diabetic living - summer 2016

8/16/2019 Diabetic Living - Summer 2016

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YOU R D ONATIONS TO GOOD WILL®

H ELP

FU ND JOB PLAC EM ENT AND TRAINING

FOR PEOPLE IN YOU R C OM M U NITY.

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DiabeticLivingOnline.com 3

SUMMER 2016

LIVE24 What’s New in Insulin

Should you switch to one of

these new insulins?

26 Get Your Best Eye ExamDiabetic retinopathy: what it isand how to screen for it.

28 What I Know NowFormer NBA All-StarDominique Wilkins reflects onlife with type 2 diabetes.

33 RX UpdateThe latest in diabetes care

34 New Cholesterol MedsIt may be time to rethink yourcholesterol-reducing strategy.

36 Navigate Your MedsOvercome common obstaclesto stick with your care plan.

42 Why Am I Exhausted?Take this quiz to find out what’smaking you sluggish.

44 D-Friendly ShoesSix DL-approved shoes and

tips for choosing your own.

46 Is Sugar Addictive?The real problem with sugar.

51 Get ConnectedJoin blogger Karen Graffeofor Diabetes Blog Week.

52 Path for Better LivingHow one town redesigneditself to get healthy.

EAT64 Healthy Latin Cuisine

Slimming recipes that aremuy delicioso!

72 Protein Spotlight: YogurtTasty ways to eat more of thisdiabetes-fighting protein.

Continued on page 4

PHOTOGRAPHER Adam AlbrightRECIPE DEVELOPER Laura Marzen, RD, LDFOOD STYLIST Jennifer Peterson

ON THE COVER

80IS SUGAR AN ADDICTIVE

DRUG?p.46

MEATLESS

MEALS

FOR 2

SLOWCOOKERSTREETTACOS

EASY & FRESH

133

D i s p l a y

u n t i l A u g .2

V o l .1 3 ,N o .2

T r u s t u s !

Y o u ’ l l L o v e

T h i s H e a l t h y

C H E E S Y

F L A T B R E A D

p. 80

POUNDSGONE!

One Woman’sAmazing

Transformation

LIVING

Summer2016

$ 7 . 9 9

6 Editor’s Letter

8 Take Charge!What’s new andnoteworthy indiabetes research,nutrition, and exercise.

19 10K Steps: NashvilleEarn your splurge inMusic City.

96

LIVE EAT MOVE


4/1084 Diabetic Living SUMMER 2016

CONNECT

WITH US

LIKE it!Blood Glucose Wednesdaysfacebook.com/DiabeticLiving

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71 SURF it!Recipes, Health Tips & More

DiabeticLivingOnline.com

76 The Bounty of TomatoesSauce, chilled soup, flatbread—the possibilities are endless.

84 Grilled Chicken 3 WaysTake chicken breast from drab

to fab with three zesty recipes.

90 Food Truck RemakesStreet food faves madehealthier.

96 Meatless Meals for 2You won’t even miss the meat

with these four flavorful dishes.

100 Soak It UpFood pairs that will help youabsorb nutrients you need.

MOVE104 I Did It!

A bad breakup motivatedAshley James to change.

106 Pool PowerWater workouts for anyfitness level.

112 A Family MatterIf one of us has type 2, dowe all have to change?

119 Recipe Index

120 A Sweet EndingThis Minty Melonade willkeep you cool on warmsummer days.

Continued from page 3

92

Lo ve Di abetic

Li ving?

Ge t mo re rec i pes a n

d t i ps se n t

to yo u r i n- bo x eac h

wee k.

I t ’s F R E E!

SI GN UP A T

D ia be t icL i v ingOn l ine

.com/Ne ws le t ter

SUMMER 2016

‘GRAM it!Daily Humor & Inspiration

instagram.com/

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All content in Diabetic Living, including medicalopinion and any other health-related information,is for informational purposes only and shouldnot be considered to be a specific diagnosis ortreatment plan for any individual situation. Useof this magazine and the information containedherein does not create a doctor-patient

relationship. Always seek the direct advice of yourown doctor in connection with any questions orissues you may have regarding your own healthor the health of others.

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item for a full three years. Itworked for her. It impressed me.

That was especially true onour yearly swimsuit expedition.Zadie was, as usual, totallyunencumbered by the body-image baggage of her mom. Sheeyed a handful of suits beforeinstantly recognizing “the one.”

The transaction was very quick.We had a little extra time to kill. Soshe chose one for me, too.

I wouldn’t even haveconsidered the thing if it hadn’tbeen so deeply on sale (thanks,JCPenney!). It was more a tennisdress than anything—kicky andfun and kinda prancy.

I loved it the minute I put iton and actually twirled in frontof the mirror. Zadie clapped.I didn’t transform into Giselleor anything, but I did resemblesomeone who might enjoy anafternoon at the lake.

That cute suit changed theswimming dynamic for me: It just matched me better.

I became the mom whowent to the pool (ratherthan the one sweatingbuckets back home).I didn’t look anydifferent than I hadbefore, but I feltlike swimsuitseason was onmy terms now.

It’s tough to dothat, change your mind-

set about something you’reself-conscious about. Especiallywhen so much in life is out ofour control: We age, we thickenat the middle, we get jarringnews from the doctor.

What we do control is howwe react. How we let thosethings affect us. How we decideto limit ourselves—and how welearn to get over it (even whenwe’re getting the lesson fromour own kids).

For me, I’ll be swimming.Happy summer, friends.

Swimsuit season is uponus. I refuse to shudderwhen I write that.I’ve never been great with

body image, but wearing what’sessentially a spandex girdle inpublic hasn’t historically gonegently on my psyche. Until Ihad a daughter.

Children require accessories,and swimsuits are among them.

For the first few years, I justpicked up whatever was cheapand fit over a swim diaper.

But Zadie has grown into alittle waterbug. She now hasrequirements for a swimsuit. Shehas to be able to run, fish, andswim in it. It must be unbearablyawesome—a sweet spot I haveyet to figure out, but she knowsit when she sees it.

Zadie knows her own style,and she’s always chosen clothes

that make her feel comfortableand confident. She’s dressedherself since preschool—the kiddidn’t match a single clothing

My swimsuit’snot in a bunch.


7/108DiabeticLivingOnline.com 7

MEET OUR ADVISERS

THE FOLLOWING EXPERTS REVIEW ARTICLES THATAPPEAR IN DIABETIC LIVING® MAGAZINE.

The short answer: maybe. Ifpatients with diabetes are eatingwell-balanced meals with a varietyof fresh vegetables and fruits, thenno. However, metformin can causesome patients to become deficientin vitamin B12, and that requires asupplement. Also, any patient whoeliminates a food group (vegetarian/vegan, low-carb, low-fat, things like

that) or has food allergies, kidneydisease, or gastrointestinal diseasemay also need a supplement.

If you choose to take asupplement, pick one with less than100–150 percent of the daily valuefor the listed vitamins and minerals.Men and postmenopausal womenshould choose a supplementwithout iron.

Q: Do people with diabetes need dietary supplements?

Marty Irons, R.Ph., CDE, practices at a communitypharmacy and also served in industry and the military. Hepresents at diabetes education classes and is an author.

Francine R. Kaufman, M.D., is chief medical officerand vice president of Global Medical Affairs at MedtronicDiabetes. She is a distinguished professor emerita ofpediatrics at the Keck School of Medicine of the UniversitySouthern California and Children’s Hospital Los Angeles.

Nathan A. Painter, Pharm.D., CDE, is an associateclinical professor of pharmacy at the University ofCalifornia San Diego Skaggs School of Pharmacy andPharmaceutical Sciences. He’s on the board of directorsfor the American Association of Diabetes Educators (AADE).

Chef Art Smith, star of Bravo’s Top Chef Masters andformer personal chef for Oprah Winfrey, has type 2diabetes. He’s the winner of two James Beard Awards.

