05 Jun Living Well with Diabetes Newsletter – May 2017
Grow Your Diabetes Knowledge!
By: Director of education – Jessica Cook MS, RD, LD, CDE
This newsletter focuses on new and upcoming technology as well as diabetes treatments. When is the last time you increased your own diabetes knowledge? With changing treatments, medications, foods and recommendations it can become a challenge to keep up! Currently at Palm Beach Diabetes and Endocrine Specialists we have a team of certified diabetes educators, registered dietitians, pump therapy/CGM workshops and healthy meal planning sessions for people with diabetes that can help you learn more about new medications, food recommendations, guidelines plus more! Being educated about diabetes can not only help you understand symptoms, side effects and how diabetes affects your body, but can also put you in control of the disease. To learn more today call 561- 659-6336 ext 8012 to schedule an appointment today. Pease enjoy our May 2017 Living Well with Diabetes Newsletter.
Technology Moving Diabetes Care Into The Future
By: Barry Horowitz, M.D., F.A.C.P., F.A.C.E.
Over the past 2 decades, we have had an explosion of treatments to help manage diabetes. When I came out of my fellowship 25 years ago (yes, I am dating myself), we had only one class of oral medications to treat type 2 diabetes and now we have 12 classes with more on the way. Back then, we had rudimentary insulins (anyone remember R, N, Lente or Ultralente?) and now we have both long and short acting insulins that more closely mimic how our bodies produce insulin. At the same time that we have had this advance in medications, we have also had incredible new diabetes pump and sensor technologies that have been shown to help improve blood sugar control for both Type 1 and Type 2 patients. Continuous glucose sensors (CGMs) have been around for some time but there are new advances that allow them to be used in different ways. These sensors are small devices about the size of a quarter that are placed on the skin and Palm Beach Diabetes and Endocrine Specialists 1515 N. Flagler Drive, Suite 430 West Palm Beach, FL 33401 561-659- 6336 email@example.com m measure the sugar in the fluid under the skin 24 hours a day. Their accuracy has improved tremendously so that they can truly reflect the blood sugar, but they are not meant as a substitution for checking sugars with a glucose monitor. One of the ways that CGMs are being used is as stand-alone devices to assist patients and physicians in managing their diabetes. In this case, the sensor transmits the sugar reading to a small device so the patient can see it on a continuous basis. In addition, the physician can download the device and retrospectively look at the data in order to aid in making changes in the patient’s diabetic medications. In fact, one of these devices, the Dexcom Mobile G5, has just been approved for Medicare patients with type 1 and type 2 diabetes who are on intensive insulin therapy. CGMs have been integrated into insulin pumps made by Medtronic for many years. Here, the sensor transmits the glucose reading to the pump itself for the patient to see contemporaneously and is part of the information that the physician can view when the pump is downloaded. The new Medtronic 670 pump, which is just coming out to the market, takes this to a whole new level. Utilizing the new Guardian Sensor 3, the sensor actually tells the pump how much basal insulin to deliver. Studies have shown that patients experience fewer highs and lows and less variability in their sugars. This hybrid closed-loop system still requires patients to interact with the pump to bolus insulin for meals, but a fully closed-loop system is being developed. Finally, CGMs are being utilized in physician offices to help us make changes in our patient’s diabetic regimen. For example, we often have patients who report good sugars at certain times of the day, but the A1c (3 month average sugar) is high. In order to see where the problem is, we place a professional CGM, like the FreeStyle Libre made by Abbott, for a week or so. This device continuously records the sugar on a chip inside of it so the patient is blinded to the readings and is then downloaded on a computer. It connects the dots of the patient’s home monitoring of sugars with a meter in between meals and overnight, to give the physician much more date to make decisions about their medical regimen. All of these new devices and more are utilized by the physicians at Palm Beach Diabetes and Endocrine Specialists. We pride ourselves in being on the cutting edge of new treatments for our patients. Please feel free to ask you physician if any of these technologies may be of value to your care.
