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The Results Are In

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The Results Are In Powered By Docstoc
					                                                                                         Winter, 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
www.integrateddiabetes.com

 2002, Gary Scheiner , MS, CDE




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The Results Are In:
Our patients show significant improvements in blood sugar control

Ever since the results of the Diabetes Control and Complications Trial (DCCT) were published
in 1992, emphasis has been placed on lowering hemoglobin HbA1c levels in people with
diabetes. The HbA1c is a blood test that shows a person‟s average blood glucose level for the
past 2-3 months. The DCCT proved that the risk of diabetic complications such as vision loss,
kidney failure and nerve/foot problems goes down as the HbA1c goes down. Post-study analysis
indicated that every 1-point (1%) reduction in HbA1c correlates with a 14% reduction in the risk
of complications.
Since getting HbA1c levels down close to normal is a goal for almost all people with diabetes,
we decided to perform a chart review of our patients to see if we are helping them reach that
goal. To our delight, the answer is a definitive YES.
Within our patient base of approximately 1000 patients, we have documented evidence of pre-
and post-visit HbA1c levels in 225 patients. Because many patients came to us with HbA1c
levels already close to normal (and with a goal of more stable control and fewer hypogly-cemic
events), we decided to split our patients into two groups: Those whose HbA1c was below 8.0 at
the time of their first visit, and those whose HbA1c was 8.0 or more. The results are as follows:
In patients whose HbA1c was 8 or more before coming to see us for consultation (136 patients),
71% saw their levels drop by at least ½ a point. The average HbA1c dropped significantly: from
9.27 to 8.02, and despite the high starting point, nearly 60% had HbA1cs levels of less than 8 at
their most recent test.
In patients whose HbA1c was 7.9 or less, the average did not change (7.17 before consultation,
7.16 after). Since a major focus with most of these patients was to reduce the frequency and
severity of hypoglycemia, it is safe to say that we achieved greater stability in blood glucose
levels; fewer highs and lows, and more readings within target.
At Integrated Diabetes Services, we take an empowerment approach to diabetes care. We believe
that patients themselves should be the decision makers regarding the daily management of their
diabetes. It is only by giving people the tools and skills necessary to manage their diabetes that
results like these are obtainable.
To all our patients, keep up the good work!



Fingerstick A1c Testing Now Available

Don‟t you wish you didn‟t have to go to a lab to get your A1c? The inconvenience. The
waiting. The paperwork. The painful needle in the arm. The days (or weeks) until you and your
doctor get the result.




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Now, you can get your HbA1c result instantly and almost painlessly when you visit Integrated
Diabetes Services. The MicroMat II analyzer that we use is made by BioRad -- the same
company that makes the big equipment used in hospital labs. Our equipment is calibrated
against the results of the DCCT study. It requires a fingerstick blood sample and takes just 4
minutes. A copy of the result will be faxed to your physician immediately.
From a diabetes management standpoint, immediate results are important because they can help
us direct your care. And we believe that frequent HbA1c testing helps to motivate patients to
stay on track. The ADA recommends HbA1c testing every 3 months for people with Type 1
diabetes, and every 3-6 months for those with Type 2 diabetes. More frequent testing might give
you extra incentive to count carbs carefully, exercise more, and keep good written records.
The cost of the test is $20, payable by cash, check or credit card. It can be done during a routine
office visit or any time the office is open, so stop by any time!




Disk Golf Event Planned for
Diabetic Fitness Enthusiasts
The greater Philadelphia chapter of the Diabetes Exercise and Sports Association (DESA) will
be holding its first meeting of the new millennium on Sunday, April 21, at Brandywine Creek
State Park, just north of Wilmington (30 minutes from downtown Philadelphia). DESA is the
new name for the International Diabetic Athletes Association (IDAA). The meeting will feature
guest speaker Bob Scheidt of Kutztown, PA. Bob‟s walks across America have inspired
countless people with diabetes and raised tens of thousands of dollars for diabetes-related causes.
The recreational activity for the meeting will be a round of “Frisbee Golf” on Brandywine‟s
beautiful course. If you‟ve never played, come give it a try. It‟s fun, free, and do-able by just
about anyone with arms. Frisbees and basic instruction will be provided.
The DESA program will be held from 10 am to 1 pm, with a picnic-style lunch at noon and
plenty of time to mix & mingle with other active people with diabetes. It is open to all members
of DESA, as well as anyone interested in finding out more about the organization. Family
members are more than welcome. There is no fee.
For more information or directions, please call:
Gary Scheiner: (610) 642-6055 or Bill King: (215) 704-7473




