dafmd35.org & fldrf.org August 2020

PO Box 1407 Deland, FL 32721 1

In this issue

The Boards, 2

DAF MD-35 President, 3

Fundraising, 4

COVID-19 & Exec. Dir., 6

FLDRF, 7

Glucose Monitoring, 9

Tips From a Doctor, 11

Webmaster, 14

NEWSLETTER Diabetes Awareness Foundation MD 35 & Florida Lions Diabetic Retinopathy Foundation

dafmd35.org & fldrf.org August 2020

The Boards Diabetes Awareness Foundation MD 35President: Jane Colona Vice President: Dr. Glenn Brown 2nd Vice President: Greg Evans Secretary: Dr. Darcy Eberle Treasurer: Gary Hardacre Immediate Past President: Vivian Henegar Executive Director: Dr. Norma Callahan Directors: Betsey Messer Nancy Epps Miriam Navarro

Florida Lions Diabetic Retinopathy FoundationPresident: Betsy Messer Vice President: Diana Castillo 2nd Vice President: Tom Mavor Secretary: Dr. Darcy Eberle Treasurer: Gary Hardacre Immediate Past President: Erick Rumold Executive Director: Dr. Norma Callahan Directors: GeorgAnn Grant Joe Langello Joel Levenson Consultants: Dr. Shalesh Kaushal Geoff Wade Roger Messer David Goll

PO Box 1407 Deland, FL 32721 2

Zoom meetings

3rd Monday each month, 7:00pm

• Latest news for both DAFMD35 & FLDRF

• Next meeting: May 18th

https://zoom.us/j/8245728510 1-408-638-0968 Meeting ID: 824 572 8510

dafmd35.org & fldrf.org August 2020

Message from the President Diabetes Awareness Foundation MD 35

“What’s Clucking”: From the Desk of the President (Pandemic Day #122)

It is only fi+een (15) days into my presidency and I honestly never expected to s:ll be in Pennsylvania. I hoped quaran:ne would be a mere memory of 2020 and I would be seDng-up and going-to diabetes and re:na screenings around MD-35. I don’t know about you, but I really miss service, aMending conferences/conven:ons, club installa:ons and just being out-and-about with fellow Lions of the MD. With Florida being the current “epicenter” of the COVID-19 pandemic, the immediate future for our Lionis:c service seems to be uncertain.

It is crazy to be in northwestern PA where we are in the “green” zone and reopening everything. When I speak with locals, they cannot imagine (and in a lot of cases don’t believe) how bad it has become in the South. I watch the news every day hoping that the curve will start to trend downward. Our medical professionals and front-line workers are exhausted and need a break sooner rather than later.

I am op:mis:c that we will be dus:ng off our DRS cameras and glucometers and geDng ready for screenings as soon as it is safe to do so. Know that your Lion leaders for this founda:on and MD-35 are staying abreast of CDC recommenda:ons and will reschedule the re-cer:fica:on training previously scheduled for July 25 as well as resume screenings. There will be new guidelines for screening for all cer:fied Lions that must be reviewed prior to resuming service in MD-35 as well as obtaining supplies.

On a bright note, we are working on seDng up several educa:onal Zoom webinars on “hot topics” in diabetes and eye disease that will be open to everyone in the MD. If there is a specific disease or topic you would like us to cover please let me know. I’m very excited to work on this project with PDG Norma and fellow Lions.

It has been almost 100 days since my last post and unfortunately, not much has changed regarding the pandemic. In the mean:me, I am on the farm, watching the chicks geDng bigger, including my very own chicken that I named “Florence Nightenchick”. Know that I am thinking of everyone from afar. Con:nue to stay safe and healthy Lions. Wear your mask, wash your hands, and maintain social distancing!

- Lion Jane Colona, RN, President Diabetes Awareness Foundation of MD-35PO Box 1407 Deland, FL 32721 3

dafmd35.org & fldrf.org August 2020

Donations Welcome Lions & Lions Clubs Donations to the Foundations

We know many of you planned to make donations during your spring conferences. In lieu of this, please mail checks to:

PO Box 1407

Deland, FL 32721

The missions and goals of DAFMD35 & FLDRF are intertwined, but our expenses are not. The retina foundation operating costs for connectivity and warranty of all of the cameras is $10,000 a year.

We appreciate your continued support!

PO Box 1407 Deland, FL 32721 4

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dafmd35.org & fldrf.org August 2020

Other ways to support the foundations

Lions and Lions Clubs can support the Foundations with Life/Progressive Life Memberships for $100.

These funds go toward continued support of Free Diabetes Screening and education on prevention of the complications of diabetes.

