STEPS TO GET YOU MOTIVATED!
By: Director of Education – Jessica Cook MS, RD, LD, CDE
The holiday season is among us and for many this can be a problematic time of the year for stress, blood sugars and weight maintenance. This however can be avoided if you have the right motivation! Becoming motivated for many is a challenge and staying motivated even more challenging, but if you learn simple strategies to help you stay on track this season doesn’t have to become an enemy!
Step 1: Do not compare yourself to others. Comparing medications, diets, weight and blood sugars may seem normal, but actually may be hurting you. No two people are the same and have the same goals. Focus on your own A1c, blood sugar and weight goals to keep you motivated about your life.
Step 2: Make realistic, specific goals. When choosing a goal for yourself remember to make it specific to your lifestyle, needs and schedule. Simple saying “I will exercise more” has good intentions, but what does that mean? How many days will you exercise? How many minutes? What kind of exercise? Make it specific to create a plan!
Step 3: Start with small steps. Completly changing diet and exercise routines does not happen overnight. Start by removing tempting treats from your grocery list or put your sneakers by your door to remind you about your morning walk. Or try setting alarms on your cell phone to remember blood glucose monitoring times or medications. You can do it!
Our education team has helped countless patients lose weight, reduce blood glucose levels, reduce medication use and feel better. If you want to take steps to controlling your blood sugars, schedule an appointment with a certified diabetes educator or registered dietitian at any of our four office locations. Please call (561) 513-5100 to schedule your appointment today! Thank you for taking time to read our Living Well with Diabetes December 2015 Newsletter. Enjoy!
INSULIN PRODUCTION IN DIABETES
By: Kort Knudson, MD
All people with diabetes have some insulin deficiency. In type 1 diabetes (the juvenile type), there is severe deficiency of insulin and we always use insulin replacement. Patients with type 2 diabetes (adult type) usually can make insulin but they do not make enough. In this case, we can use medicines to reduce the body’s need for insulin or to increase the production of insulin.
Juvenile diabetes usually develops before age 40 and the patient needs to start insulin replacement from the onset and continue it for life. We can confirm the absence of insulin with a blood test. We can also test for antibodies to the insulin-producing beta cells to determine that they are being destroyed and not likely to come back. In typical adult diabetes, we can use a blood test to confirm that the pancreas is still making some insulin.
Another type of diabetes that sometimes develops in adults is caused by antibodies to the beta cells and looks like juvenile diabetes. This condition can only be treated with insulin similar to juvenile diabetes. We have a test for these antibodies called GAD 65.
So, for juvenile diabetes we can test islet cell antibodies to determine the cause of islet cell destruction. This test may be negative because sometimes the antibodies are gone by the time diabetes develops. We can also test c-peptide to determine how little insulin is being made. The c-peptide is a portion of the insulin molecule. It is found in the blood in an amount corresponding to the quantity of insulin that is being made.
If the patient has type 2 diabetes and the c-peptide level is normal or high, then we have many classes of medicines which include pills and injections that may be useful to bring down the glucose.
The tests for insulin production include c-peptide and insulin level. The tests for beta cell destruction include islet cell antibodies and GAD 65 antibodies.
We do tests for insulin production and islet cell destruction when we want to know if insulin will be the only medicine that will control the blood sugar. If the patient is making little or no insulin then insulin replacement is the only effective treatment. Even if the patient is making some insulin it may not be enough to keep the blood sugar normal. In that case we can use pills or a combination of pills and insulin to bring the blood sugar down to the normal range.
Consult with your physician to determine which treatment plan is right for you.
7 HABITS OF HIGHLY EFFECTIVE PUMP USERS
By: Monika Lambertson MS, RD, LD/N, CDEg
An insulin pump can be an amazing tool to help optimize blood sugar control. Insulin pump therapy has several advantages over conventional syringe or pen injections, including allowing more precise insulin delivery and giving greater flexibility in meal times. Instead of having to give multiple injections, a infusion set is inserted once every two to three days. The insulin pump automatically delivers a constant flow of insulin 24 hours a day, which is called the basal rate. The basal rate can be programmed to provide the user with different basal rates throughout the day. Larger amounts of insulin, called bolus, are taken when eating or to correct a high blood sugar. Insulin pump settings are customized to provide the right amount of insulin based on the food you are eating and your blood sugar level. There are other setting features on the pump as well, such as temporary basal, dual wave bolus, and blood sugar testing reminders, to name a few, which can be helpful in achieving tighter blood sugar control. As you can see, an insulin pump can provide the tools to help fine-tune your insulin therapy.
As with any tool though, it only works if it is used correctly! As a pump trainer, I have found the most successful pump users have the following habits:
- They test, test, test. Let’s face it no one likes testing their blood sugar, but the bottom line is that it’s the only way you really know what’s going on. Savvy pump users typically test before meals, 2 hours after meals, before bed and more often as needed such as before and after exercise,
- They are carb counting experts. Don’t guess. Read food labels, measure or weigh portion sizes and use a carb count cheat sheet. When dining out, using a carb counting app can be particularly helpful and take mystery out of “mystery foods.”
- They use the “bolus calculator” feature on the pump for all meals and snacks. Entering your blood sugar and grams of carbs to be eaten into the “calculator” will result in the most accurate insulin dose therapy reducing your risk of highs and lows.
- They change the infusion set ever 2-3 days to rotate infusion sites. Keeping the set in longer can increase the risk of infection and high blood sugars. Make sure to only fill your reservoir with enough insulin to last about three days, so you won’t be tempted to keep it in longer.
- They keep fast acting carbohydrates on hand at all times to treat lows (blood sugars below 70.) I recommend glucose tabs because they work fast, provide a predictable amount of glucose (4g per tablet), are easy to carry in your purse or pocket and they don’t expire. Always use the 15:15 rule.
- They keep a kit with extra pump supplies at work and when traveling which may include: infusion sets, reservoirs, batteries, syringes/ insulin pens or vials, and alcohol wipes or hand sanitizer.
- They visit their endocrinologist at least every three months to have their A1c checked and have pump settings reviewed.
If you want to improve your pump knowledge and skills, whether you are brand new to pump therapy, an experienced pump user or maybe considering using an insulin pump, please register for our new intro to pump therapy workshop or advanced pump therapy workshop starting January 2016.
Our pump therapy workshops will include information about varying types of insulin pumps, infusion sets, advanced pump features, CGMS, pump failure strategies and more. We want you to feel comfortable and confident in using your pump, which may result in better blood sugar control. Individual pump training sessions, nutrition and carb counting sessions as well as help with setting adjustments are available as well to better assist you utilize all features the pump has to offer!
If interested attending this program please contact our scheduling department at (561) 513-5100 today
At Healthy Living with Diabetes we want to ensure that you are satisfied with all services received. We also would like your input on educational workshops that you would like us to offer, information you would like to read about in Healthy Living with Diabetes Monthly or feedback on any workshop that you may have attended. You can contact the director of education personally by email jcook@PBDES.COM or leave a message at (561) 513-5100. We would love to hear from you!