Patient Spotlight:
Morton Waldbaum


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Having diabetes for 43 years, you would think that Morton Waldbaum has seen it all.
“The changes in diabetes still amaze me,” admits Morton. “So much has happened in recent
years – new methods for testing blood sugar, receiving insulin, even our knowledge of the
disease itself.”
Morton‟s diabetes care has seen lots of changes too, most recently including insulin pump
therapy. Despite having his best control ever (HbA1c in the low 6s, 70-80% of readings “in
target”), Morton still seeks explanations for any inconsistencies.
A Philadelphia native, 75-year-old Morton continues to broaden his knowledge in other areas.
He takes a new class at the University of Pennsylvania each semester. Last semester he studied
Human Evolution; this semester, it‟s European History.
“Age should be no limit,” says Morton proudly. After living in Havertown for many years, he
and his wife Joan now live in Wynnewood. They have three children and 5 grandchildren, of
whom they speak very proudly. To stay fit, Morton walks on a treadmill, lifts weights and
performs calisthenics four times a week.
What is Morton‟s favorite way to relax? Watching basketball, which he played in high school
and college. If the Sixers need an experienced point guard, he‟s the man!




The Pump Room

Sil-serter makes angled insertion easier
As most of you know by now, our infusion set of choice at Integrated Diabetes Services is the
Silhouette / Tender / Comfort set. The angled insertion and long canula help minimize the risk
of occlusions and displacement while maximizing comfort. But the imposing introducer needle
keeps many people from taking advantage of this set‟s design advantages. Until now.
Medtronic MiniMed has introduced the Sil-serter, a spring-loaded device that injects the
Silhouette into the skin at an appropriate angle with the touch of a button. The procedure is
virtually painless because the introducer needle is popped into the skin so rapidly.
The Sil-serter cannot be used with the Tender or Comfort sets. Only the latest version of the
Silhouette (which sports a gray/brown needle hub) has been outfitted with two small holes that
allow it to fit properly into the Sil-Serter.
For more information or to order the Sil-serter and Silhouette infusion sets, please call Medtronic
MiniMed customer service at 800-843-6687.
Diabetes Station Pump Programs
Our very own pump guru, Gary Scheiner, will be hosting two monthly chat rooms on
DiabetesStation.Com.
On the first Tuesday of each month at 9 p.m. EST (assuming he can get his kids to bed in time),
Gary will field questions and lead a discussion on insulin pump basics: Is the pump right for
you? What are the pros and cons? How do the different pumps compare? Those considering


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pump therapy (as well as experienced pumpers willing to share their insight) are welcome to
participate – or just follow the conversation.
A more advanced program for experienced pumpers is held on the third Tuesday of each month
(also 9 pm EST). Topics include the use of advanced pump features, ideas for troubleshooting,
sports & exercise with the pump, infusion set & site tips, and anything else that floats your boat.
Come ask your toughest questions (can you stump the guru?) or share your own ideas with the
other participants.
See you on line!


Pump Club to Honor 50-Year Insulin Veteran
On Wednesday, March 6, the Insulin Pump Club of Greater Philadelphia will honor Rev. Edward
Poole on the anniversary of his 50th year using insulin. Rev. Poole will be receiving medals
from Eli Lilly and Company and the Joslin Diabetes Center in recognition of his perseverance in
living with Type-1 diabetes.
“I think it was the 3rd Thursday in February, 1952, that I walked into the office of Wheaton (IL)
College‟s physician to complain that I couldn‟t sit through a 50 minute class without running to
the „John‟”, recalls Ed. “The next thing I know, I‟m in a pharmacy enjoying a fried egg
sandwich and having a prescription filled for insulin, glass syringes, needles, urine testing
equipment, cotton balls and ethyl alcohol.” The rest, as they say, is history.
Join us as Rev. Poole and other guest speakers take us on an exciting and revealing look back at
diabetes care over the past 50 years. The program should be fascinating to those who are new to
diabetes as well as fellow diabetes veterans.
The meeting will be held at the Friends Central School cafeteria on City Ave. in Wynnewood,
PA, at
7:30 p.m. Come one and all to honor this very special person and his very special achievement.
For more information or directions, please call 610-642-6055.


