Summer 2013

NON-PROFIT ORG.U.S. POSTAGE

PAIDOMAHA, NE

NO. 58

Inside This Issue

Age Related Muscle LossBy Nancy L. Schwartz, RD, LMNT, CDE

Diabetes Education Center of the Midlands

NEWS• Age Related Muscle Loss• High Fat Diet Causes Insulin

Resistance"• Services Available from Nurse

Practitioner• New Drug for Type 2 Diabetes

Look for us on the web:

www.diabetes-education.com

Diabetes

Diabetes Education Center of the Midlands (DECM) is a community based, nonprofit organization dedicated to enhancing the quality of life of diabetic individuals and their families by empowering them through health education to take charge of their lives.

Strength loss can result in difficulty opening a jar of pickles all the way to disability and increased mortality risk due to frailty. The medical term for age related muscle loss is Sarcopenia. Studies show we lose 1/2 to 1 percent of our lean muscle mass each year, starting as early as our thirties. By our seventies we’ve lost an estimated 20 to 40 percent of our strength. There is even greater loss among people who eat less healthfully, don’t exercise regularly and even those who lose a significant amount of weight (since muscle tends to vanish along with the fat). Sarcopenia tends to be a slow and insidious process-it’s not something that just happens when you reach old age. That’s why it is so important to maintain as much lean muscle mass as you can, from your thirties and forties onward. But, even if you start later in life you can make a big difference.

THE GOOD NEWS!!! Experts say there are simple, science-proven steps you can take to preserve those muscles of yours and even reverse age-related loss that has already occurred. So, here’s the magic:

• Consume high quality protein. Protein is composed of amino acids and leucine in particular is good at muscle building. You should have a source of leucine with each meal. Dairy products, especially those high in whey protein like milk and Greek yogurt are excellent sources of leucine. Lean meat, fish and soy, such as edamame and tofu, are also rich in leucine.

• Aim for 30 grams of protein per meal, consistently. This amount appears to be optimal for building and maintaining lean muscle mass. More is not better. Your body does not have a storage depot for protein so if you eat more you’ll only use part of it

GREAT NEWS!!!

Diabetes Education Center of the Midlands

.... making diabetes education more

affordable in 2013!

To help serve more families in the community,

we have redesigned our Basic Skills and

Comprehensive Treatment and Training classes and removed the biggest barrier...COST!

Certified Diabetes Educators will equip

you with the skills and confidence you need to

successfully manage your diabetes.

To learn more call 402-399-0777 ext. 230

today!

2910 South 84th StreetOmaha, NE 68124

DIABETES AFFECTS MILLIONS OF LIVES DOES IT AFFECT YOURS?

Quality Clinical Research is currently conducting Diabetic Studies

WE ALSO OFFER FREE HBA1C TESTING FOR QUALIFIED PARTICIPANTS!

For more information call:

Quality Clinical Reasearch

402-934-0044

We also have several other studies currently enrolling!!Contact us today to find out more information!! Continued on page 3

High Fat Diet Causes Insulin ResistanceBy Nancy L. Schwartz, RD, LMNT, CDE

From an original article in Diabetes Care, Volume 36, April 2013.

It is well known that type 2 diabetes is a disease of insulin resistance. And, eating a high fat diet contributes to the development of type 2 diabetes. Recently a study has reported that a high fat meal causes insulin resistance in those with type 1. Researchers used a crossover design comparing two 18-hour periods of glucose control monitoring after high-fat dinner and low-fat dinner. Each dinner had identical carbohydrate and protein content but different fat content. The high fat dinner required more insulin to normalize the blood sugar even 5 to 10 hours following the meal. On average the insulin need was 40% more than the amount based on insulin to carb ratio alone. Fat may need to be considered when determining one’s bolus amount for a meal.

Studies in nondiabetic individuals indicate that saturated fats cause more profound insulin resistance than monounsaturated and polyunsaturated fats. By design, the high-fat dinner meal in the current study was predominantly saturated fat (lots of full fat dairy was included, like you might find in pizza, Mexican food and even Alfredo sauce)

So, how much fat is high fat? In the study, the high-fat dinner provided 60 grams. Because the breakfasts and lunches were low-fat, the individuals did not consume more than 34% of their calories from fat even on the high-fat dinner day. The take home message is to avoid eating high in fat, especially saturated fat, and space the fat intake out through the day, preventing a large amount at one time.