Business, Corporate, & Foundation Donations Corporations, Foundations, and Businesses can support the Florida Lions Diabetic

Retinopathy Foundation by giving donations or diabetes testing supplies to support our Foundation. Our Foundation is a 501C3 Not-For-Profit Corporation and

all donations are tax deductible.

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Dear Team Players,

Please always be cognizant of our “We Serve” moMo. We are important members of our society and of our communi:es. We must set the example by following published guidelines of medical and scien:fic experts in order to keep each other and ourselves safe.

We should be seen washing our hands, social distancing, and wearing a mask. We perform medical screenings and we strive to be excellent examples.

We are working on a program of teaching and educa:on via zoom and webinars during this unique :me. We will not be restar:ng screenings un:l our numbers are down and stable. This is for your safety and the clients and again being a good example.

We will be doing retrain the trainer first with our batch of current trainers who were training within the 6 months prior to closing down. They will then use some of principles on zoom and video as well as some in person to recer:fica:on to anyone who wants to train. These will be small classes to confirm the safety guidelines we have put in place as required by CDC are being followed. We will also be handing out the new supplies and equipment required. Therefor, fundraising con:nues to be important.

If you have not read the new 2020 manual or the new shorter recer:fica:on version, now is the :me to download off our website. There are important updates, although the new procedures are not in there yet. We are wai:ng to see what our status is during that :me. We may not allow all groups to open at the same :me. It will be by the numbers of cases and hospitaliza:ons at that :me.

Hang in there. Do some reading on diabetes. You will be no:fied of all our educa:onal classes. Jane, Glenn, and I are currently working on puDng some excellent experts and speaker panels together.

Stay safe and healthy,

- Norma Callahan, Executive Director

PO Box 1407 Deland, FL 32721 6

dafmd35.org & fldrf.org August 2020

Past President’s Message

We have been challenged with unexpected circumstances that poten:ally will make us stronger as Lions in service throughout the world. The cancella:on of our service and social events offers an opportunity to review our service and goals.

The Florida Diabe:c Re:nopathy Founda:on became a recognized en:ty of MD35 one year ago. Lions provided financial support as well as improved visibility for re:nopathy screenings along with blood sugar tes:ng for diabetes. The result has been more service needs for medical procedures from the Florida Founda:on for the Blind.

The Board of Directors and trainers of both the diabetes and re:nopathy founda:ons have had an ac:ve year reviewing and rewri:ng manuals, forms, procedures and training review to improve our screening services. We need to be respeciul in our screening services and remain cognizant of HIPPA guidelines. While maintenance on cameras is fixed we have been able to nego:ate lower costs on wi-fi service and EKN (Eye Knowledge Network). Now it is up to Lions to do their part. We need to understand that re:nopathy screening is an important part of tes:ng for diabetes. We need to be sure to include it at all our diabetes screening events. As our mission states, we must seek out new partners to expand use of our technology and interface with health care partners to iden:fy and care for at risk individuals.

As we soon return to what will be a “new normal”, look at your communi:es for opportuni:es to expand our diabetes and re:nopathy services. We will be back. Include YOUR re:nopathy founda:on along with YOUR diabetes founda:on in your budgets and dona:ons. Remember to “zoom” in on our joint mee:ngs and refer to our website for informa:on.

It’s been my pleasure to serve with an outstanding Board of Directors. Our founda:ons are in good hands and deserve your support and we appreciate your service.

- Erick Rumold, Past-President Florida Lions Diabetic Retinopathy Foundation

PO Box 1407 Deland, FL 32721 7

dafmd35.org & fldrf.org August 2020

Leadership in the Age of Covid-19 and Unrest

Every day we read or see in the news the impact of the virus and civil unrest all around us. Here in Florida we ini:ally somewhat sheltered from the effects of the virus. That unfortunately changed.

We have suspended screening for the :me being, but we have not stopped caring about people. Lions are leaders and through out our century in the United States we have led the way when it comes to improving the lives of those less fortunate. Next to ailments related to age, diabetes is the number one factor impac:ng the survivability of Covid-19. There is never a more important :me for Lions to be leaders in educa:on, preven:on and detec:on of diabetes.

As soon as it is prac:cal and safe, we will be back out there screening individuals for Diabetes and Re:nopathy most o+en caused by this disease. New protocols and new equipment will be the order of the day as we protect our volunteers and the public we serve. Even with the pause in screening events we s:ll have significant costs to meets. Warranty’s and services contracts are just the beginning.

As your club start to meet for the 2020-21 Lion year, I am asking you to lead the way. Many of you will find that your usual fundraisers will not be available. Your first ins:ncts will be to reduce your commitments and conserve funds. I am asking you to put that ins:nct aside and look for new opportuni:es to raise money – it might be online through a website; It might be just asking local businesses to help; It might be holding smaller events, more frequently; I know you can find a way to make a difference. PayPal, Stripe, Square are just three of the services that can be used to take online payments. We are going to have to find a way to help our programs survive – there is too much to do and what we do is too important to leave to others. Lions Lead!