     Note: Starting in 2002, our Insulin Pump Club meetings will be held quarterly. See
                     the schedule of events on page 8 for tentative dates.


New Medicare Guidelines
The Health Care Financing Administration (HCFA) recently expanded coverage for insulin
pumps. Under the new guidelines, Medicare will now cover pumps for people with Type-2
diabetes who take insulin, as long as the patient has documented evidence that they test their
blood sugar at least four times daily and have low-to-subnormal insulin output from their
pancreas, as measured by a C-peptide test. Medicare will also cover pump upgrades and ongoing
supplies for most patients with Type-1 diabetes who were using a pump prior to enrollment in
Medicare.




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New Product Focus:
NovoLog

Novo Nordisk, the world leader in insulin for the treatment of diabetes, is proud to introduce its
first rapid-acting insulin analog: NovoLog (generic name aspart).
Quickly absorbed, NovoLog reaches its peak action in 40-50 minutes and lasts as long as 3-5
hours. When taken with meals, it offers superior post-meal blood sugar control compared to
regular insulin. Compared to lispro insulin, NovoLog tends to have a slightly less dramatic peak
and a slightly longer duration of action. This may offers extra protection against blood sugar
elevations before meals and low blood sugars immediately after meals.
NovoLog may be mixed with most brands of NPH, Lente, Ultralente and Regular insulins. As
with other insulins, it may not be mixed or injected into the same site as Lantus insulin due to
Lantus‟ slight acidity. NovoLog can also be used in all types of insulin pumps when prescribed
by a physician for this purpose.
NovoLog is available in vial form as well as in 3ml cartridges which can be used in the NovoPen
3, Innovo and InDuo insulin delivery devices. Innovo is a new insulin injection device which
electronically monitors insulin remaining in the cartridge and offers a wide base to stabilize the
injection angle. InDuo combines a One Touch Ultra blood glucose monitor and insulin injection
device in one convenient unit.
For more information about NovoLog, please speak with your physician or call Novo Nordisk
Pharmaceuticals at 1-800-727-6500.


Accu-Chek Compact
What do you get if you cross a flip phone, a camera, and a blood glucose meter? The Accu-Chek
Compact!
Roche Diagnostics‟ latest blood glucose meter has the look, feel and size of a small cell phone,
and the convenience of a self-advancing, self-coding drum (about the size of a 35mm film
cartridge) that holds 17 test strips. The drum loads into the meter the same way film is dropped
into a camera.
After “flipping” open the front panel, one button press turns on the meter and releases the next
available test strip. The strip uses “capillary action” to draw in a small blood sample. A sensor
detects when enough blood is drawn in; the countdown will not begin until enough blood is
applied. This helps to cut down on the number of erroneous readings and wasted strips.
After about 15 seconds, the plasma-calibrated reading appears and is stored in the meter‟s
memory. One more button press ejects the used strip and readies the meter for the next test. A
window on the back of the meter reveals the number of strips remaining in the drum.
Compact‟s memory stores 100 readings with dates and times and provides a 7-day average. It is
downloadable to a personal computer via an infrared interface. The meter uses 2 AAA batteries
and works within a temperature range of 50-104 degrees farenheit.


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Accu-Chek Compact is available through most pharmacies. Test strips are packaged in sets of 3
drums (51 tests/box). Check with your insurance company regarding coverage. For more
information, contact Accu-Chek Customer Care, 800-858-8072.



Research Roundup
New Neuropathy Treatment
Hahnemann University is conducting a study on a new medication, topirimate, for the treatment
of diabetic peripheral neuropathy. Participants must have had neuropathy for at least 6 months
and HbA1c levels less than 9. A series of nerve conduction studies will be performed to evaluate
the effectiveness of the drug. Monetary compensation will be provided. For more information,
please contact Kellie Lind, study nurse, at 215-762-5186; or Thomas Brannagan, MD, at 215-
762-7037.