Saturated fats come from dairy products (not fat-free or very low fat ones), meat fat (trim the visible fat and limit sausage type meats), bakery items and tropical oils like coconut, palm and palm kernel.

27

Medicare Options for Diabetic Testing & Supplies

Thank YouDonations received from December 14, 2012 through June 10, 2013:Elliot Brown, OmahaGene Burton, Fullerton, NELori Busboom, Bellevue, NEJane Grady, OmahaCasey Haflett, Bellevue, NECharles & Carol Leo, Jr., Elkhorn, NEAllan and Ann Mactier, OmahaBonnie McEachern, OmahaThomas Ringleb, OmahaLinda Ritchie, OmahaDolores Selby, OmahaMichael & Cheryl Smith, Bennington, NEJim & Margie Timmerman, Springfield, NEDonald & Irene Treaster, OmahaDorothy Woodside, Lexington, NE

Honors and Memorials

In Memory of Dorothy Bleickl: Mary LeightonIn Memory of Bill Whitney: Anonymous Carol Allman

In Memory of Bill Whitney (continued): Gene Benash Beverly Tingley Bowers Mr. & Mrs. Douglas Burge Edwin & Audrey Heidenescher Kenneth & Susan Mayberry Barbara Pankowski Faith Porter Retired Chiefs Group c/o Michael Parente

Francis Rivas & Sharon Collins-RivasLyle & Kathryn WesternmanAnna & Mike WheelerDorine WhitneyRollie Whitworth

Corporations, Clubs & EventsEnterprise Holdings FoundationOmaha Community FoundationOmaha I-80 Cosmopolitan Club FoundationStreck, Inc.

In-Kind DonorsAbbott Diabetes CareBev Adams, Papillion, NE Patricia Barker, OmahaDorothy Bleick Estate, Papillion, NEKathleen Brown, Mason City, IAHarold Esch, Omaha

Karen Gartner, Gretna, NEAnna Grell, Danbury, IAMichael Gripp, Springfield, NEJoyce Heim, Plattsmouth, NEKelli Joseph, OmahaKim Kuklin, OmahaKaren Martin, OmahaMax Orosco, OmahaShannon Pigsley, Council Bluffs, IAMarilyn Roche, OmahaBill Rosman, OmahaRobert Ryan, OmahaCheryl F. Smith, Bennington, NEMichael Smith, OmahaAnonymous Donations

United Way of the MidlandsCraig Elvers, Elkhorn, NEMark Kriglstein, Omaha

Union Pacific Fund for Effective GovernmentCraig Elvers, Elkhorn, NEEdwin Fred Kemp, Papillion, NEJoseph Nields, Omaha

2910 S. 84th Street, Omaha, NE 68124

It's never been more important than now to understand Medicare options for diabetic testing and supplies.

As you may know, Medicare is starting a national mail-order program for diabetic testing supplies beginning July 1, 2013. With this Medicare change Diabetes Supply Center will no longer be able to mail or deliver testing supplies after July 1, 2013.

Diabetes Supply Center WILL be able to continue providing your testing supplies if you:• Pick up your supplies at Diabetes Supply Center, or• Are enrolled in a Medicare Advantage plan, or• Have a prescription drug policy that covers your testing supplies

If you have questions as to how to obtain yourdiabetic supplies and how they will be covered beginning July 1, 2013, plan on attending one of the following FREE sessions:

• Tuesday 7/16/13 at 1:00 p.m. • Thursday 7/25/13 at 10:00 a.m. • Thursday 8/1/13 at 1:00 p.m.• Tuesday 8/13/13 at 10:00 a.m.

All informational sessions will be held at:Diabetes Supply Center of the Midlands2910 S. 84th St.

