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DIABETIC FOOT CARE GUIDELINES Physicians from the American College of Foot and Ankle Surgeons o er foot-care tips to help save feet from diabetes November is National Diabetes Awareness Month and a good time to remind everyone with the disease about the importance of taking good care of your feet. According to the physician members of the American College of Foot and Ankle Surgeons, diabetes can be dangerous to your feet — even a small cut can produce serious consequences. Diabetes can cause nerve damage, which takes away the feeling in your feet. It can also reduce blood flow to the feet, making it harder to heal an injury or resist infection. To avoid serious foot problems that could result in losing a toe, foot, or leg, foot and ankle surgeons recommend following these guidelines: Inspect your feet daily. Check for cuts, blisters, redness, swelling, or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. If your eyesight is poor, ask someone to check your feet for you. Call a foot and ankle surgeon to schedule an appointment if you notice any unusual symptoms. Never walk barefoot. Not even at home! Always wear shoes or slippers. You could step on something and get a scratch or cut and not always feel it. Wash your feet in lukewarm (not hot) water. Keep your feet clean by washing them daily. Use only lukewarm water – the temperature you would use on a newborn baby. If you have numbness in your toes or feet, test the water temperature with your elbow. Cut nails carefully and straight across. Don’t cut nails too short, as this could lead to ingrown toe nails. Also, file nail edges. If you have concerns about your nails, consult your foot and ankle surgeon.

Never trim corns or calluses yourself. Don’t perform “bathroom surgery”—let your foot and ankle surgeon do the job. Don’t use sharp instruments to cut anything on your feet. Even small cuts can lead to big problems. Moisturize your feet. Use a moisturizer daily to keep dry skin from itching or cracking. But don’t moisturize between the toes, as this could lead to a fungal infection. Shake out your shoes and feel the inside before wearing. Remember, your feet may not be able to feel a pebble or other foreign objects, so always inspect your shoes before putting them on. Take care of your diabetes. Keep your blood sugar levels under control. Get regular foot exams. Seeing your foot and ankle surgeon on a regular basis can help prevent the foot complications of diabetes.

WHO ARE FOOT AND ANKLE SURGEONS? Foot and ankle surgeons are podiatric physicians who specialize in the surgical and nonsurgical treatment of a variety of conditions that a ect people of every age. They hold an advanced degree as a Doctor of Podiatric Medicine (DPM) and provide a wide range of care—from nonsurgical methods to correct common foot problems to state-of-the-art corrective and reconstructive surgical techniques.

WHY CHOOSE A FOOT AND ANKLE SURGEON? Intensive, focused training and in-depth experience are what set apart the foot and ankle surgeon from other physicians. During their education and training, foot and ankle surgeons devote more time to a wide variety of foot and ankle procedures than do other surgeons. Foot and ankle surgeons are board-certified by the American Board of Foot and Ankle Surgeons. Members of the American College of Foot and Ankle Surgeons (ACFAS) — a medical specialty society devoted to advancing foot and ankle health — are board-certified or in the process of certification and continue to train and excel in the field of foot and ankle surgery for the benefit of their patients.

WHEN SHOULD YOU SEE A FOOT AND ANKLE SURGEON? Foot and ankle surgeons are trained to treat foot and ankle problems both non-surgically and surgically. Surgery is recommended only if other options are not feasible or do not adequately relieve your problem. Foot and ankle surgeons treat all symptoms and conditions a ecting the foot and ankle, including: Bunions Fractures Heel pain Diabetes Flatfoot Poor circulation Foot or ankle Neuromas arthritis Dermatological Arthritis conditions Sports injuries Hammer toes Tendon disorders And much more

FIND A FOOT AND ANKLE SURGEON NEAR YOU For more foot and ankle health information or to find a foot and ankle surgeon near you, visit — the patient education website of the American College of Foot and Ankle Surgeons.

For more information on foot and ankle health or to find a Foot and Ankle Surgeon in your area, visit





An infographic with statistics about the disease

KNOW THE SIGNS 1 in 4 people with diabetes are undiagnosed.


The latest in research and news


8 easy steps to follow the path toward health



8 10 14 20


Tips to save on medication and treatment

NAVIGATION TOOLS Look for these categories to find info that relates best to you.