Diabetes Prevention Proven
In August 2001, the Diabetes Prevention Program (DPP) released the results of its nationwide
research to determine whether Type 2 diabetes could be prevented through modest weight loss.
The answer was a definite YES.
The DPP studied over 3000 overweight men and women with impaired glucose tolerance (a
precursor to Type 2 diabetes). Participants who were asked to reduce their weight by a modest
7% through a low-fat diet and 150 minutes of exercise per week reduced their risk of developing
Type-2 diabetes by 58%. This decrease held across all age groups, all ethnic groups, and was
similar for men and women. Those who were given diabetes medication and basic education
only saw a 31% reduction in their risk of developing diabetes.
The bottom line: those at risk of Type-2 diabetes can do a lot to prevent it through moderate,
feasible levels of activity, a healthy diet and modest weight loss.



U of Penn Working Towards Cure
The Juvenile Diabetes Research Foundation is awarding over $15 million to the University of
Pennsylvania for continuing research in Islet Transplantation (for restoring normal insulin
production) and Gene Transfer Technology (for treating diabetic complications). Such gene
therapy would be utilized for improving blood flow in those with foot wounds/ulcers and
diabetic retinopathy.
According to Dr. Ali Naji, MD, PhD, director of the JDRF – WW Smith Charitable Trust Center
for Islet Transplantation, “We are working to make islets less vulnerable to attacks from the
body‟s immune system, and we are investigating new methods of observing those transplanted
cells in action.”




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Dr. Naji‟s Human Islet Transplantation Clinical identifies and monitors patients with Type 1
diabetes who are suitable candidates for islet transplantation. The program is currently testing
the “Edmonton Protocol” for islet transplantation, using a combination of three steroid-free drugs
to prevent rejection of the donor islets. The program is also developing a standardized system
for procuring and isolating high-quality islets for distribution.



Retinopathy Develops Earlier Than Expected
Traditionally, doctors and diabetes educators have recommended annual dilated eye exams for
people with diabetes, starting about five years after diagnosis. But is this too conservative?
Researchers at the University of South Florida in Tampa went back to data collected in the
Diabetes Control and Complications Trial (DCCT) to find out.
By examining the retinal photographs of more than 1600 patients with Type 1 diabetes of less
than 5 years‟ duration, they found that 44% had evidence of early diabetic retinopathy. DCCT
follow-up identified an additional 341 patients in whom retinopathy developed before five years.
To make matters worse, they found that retinopathy tends to progress more rapidly when it
develops during the first five years of having diabetes.
Their conclusion:
Dilated eye exams and retinal photography should be included in the routine management of
Type-1 diabetes during the first five years to identify those at risk for vision-threatening
problems.




Numbers to Know
40 Nationally, more than 40% of people treated for Type 2 diabetes have an HbA1c above 8.
14 For every 1-point reduction in HbA1c, the risk of long-term complications decreases by 14%.
.7     For every 30 blood sugar tests done per month, the HbA1c decreases by an average of .7.




Gettin’ Leana With Regina
by Regina Taddeo MA, RD, CDE
(Regina Taddeo is a registered dietitian, certified diabetes educator and insulin pump trainer at
Integrated Diabetes Services. She is available on days, evenings and weekends to assist with
weight loss, carb counting and special nutritional issues.)

Keeping Lean in a Fattening World



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As Americans, not only are we getting fatter, we‟re doing it faster than ever! The number of
overweight Americans has jumped from 45% to 56% since 1991. The number of obese children
and adolescents has doubled since 1980.
Why? There are several reasons. One is that we are less active than ever before. Widespread
use of cars, computers, power tools other “labor-saving” devices has made our daily routine less
physically demanding. Our children spend more time in front of televisions and computers than
playing outside.
Food has also become more accessible and calorie-dense. Convenience food is available
everywhere -- from drug stores and gas stations to malls and schools. Also, portion sizes are
larger than ever. In the 1960‟s, the average meal from McDonald‟s was a small soda, small fries
and regular hamburger -- totalling about 600 calories. At some McDonald‟s, you can‟t even buy
a small soda or fries! The average meal is now a Quarter Pounder, super size fries and large soda
– totaling about 1500 calories.
Adding to the obesity problem in America is the fact that we are conditioned to eat even when
we are not hungry, and to prefer high-calorie foods. In ancient times, this “hoarding” approach
would allow us to store calories and survive the next famine. Today, it just contributes to
obesity.
To lose weight and stay lean in our society takes constant work. A good first step is to be aware
of portion sizes.
The more we are served, the more we tend to eat, regardless of body size. Try putting less on
your plate, sharing with a friend or taking half home. Limit your portions of calorically dense
items (high-fat foods, sweets, refined carbohydrates). Instead, try filling your plate with low-
calorie foods like fruit, salads and vegetables. These will help give you a feeling of fullness
without loading up on calories.
Another strategy is to avoid liquid calories. Appetites are not met well from liquid calories.
Stick with calorie-free beverages such as water, seltzer, diet sodas and teas.
The other component to avoiding/losing excess body fat is to exercise regularly. People who
maintain a healthy weight typically perform activities that are equal to walking 4 miles daily.
It‟s not easy staying lean in a fattening world, but with some planning and persistence, you can
do it!