Thank you, Diabetes Supply Center Staff

"LIVING WELL WITH DIABETES"OMAHA SUPPORT GROUP

MEETING TIME:10:00 to 11:30 (Second Saturday

Every Month)with a discussion session after the speaker from 11:00-11:30

beginning in March

MEETING LOCATION:Diabetes Education Center

of the Midlands

Sponsored by Diabetes Education Center of the Midlands at 2910 South 84th Street (East Endcap

- Frederick Square Shopping Center)

Thank YouDiabetes Education Center

Diabetes Education Center of the Midlands, a 501(c)3 nonprofit agency, gratefully acknowledges those whose gifts have been instrumental in helping the Center meet the needs of diabetic individuals and their families.

1 Coverage and reimbursement depend on a number of factors and may be subject to deductible and coinsurance.

ACCU-CHEK, ACCU-CHEK NANO SMARTVIEW and ACCU-CHEK AVIVA are trademarks of Roche. All other product names and trademarks are the property of their respective owners. © 2012 Roche. 304-50820-0312

Covered on Medicare Part B1

Attention: Medicare Diabetes Patients

Ask me. I can help!

Did you know that you have a choice?

Knowing the ins and outs of your coverage can be tricky.

Especially knowing which products are covered and are right for you. That’s where your pharmacy can help. We’ll take the time to discuss your personal preferences and help you select the products that meet your specific diabetes health needs.

Diabetes Education Centerof the Midlands is acommunity basednonprofit agency.

Its Education programsand services are madepossible through thosewho support Diabetes

Supply Center Pharmacy.

Thank You.

36

Look for us on the web:www.diabetes-education.com

Visit our Website at www.diabetes-supply.com for MORE products!!

Supply CenterDiabetes

of the Midlands

TO ORDER: CALL Diabetes Supply Center of the Midlands402/399-8444inOmaha•800/779-3374OutsideofOmaha

2910 South 84th Street, Omaha, NE 68124Hours:8a.m.-6:00p.m.Monday-Friday•9a.m.-1p.m.SaturdayCST

Age Related Muscle LossContinued from Page 1

Quick StickJust tear open the Quick Stick and pour directly into your mouth, no water needed. Enjoy a quick boost of glucose. It’s that simple! 40 calories in one 10g stick, 10g of carbs in each stick as well as Gluten Free. You will get 12 sticks per box and this product is great for kids and adults on the go. Fast, Effective, and easily fits into your bag, purse, or pocket! $5.99

and the rest will be stored as fat. • Get your omega-3 fats. You know

they are good for heart health. A growing body of research has linked the Omega-3 fats with muscle maintenance. What’s the mechanism? Inflammation in the body causes muscle to break down and omega-3’s are anti-inflammatory powerhouses. They also improve the way your muscles use protein and can actually help treat sarcopenia, not simply prevent it. Foods like salmon, walnuts and omega-3 enriched eggs give you the omega-3’s and protein. There are also supplements available.

• Get some vitamin D. A recent

review of studies found that getting adequate vitamin D helps with muscle protein synthesis and fights inflammation, both of which contribute to muscle strength, power and balance. As we age, the body becomes less able to make vitamin D through sun exposure and it’s difficult to get enough through diet so a supplement is recommended.

• Do some resistance training. About 20 to 30 minutes of resistance training, three times a week is recommended. It is absolutely important for building muscle and preventing it from vanishing in the first place. Even one to two short resistance

workouts each week can improve muscle mass and strength. The key is to really tax your muscles and vary your workouts by mixing up the exercises, number of reps and the weight you use. Make sure you get some protein in your system about an hour or so before (or right after) the workout. 30 grams of protein pre-workout can increase your muscle building potential.

• Cardio is a must for muscle maintenance. Aim for at least 30 minutes of moderate to intense aerobic exercise, such as brisk walking, biking or swimming, three or more days a week.