EDITORIAL DIRECTOR Jeanette Barrett-Stokes

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MANAGING EDITOR Michelle Washington

7 symptoms patients shouldn’t ignore



How caregivers can help adolescents navigate difficult years

EDITORS Chris Garsson Elizabeth Neus Hannah Prince Lori Santos Sara Schwartz DESIGNERS Ashleigh Carter Lisa M. Zilka Gina Saunders INTERNS Miranda Pellicano


A look at how technology is changing treatment

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Diabetes Diagnosis:


Recipe for

Goo d Living

An astonishing 21 million Americans are living with diabetes. If you’re reading this publication, you may be one of them. Or you may be a physician or family member trying to help others manage the metabolic disease.

WITH TYPE 1 DIABETES, typically diagnosed in children and young adults, patients do not produce insulin. The body depends on this essential hormone to move glucose (a form of sugar) from the bloodstream into cells to create energy. WITH TYPE 2 DIABETES, the more common diagnosis, patients make insulin, but cells can’t process it as well as they should, causing glucose to build up in the bloodstream. Medication may be necessary, and patients may choose to make lifestyle changes. And that’s where things get amazing, when patients take charge by following a recipe for good living: eating meals that include fresh veggies; exercising; quitting smoking, reducing stress and sleeping more and better. All of these changes can have a big effect on a disease that affects far too many of us.

What we hope you’re reminded of — or discover for the first time — is this: You can live and thrive with diabetes. And we’re honored to help you on that mission.



In the articles ahead, which have been reviewed and approved by the American Diabetes Association, you’ll get expert advice on how to dominate the disease and stay on course with treatment. Caregivers will learn how to better support loved ones, and physicians will be briefed on the latest news and advances.

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Diabetes Diagnosis:


Diabetes Breakdown

Take a closer look at the disease that affects 9.3 percent of Americans TYPES OF DIABETES



Occurs when the body does not make enough insulin • Can develop at any age; most often diagnosed in children, adolescents and young adults. • No known way to prevent or reverse.

Occurs when the body does not use insulin properly • Can develop at any age; diagnosis typically happens after the age of 40. • Can sometimes be delayed or even prevented through lifestyle modifications.





Diabetes Diagnosis:



AMERICANS younger than 20 years have been diagnosed with diabetes (type 1 or type 2).



MILLION people in the U.S. have diabetes.

• Non-Hispanic black, Hispanic and American Indian/Alaska Native adults are about twice as likely to have diagnosed diabetes as non-Hispanic white adults.

• 15 percent to 30 percent of people with prediabetes will develop type 2 diabetes within five years.



IN FOUR people with diabetes doesn’t know he or she has it.

• Age 45 or older • Overweight • Family history of disease • Ethnicity (African American, Hispanic, American Indian, Asian American or Pacific Islander) • High blood pressure • Abnormal cholesterol levels • Low activity levels


MILLION adults aged 20 and older have prediabetes with higherthan-normal blood sugar levels.

WHAT’S THE COST? • Medical expenses are 2.3 times higher for people with diabetes. • As the seventh leading cause of death in the U.S., diabetes killed Americans in 2010.


AM I OVERWEIGHT? The condition is typically determined by body mass index. Discover your BMI here.


BILLION estimated to have been spent on medical care and reduced productivity from diabetes in 2012.

= 1 million SOURCES: American Diabetes Association; Centers for Disease Control and Prevention; National Diabetes Education Program

Diabetes Diagnosis:


In the Know Research leads to new discoveries every day LACK OF SLEEP LINKED TO DIABETES RISK New results from a South Korean study suggest that people who sleep fewer than six hours a night may be more likely to have risk factors that increase their chances of diabetes, heart disease and strokes. Risk factors include high blood glucose, high cholesterol, extra fat around the midsection and high blood pressure.

People with diabetes know how important it is to keep blood glucose levels under control to prevent long-term health concerns. But recent studies show some older patients are actually controlling the disease too tightly, increasing their risk for hypoglycemia unnecessarily. “Studies show that tight control is not for everyone,” says Patricia Bononi, medical director of the Joslin Diabetes Center affiliates at Allegheny Health Network in Pennsylvania. “Treatment should be individualized.”


GLASS OF WINE MAY BOOST HEART HEALTH New research suggests that enjoying a daily glass of wine may improve cholesterol and blood glucose levels for people with type 2 diabetes. While both red and white wine helped control blood sugar levels, red was better at increasing levels of HDL cholesterol (the “good” kind of cholesterol).

‘BIONIC’ PANCREAS HELPS CONTROL DIABETES People with type 1 diabetes who used a ‘bionic’ pancreas were able to better control blood glucose levels, according to a recent study. The artificial systems involve three devices worn or carried outside the body: two pager-sized hormone pumps connected to the body with thin tubes inserted under the skin and a small “brick” combining an iPhone and a continuous glucose monitor.