Thinking About “Downsizing”?
If you‟re looking to adopt the kind of healthy habits that will help you lose body fat and look &
feel your best, sign up now for “DOWNSIZING WITH DIABETES”! “Downsizing” is a fun-
filled 10-week program designed to promote weight loss, fitness and good nutrition. For
information, call Regina at (610) 642-6055, or simply speak to our receptionist to schedule a pre-
class orientation.




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Thumbs Up!
Congratulations to the following patients:
Rob Atkins for his best-ever HbA1c of 6.6!
Chris Bell for lowering his HbA1c from 9 to 7.6!
Lori Christy for lowering her HbA1c from 7.6 to 6.6!
Tom Ciccarone for lowering his HbA1c from 8.1 to 6.1!
Kathy Fessler for lowering her HbA1c from 8 to 6.7!
Arlene Gerson, on the birth of her son Nicholas Jeffrey!
Andrew Hackett for lowering his HbA1c from 7.6 to 6.2!
Ross Myers for taking 1st place in the Schuylkill City Summer Swim Championships!
Billy Palmer on the birth of his sister Gianna, 11/8/01!
Ryan Pashley for lowering his HbA1c from 7.4 to 6.6!
Jordan Seeburger for lowering his A1c from 14 to 6.7!
Morton Waldbaum for lowering his HbA1c from 7.9 to 6.2 and losing 5 lbs!




Diabetes Events Calendar, 2002
Integrated Diabetes Services programs, held at IDS office unless noted. Call 610-642-6055 for
info
       Insulin Pump Club of Greater Philadelphia – support/educational meetings for those
       who use or are interested in insulin pumps; held at Friends Central School in
       Wynnewood, PA, 7:30-9:30 pm. March 6, June 5, Sep 4, Dec 4.
       The Survivor Series – support group for parents of children with diabetes, 7:30-9:00
       p.m. Jan 9, Apr 3, July 10, Oct 2.
       Neuropathy Association – support group for those with neuropathy, 7:00 – 8:30 p.m.
       Feb 6, May 1, Aug 7, Nov 6.
       Good Nutrition – support group/lecture series on various dietary topics, noon – 1 pm,
       the first Saturday of each month.
       Great Expectations – support group for pregnancy and diabetes, 12 noon – 1 pm, the
       third Thursday of each month.


Diabetes Exercise & Sports Association (DESA)
       Frisbee Golf Outing with special guest speaker Bob Scheidt at Brandywine State Park,
       10am April 21. (call 215-704-7473 for info)

Juvenile Diabetes Research Foundation (JDRF) Programs For info call: 610-664-9255



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       Educational Conference, dinner on April 12 (location TBD); program on April 13 at
       Conshohocken Marriott.
       Philadelphia Chapter Gala – black tie event at Hyatt Regency, Penns Landing, April
       27. South Jersey Gala at the Cherry Hill Hilton April 13; Delaware Gala at First USA
       Riverview Arts Center, June 1.
       Grandparents Day Event - at Hyatt Regency, Penns Landing, April 28.



American Diabetes Association (ADA) Programs For info call: 610-828-5003

       Diabetes Sunday African American Program in local churches, Feb-March.
       2nd Annual Diabetes Expo at Valley Forge Convention Center, 8:30 am – 4:30 pm.
       Avenue of Dreams Gala at Philadelphia Museum of Art, June 1, 6:30-11 pm.
       Tour DeCure bike outing at Peace Valley Park, PA, June 2.



Setebaid Services: For info call 570-524-9090

       Teen Skiing Weekend – Feb 22-24
       Diabetes Family Retreat – May 17-19
       Camp Setebaid with sessions for children and teens with diabetes – August 5-16
       Teen Whitewater Rafting Weekend – Sep 20-22




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