Secure A. . .Have you ever needed a pocket but didn’t have one? Maybe you wear an insulin pump and can’t find where to carry it or even keep from getting tangled in the tubing at night. The answer to your dilemma could be Secure A. . . a pocket you wear on your arm, your leg and even your waist. Made of very stretchy fabric, Secure A. . . can hold your pump, CGM receiver, ID, money, phone or music player (must avoid brands, you know). One person even used Secure A. . .when travelling abroad to hold her passport securely to her body. For those who wear a tubeless pump, Secure A. . . can cover the pump, preventing it from being knocked off. The pocket can be used for glucose tablets. (We tried a candy bar in the pocket but it melted due to body heat so not a good idea.) Secure A. . . comes in many sizes and colors, some even are reversible so have two colors/patterns. Stop in and check them out.. Arm Band $12, Waist Band $16.

The "I Hate to Exercise" BookSticking to an exercise plan is tough, but the key is simple: stay active by making the most of the activities you already do. This revised and expanded edition contains even more easy ways to build activity and exercise into your daily routine, including low-impact activities that are perfect if you're older, and a new chapter on walking and on exercising for healthy aging makes this a must-have for you. $14.95

High Protein Breakfast IdeasFood Items Protein

GramsCarbohydrate

GramsFood Items Protein

GramsCarbohydrate

Grams

3/4 c. cottage cheese 20 8 1 1/2 c. Special K Protein 20 383 Clementines 0 21 1 c. milk 8 122 Tbsp. soy protein powder 10 0 Total 28 50

1 slice whole grain toast 3-4 13-20Total 33-34 42-49 3/4 c. reduced fat Ricotta cheese 21 6

1 oz. almonds 6 66 oz. Light Greek Yogurt 12 8 Vanilla extract to taste 0 01 oz. almonds 6 6 Sugar substitute to taste 0 02 Tbsp. soy protein powder 10 0 1 Pepperidge Farm Mini Bagel 4 201 slice whole grain toast 3-4 13-20 Total 31 32

Total 27 40-44

6 oz. Kroger Carb Master Yogurt 9-12 46 oz. Oikos Greek Yogurt 12 19 1/2 c. blueberries 0 102 Tbsp. soy protein powder 10 0 2 Tbsp. soy protein powder 10 0Whole Wheat thin bun or English Muffin

5 21-25 2 whole grain toast 6-8 26-40

Total Total 25-30 40-54

3/4 c. Egg Substitute 18 31 oz. 2% cheese 7 11 whole grain toast 3-4 13-201 c. cubed melon 0 15Total 28-29 32-39

♥♥♥ 2 out of 3 people with diabetes die of heart disease or stroke.

6-Hour Basic Skills Class: July 23 & 25, 2013 5:00 PM - 8:00 PM August 20 & 22, 2013 5:00 PM - 8:00 PM September 24 & 26, 2013 5:00 PM - 8:00 PM

4-Day Comprehensive Class: July 8-11, 2013 5-9 PM (Day 1) & 5-8 PM (Days 2-4) September 9-12, 2013 5-9 PM (Day 1) & 5-8 PM (Days 2-4) Pre-Diabetes Class: July17,2013from4-6PM&July24,2013from5-6PM Sept. 18, 2013 from 4-6 PM & Sept. 25, 2013 from 5-6 PM

Intensive Insulin Management Class: Tuesday,August27,2013 4:00PM-6:00PM Tuesday, October 8, 2013 4:00 PM - 6:00 PM

Support Group: 10:00 AM - 11:30 AM the Second Saturday of every Month July 13, 2013 Topic - To be announced Speaker - To be announced

August 10, 2013 Topic - To be announced Speaker - To be announced

September 14, 2013 Topic - To be announced Speaker - To be announced

4 5

Upcoming ProgramsSGLT2 Inhibitors: A New Class of Diabetes MedicationsBy Mary Leighton, RN, BSN, CDE

Diabetes Education Center

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new class of medications indicated for the treatment of type 2 diabetes. They can be used alone or with metformin, other diabetes pills and insulin.

The kidneys are an important organ in glucose regulation. It is proposed that in prehistoric times, we developed a system for maximizing energy conservation and storage due to lack of consistent food supplies. This system included reducing the activity of our neurological endocrine system to slow metabolism and conserve the stored energy in our bodies, as well as a method to increase reabsorption of excess glucose that was removed by the kidneys. Now that we have adequate or even excess glucose from our food this system to conserve glucose is no longer needed. In fact it leads to excess weight gain and diabetes risk. SGLT2 is a glucose

transporter that is responsible for 90% of glucose reabsorption. The kidneys filter glucose out of the blood stream and if the glucose levels are normal all the glucose is reabsorbed back into the blood stream.