Hope S. Warshaw, M.M.Sc., RD, CDE, is a dietitian,diabetes educator, and freelance writer specializing indiabetes. She’s authored numerous books for the ADA

and is a contributing editor to Diabetic Living magazine.

John Zrebiec, M.S.W., CDE, is director of BehavioralHealth Services at the Joslin Diabetes Center in Bostonand a lecturer in the department of psychiatry at HarvardMedical School.

A:

NATHAN A. PAINTER,Pharm.D., CDE

ASK OUR EXPERT

Sheri R. Colberg, Ph.D., FACSM, is a professor ofexercise science at Old Dominion University. She providesprofessional expertise on physical activity to the AmericanDiabetes Association (ADA) and is a fellow of theAmerican College of Sports Medicine.

Marjorie Cypress, Ph.D., CNP, CDE, is a diabetes nursepractitioner in Albuquerque. She’s the past president ofHealth Care and Education for the ADA.

Alison Evert, M.S., RD, CDE, is a diabetes nutritioneducator and the coordinator of diabetes educationprograms at the University of Washington Medical CenterEndocrine and Diabetes Care Center in Seattle.

Joanne Gallivan, M.S., RDN, is executive director of theNational Diabetes Education Program at the NationalInstitutes of Health. She’s a member of the Academy ofNutrition and Dietetics (AND) and the AND’s DiabetesCare and Education Practice Group.

Sharonne N. Hayes, M.D., FACC, FAHA, is a cardiologistand founder of the Women’s Heart Clinic at Mayo Clinic

in Rochester, Minnesota.

Manny Hernandez is an internationally recognizedhealth advocate who has lived with type 1 diabetes since2002. He is cofounder of the Diabetes Hands Foundationand is on Livongo Health’s leadership team.


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TAKE CHARGE!WRITER Marsha McCulloch, RD, LD

As evidence stacks upon the health hazardsof sitting too much, allkinds of tools are hittingthe market to remind

Planning a sunny-destination trip? Pack sunscreen. Sunburned, cracking, andpeeling skin leaves people with diabetes especially vulnerable to infection. Butchoose sun protection carefully. The majority of sunscreens contain an array ofpotentially harmful chemicals, including ones that may mimic hormones anddisrupt hormone systems in the body, according to the Environmental WorkingGroup (EWG). Fortunately, nontoxic yet effective sunscreens are available, basedon a review of more than 1,000 sunscreens by the EWG for safety. The picksbelow have an SPF of 30 (heads up: they also contain non-nano zinc oxide as theactive ingredient, so they may appear a little white on the skin). Learn more atewg.org/2015sunscreen.

BUZZ!

C L E A N

S u n s c r e e n

buygarmin.com

Badger OrganicUnscented

Sunscreen Cream$15.99 for 2.9 oz.badgerbalm.com

Bare Belly OrganicsSunscreen Cream

$17.95 for 4 oz.barebellyorganics.com

Poofy's Organics”The” Sunscreen

$16 for 3.4 oz.poofyorganics.com

JAWBONE UP2 VIVOSMART

RULE OF THUMB FORWHEN TO REPLACEATHLETIC SHOES— American College of Sports Medicine

Track the miles on your

sneakers using the GPS on

your mobile device and the

MapMyWalk free app for

iOS and Android. Details at

mapmywalk.com/app.

8 Diabetic Living SUMMER 2016


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This funny-sounding, tangyfruit that grows in SouthAfrica is dubbed a superfruit—nutritional studies have found

it contains thousands oftimes more antioxidants(including polyphenols) thangoji berries and blueberries.It’s also an excellent sourceof vitamin C and fiber.

What’s more, preliminarystudies suggest the fruit’spolyphenols may slowdigestion of starch in the gut,which helps blunt the rise inblood glucose after eatingstarchy foods like bread.

Baobab is most commonlysold as a powder you can mixinto foods such as smoothies,yogurt, oatmeal, pancakes,and baked goods. It’s alsomaking its way into a growingnumber of packaged foods,including trail mixes, nutritionbars, cereals, and fruit chews.

Try it! Baobest BaobabSuperfruit Powder, $15.99,


baobab:

[BEY-oh-bab]

(noun)

➻ Wet Your Whistle,Whittle Your Middle You may

have heard that drinking water before

meals helps fill you up, but there hasn’tbeen much scientific proof—until now. Ina small study, obese adults drank 16 ounces

of water 30 minutes before breakfast,

lunch, and dinner for 12 weeks and weregiven general healthy lifestyle advice.Compared with a control group, the

water drinkers lost an average of

2½ pounds more.

—Obesity, 2015

STAND MORE, SIT LESSIt may be time to part with your old desk and enlist one thatenables you to quickly switch between sitting and standing, arecent study suggests. For seven days, scientists put a highlyaccurate activity monitor on more than 700 men and women inthe Australian Diabetes, Obesity, and Lifestyle Study, then lookedfor associations between sitting and standing and several healthmarkers. Every two additional hours per day that participants spentstanding instead of sitting was linked with

• 2 percent lower fasting blood glucose • 6 percent lower total/HDL cholesterol ratio • 11 percent lower triglycerides —European Heart Journal, 2015

The Sohoflexible desksits on top ofa regular desk,pops up andfolds downquickly, andsqueezes intosmall spaces.$175; Varidesk;varidesk.com


10/10814 Diabetic Living 2016

TAKE CHARGE!

Susan Weiner, M.S., RDN,

CDE, CDN, runs a private

practice, has written

diabetes books, is the editor

of On the Cutting Edge

(a triannual newsletter

from Diabetes Care and

Education), and she still

finds time to volunteer on

advisory boards for several

We caught up with her to

find out more.

Q | What’s yourteaching style? A | ”My office is in a housethat's been converted to a

professional building; it’s a very

comfortable, open area. I don’t

use a desk when I speak to

patients—there’s nothing in

between us. I use a couch

for my patients to sit on, sonobody feels bad if they’re

uncomfortable in the chair

because of their weight. I make

it very nonthreatening. I use

motivational interviewing

techniques that help me listen

to where they are. We start at

their goals. Even though I have

a lot of wonderful information

to impart, when you bombard

a patient with a ton of

information, they go nowhere.

People are very overwhelmedwith their diabetes. We take one

small piece at a time. We work

on it. Patients feel accomplished,

and we talk about what their

next smart goal is going to be

as they are ready to accept it.”

Q | Why do you think it’simportant to see a diabeteseducator regularly even ifyou feel you have a handleon your disease? A | ”I think we’re unique. We helpour patients meet their goals, not

necessarily the goals of their

physicians, spouses, or significant

others. And what we help them do

in terms of managing their daily

diabetes self-care behaviors is

extremely important for their

health and well-being physically,

mentally, and emotionally. Many

patients who have a lot ofknowledge and information come

back to me after years just for a

reboot because they’re burnt out,

or their disease has progressed and

they need more information.”

Q | What’s your favoritediabetes organizational tip? A | “Group like with like. Groupyour diabetes supplies that you

need to use every day together.

Group your spices together in your

pantry. Keep your fast-actingsources of carbohydrate together

in one place so they’re reachable.

Grouping like with like will help

you find things when you need

them and will also keep you in

your budget.” —Bailey McGrath

10 MINUTES with SUSAN WEINER2015 American Association of DiabetesEducators Educator of the Year

Safer ExerciseIf you manage your diabetes with insulin, plan ahead beforeyou hit the gym. ExCarbs (excarbs.com) is full of exercise tips

for people with diabetes and offers a handy Exercise Intensity

Calculator to help you figure out what adjustments you

can make to your insulin and/or carbohydrate intake

to reduce the likelihood of a low (hypoglycemia)

from aerobic exercise, such as walking, jogging, or

swimming. The site also guides you through how to

adjust for unplanned aerobic exercise. (Not intended

for elite athletes or nonaerobic exercise, such as weight

lifting or squats.)