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Diabetes Diagnosis:


Be a Diabetes Dominator 8 easy and effective steps to a healthier you BY CHRYSTLE FIEDLER

There is no one-sizefits-all “diabetes diet.” Instead, the American Diabetes Association recommends finding a healthful way to eat that can be followed long term. “Whether you prefer a Mediterranean, vegetarian or lower-carbohydrate eating plan is less important than finding an eating pattern that fits your food preferences and lifestyle, can be consistently followed and that provides you with the nutrition you need for good health,” says Jackie Boucher, vice president for education at the Minneapolis Heart Institute Foundation. The ADA’s “Nutrition Therapy Recommendations for the Management of Adults With Diabetes,” which Boucher co-authored, recommends meeting with a registered dietitian to customize your meal plan.



For your best health, look at your plate — are you eating a lot of greens? If not, follow the ADA’s Diabetes Plate Method, which helps limit starchy carbohydrates that affect blood glucose levels and fats that can cause weight gain. Start by making sure over half of your plate contains nonstarchy vegetables such as broccoli, cabbage, cauliflower, green beans and salad. One-fourth should have whole grains or starchy foods such as beans, brown rice, bulgur, green peas, sweet potatoes and whole-wheat bread. Lean protein foods, such as fish, chicken, eggs and lean beef or pork, and soy products such as tofu fill the rest. And as your meal plan allows, add a small serving of fruit or dairy on the side. Choose healthy fats such as nuts, seeds and avocados in small amounts and cook with olive oil instead of vegetable oil.




Research conducted in 2014 at the Joslin Diabetes Center in Boston showed that the high-fiber, low-fat diet of traditional Asian cuisines helps patients lose weight and improve insulin sensitivity. The diets revolve around rice, noodles, breads, millet, corn and other whole grains, as well as fruits and vegetables. In the study, 70 percent of participants’ controlled calories came from carbohydrates, 15 percent from protein and 15 percent from fat. They consumed 15 grams of fiber daily. While the study involved Asian Americans, who are at higher risk of developing type 2 diabetes than Caucasian Americans, the results showed the low-fat/high-fiber combo can be part of any plan for better health.







If you want to dominate diabetes, you need to have good sleep habits. “It’s critical to get seven to eight hours of high-quality sleep every night,” says Dr. George King. chief scientific officer at the Joslin Diabetes Center. “When you don’t get enough sleep, glucose levels go out of range.” Some studies indicate that the body’s reaction to sleep loss can resemble insulin resistance, and there’s a proven link between sleep loss and weight gain. So if sleep isn’t a priority for you, make it one.

EXERCISE Try 30 minutes of moderate-tovigorous aerobic exercise a day.


Shedding excess pounds is difficult, but not if you aim for manageable goals. “You don’t have to lose 30 pounds to become more sensitive to insulin,” says King. In fact, the National Diabetes Prevention Program study of the Centers for Disease Control and Prevention showed that if you are overweight — with a body mass index (BMI) of 25 or above — you can help prevent developing diabetes by reducing your body weight by only 5 percent to 7 percent. Put your metabolism to work for you by not sitting for longer than 90 minutes at a time, and try working up to exercising aerobically five days a week and doing resistance training twice a week.

Diabetes Diagnosis:


“No one wants to hear that their blood glucose isn’t what it should be. But you can look at it as an opportunity towards better health and improved glucose metabolism.” – Dr. George King, chief scientific officer at the Joslin Diabetes Center in Boston




You need to know all the facts about your disease, especially your blood glucose numbers. “You wouldn’t drive a car with your eyes closed, and you shouldn’t try to treat your diabetes without knowing what your blood sugar levels are,” says Dr. Adrian Vella, professor of medicine in the Division of Endocrinology, Diabetes, Metabolism and Nutrition at the Mayo Clinic in Rochester, Minn. Keep track of blood pressure and cholesterol, too. “Heart disease is far more common in people who have diabetes, because of high glucose levels in the body,” says Vella. “Keep your blood pressure and cholesterol under control, through healthy eating, exercise and, as needed, medication.”



Finally, Vella says it’s essential to have open lines of communication with your doctor. “It’s surprising how often patients don’t understand what the goals of treatment are,” he says. If you think of questions about your health or medications, write them down so you won’t forget at your next appointment.