Thank you for all you do to serve the communi:es you live in.

- Tom Mavor, Vice President Florida Lions Diabetic Retinopathy Foundation

PO Box 1407 Deland, FL 32721 8

dafmd35.org & fldrf.org August 2020

An update on Blood Glucose Monitoring

Many Type 1 and some Type 2 diabe:cs have insulin pumps and use Self- Monitoring Blood Glucose (SMBG) systems, the finger s:ck and glucose meter test as we know it. The FDA requires 95% of all measured glucose meter values to be within 15% of true lab measurements. However, self-monitoring (SMBG) offers no alerts for low or high glucose readings due to infrequent tes:ng (glycemic variability). Thus, SMBG tes:ng, as well as A1C tes:ng, provide no informa:on on glycemic variability, hypo- or hyper-glycemic events. A1C is the average blood sugar level over a 2-3 month period. Glucose meters can introduce addi:onal errors such as, squeezing the site too much, collec:ng too liMle or too much blood, or the site is not fully cleaned and contains residual food, dirt, alcohol, etc. Factors known to affect glucose levels include food, medica:on, ac:vity, environment, biology, and behavior.

The newer Con:nuous Glucose Monitoring (CGM) systems can detect the previously men:oned glycemic variability deficiencies that appear outside target ranges or goals. This is especially cri:cal to Type 1 diabe:cs. CGM systems consist of a sensor and transmiMer, which may be part of an insulin pump, an implanted device or externally aMached device, and a receiver either hand held or via an APP on a cell phone or computer. CGM’s measure glucose every 1 to 5 minutes and record data every 5 to 15 minutes. This equates to 288 readings per day at 5 minute intervals. There is a lag :me of 5-15 minutes. There are several devices by several manufacturers available. Depending on the device, a pa:ent may change the sensor every 7-14 days. Alarms outside the target range will alert to hypo- or hyper-glycemic events via its device receiver. Benefits include reduc:on in A1C and glycemic variability and the reduced risk of hypo-glycemic and hyper-glycemic events.

When there is insurance coverage, it is limited to Type 1 diabe:cs or those on insulin. Cost is currently a barrier to diabe:cs who do not have coverage and eventually the insurance industry will come to understand the value and hopefully manufacturers’ compe::on and technology improvements will drive pricing lower.

Diabe:cs who use insulin pumps and CGM devices can provide their readings when we do tes:ng. No finger s:ck and blood glucose tes:ng device is necessary. Have the pa:ent provide their reading and record as such on our report form.

- Erick Rumold, Rph

PO Box 1407 Deland, FL 32721 9

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Should I Believe or Should I Not?

Be very skep:cal when reading internet and newspaper accounts of medical (and nutri:on) studies. Good medical and good diet studies are extremely difficult to do. They are also very difficult to report on correctly. Here are some of the common piialls.

First, all meaningful medical studies compare the results obtained with a study popula:on that receive a treatment with results obtained with a control popula:on that do not receive the treatment. The people in the two groups must be interchangeable. That is, they should be alike in all the ways that could influence the results of the study. Do they have the same age distribu:on, life style, diet, ethnicity, etc? Are their life histories similar? Are their medical histories similar? Gathering the volunteers and their relevant data is very difficult and :me consuming. Basically, no study without well matched controls can ever yield believable data.

Second, internet reports are almost never supported by data, but by one or a few anecdotes. Some:mes the reports are based en:rely upon opinions without any data. Anecdotes by defini:on are never supported by controls. Conclusions drawn from one or two or a few events can be interes:ng and can lead to carefully designed studies to test the anecdotes. But the anecdotes themselves are incapable of proving anything. Don’t let strong opinions in the news or on the internet that are not supported by carefully designed and executed studies ever sway your opinions. Remember, whenever you read a report ask these ques:ons: Who is saying it? What is the data? Does the data include controls? Are the writers qualified to analyze the report? Why are they saying it? Do they have an axe to grind? Are they trying to sell something?

Just like medical studies on the effects of a drug, food and diet studies also require matched controls to have any meaning. Hardly any two people eat exactly the same foods at the same :mes of day. Also, people generally do not appreciate how much they eat and how much they snack. Many people really do not want to know how much they are ea:ng, especially if they are obese. It is not uncommon for people to “lie” to themselves about their ea:ng and drinking habits. The result is that there are very few diet studies that have properly matched controls or are done properly. In fact, reports on food, diet aids and ads for over the counter medicine are rarely from studies at all. They are unsubstan:ated opinions. Such opinions are completely meaningless.