SUMMER

diabetes organizations.



WORK OUT

AT HOMETO THE DVD($89.99 plus

shipping;includes two

Ripstix). Or finda local class at

poundfit.com.

Quick—try to think of adrummer in a rock ’n’ rollband who is extremelyoverweight. Tough, right?Probably because drummingis a terrific workout.

Drummers can elevate theirheart rate up to 190 beatsper minute—comparable toelite athletes. You can get a drummer’sworkout, whether or notyou have an instinct for the

backbeat, with POUND,

ROCK

OUTFORFITNESS

a new exercise programthat uses a pair of weighteddrumsticks in a 45-minutecardio jam session. Createdby two women drummers,the classes follow routines tomusic that work your wholebody, especially your core.Participants do aerobic andlight resistance moves whileconstantly drumming on thefloor with quarter-pound-weighted Ripstix.

—Martha Miller Johnson



TAKE CHARGE!

CURBCRAVINGS

PLAYTE RIS

A recent study found that playingTetris—an electronic puzzle gamethat requires quickly movingcolorful blocks—for just threeminutes helped weaken food andbeverage cravings by about one-fifth in a seven-day study. It seemsthat playing a game like Tetris fillsthe brain space you’d otherwise useto imagine consuming temptingfare. Play on tetris.com for free orbuy the app for 99 cents.—Addictive Behaviors, 2015

Billie Jean King, tennis playerHoward Hughes, eccentric billionaire

Thomas Edison, inventor Laura Ingalls Wilder, author Mikhail Gorbachev, former president of

the Soviet UnionNeil Young, rocker Walt Frazier, New York Knicks

basketball player —M. M. J.

EAT THIS, THEN THAT

They Had Diabetes?

later by protein and nonstarchyvegetables. A week later, theyrepeated the experiment with thefood order reversed.

When participants ate proteinand nonstarchy vegetables first, their blood glucose levels were37 percent lower one hour afterthe meal and were still nearly17 percent lower two hours after

the meal compared with when theyate carbohydrate-rich foods first.Additionally, insulin levels one hourafter the meal were 49 percentlower when protein and nonstarchyveggies were eaten first.

Although further study is needed,this simple strategy might be aneasy way to improve blood sugarcontrol. —Diabetes Care, 2015

Could the order in which you eatdifferent types of foods affectyour blood glucose and insulinlevels after a meal? A preliminarystudy suggests it might. After anovernight fast, a small group ofobese people with type 2 diabetes(treated with metformin) ate thecarbohydrate-rich foods in a testmeal first, followed 15 minutes

EATTHESEFIRST


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Nutrino

To answer thequestion “Whatshould I eat?”

Nutrino offers personalizedmeal plans based on the latestfood science. Nutrino takes

into consideration your tastesand dietary restrictions (suchas gluten and dairy allergies)and provides a daily meal planto help users stay healthy(the premium service allowsyou to plan ahead). You canalso log your own food if yougo off the recommendedmeal plan. After you exercise,Nutrino can suggest the bestrecovery snacks and links to

other fitness apps, such asFitbit and Runkeeper. Basic isfree; premium is $39.96/yearor $18/3 months. Available onAndroid and iOS.

Fooducate

In addition tostandard calorie,exercise, and weight

tracking, this app shoots you adaily tip, healthy recipes, andgroup-chat options. We love

the Fooducate rating system,which allows you to scanan item or use the extensivedatabase to find the best

versions of your favorite foods.Using a grading scale from A+to D, Fooducate analyzes foodsbased on nutrient quality aswell as how processed they are.Premium options include dietarypersonalization, such as gluten-free, Paleo, or vegetarian,and you can customize thesearch to eliminate GMO andartificial ingredients. Basic isfree; premium is $29.99/year

or $4.99/month. Available onAndroid and iOS.

MyNetDiary

Diabetes

Want a caloriecounter with a

side of diabetes management?MyNetDiary features a speciald-friendly version that allowsyou to log blood sugarsand medication while also

tracking food and exercise foran all-encompassing healthsnapshot. Features includeblood sugar reminders, barcodescanning, and graphs for bothblood sugars and nutrition.MyNetDiary reports that itsaverage user loses 12 percentof body weight and lowers A1Cby 1.4 points. Diabetes version is$9.99. Available on Android, iOS,and mynetdiary.com.—Allison Nimlos


14/108

Download the Instagram app on your smartphone or

follow @diabeticlivingmag online for more carb-smartrecipes, healthy tips, and fun behind-the-scenes photos!

FIND USON

INSTAGRAM!



Lucky for your step count, thecountry-music icons that bringhordes to Nashville huddle in a super-walkable downtown. Any respectabletour starts at the Country Music Hall ofFame (countrymusichalloffame.org), where you’ll forever get to brag thatyou saw Elvis’ gold Cadillac, Hank

Williams’ fringed jacket, and (for anadditional cost) historic Studio B,where big names like Dolly Parton andCarrie Underwood have recorded.

From there, you can do a loop pastany number of legendary sights—theJohnny Cash Museum (his Gibson! johnnycashmuseum.com) and theGeorge Jones Museum (his ridinglawn mower! georgejonesmuseum.com). Then catch a show at the“Mother Church of Country Music,”the Ryman Auditorium (ryman.com). But museum-musing is slow-going,so I started each day with a briskwalk, exploring anything that wasn’tin NashVegas central—the sprawlingover-the-topness of Gaylord OprylandResort (live radio broadcasts of theGrand Ole Opry down the road, opry.com) and a replica of the Parthenonin Centennial Park (nashville.gov). I glimpsed Tennessee’s forestedmountain splendor on my favoritewalk: the easy Radnor Lake trail about20 minutes south of town. My Uberdriver said I’d just missed Mick Jagger

getting in his steps before a concertwith Taylor Swift. Nashville blogger McKel Hill, RD,says the city’s walkability works in ahealthy traveler’s favor, but bewarewhen dining out. “Sugar can hide inthe sneakiest places, including good-ol’ Southern barbecue,” she says.

I’m going to be honest. You can’twalk far enough in a single day toearn the splurge of lunch at Arnold’s,the gold-standard meat-and-three

joint founded on country food(arnoldscountrykitchen.com). But iffellow travelers insist, use all the trickswe’ve taught you: Pick the smokedturkey over fried chicken, order simpleveggies for sides, avoid the mac andcheese, and drink unsweetened tea.

For a taste of the nontraditional,Hill likes the Sunflower VegetarianCafe (sunflowercafenashville.com)—“a great buffet-style, plant-basedcafé that even meat-eaters willlove!” Find more recommendationson her blog, Nutrition Stripped(nutritionstripped.com). If you do this city right, you’llbe rocking honky-tonks at night.Nashville’s warm-up bands killed itharder than most cities’ arena acts,and I finally danced off the last oflunch between Acme Feed & Seed(theacmenashville.com) and Robert’s(robertswesternworld.com).

Few places make it easier to keep moving than

Music City—stroll past Elvis’ gold Caddy by day, thenshake it through the honky-tonks all night.WRITER Jennifer Wilson

P ar t he no n i n C e nt e nni al P ar k

S u n fl o w e r

C a f é

Radnor Lake Trail

Countr y Music Hall of F ameGa y lo r d O pr y land R e s o

r t

p

R y m a n A u d

i t o r i u m


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WAYS FOR YOU TOSTAY POSITIVE

IMPROVING HER MOOD



LIVE

p

GUIDE TO GOOD HEALTH8

A study by BMCPsychiatry in 2015

found that justone workout perweek can boost

your mood.Researcherssuggest that

exercise shouldbe a fundamental

part of mentalhealth treatment.


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N E WIf you’re using insulin or

considering insulin therapy,many new options are available.

