fast And Easy
Simple Easy To Handle
Patterns Are Easy To See And Understand
Glucose Monitor
No Waiting — Accurate Test Results In Just 5 Seconds
For Use with OneTouch Ultra Test Strips
Insulin Doser
Accurate and Easy Insulin Dosing with Built-in Memory For Use with Novo Nordisk PenFill 3mL Cartridges
Proven Accuracy
SureStep
TEST STRIPS
Less Pain, Less Blood, Accurate Results In 5 Seconds
System includes meter and accessories OneTouch Ultra OneTouch Ultra Test Strips SOLD SEPARATELY
See top panel for details
For blood glucose testing with OneTouch SureStep OneTouch SureStep Meter only
System includes
meter and accessories OneTouch Basic,Profile OneTouch Basic,Profile, Basic ,Profile, OneTouch OneTouch II Test Strips SOLD SEPARATELY
See top panel for details
UltraSoft FinePoint LANCETS LANCETS
TM
Ultra Thin Design For Less Painful Testing
Ideal for testing with the following systems: OneTouch OneTouch Basic OneTouch OneTouch Profile OneTouch OneTouch II OneTouch SureStep OneTouch SureStep OneTouch FastTake OneTouch FastTake
SAVE up up
100
TEST STRIPS
to to
SEE SIDE PANEL FOR DETAILS
50
SAVE
SEE SIDE PANEL FOR DETAILS
30
System includes device and accessories
See top panel for details
wwwinduocom
100
STERILE LANCETS
100
STERILE LANCETS
The OneTouch InDuo System is only available at Walgreenscom You must have Medicare Part B coverage and a prescription from your healthcare professional DDD Share data - December 2003
2004 LifeScan, Inc Milpitas, CA 95035 AW 083-228A
Diabetes Care
ing your physical activity and choosing to eat more fruits, vegetables and whole grains These actions can improve blood glucose, blood pressure and heart health and can promote weight loss and maintenance
Weighing in on Weight
By Belinda OConnell, MS, RD, CDE
STEPS FOR SUCCESS
Here are some tips from the National Weight Control Registry to help you on your way The NWCR is a national database of information on 5,000 people who have lost weight and kept it off On average, they have lost 60 pounds, and 16 percent have kept the weight off for more than 10 years
Keep on trying More than 90 percent of people had lost and gained weight several times before successfully keeping the weight off Change your eating and activity habits Most people 89 percent reported making significant changes in both eating and activity habits Only 11 percent reported changing only eating or exercise habits Consume fewer calories and fat Women ate about 1,300 calories per day, and men ate 1,700 calories per day Participants limited fat, ate about five times each day and had less than one meal per week in fast food restaurants Physical activity More than 80 percent of people who lost weight successfully burned 2,700 calories women to 3,500 calories men per week in exercise Keep track Most people monitored their weight and kept food and activity records About half of all those who successfully lost weight still kept records two to six years after their initial weight loss
I
ts no
surprise that being overweight is unhealthy It can lead to diabetes, heart disease and high blood pressure In fact, nearly 90 percent of people who have type 2 diabetes are overweight Research has shown that decreasing calories, increasing physical activity and losing weight can lead to significant health improvements Losing as little as 5 to 10 percent of your body weight and being active for 30 minutes, five days per week can help you: lower blood glucose and A1C levels lower blood pressure lower LDL bad cholesterol, increase HDL good cholesterol, and decrease triglycerides, the main part of fats and oils decrease your need for diabetes, high blood pressure and blood lipid medications
health It is the weight at which you have the most energy and feel your best And most important, it should be a weight that you can maintain realistically over the long term It does little good to lose a great deal of weight, only to end up putting it all, or more, back on Setting realistic goals for weight loss and maintenance is hard But its an important step in achieving your weight goals and keeping the weight off Be sure to speak with your health care provider to set the weight goal that is
right for you
WHATS A HEALTHY WEIGHT FOR ME? A healthy weight for you should be one that supports the greatest degree of physical and emotional
44 Holiday 2004
PUTTING WEIGHT LOSS IN ITS PLACE Research has shown that keeping blood glucose, blood pressure and blood fat lipid levels within your target range is what really matters most in staying healthy with diabetes Weight loss is one of the most important tools to help you reach your goal of glucose, blood fat and blood pressure management But losing weight is only part of the package Simply said, take steps to build a healthy lifestyle, such as increas-
