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Diabetes Bites

August, 2011 Edition

Integrated Diabetes Services presents a quick synopsis of the latest diabetes discoveries and happenings. Send your comments or questions to: info@integrateddiabetes.com* *this e-mail goes to office administration. To reach Gary Scheiner directly, e-mail gary@integrateddiabetes.com. To reach Karen Franey directly, e-mail karenf@integrateddiabetes.com ŠCopyright 2011, Integrated Diabetes Services LLC

333 E. Lancaster Ave., Suite 204 Wynnewood, PA 19096 (610) 642-6055 (877) 735-3648 Fax: (610) 642-8046 www.integrateddiabetes.com www.type1university.com

In This Issue New Uses for Type-1 University News You Can Use Diabetes App Feature Sitter Services Trivia Question


Type-1 University: Training the Trainers Since its inception earlier this year, Type-1 University (let’s just call it T1U) has provided high-level education for hundreds of insulin users worldwide. But did you know that T1U has also become a popular source of information for those who treat, manage, and care for people with diabetes? T1U is now utilized by: Healthcare teams, including diabetes specialty centers and primary care offices Diabetes Organizations, such as chapters of the ADA and JDRF Pharmaceutical Companies and Device Manufacturers, for training their field staff and home office personnel on everything there is to know about managing diabetes with insulin. A number of support groups have also used T1U classes as a cost-effective educational resource at meeting and for individual members. Remember, classes cost the same whether one person watches or fifty! If your group is interested in utilizing T1U for professional education purposes, let us know. We are more than happy to offer discount packages for group purchases.

Free Pizza Class Don’t forget, T1U continues to offer a FREE “podcast”-type webinar on how to manage blood sugar when eating pizza. Go to www.type1university.com and click on the YouTube video link for the free 15-minute course, entitled “Pizza & Blood Sugar Control: Not Quite Easy As Pie”.

Symlin Class Added Type-1 University has added a new course focusing on the use of Symlin in managing diabetes. Symlin serves as a replacement for the hormone Amylin, which is normally secreted along with insulin by the beta cells of the pancreas. Amylin is completely lacking in people with Type-1 diabetes, and is produced in insufficient amounts in those with Type-2 diabetes requiring insulin. Unlike insulin, which controls the removal of glucose from the bookstream, Amylin’s job is to regulate the appearance of glucose. When administered at mealtimes, Symlin slows down the rate at which food digests, blunts appetite, and keeps the pancreas from secreting glucagon at times it shouldn’t (after meals). As a result, Symlin keeps blood sugar from spiking too high after meals and can also be used to help promote weight loss.


Unfortunately, many people who have tried Symlin have had a difficult time using it successfully. When not utilized properly, Symlin can cause a wide range of side effects and can complicate blood sugar control. The Symlin class at T1U guides participants on: • • • • •

The basics of Symlin – what it is and how it works Potential pitfalls in using Symlin Methods for initiating Symlin safety and effectively Creative strategies for minimizing Symlin’s side effects Managing blood sugar when using Symlin

As with all T1U classes, the Symlin course is offered in a “live” format once or twice monthly, or it can be viewed in a recorded “podcast” format whenever you choose. For more information or to enroll, visit www.type1university.com. While you’re there, check out our full catalog of courses:          

Blood Glucose Control During Sports & Exercise Mastering Pump Therapy Advanced Carb Counting Managing Pregnancy with Type-1 Diabetes Strike the Spike: After-Meal Glucose Control Getting the Most from Your Continuous Glucose Monitor Weight Loss for Insulin Users Fine-Tuning Basal Insulin Pregnancy and Type-1 Diabetes Using Symlin to Improve Diabetes Control

For any additional information about Type-1 University, please contact the “registrar” (OK, she’s also our receptionist) at 877-735-3648. You can also check out Type-1 University and “Friend” us on Facebook: http://www.facebook.com/pages/Type-1-University/191612930853897

News Youz* Can Use (*Philly for “you all”) New Pump Squeezes Its Way Through FDA Asante Solutions has received 510(k) clearance from the FDA for its Pearl insulin pump, which uses prefilled insulin cartridges and disposable “pump bodies” that enable a pay-as-you-go pricing model. In essence, it combines the ease and low upfront cost of a "pod" type pump with the full-programming capability of a traditional pump with tubing.