WRITER Marty Irons, R.Ph., CDEPHOTOGRAPHER Jason Donnelly

The goal of insulin therapyis to keep blood sugarsunder control withoutcausing low blood glucose(hypoglycemia), so it should beflexible enough that you don’thave to make major changes toyour daily activities.

The good news: Recentadditions to the market allowphysicians to better personalizeyour care to your body’s needs.But always ask if an insulin will fityour lifestyle when your doctortalks about prescribing it.

Here’s a review of the insulinsavailable now and new additionsto each category. The optionsmight seem confusing at first,but your prescribing physician,pharmacist, and certified

diabetes educator can helpyou identify the insulin(s) thatsuit you best.

HOW INSULINS WORKInsulins differ from one anotherbased on a few factors.• Onset: How quickly theinsulin starts to work• Peak: When the insulin will

have its greatest action• Concentration: The numberof units of insulin per milliliter.It’s measured by how manyunits of insulin are in 1 cc.For example, Humalog U-200has twice as much insulinper cc as U-100.• Duration: How long theinsulin acts in the body• Route of administration:

Injection, inhalation, orinsulin pump



19/108

These insulins are essentially generic

versions of existing insulins. They

should provide some cost savings for

patients. Basaglar, a biosimilar of Lantus,

will be the first available, starting inDecember 2016.

These insulins act to help your body

clear sugar after meals. They are used in

insulin pumps as well as with multiple

daily injection therapy at mealtimes and

for blood sugar correction. Several new

rapid-acting insulins are available: In the

Humalog family is a new higher-

concentration U-200 KwikPen;

Humalog U-100 now comes in a

smaller 3-ml vial for patients who needonly a few units per meal. Humulin R

U-500 is now available in a prefilled pen

for easier and more accurate dosing

(ususally only 2–3 injections per day).

No new additions to this category

of insulins, which last longer than

mealtime insulins. They’re used once or

twice daily, sometimes to help with

meals, and often during a specific

period of the day, such as daytime or

overnight. Commonly called NPHinsulin, on market examples include

Novolin N and Humulin N.

Often the first type of insulin patients

need, these are injected once or twice

daily and work for an extended period.

A new, more concentrated version of

Lantus is now available: Toujeo U-300.The U.S. Food and Drug Administration

(FDA) also recently approved Tresiba

U-100 and Tresiba U-200. Both are

available in prefilled pens.

Combining a rapid/short-acting insulin

with an intermediate/long-acting

insulin, premixed insulins are usually

injected twice a day. Though simple to

use, they don’t provide much flexibility

for dosing changes and require users

to eat at the same times each day.Ryzodeg U-100 is a new combination

insulin of aspart (rapid-acting) +

degludec (long-acting) injected once

or twice daily. It offers more flexibility

in dosing time than older mixes.

IGlarLixi is a fixed-ratio combination of

U-100 glargine (Lantus insulin) +

lixisenatide (a GLP-1 receptor agonist).

It will be available in a pen only. Unlike

most insulins, it appears to be weight-

neutral (most patients gain weightwhile on insulin). FDA approval is

expected August 2016.

BIOSIMILAR

INSULINS

RAPID

ACTING AND

SHORT

ACTING

MEALTIME

INSULINS

INTERMEDIATE

INSULINS

LONG

ACTING

INSULINS

PREMIXED

INSULINS

BASAL

INSULIN +

GLP1

RECEPTOR

AGONIST

There’s an influx of new insulins on the market. Read onto find out if there’s a new product that’s right for you.

STOP! INSULIN SAFETYInsulin errors are common—andscary. Here’s what you can do.

WATCH sound-alikes—Humulinvs. Humalog, Novolin vs. Novolog.

CHECK THE CONCENTRATION.Humalog, Novolog, and Tresiba are

available in both U-100 and U-200.

Humulin R is available in U-100

and U-500.

MIXED? Combination insulins

aren’t interchangeable. Humalogis not the same as Humalog Mix

75/25, nor is Humulin Mix 70/30

the same as Novolog Mix 70/30.

USE A PREFILLED PEN. Dosingwith pens is almost foolproof. Vials

require extra effort, and dosing

errors occur frequently.

CARRY A LIST of medicationswith the box end flap(s) from

the insulin you currently use.

SEPARATE day and evening

insulins in different locations.

IF YOU’RE DISCHARGED froma hospital, bring your discharge

summary to the pharmacy.

Compare the strength, directions,

and name of the insulin to the

insulin that is dispensed to you.

DON’T BE SHY TO ASK yourdoctor or pharmacist anything,

especially if you have a concern or

when a new insulin is prescribed.

NEW INSULINS

!




WRITER Jennifer Larson

GET YOUR

BESTEYE EXAMYour eyes are the windows to yoursoul. Are you taking care of them?

As a person with diabetes, the

greatest risk to your vision is a

condition called diabetic retinopathy,

in which the blood vessels of the

light-sensitive tissue at the back of

the eye (the retina) begin to swell

or leak blood or fluid. It can lead to

blindness if not treated early enough.

In fact, nearly one-third of adults

with diabetes over age 40 have

diabetic retinopathy, according to

the U.S. Centers for Disease Control

and Prevention. The good news

is that it’s preventable and very

treatable if found in the early stages.“If we catch patients at the right

time, we can treat them and prevent

that vision loss,” says Paul Aiello,

M.D., professor of ophthalmology

at Harvard University and director

of the Joslin Diabetes Center’s

Beetham Eye Institute.

Comprehensive eye examMaybe your vision is fine. Maybe you

wear glasses, but other than that, no

problems. Right?

Well, not necessarily.

With diabetic retinopathy, the

damage to your retinas can develop

slowly and without any noticeable

effect on your vision.

“Good vision doesn’t equalhealthy eyes,” says Paul Chous,

Diabetic

retinopathy is

more common

than you mightthink, but you

may not even

realize you

have it. Proper

screening is key

to preserving

your vision.



an optometrist in Tacoma,

Washington, who specializes in

caring for people with diabetes and

who has type 1 himself.

As diabetic retinopathy develops,it first may cause vision to become

blurry. The retina may swell, a

complication called diabetic

macular edema. Eventually, it may

advance to the stage known as

proliferative diabetic retinopathy,

in which the eye tries to grow new

blood vessels, causing additional

bleeding or even tearing of the

retina, which can cause blindness.

The only way to detect diabetic

retinopathy before these symptomsbegin is for a doctor to get a good,

prescription for glasses or contact

lenses as needed.

What else are they

looking for?A comprehensive dilated eye

exam isn’t just about searching

for signs of diabetic retinopathy.

Because you have diabetes, you

have an elevated risk of glaucoma

(a disease that damages the optic

nerve) and cataracts (a clouding of

the lens), so your ophthalmologist

or optometrist will search for signs

of these conditions as well.

Your doctor may also talk to

you about your lifestyle. Eating ahealthy diet and getting enough

close look at your retinas with a

comprehensive eye exam—wherethe doctor dilates your eyes. You

won’t get that type of screening

with your basic vision exam.

“The key is early exams,

prevention of damage to the retina,

and early treatment,” says Anne

Sumers, M.D., an ophthalmologist

based in New Jersey and a clinical

spokesperson for the American

Academy of Ophthalmology.

And don’t put off scheduling

your appointment if you’re having

trouble stabilizing your blood

sugar levels—you may hear that

recommendation before getting

a new prescription because high

blood glucose can temporarily

blur your vision. But one in five

people with diabetes already shows

signs of retinopathy at the time of

diagnosis, Chous says.

So be sure to get the

comprehensive exam andschedule a follow-up to get a new

sleep can help you maintain better

control of your blood sugar, whichhelps keep your eyes healthier.

Good blood pressure and lipid

control help reduce the risk or

slow the progression of diabetic

retinopathy, too.