Learn more about fitness at wwwwalgreenscom/fitness
I
DIABETES YOU
F O R P E O P L E W I T H D I A B E T E S, L I F E S B E T T E R U N D E R 7
2004 Aventis Pharmaceuticals Inc Bridgewater, NJ 08807-2854 LAN-JA-12222-1
Most people with diabetes can lead healthier, longer lives It all comes down to a number An A1C number less than 7 A1C is a simple test that helps you and your healthcare provider determine how well your blood sugar levels are controlled over time Maintaining an A1C level below 7 can help lower your risk of developing diabetes complications in the future
Make an appointment to speak with your healthcare provider about your A1C level and the latest medications that can help you keep it under 7 Taking action today could help you prevent more serious complications tomorrow And staying below 7 can help you lead a healthier and longer life FOR MORE INFORMATION, CALL 1-800-515-4422, OR VISIT wwwA1Corg
Research Update
balance enough to stop the killer cells from attacking The result, they hoped, would be to prevent type 1 diabetes The researchers took regulatory T cells from diabetic mice, made more of them in the lab and then injected them back into the animals This greater number of regulatory T cells stopped the killer T cells from destroying the beta cells and successfully prevented diabetes BLOCKING INTERACTION OF PROTEINS PREVENTS DIABETES IN MICE Researchers at the JDRF Center for Islet Transplantation at the University of California, San Francisco, and the University of Minnesota have identified a protein on T cells that triggers type 1 diabetes in mice This happens when the protein interacts with another protein found in the pancreas cells The scientists report that stopping the interaction of these two proteins prevents
diabetes without causing too many side effects The finding suggests a possible strategy for preventing type 1 diabetes in humans, since people have a similar T cell protein in their immune systems If we can develop this finding into a treatment for human type 1 diabetes, it would represent a very specific therapy that would help some people with diabetes, explained the studys leader, Dr Jeffrey Bluestone COMBINATION THERAPIES CURES DIABETES IN MICE Researchers at two medical centers affiliated with Harvard Medical School in Boston report curing diabetes in mice by using two drugs at the same time They used a combination of drugs–one that stopped the body from destroying its own beta cells and one that helps beta cells grow–to cure diabetes in mice In the study, diabetic mice received an antibody that already had been used to stop killer T cells, along with a hormone that speeds up insulin and beta cell production Nearly all of the animals were diabetesfree within 76 days, showing normal control of glucose These results did not occur when the drugs were used alone Using drugs in combination would be a new way to cure patients with type 1 diabetes Curing diabetes will likely
require a combination of therapies given at the same time, said Richard Insel, MD, JDRFs executive vice president for research This study is intriguing in showing one way this might be accomplished
J
uvenile or type 1 diabetes happens when the bodys immune system mistakenly attacks the insulin-making beta cells–which are found in the pancreas–and destroys them Finding new drugs to stop this is one of the Juvenile Diabetes Research Foundations JDRFs top goals in its efforts to bring research from the laboratory into the real world New research has revealed important information about how the immune system works and is heading toward the prevention of juvenile diabetes BLOCKING DIABETES BY RETRAINING THE IMMUNE SYSTEM Through new JDRF-funded research, Rockefeller University in New York is working on retraining the sick immune system and stopping it from attacking the bodys own beta cells The approach worked in preventing diabetes in mice, and the researchers next step is to apply their findings to humans Immune cells involved in type 1 diabetes are called T cells There are several types of T cells One type is the killer T cells, which attack foreign cells and are responsible for
destroying the bodys own insulinmaking cells Thats what causes type 1 diabetes Another type is the regulatory T cells, which keep the killer T cells in line and prevent them from attacking the bodys own cells When these two types of T cells are interacting properly, the immune system works normally In the case of type 1 diabetes, there appears to be too few regulatory T cells to block the killer T cells from destroying the bodys own cells The team at Rockefeller thought that increasing the number of the regulatory T cells could change the
46 Holiday 2004
Learn more about diabetes at wwwwalgreenscom/diabetes
I
DIABETES YOU
3/31/05
Source:aap.org