You probably know that the antioxidants found in colorful fruits like raspberries and blueberries can neutralize damaging free radicals and improve insulin resistance. But here’s something new: “Research shows that green vegetables with high fiber, like broccoli, have (the same) natural occurring chemicals,” says King, author of The Diabetes Reset. “They activate your own defense mechanisms, by creating what are known as Phase 2 antioxidants.” Find these little fighters in the cruciferous vegetable family, which includes Brussels sprouts, cauliflower, cabbage and everyone’s favorite little green trees.




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Diabetes Diagnosis:



Help your patients dominate the disease

• Share the latest

research on diet, exercise and medications with patients.

Educate. Establish your own lending library with books and DVDs and encourage patients and caregivers to use them. Refer patients to online programs or classes and local support groups.

• Give patients hope.

Tell patients how other patients have succeeded by changing their diet and habits.

• Schedule a follow-up appointment in 30 days to check on their progress so you stay on track.

• Be a problem solver. Be positive. Listen. Involve the family.


Support your loved ones on their path to health

it one step at a time, especially when it comes to diet and exercise.

• Give them space. Your

• Learn as much as you can about diabetes. Talk to the doctor, read books, join support groups, access online resources.

loved one needs time to process a diagnosis.

• Take time for you.

Caring for someone can be stressful. Consider joining a support group for caregivers.


• Make changes

together. Prepare and enjoy healthy dishes and exercise routines.

• Work with the

diabetes care team. Go to doctor’s appointments together. Be an advocate regarding medications, the diet plan or help that is needed.


• Set small goals. Take

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Diabetes Diagnosis:


6 Ways to Save Money

With the price of medication going up, your care can become a financial burden. Consider these tips to lower costs. BY CINDY KUZMA


“At least a couple times a week, we’re getting people calling in and saying, ‘These medications — my cost has gone up, my copay has gone up or it’s not covered at all, so I can’t use it’,” says Dr. Kristine Arthur, an internist who treats diabetes patients at Orange Coast Memorial Medical Center in Fountain Valley, Calif. But you don’t just have to roll over and open up your bank account. “Patients really do have some power in this,” says Dr. David Robbins, director of the Kansas University Diabetes Institute in Kansas City. From getting selective about your health plan to comparison-shopping for food and medications, you can do a lot to reduce your costs. Here are six ways to start.


Americans receive a diabetes diagnosis every day – American Diabetes Association



ew medications and cuttingedge devices, from pumps to pens to continuous glucose monitors, have made managing diabetes easier than ever. But all of this progress comes at financial cost. “Diabetes is expensive,” says Matt Petersen, director of medical information at the American Diabetes Association. On average, a person with the disease has more than double the total health care costs of someone the same age who doesn’t have the illness. And when it comes to drug prices, there’s little relief in sight. A recent report by pharmacy benefit management company Express Scripts suggests prices will continue to climb more than 18 percent annually for at least the next three years. Employers and health plans used to shoulder much of the burden. But, thanks to a complicated, ever-changing health care system, doctors who treat diabetes say they’ve seen an uptick in patients struggling to cover their costs.

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Diabetes Diagnosis:


FOR PROFESSIONALS If you have a choice between health plans, weigh your options carefully to maximize your benefits. Compare formularies — lists of covered drugs — to see how much each plan pays for the prescriptions you’re already taking. Clarify coverage on diabetes supplies, nutritionist visits and lab tests. Keep in mind that plans with low premiums often have higher deductibles that can add up to more out-of-pocket expenses by the end of the year, says Dr. Robert Gabbay, chief medical officer at Joslin Diabetes Center in Boston.

2. GO GENERIC WHEN YOU CAN. Many diabetes treatments come in relatively inexpensive generic formulas, says Petersen. For instance, metformin — the most widely used oral diabetes drug — can cost as little as $5 per prescription. And while insulin isn’t available in generic form, older human insulins typically cost about one-third as much as newer versions called insulin analogs. The older drugs have some limitations — for instance, you’ll have to give an injection a certain amount of time before your meals, instead of taking

1 IN 3

Medicare dollars are spent caring for people with diabetes – American Diabetes Association


In the meantime, ask patients up front about their financial constraints to save time and aggravation later. Framing the issue the right way avoids blame or shame. Try this phrase: “You know, sometimes people struggle with taking their medicine every day. How’s it going for you?” Gabbay advises. Patients may be more prone to open up about costs and other barriers if you pose the question this way.