Exam prepBe ready when the doctorwalks into the exam room:• Tell the doctor that you havediabetes. Your doctor needs to

be aware of your specific risk fordiabetes-related eye diseases.• List all the medications you’retaking—not just the ones fordiabetes. Blood pressure andcholesterol-lowering medicationscan affect your vision and eyehealth, too.• Ask when you need to return and schedule the appointmentbefore you leave. You may needmore frequent follow-ups if you’ve

developed signs of retinopathy.

“Good vision doesn’t equal healthy eyes."

WHEN YOU NEED ONEAccording to the American

Diabetes Association (ADA):

• Type 1: first exam within

five years of diagnosis.• Type 2: first exam at thetime of diagnosis.

After that, the ADArecommends an annualexam. But if you havewell-controlled diabetesand show no signs of thedisease, an exam every twoyears may be an option. While newer technologiessuch as retinal cameras

serve as a screening tool,they’re not a substitute fora comprehensive dilatedeye exam.

WHAT TO EXPECTWHEN YOU GET THERE

Step 1: The DilationThe ophthalmologist oroptometrist will put dilatingdrops into each eye, whichmight make your eyes feelcool or a little dry or sticky.The drops force your pupilsto widen so the doctorcan examine your retina,the light-sensitive lining atthe back of each eye. (Theeffect may also make yourvision temporarily blurry,like you accidentally put onsomeone else’s glasses.)

Step 2: The ExamOnce your eyes dilate (ittakes a few minutes), thedoctor will use a specialmachine and a brightlight to look into youreyes; you’ll rest your chinand forehead on specialsupports that are part of themachine. The doctor willlook for problematic signslike swelling, abnormalblood vessel growth,microaneurysms, andprotein deposits.


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“If you workhard enoughand youbelieve inyourself,you canaccomplishany goal.”

“You’ve got

to tell whole

truths—not

half-truths—to

your doctor

so he’ll know

what to treat.

You have to

get away from

pride and

from being

ashamed that

you have an

illness or a

problem.”

“I can get impatient. Then I say,

OK, this isn’t going to change ifI’m depressed or frustrated, so just stay the course. And I think that’swhen people make mistakes—when

they don’t stay the course.”

AS TOLD TO Bailey McGrath

“Seeing what myfather and grandfatherwent through withthe amputations and

the lack of taking

care, I decidedI wouldn’t letthis disease doto me what itdid to them. Ihad to take ithead-on.”

“You’ll always feelpressured when

you’re around foodyou know you’re not

supposed to eat.It’s tempting. But

look at how you feelnow as opposed tohow you’re going

to feel later.”


WhatI KnowNow...

WHO: RETIRED

NBA ALLSTAR,

ATLANTA HAWKS

VICE PRESIDENT

OF BASKETBALLWHY: DIABETES

ADVOCATE,

PERSON WITH

TYPE 2 DIABETES

AGE: 56

DOMINIQUE WILKINS


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p

WRITER Marty Irons, R.Ph., CDEUPDATENew FDA alertThe U.S. Food and Drug

Administration (FDA) warns that the

glucose-lowering drugs Invokana

(canagliflozin) and Invokamet

(canagliflozin/metformin combination)

can decrease bone mineral density,

which affects the strength of yourbones. If you are taking either of these

medications, talk to your doctor about

the risk for bone fracture.

Beefed-up benefitsCan one drug do it all? A recent study

suggests yes. The results, published

in The New England Journal of

Medicine (November 2015), indicate

that the drug Jardiance (empagliflozin)

helps the kidneys by lowering both

blood sugar and blood pressure, twothings that damage the kidneys if

elevated. Patients also lost weight and

reduced their risk of stroke or heart

attack. The FDA is currently reviewing

the use of the drug to prevent

cardiovascular death. Empagliflozin

is also marketed in combination with

other diabetes meds such as

Synjardy (with metformin) and

Glyxambi (with linagliptin). Talk to your

doctor if you’re curious about these

potential benefits.

What’s new andon the horizon in

diabetes treatment.

Double-duty medicationA medication that can control weight

and decrease blood sugar: That’s the

possibility of Xultophy, which is under

FDA review. This injectable medication

combines a long-acting insulin with

an incretin mimetic (a drug that tells

your pancreas to release insulin). Ina 26-week study sponsored by Novo

Nordisk, the drug’s manufacturer, on

average patients lowered their A1C

by 1.8 percentage points and lost

one pound.

Diabetes and dementiaAnother reason to follow your

treatment plan: New research

indicates that keeping blood glucose

under control can also dramatically

reduce the risk for dementia forpeople with type 2 diabetes.

—Diabetologia, September 2015

Emergency-ready glucagonIf you experience severe

hypoglycemia that leads to

unconsciousness, an intranasal

treatment in development could help.

Currently in test trials, the single-use

device releases a spray of glucagon

(a natural hormone that helps to raise

blood sugar) powder into the nose.

If this form of glucagon is approved

by the FDA, it will join the ranks of

glucagon shots now available.

What’s next in researchIt may be possible to extend insulin

production for patients with type 1

diabetes, a small clinical trial suggests.

Scientists injected mega doses of

patients’ own T cells, a type of white

blood cell, into their bloodstream.

They found the injections preventedother cells from destroying the insulin

cells of the pancreas. It’s too early

to anticipate insulin injections

becoming a thing of the past, but

this therapy will certainly get further

scrutiny.—Science Translational

Medicine, November 2015

Overwhelmed?We can help you

ask the rightquestions at yournext doctor’s visit.

Download ourappointmentcheat sheet:

DiabeticLivingOnline.com/

Cheat-Sheet



26/108



recommended lowering LDL toless than 70 mg/dl.

Here’s the big news: Last year,the ADA recommended a statin-type cholesterol-lowering drugfor most people with diabetes, no

matter their LDL cholesterol levels.Whether you’re at moderate or

high risk for cardiovascular diseasedetermines the particular statindrug and dose for you. The ADArecommends other cholesterol-lowering medications only if youdon’t tolerate a statin medicationor otherwise don’t benefit from it.

The ADA—like the AmericanHeart Association (AHA)—nolonger has specific targets for LDLcholesterol. However, both the

National Lipid Association (NLA)and the American Association ofClinical Endocrinologists (AACE)recommend LDL goals of less than70 mg/dl for people with diabetesat high risk for heart trouble andless than 100 mg/dl for others.

All four organizations agree: Astatin is the first drug of choice.

How statin drugs workBoth the ADA and AHA changedtheir recommendations on statin

drugs, says Evan Sisson, Pharm.D.,CDE, associate professor at VirginiaCommonwealth University Schoolof Pharmacy and a spokespersonfor the American Association ofDiabetes Educators.

“We need to prevent some ofthose 600,000 deaths each year.Statins do that,” Sisson says. “Theyprotect against heart attacks.”

Not only do statin drugs lowerLDL cholesterol levels, they appearto have an anti-inflammatory effectand stabilize plaque in the bloodvessels, says James Underberg,M.D., FACPM, FACP, FNLA, clinicallipidologist and an executivecommittee member of the NLA.

When plaque ruptures and spewsinflammatory contents inside avessel and an obstructing bloodclot forms on that rupture, blockingblood flow, you have a greater riskof heart attack or stroke.

In most situations, the ADAdoesn’t recommend combininga statin drug with another

cholesterol-lowering medicationto further reduce LDL levels. Theproof of benefit relative to the riskof side effects is not there, they say.

But because the NLA andAACE recommend specific LDL

goals, they support combiningmedications to bring patients’cholesterol numbers to target.

New meds on the horizonA brand-new class of cholesterol-lowering medications will soonbe available, and they differ fromcurrent therapy in many ways.

The new drugs are known asPCSK9 inhibitors and go by thetrade names Praluent and Repatha.

They don’t come in a bottle.