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The Pearl is also the only pump on the market that uses prefilled insulin cartridges containing slightly more than 300 units of Humalog. These are the same cartridges used in insulin pens. Previous pumps that used prefilled cartridges (such as the Disetronic D-Tron) were abnormally long in order to accommodate the cartridge plus the piston that drove the plunger. Pearl uses a segmented, flexible drive


system that curves around a corner, allowing it to be sleek and similar or lighter in weight than current traditional (nondisposable) pumps. The pump consists of two parts: an electronic brain (called a “controller”) and a disposable portion (called a “pump body”) that holds the insulin cartridge and has a built-in battery. The pump body is approved for up to seven days of use. For most users, this means that the insulin and tubing would only need to be changed once for every two or three infusion site changes. The controller is usable and warranted for four years. The Pearl system uses standard infusion sets with a leur-lock connection, so a very wide variety of infusion set types may be used. By positioning the occlusion detector near the tubing connection (rather than linking it to pressure on the drive mechanism), Pearl’s design may provide earlier occlusion detection capabilities. Oh, before we forget, The Pearl comes equipped with a tiny (but powerful) flashlight, making it easier to know when priming is complete and see if bubbles are present in the tubing. Although a timeline for release has not been finalized, speculation is that the first Pearls will roll out in early 2012. For now, the company is focusing on building up its operational and customer support capabilities. For more information, visit www.asantesolutions.com.

Advances in Slowing Type-1 Diabetes According to data presented by researchers at the American Diabetes Association's 71st Scientific Sessions in San Diego, the progression of type 1 diabetes may be slowed in those newly diagnosed through the use of promising new medications currently under development. One such medication, DiaPep277, may serve as a potential vaccine for type 1 diabetes. During the development of type 1 diabetes, it is believed that an increase in a protein in the beta cell called "heat shock" protein causes beta cell destruction through activation of destructive T-cells. However, part of this protein has the ability to change the destructive T-cells into protective T-cells – sort of like re-programming a robot to do good rather than evil. Researchers altered the structure of the "heat shock" protein to see if doing so would protect beta cells from attack by the T-cells. It worked in studies conducted in laboratory mice with a form of diabetes similar to human type 1 diabetes. And just recently, in a phase-two human study conducted at Hadassah Hebrew University Hospital in Jerusalem, administering the vaccine allowed beta cells to continue to secrete insulin for up to two years following type 1 diagnosis. The drug is currently undergoing phase three trials in which beta cell function, insulin use and glucose control are being monitored as key outcomes. Researchers believe that findings like these could eventually lead to the development of drugs to prevent or treat existing type 1 diabetes.

Amylin and JDRF Collaborate to Combine Insulin and Symlin One of the challenges to using Symlin (an analog of the human Amylin hormone, which blunts after-meal blood sugar spikes) is the need to take separate injections of Symlin and insulin at each meal. Symlin and insulin cannot be mixed in the same syringe (or pump cartridge) because their pH levels are incompatible. Amylin and JDRF have announced a partnership to investigate the feasibility of combining Symlin (pramlintide) with insulin in a fixed ratio into one injection and to see how effective it is as a treatment for type 1 diabetes compared to insulin therapy alone. Bringing these two hormones together would more closely represent the natural workings of the pancreas due to the fact that insulin and amylin are secreted and


used simultaneously in the body to stabilize blood glucose levels. Also, co-formulation would reduce the complexity of daily treatment by eliminating all the extra injections. Stay tuned for more as this project unfolds.

Carb Counting Improves Control for Type 1s It may be a royal pain in the you-know-what, but quantifying carbohydrate intake is an important aspect of glycemic control for those with type 1 diabetes. In a prospective, randomized, controlled, open-label study, the impact of carbohydrate counting on BG control and quality of life was assessed. Compared to those who simply took standard doses of insulin and ate standard meals, those who were trained to quantify and manage their carbohydrate intake experienced significantly greater reductions in body mass index, waist circumference and HbA1c – without an increased incidence of hypoglycemia. Quality of life scores were also better among those trained to carb count. The researchers concluded that “…carbohydrate quantification is an effective and safe strategy to manage glycemia and improve quality of life in T1DM patients.” The study appeared in the April edition of Diabetes Care.

A Therapeutic Use for Margaritas? Researchers at The Salk Institute for Biological Studies have shown that fisetin, a type of flavonoid found mainly in strawberries, may reduce neurologic complications and kidney damage in type 1 diabetes. It was suggested that fisetin may protect nerve cells from toxic insults through its antioxidant and anti-inflammatory activities. Fisetin, or a synthetic version of it, might eventually be used to treat patients with diabetes, said corresponding author, Pamela Maher, PhD, senior staff scientist. For their experiments, the researchers used mice with a propensity for developing type-1 diabetes by 4 weeks of age, followed by nerve and kidney diseases. Adding fisetin daily to the food of the mice had no effect on blood glucose. However, kidney inflammation was markedly reduced compared to mice in the control group, and albuminuria was almost completely eliminated. The researchers also found that C-reactive protein (a marker of harmful inflammation associated with diabetes) was attenuated in the plasma of mice that received fisetin. Flavonoids are thought to protect the leaves and fruit of plants against the sun and insects. They're an integral part of the healthy "Mediterranean" diet that is rich in fruits and vegetables and includes red wine, which contains flavonoids called polyphenols. The fisetin flavonoid is found in highest quantities in strawberries. Unfortunately, to consume the equivalent of what the mice ate in the study, an average 150-lb person would have to down 37 strawberries every day. Fisetin is also found, although in much lower quantities, in apples and persimmons and even smaller amounts in kiwi fruit, peaches, grapes, tomatoes, onions, and cucumbers. Supplements containing fisetin are apparently available over the Internet but in doses substantially lower than those used in this study.