HOW THEY WORK: SGLT2 inhibitors block the reabsorption of the glucose in the kidneys, which leads to less glucose being reabsorbed. This results in an excretion of glucose in the urine. Further glucose control is achieved by allowing increased insulin sensitivity and uptake of glucose in the muscle cells, decrease gluconeogenesis (making of glucose from the liver), and improved first phase insulin release from the pancreas.

There are several drugs in this class being studied but at this time canaglifozin (Invokana) is the only drug in this class approved by the FDA.

SIDE EFFECTS: This medication can cause an increase in urination as it works to expel excess glucose. Because of this, loss of water and salt can result in dehydration, especially in those individuals who take diuretics (water pills) and drugs to lower blood pressure. Symptoms of dehydration include: dizziness, faintness, lightheadedness, and weakness. In addition, there can be an increase in vaginal yeast infections and urinary tract infections in some people.

DOSING: The starting dose of Invokana is 100 mg per day. It is best to take it before the first meal of the day to optimize the effects on post meal blood glucose levels. The dose can be increased to 300 mg daily if there is normal kidney function.

*Information from diabetesincontrol.com

Focus on Faculty Diabetes News

I hate being poked with a needle, and the sight of blood makes me queasy. I’ve been this way for most of my adult life. But I wasn’t even thinking about that when I was diagnosed as a Type 1 Diabetic. I was thinking about going back to the office to see what Google had to say about my condition……

My path to Type 1 might be different than most. No family history, no knowledge of Diabetes, little to no experience in dealing with someone with Diabetes. Years ago, my physician noticed a higher than normal A1C, but not considered Diabetic. For years, I managed the situation through “doing the right things” – diet, exercise, etc. Then this spring, through a normal check-up my A1C was elevated, and my doctor referred me to an Endocrinologist. And we all know the outcome of that visit.

I recall the initial reaction being “I know nothing about this condition, how am I going to deal with this?” Google gave me all the history, medical updates, and lots of stories, but it did not tell me how I was going to deal with this. I had MANY more questions than answers, and that left me extremely frustrated.

My Endocrinologist recommended the class at DECM. For four consecutive nights, I attended the class and met with Dietitians, Nurses, Educators, and an Endocrinologist. They presented useful information and answered all of my questions. In short, they gave me what I needed to manage my diabetes.

The needle pokes and blood are not so bad anymore – it's a part of my life. I am grateful for my experience at DECM. Now I know how I am going to deal with this.

Chris McGowan

SAVE THE DATE!

DECM's 30thAnnual Seminar!

SaturdayApril 12, 2014

Ramada Plaza Convention Center, 3321 S. 72nd Street

Omaha, NE.

I am very excited to be the new Program Coordinator at DECM. I have been involved with DECM since its beginnings many years ago (we won’t mention HOW many) and consider it one of the finest organizations in the country dedicated to serving people with diabetes. I am honored to be given this opportunity to be a part of this professional and dynamic center.

I am also a Nurse Practitioner specializing in diabetes management. In this role I am a partner with primary care physicians and other providers to assist with diabetes medication management as well as other advanced management, such as insulin pump therapy. I have been a Certified Diabetes Educator for many years as well.

As a lifelong condition, diabetes can be a challenge. Many aspects of daily life must be given thought and energy to live healthily. Meals, exercise, stress, even sleep can

Rebecca Newberry, APRN, MS, CDE

Program Coordinator &Nurse Practitioner

affect blood sugar levels, which can have immediate as well as long lasting consequences.

It is important for people with diabetes to have a place and people who understand this daily burden and offer support. Support can be through education, equipment, medications, and personal attention. DECM is that place and we are the people who have, and will continue, to be YOUR oasis of understanding and support.

Please allow me to serve you in any way possible. Don’t hesitate to call or set up an appointment. I look forward to this journey with you.