You don’t swallow a pill every day.Rather, a PCSK9 inhibitor is injectedevery other week or so. Some people in clinical trialshave seen LDL cholesterolplummet to levels well below40 mg/dl. PCSK9 inhibitorssignificantly lower LDL even inpeople who have already benefitedfrom a statin drug, Underberg says.

But it will take more studies toshow that these new drugs preventheart attacks, he says.

Sisson says that PCSK9 inhibitorsare currently indicated for a limitedgroup of people: • Patients with establishedheart disease who are unable toadequately reduce LDL cholesterolwith current therapies. • Individuals with a geneticcondition called heterozygousfamilial hypercholesterolemia. Sisson and Underberg say thenew drug class appears to be safe,though it’s only been tested ona small number of people. Andthey’re pricey (see sidebar). If you’re concerned about yourLDL cholesterol dropping too low,Underberg says that individualswith genetically low LDL levels ofless than 25 mg/dl do live healthy,active lives without heart disease. In fact, PCSK9 inhibitors weredeveloped after researcherslearned of people who havegenetically low cholesterol due toa gene mutation. PCSK9 inhibitorstarget that gene.

WHAT TO ASK YOURHEALTH CARE PROVIDER

You are the best advocate for your health. Use these questionsto start a conversation aboutheart health with your doctor:

What is my risk of havinga heart attack or stroke?

Should I aim for a specificLDL cholesterol goal?What else should I know aboutmy cholesterol levels?

What are some ways I can helpprevent a heart attack or stroke?

Who should usea statin to controlcholesterol levels?The ADA published new

standards to help preventheart attack and stroke.

BEFORE People withdiabetes and cardiovasculardisease whose LDL levelsare more than 70 mg/dl or100 mg/dl if only diabetes.

NOW All people with

diabetes age 40 and olderand those under 40 if theyhave additional risk factorsfor heart disease or stroke.

New medication:PCSK9 inhibitorsInjectable drugs that go bythe trade names Praluentand Repatha.

PRO Expect it to drop your

LDL cholesterol level muchlower than any other drugon the market.

CON Not widely tested yet,so may learn of side effectsat a later date. May cost youor your insurance company$12,000 yearly.

QUICK NOTES


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NAVIGATE

YOUR MEDSFear, cost, busy schedules—many factorscan get in the way of taking your diabetesdrugs. Tap into our insider tips to conquer the

obstacles and control your health.

WRITER Marsha McCulloch, M.S., RD, LD | ILLUSTRATOR Bee Johnson


29/108

Anxiety about takingdiabetes medication isunderstandable. You mightworry about side effects, the strain

on your pocketbook, or the hassle

it adds to daily life. If you have

type 2 diabetes, you may be able

to dodge the need for medications

for a while, but eventually they

may become necessary. If you

have type 1 diabetes, you realizepretty quickly that taking insulin is

essential to your survival.

Medications and insulin are tools

to improve your blood glucose—

and they work.

“Taking your medications

regularly can greatly reduce your

risk of developing unwanted

diabetes complications,” says David

Pope, Pharm.D., CDE, editor in chief

at creativepharmacist.com.

Sometimes remembering to take

pills or injections and keeping up

with refills is a challenge of its own.

“The average person with

diabetes is on six medicines, so

it can feel like juggling,” says Jan

Berger, M.D., M.J., chief executive

offi cer of Health Intelligence

Partners in Chicago.

We've got tips for staying on top

of your regimen and information

that may ease concerns keepingyou from your healthiest self.

in Bessemer, Alabama. Some

patients skip pills when their blood

glucose is in check—though missing

just 24 hours of your sulfonylurea

dosage, for example, could affect

your blood glucose for up to fivedays. Similarly, although metformin

generally improves blood glucose

control in one to two weeks, it may

take two to three months to exert

its full benefit.

“Diabetes is progressive, so it

generally gets worse over time as

the pancreas wears out,” Devereux

says. “People typically need to add

medication, and sometimes insulin,

to their eating and exercise plans at

some point to stay healthy.”

Some people with diabetes avoid

their medicine because they feel

shame about being on diabetes

pills or insulin. For support, reach

out to other people with similar

cultural and health beliefs who

have diabetes. Your health care

provider may be able to help you

make connections, or you can seek

support through diabetes education

programs, places of worship, orcommunity centers.

1. Understand your medications

If you feel reluctant about taking

your diabetes meds, the solution

may be as simple as grasping how

they work.

“If we don’t understand

why we’ve been prescribed a

medication, our inner 3-year-olds

come out and we say no,” Bergersays. So ask questions.

For example, metformin improves

fasting blood glucose readings by

decreasing your liver’s production

of glucose at night and increasing

your muscles’ uptake of glucose.

Insulin injections lower blood

glucose by helping to move glucose

from your blood into your body's

cells, where it’s used for energy.

Sulfonylureas (such as glipizide and

glyburide) increase the amount of

insulin the pancreas releases.

Keep new prescription handouts

in a safe place (or snap a photo)

to review and ask your pharmacist

questions as they come up.

Now, perhaps you take your

diabetes meds but not regularly.

“Sometimes people are resistant

to taking medicine because they

just don’t feel they need it,” says

Patrick Devereux, Pharm.D., ofFamily Medical Services Pharmacy

”TAKING YOURMEDICATIONS

REGULARLYCAN GREATLY

REDUCEYOUR RISK OFDEVELOPINGUNWANTED

DIABETESCOMPLICATIONS.”




LEARN THE OBSTACLES

2. Sidestep adverse effects

Some people with diabetes fear the

side effects of their medications.

Here are ways to reduce some

common symptoms:

Nausea from metformin. “This

can be minimized if the providerhas the patient start with a very

small dose of metformin, then

slowly increases it,” says Susan

Alexander, D.N.P., ANP-BC, ADM-

BC, a clinical associate professor

at the University of Alabama

in Huntsville. Plus, studies show the

stomach upset associated with it is

markedly better within 30 days.

Additionally, there is an

extended-release version of

metformin that minimizes theseside effects.

Hypoglycemia. Insulin and

sulfonylureas (glyburide, glipizide,

and glimepiride) are the main

diabetes medications that can

cause hypoglycemia (low blood

sugar), Alexander says. Keeping

a blood glucose meter and

glucose tablets on hand can help

ease your mind.

Weight and appetite issues.

“Although insulin and sulfonylureas

may increase fluid retention or

appetite, other drugs used to treat

diabetes, such as metformin and

GLP-1 receptor agonists (such

as exenatide and liraglutide), are

weight-neutral or even have been

associated with weight loss,”

Alexander says. “If you’re taking

a diabetes medication that could

affect your weight, eating sensibly

and being physically active areespecially important."

COSTSAVING HACKS FOR MEDSTalk turkey. “Ask what medications

cost,” says Dr. Jan Berger. “Your

pharmacist can check with your

doctor about using less-expensivemedication when possible.”

Don’t fear generics. “The FDA has

approved generics. They’re just as

safe and effective as brand-name

drugs,” Berger says.

Shop around. Use websites and

apps such as medfisher.com,

goodrx.com, and werx.org to find

the lowest prices for medications.

Check prices at your localindependent pharmacy.

Check with drug manufacturers.

“Look for links on drug company

websites that say ‘medication

assistance’ or ‘patient assistance

program,’ which provide

medication for free or a reduced

cost to those who qualify,”

says Sandra Garcia, program

coordinator for the Medical

Assistance Program at Texas A&M

Health Science Center in Corpus

Christi. Find contact information

for diabetes drug companies at

diabetes.org or search for drug

assistance programs through

the Partnership for Prescription

Assistance (888/477-2669 or

pparx.org), rxassist.org, andrxoutreach.org.

Consider insulin pens. “Although

generic insulin isn’t available,

insulin pens hold a little more

insulin than vials—1,500 units

per box versus 1,000 units,

respectively—but often cost

the same copay,” pharmacist

Patrick Devereux says. Ask your

pharmacist about your options.