App Focus: “Daily Coach” Last month, QuantiaCare released its fourth application, DailyCoach with (yours truly) Gary Scheiner, MS, CDE. Daily Coach provides interactive tools and insights that will help people incorporate physical activity into the daily routines at work, at home and everywhere in between.


After only a few days in the Apple App Store, DailyCoach was featured as a top-10 New and Noteworthy health and fitness application. Please help us keep the momentum strong by downloading (see links below), rating the app, and referring it to a friend… or two. Apple iOS Users: http://itunes.apple.com/us/app/dailycoach-gary-scheiner-powered/id450301954?mt=8 Android Users: https://market.android.com/details?id=com.quantiaco.dailycoach

Calling - Parents Who Need a Break Do you need a babysitter who knows how to handle the ins & outs of diabetes management? Take advantage of our new BABYSITTER LIST! We have sitters that cover a variety of geographic areas. Everyone on the list has Type-1 diabetes; most are on (or have used) insulin pumps. Many are on CGM or have used it, and most have been patients of Integrated Diabetes Services, so we presume they know a thing or two about dealing with diabetes! Many drive, and all can serve as great role models for young children because they develop an easy rapport. We've made notes of special abilities or services. As a parent, this may be just the thing to put your mind at ease when you need a break. Call our office (877-735-3648) Monday through Friday and we'll be happy to help you find someone near you. And if you (or your child) are qualified and available for babysitting, let us know. We’re looking for people in all parts of the country… and the world!

The Diabetes Store Is Open! The Integrated Diabetes Services store features a variety of useful and hard-to-find over-the-counter products for making living with diabetes just a little bit easier. For example, the NutriWeigh computerized nutrition scale and The Ultimate Guide to Accurate Carb Counting, both of which can improve your carbohydrate counting skills tremendously. Choose from:

• • • • • •

Books Pump Accessories Hypoglycemia Treatments Sharps Containers Skin Wipes Lancing Supplies

• • • • • •

Food Scales Exercise Videos Supply/Travel Cases Cooling Pouches Ketostix Injection Aids

For a complete catalog and to place orders, please visit http://www.integrateddiabetes.com/webstore/


Coming Soon… Think Like A Pancreas, 2nd Edition!

Watch for it later this year.

Sample a CGM Use of Continuous Glucose Monitors is growing steadily as the systems become more accurate & user-friendly, and insurance coverage expands. Still, many people are hesitant to purchase a system outright without knowing if it’s really worth all the effort. If you’re interested in trying a CGM (and learning some things that can improve your control), Integrated Diabetes Services offers a CGM Trial Service. This service is available just about anywhere since we can ship the necessary equipment to you and talk you through the sensor attachment process via phone or video chat (skype). Select either a two-week Dexcom Seven-Plus trial, or a one-week Medtronic sensor-augmented pump trial (you must have a Medtronic 522, 722 or Revel pump). The trial service includes a detailed analysis of your sensor data as well as specific recommendations for fine-tuning your glucose control. The cost for the service is $249, including all necessary equipment, initial training and data analysis. Details can be found at http://www.integrateddiabetes.com/cg_trialserv.shtml. Call 1-877-735-3648 to schedule.


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TRIVIA QUESTION

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What form of carbohydrate (i.e. what type of sugar) raises blood sugar the fastest? For the answer, visit www.type1university.com and click on “trivia” at the top of the home page.

Parting Thoughts… The Food and Drug Administration (FDA) is making it harder than ever for device manufacturers such as pump, CGM and meter companies to bring new products to market. This year’s American Diabetes Association and American Association of Diabetes Educators meetings featured many valuable sessions on ways to improve diabetes care, but the exhibit halls were virtually barren when it came to new products that are available for use. What that means is that, for the time being, we need to make the best possible use of what’s available to us. And that takes EDUCATION. If it’s been a while since you’ve seen or spoken with your diabetes educator, give them a call!

Advertisers: Diabetes Bites is published monthly by Integrated Diabetes Services LLC and is distributed to more than 5000 individuals who either have or treat diabetes. For advertising opportunities, please contact gary@integrateddiabetes.com or call (877) 735-3648.


Integrated Diabetes Services - Newsletter "Diabetes Bites"