The Food Diary New Methods
By: Rosemarie Steinsapir MS, RD, LD, CDE
The food diary and its cousin, the 24 hour food recall, is a very old tool in the practice of dietetics and nutrition. It might have seen better days in usefulness too. If we think back to a time when patients were not necessarily overweight, the diary pinpointed areas of intake that could be addressed and improved. In today's society, the more overweight you are, the less impact the diary will have. (If a patient has a BMI over 30, we could generalize and state they are eating too much and go from there, starting with portion sizes.) But that's from the perspective of the dietitian. For the overweight patient trying to shed some pounds, the diary has a different impact. It has 3 major uses:
Firstly, it creates a tracking record to be used by the patient him/herself. The single most effective weight management tool is knowing what you have eaten in the last 2 meals and adjusting the amount in the third meal of the day. Thereby keeping your calories in an acceptable range for weight loss. Tracking food intake holds the patient accountable for every bite by calling one's attention back to the goal several times a day.
Secondly, the diary, accumulated over several days/weeks, verifies trends in eating. Too much sugar? Too few vegetables and fiber? Too many meals at the restaurants? Holiday season eating? Bread at every meal? A well kept diary is invaluable for setting personal goals in changing habits and gaining insight into overeating.
Thirdly, the diary can help you to establish your own “go-to” meals that really work. Those are meals that held your blood sugar down, kept your weight on target, were easy to prepare and tasted good! It takes about 30 days of diligent tracking to come up with about 12 dinners, 10 lunches and 5 breakfasts that you can then use as a grocery shopping guide, and then a menu guide. Having go-to meals in your kitchen pantry and fridge, takes the stress out of food prep and decision making when you're hungry and tired.
Below are some thoughts about tracking that jump out at me from new technology:
1. If you find yourself in a hurry, or less accurate when you are hungry, take a picture of the meal you plan to eat, just as you sit down (of course with your cell phone.) Be sure to put a size reference in the photo. A size reference could be a pen, a lipstick, a packet of sweetener, a business card, etc. It creates a photo of a standard size with which to gauge portion sizes later. Later, that same day, pull up the photo and record what you ate and how much.
2. When you are describing food for a dietitian to review later, remember to write as clearly as you possibly can. All the trouble you went to recording can be
lost if no one can read it.
3. Capture the amount of everything you eat. It really doesn't matter if you use cups, tablespoons, grams, or ounces. It matters that you capture accuracy of what you eat. Both in amount and in description.
4. Walking into a clinical study or a counseling session without the diary that is being expected, screams “I don't care and won't comply.” Do you really want to send that message?
5. You can’t trust your memory. Memories lie. Just ask the court or a good lawyer. We may remember a meal eaten for 3 hours. But at the end of a busy day, the little nibbles that can add on pounds are seriously discounted and washed away as too insignificant to matter.
6. In a clinic far far away, I actually found a patient who kept a striking diary. He logged it on his computer and brought me the log to review. He had kept if or two weeks, diligently, and had not lost a pound. He measured and recorded everything. I passed it along to his physician with a note that I couldn’t see any nutritional problem. A blood test later, he was diagnosed with… of course, hypothyroidism. If you want a clear diagnosis, you have to give a clear history. Be as clear with your diary as you can.
Want to Slim Down and Gain Energy for Summer?
Then come to Our Living Well with Diabetes 1,2,3 Program! Learn foods to help you lose weight, balance blood sugars, gain energy and how to eat out without adding extra pounds! Now at 3 Convenient Locations!
Tuesday April 11 th 10am-12pm Temple Israel 1901 N. Flagler Drive West Palm Beach, FL 33401
Wednesday April 12 th 5:30-7:30pm 550 Heritage Drive, Suite 150 Jupiter FL, 33458
Wednesday April 19t 10am-12pm Brookdale 8220 Jog Rd. Boynton Beach, FL 33472
Will provide Healthy Snacks! **May bring one guest free of charge! If interested attending this program please contact our scheduling department at (561) 659-6336 Extension 8001 today!
At Healthy Living with Diabetes we want to ensure that you are satisfied with all services received. We also would like your input on educational workshops that you would like us to offer, information you would like to read about in Healthy Living with Diabetes Monthly or feedback on any workshop that you may have attended. You can contact the director of education personally by email jcook@PBDES.COM or leave a message at (561) 659-6336 ext. 8012. We would love to hear from you!