Research mail-order pharmacies.

These may save you money by

selling three months’ worth of pills

at a time. Talk with your pharmacist

to see if the option is right for you.

Use coupons. “Legitimate coupons

are ones sponsored by the drug

manufacturer,” Devereux says. Free

pharmacy discount cards may land

you on marketing lists, so steer clear.

Call your local health department.

Ask about income-based

medication-assistance programs.

packs, in which one dose of all

your medications for a certain

time of day are together, such as

in a blister pack,” Pope says. You

also can use a smartphone app,

such as Medisafe or Dosecast, for

reminders. If you’d rather keep

things low-tech, the standard

pillbox is always an option.

Pope and Devereux also

encourage patients to ask

pharmacies about synchronizing

medications (sometimes called

“medication sync”) so all drug

refills can be picked up at onetime each month.

STREAMLINE THE PROCESS

3. Simplify your regimen

When you take several medications

at different times, it can be diffi cult

to keep them straight and work

them into your routine.

“Ask your pharmacist aboutmedication packaging or calendar


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32/108

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d

u e t o b a t h r o o m v

i s i t s o r a r e s t l e s s

p e t o r s p o u s e — d i s t u r b y o u r

s l e e p q u a l i t y , R a l s t o n s a y s .

T O

D O : A d j u s t y o u r l i f e s t y l e t o m a k e

r o o m f o r s e v e n t o e i g h t h o u r s o f

u n i n t e r r u p t e d Z ’ s e a c h n i g h t .

H

o w m u c h d o

y o u e x e r c i s e ?

“ E x e

r c i s e e q u a l s m o r e e n e r g y , n o t

l e s s , ”

R a l s t o n s a y s . S t u d y a f t e r s t u d y h a s

s h o w n t h a t e x e r c i s e d e c r e a s e s f a t i g u e — b y a s

m u c

h a s 6 5 p e r c e n t i n j u s t s i x w e e k s , a c c o r d i n g t o

a 2 0

0 8 s t u d y f r o m t

h e U n i v e r s i t y o f G e o r g i a .

R a l s t o n s u g g e s t s

4 0 –

4 5 m i n u t e s o f e x e r c i s e f o u r d a y s a w

e e k .

T h e s t u d y f o u n d

y o u

c a n r e a p e n e r g y b e n e fi t s f r o m j

u s t 2

0 m i n u t e s o f m o d e r a t e

e x e r c i s e t h r e e d a y s a w e e k .

T O D O : A d d

a d a i l y w a l k t o y o u r

s c h e d u l e o r c h e c k o u t a g y m f o r c l a s s e s t h a t a p p e a l t o y o u .

D o y o u d

r i n k a

l o t o f c a ff e i n e ?

Y o u m i g h t b e s u r p

r i s e d b y h o w

l o n g t h e e ff e c t s o f c a ff e i n e c a n l i n g e r a f t e r

y o u c o n s u m e i t .

A c u p o f c o ff e e w i t h d i n n e r

c a n d i s r u p t y o u r s h u t - e y e a l m o s t a s m u c h

a s s i p p i n g b e f o r e s l e e p

. T O D O : S w i t c h

t o d e c a f b y l a t e a f t e r

n o o n a n d l i m i t

c a ff e i n e t o 4 0 0

m i l l i g r a m s

d a i l y ( t h a t ’ s

a b o u t

3 – 5 c u p s o f c o ff e e ) .

1

2

3


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34/108

DFRIENDLY

SHOE

WHAT TO LOOK FOR IN A

You may have developed footproblems since your diabetesdiagnosis—nerve damage, footulcers, neuropathy, or slow-to-heal cuts or blisters. When youhave diabetes, your feet requireextra care. Keep these factors inmind when shopping for safe andcomfy kicks.

TOE BOXWatch the fit in the toe area. In general, lookfor a higher, wide toe box that allows somewiggle room.

FOOT WIDTHIf your foot is narrow, you’ll want a shoethat is narrow in the heel so it won’t slip andcause blisters.

1

23

WRITER Avery HurtPHOTOGRAPHER Adam Albright



35/108

ACCURATE SIZEDon’t assume you know your size. Our feetchange shape as we age, and every shoe brandis a little different. So it’s important to havesomeone accurately size your foot.

MATERIALMaterials should be protective yet comfortable.Leather is good, but you don’t want anythingtoo stiff. Aim for a balance between supportiveand soft. Break in all new shoes gradually.

TIME OF DAYShoe-shop later in the day. Your feet swell asthe day wears on, especially if you have heartdisease or kidney problems. Bring along thesocks you’ll likely be wearing with them.

SUPPORTChoose a shoe that supports your arches,ankles, and heels. Sandals are okay if you don’thave neuropathy (just avoid styles that slipbetween the toes, which could cause sores orblistering). Avoid flip-flops.

PRICE CHECK

You may need tobudget for quality

shoes that will keep

your feet safe. If

you have severe

diabetic foot disease,

talk to your doctor

about prescribed

therapeutic shoes

or inserts, which

are provided by a

podiatrist, orthotist,

prosthetist, orpedorthist. Medicare

may cover the cost.

Go for sturdy andprotective sandals likethese from Clarks, which

provide cooling circulationand a hook-and-loop closurefor a custom fit. $70; BrighamCove—Clarks; clarksusa.com

For casual comfort, sportsomething roomy in thetoe with a closed-heel

that doesn’t slip like thesepodiatrist-approved MaryJanes. $100; Hazel Suede—Dansko; dansko.com

Look for foot-friendlytech as seen in theseboat shoes, which feature

podiatrist-designed Orthaheeltechnology that keeps yourfeet from turning in or outwhen you walk. $139.95;Eddy Casual Shoe—Vionic;

vionicshoes.com

Though sandals are OK,they must be supportive.Choose styles without

straps or thongs that mightcause blisters, such as thesepodiatrist-designed mules.$79.95; Camila Slide Sandal—Vionic; vionicshoes.com

Check to be sure you haveample room between yourtoes and the tip of your

shoe, especially with heels.These wedges feature a deepheel cup for added stability.$129.95; Hayes Wedge—Vionic; vionicshoes.com

Slip-on dress shoeslend style, comfort, andstability. Look for hidden

stretch gores, like the onesin these leather slip-ons, fora custom fit. $110; Capi—Bostonian; clarksusa.com

1

2

3

4

5

6

GOOD-FOR-YOU

SHOES

4

5 6

Sources:

Jacqueline Shahar

Director of Exercise Physiology

at Joslin Diabetes Center

David Armstrong, M.D., Ph.D.,

University of Arizona, director

of Southern Arizona Limb

Salvage Alliance



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Sugar-rich

foods and illicit

drugs light up the same regionof the brain—butdoes that meanwe’re hooked?



You’ve seen the scary

headlines warning that sugaris like a drug that can hijack

your brain. “Sugar: Addictive as

Cocaine and Heroin, Studies Say,”

screams one newspaper. “Is Sugar

Your Crack?” reads another.

But are you truly at the mercy of

your brain chemistry?

If feeling remorseful and out of

control after eating sweets leads

you to more overeating, are you

addicted to sugar?

Many experts say no and no.

Food struggles are commonMany people struggle with

overeating and make poor food

choices. They may think about

food a lot and feel very emotional

about it.

That struggle is quite real,

but that’s not addiction, says

Rebecca L. W. Corwin, Ph.D.,

RDN, LDN, professor of nutritionalneuroscience at Pennsylvania

50 Ways to Soothe Yourself

Without Food (New HarbingerPublications, 2009).

Happy emotions may also

spark cravings, such as wanting to

celebrate a job promotion with your

favorite party foods.