Third, is the study popula:on large enough so that the results are sta:s:cally meaningful? Are the studies carried out long enough to allow the study agent to have enough :me to influence the subjects’ status? Are the studies carried out long enough to allow the study agent to have enough :me to show significant unintended side effects?

Once again, is the study properly designed, i.e., is it big enough? For example, a small posi:ve result might be important and correct. However, small effects imply the need to study a very large group of

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people, perhaps tens of thousands for years in order for the results to achieve acceptable sta:s:cal significance.

Fourth, when reading a report on a medical study, is there enough informa:on in the ar:cle to help you evaluate the results? An example is a recent brief report regarding the effects of B12 on diabe:c neuropathy. The report claimed a posi:ve benefit of administering B12 to a group of about 50 people. The brief report gave none of the necessary background informa:on such as the prestudy levels of B12 in the subjects, or the A1C average and standard devia:ons for the treatment and control groups. How long was the study performed? B12 has a long life in the human body and it takes quite a while to significantly increase blood B12 concentra:ons. How much was the treatment group’s B12 levels increased? How long did it take to see the posi:ve effect of giving B12? Do you think the report of this study was meaningful? I don’t. The study might have had meaningful results, but there is no way to tell from the ar:cle.

Fi+h, a very important condi:on for performing a valid medical study is due to a phenomena that is some:mes called the “Hawthorne Effect”. The Hawthorne effect means that the aDtude (aka biases) of the people who come in contact with the study group can profoundly impact the analysis of the data. Basically, if you believe that some treatment is going to work, that belief o+en rubs off on the study popula:on and on the scien:sts analyzing the data. Every medical study must be done “double blinded”. Everyone in the treatment and control groups and everyone who comes in contact with those two groups must not know if the agent being given is real or a placebo. It is best that everyone analyzing the data does not know which group is which un:l all of the data has been thoroughly analyzed. At the very least, the ini:al analyzers must be as objec:ve (aka skep:cal) as is possible. Finally, the data must be analyzed by more than one person or group of people to reduce the possibility that personal biases influenced the data interpreta:on.

Sixth, is the study I am reading about relevant to people? Were the studies done on mice, armadillos, cats, etc? Animal studies can be very useful for ini:al work, but we humans do not have iden:cal biology and biochemistries to any other animal species anywhere. Many studies showing posi:ve effects in animals have not been repeated successfully in people.

Seventh, is the study I am reading about relevant to me? Was the study group all white men, but I am a Hispanic woman? Were their ages similar to mine? Did the study groups have the same medical issues that I have? Did they have my life style? All of these factors and many others could make the study completely irrelevant to most of the people on the planet. All of these considera:ons (and more) can really impact the relevance of any study to my health and well-being as well as to yours.

Eighth, what did the scien:sts actually conclude? Scien:sts performing carefully designed controlled studies are almost always very careful in drawing conclusions. They really do not want their compe:tors to gleefully poke holes in their results and conclusions. Scien:sts also want to preserve PO Box 1407 Deland, FL 32721 12

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their sources of research funding by doing a great job. Research and salary funding and peer respect are directly propor:onal to study quality and to care in data interpreta:on.

Unfortunately, even though reporters are o+en highly educated and experienced in their cra+, reporters rarely are trained scien:sts. They almost never have enough training in science to rigorously and skep:cally evaluate what they are repor:ng on. They do, however, want to make their bosses happy by geDng the public to enthusias:cally read their reports. This some:mes means that scien:sts concluding “maybe significant results” are magnified to ”earth shaMering discovery” in the newspaper ar:cles. I have seen very many cases of careful qualifying remarks by scien:sts being ignored or even suppressed in newspaper ar:cles repor:ng on the studies. So much so that the ar:cles were misleading, perhaps dangerously so.

And finally, don‘t let your skep:cism keep you from doing good works. We Lions are an amazing group of people. We serve because we really care about our families, our friends, our communi:es, our country and about people everywhere. And we Lions can do even beMer service when we are careful with our opinions and our conclusions. You might want to look up the text of the Sturgeon’s Revela:on. And remember, that was wriMen in the 1950s well before the inven:on of the internet.

- Dr. Glenn Bronw,Vice President Diabetes Awareness Foundation of MD-35

Webmaster, DAFMD35 & FLDRFPO Box 1407 Deland, FL 32721 13

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We’re ready to update our website with current photos! Please submit. We’ll review and post. Thanks! liongarylp35i@gmail.com

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Gary LaSpina,Webmaster

dafmd35.org & fldrf.org August 2020

Let’s hear from you!

Submit articles to:

darcy_eberle@yahoo.com

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