Memories of being comforted

may bring on cravings during

stressful times. For example, craving

Mom’s homemade cookies may

indicate a need to be soothed after

a difficult day.

Again, that's a complicated

emotional reaction, not addiction.

“We don’t usually crave sugar right

out of the sugar bowl,” Albers says.

Instead, we’re seeking the

experience certain foods can give

us or have given us in the past.

Which is why jelly beans won’t

satisfy a craving for chocolate ice

cream, and chocolate ice cream

just won’t satisfy a craving for your

Mom’s cookies.

State University.

“Some foods are hard to resistbecause they’re pleasurable, not

because they’re addictive,” she says.

Corwin says the distinction is

important because addictions are

commonly treated with complete

abstinence from the problem

substance, such as avoiding all

tobacco products or illegal drugs.

Planning to give up favorite foods,

however, often makes the problem

worse and the craving stronger.

“If sugar addiction is real, it occurs

in a small subset of the population.

It’s not pervasive, and it doesn’t

explain the obesity problem in this

country,” Corwin says.

Intense cravings may also come

from feelings of discomfort. That

discomfort could be physical, such

as during a menstrual cycle, or it

could be emotional, such as feelings

of anxiety or low self-esteem, says

Susan Albers, Psy.D., psychologist atthe Cleveland Clinic and author of

WRITER Jill Weisenberger, RDN, CDE, FAND | PHOTO ILLUSTRATORS Ananda Spadt/Jason Donnelly

IS SUGAR



CRUSH THE

When the urge to eat something on your taboo list is

overwhelmingly strong, address those out-of-control

feelings with one or more of these strategies:

Sugar lights up the brainMany people who worry about

sugar addiction cite research in

which brain scans show that bothsugar-rich foods and illicit drugs

activate the same brain region.

“We can’t interpret that to

mean sugar is an addictive

substance,” says Hisham Ziauddeen,

M.R.C.Pysch., Ph.D, clinical senior

research associate at Cambridge

Neuroscience at the University of

Cambridge. “The sight or taste of

foods—not just sweet ones—will

cause increased activity in the

brain’s reward system.” Money andsex do, too, for that matter.

So when people claim that

food hijacks the brain, they have it

backward, Ziauddeen says.

We expect pleasurable things to

activate the brain’s reward system,

so it’s normal that sugar and other

foods do that. It’s illicit drugs that

hijack the natural responses in

the brain.

The real problem with sugarNo matter where the scientific

community stands on the addiction

question, there are good reasons to

limit your sugar intake.

Sugars are often added to foods

that are not healthful to begin with.

And in some people, sugars raise

triglyceride levels.

Perhaps the greatest problem is

that sugars can crowd out nutrients

your body needs, says Ted Kyle,

R.Ph., MBA, principal and founder

of ConscienHealth, a policy center

working to advance sensible

approaches to health and obesity.

“So if you eat too much added

sugar, you can wind up getting the

worst of both worlds—overfed and

undernourished,” Kyle says.

Most experts agree: Being mindful

about what you eat and why you

eat it gives you more control than

the headlines lead you to believe.

PRACTICE MINDFULNESS. “Mindfulness puts in

a pause and helps you ride through the craving,”

Albers says. “Instead of acting on a craving

immediately, mindfulness makes you sit with it and get

to the other side of the feeling or craving without reacting to it.”

Eat only when sitting down.

Chew slowly and focus on the food.

Eat without distractions. Ask yourself what you’re feeling. If it’s too scary to tempt yourself with trigger foods, practice

mindful eating with other foods until you’re more confident.

Try mindful movement. For example, noticing your feet and their

sounds as you walk down the hallway can teach you to be more in

tune with your body instead of stuck in your head.

DITCH THE DIET MENTALITY. For many people, once the forbidden

foods become allowed, the cravings stop.

Realize that you don’t need to eat the sweet food every time you

see it. Chances are pretty good that when you really want to

indulge, you can find what you want.

Ditch the guilt and plan a time (maybe once a month) when youcan savor a forbidden food.

NOTICE WHEN YOU’RE STRESSED AND ADDRESS IT. If stress leads

to overeating, de-stressing is a logical solution.

Don’t blow off exercise and sleep when you’re overwhelmed—

that’s when you need them most.

Make a list of your comforts (hot tea, calling a friend) and use them.

CLEAN UP YOUR DIET. Many people find that eating more healthfully

reduces their cravings.

Take a look at your diet to see where you can make improvements.

Avoid skipping meals, and balance meals with healthy fats,

carbohydrate, and protein.

MANAGE BLOOD SUGAR. Some people find that cravings increase

when blood sugar levels are out of control.

Talk to your health care team about ways to better manage your

blood sugar.

SEEK HELP. If bingeing and emotional eating affect your quality of life,

a psychotherapist can help you through cognitive behavioral therapy,

mindfulness training, or other credible practices.

Talk to a registered dietitian or nutritionist who can help you createa wholesome eating plan that fits your lifestyle and health needs.



1. Visit Facebook orTwitter. Click in thesearch bar.

2. Type the “#” iconand the topic youwant to follow,like ”#dblogweek.”Then hit enter.

3. Refresh the page

periodically.

HASHTAG HOWTO

bittersweetdiabetes.com

FINDINGCOMFORT PAYING ITFORWARD

WHY HASHTAG?Hashtags make it easier to findand follow discussions, news,

events, and trends on topics ofinterest to you.

Diagnosed with type 1 diabetesin 1979 at age 11, Karen Graffeogrew up as the kid at the party

who couldn’t have a slice of cake.“In my teenage years, I rebelled.I had candy bars hidden under mybed, and I’d eat them. My parentswouldn’t know,” she says.

When her doctor suggested shestart on an insulin pump in 2008,she balked. “I was really freakedover the idea of having a pump—of having something attached tome all the time,” says the NewEngland-based blogger.

She went online searching for

information on how to hide thething under clothes. There, Karenfound something amazing: type 1bloggers all over the world talkingabout their pumps.

At last, she’d found the partyshe was invited to. “That was myaha moment,” she says.

A month later, Karen startedher own blog about life with type1, Bittersweet Diabetes, to giveback to the D-community someof the help she’d found there. Shestarted writing about her day-to-day life with the pump, things likeclever and fashionable knittingmethods she used to conceal it.

“I write to help people feel lessalone. To help them understandthat we all go through this. Thatthey’re stronger than they think,and they’re doing OK.”

Two years into the blog, Karencreated Diabetes Blog Week for

bloggers of all types and theircaregivers. Posts sprouted all overthe diabetes online community

(DOC), a new topic for eachday for a week. The idea cameto her after participating in aknitting blog week that had reallyconnected fiber-arts fans.

“I really wanted the diabetesblogger community to havesomething similar,” Karen says.

More than 100 people signed upthe first year. Now, Diabetes BlogWeek is in its seventh year, with200-some participants who writeto Karen’s prompts: Talk about theemotional side of diabetes andhow you cope. Share your non-medical diabetes tips and tricks.Personify your diabetes.

Karen’s favorite topic yet: Admire our differences. Bloggersshared what they’d learned fromsomeone with a different type of

diabetes than their own.She’d experienced the

disparities firsthand when shemet type 2 blogger Kate Cornellfor dinner. When the two wroteabout their night out together,they discovered each believed theother had things harder.

“I think it put into perspective

how we may have differentaspects of diabetes that aretough, but we’re all dealing with adiffi cult illness,” Karen says.

Diabetes Blog Week is May 16–22,2016. Visit bittersweetdiabetes.com/#dblogweek for topics and links toevery post. You can also search for#DBlogWeek on Twitter or Facebookto follow along.

GET CONNECTED

WRITER Bailey McGrath

“I WRITE TOHELP PEOPLE

FEEL LESSALONE. TOHELP THEM

UNDERSTANDTHAT WE ALL

GO THROUGHTHIS.”

diabetic living - summer 2016

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