FOR CAREGIVERS A little research on your part can go a long way to easing your loved one’s financial burdens. Search online for drug company discount programs or call around to pharmacies to find the best deals on prescriptions. “Just check around for them,” says Dr. Kristine Arthur, an internist at Orange Coast Memorial Medical Center in Fountain Valley, Calif. “There’s more available than you might think.” And if you’re concerned about the costs of cooking healthy meals, tap into your creative side. With a little knowledge and planning, you can prepare at least one simple meal that’s adaptable for family members with and without diabetes.



With so many health care plans, providers don’t always know the details of what patients are paying. By updating electronic health records, physicians can more easily access formularies and streamline the process of choosing affordable prescriptions, Dr. Robert Gabbay of the Joslin Diabetes Center in Boston says.

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Diabetes Diagnosis:


“The vast majority of controlling diabetes is all about what you’re eating and what you’re doing for physical activity.” – Dr. Kristine Arthur, internist at Orange Coast Memorial Medical Center in Fountain Valley, Calif.

3. WHEN YOU CAN’T, EXPLORE YOUR OPTIONS. If metformin or other generic drugs don’t work for you, talk with your doctor about other ways to save. First, refer back to your formulary — your copay might be $50 for one brand-name drug and $10 for another, Arthur says. Your doctor won’t always know these details, so come to your appointment armed with information. If you take more than one diabetes medication, ask about new combination formulas; by packing two active ingredients into one pill, you can save a copay.

4. CLIP COUPONS. They might not come with your Sunday paper, but many drug companies offer discount cards, codes or coupons that can save people with private health insurance a substantial amount. And nearly all offer programs to help patients with lower incomes afford their products. Ask your doctor or pharmacist about these options, or just Google the drug name; you’ll likely find details on the company website, Arthur says.

5. GO SHOPPING. Call or visit different pharmacies to see which one offers the


best deal on your drugs. In some cases, retailers like Target or Costco sell certain medications at such a low price you’ll pay less in cash than you would by using your insurance benefits, Arthur says. Also, check into mail-order pharmacies. Having a 90-day supply shipped to your house often costs less, Gabbay says, and also helps ensure you don’t run out before you have a chance to get refills.

6. UPGRADE YOUR LIFESTYLE. While type 1 diabetes always requires medication, “the vast majority of controlling (type 2) diabetes is all about what you’re eating and what you’re doing for physical activity — that’s going to be your No. 1 way to prevent having to add more expensive medications,” Arthur says. Start walking, do body-weight exercises at home or join a low-cost gym like the Amount that YMCA. You prescription don’t have to prices will buy expenclimb annually sive, packaged – Express Scripts diabetes foods; instead shop for fresh, inseason fruits and vegetables at discount chains or farmers markets. And quit smoking if you’re still lighting up — you’ll save on money and costly complications.



them right when you start eating. “But the large savings is something you ought to discuss with your provider,” Robbins says.

Diabetes Diagnosis:


DANGER AHEAD 7 symptoms you can’t ignore


s your diabetes under control? Are you sure? Warning signs aren’t always clear. Some may seem trivial, unrelated to your diagnosis or even too embarrassing to discuss with a doctor. If I just ignore it, you may think, it will go away. And while you don’t want to rush to the doctor with every ache and pain,


you also don’t want to minimize or ignore symptoms that could signal a significant problem with your ongoing treatment. Three diabetes experts weighed in on surprising symptoms that can mean trouble ahead. If you’re experiencing any one of these seven, reach out to your physician to change course.



1. Fatigue

“Many people come to accept a low level of fatigue as being normal,” says diabetes educator and registered dietitian Jill Weisenberger, author of Diabetes Weight Loss, Week by Week and 21 Things You Need to Know about Diabetes and Your Heart. Patients often tell her, “I never knew how lousy I felt until I started to feel better,” she says. While being tired after physical exertion or skimping on sleep is normal, extreme fatigue — feeling more tired than you think you should and not feeling better after you’ve had what seems like enough rest — isn’t. People with type 1 and type 2 diabetes can experience tiredness as a result of having an imbalance between blood glucose levels and insulin amounts. For example, you may experience fatigue after eating a large meal. “You’ll feel really, really tired” and just want to go to sleep because your blood glucose is too high, says David Marrero, professor of medicine and director of the Diabetes Translational Research Center at Indiana University in Indianapolis and president of health care and education at the American Diabetes Association. This can be a sign that you need to test your blood glucose and adjust your treatment course. Be sure to discuss with your physician first.

2. Anxiety Suddenly feeling anxious can signal your blood glucose is too low, says Marrero. Any patient who takes insulin — as all diabetes type 1 and a large percentage of type 2 do — “should always be aware of the possibility of having hypoglycemia, or low blood sugar,” he says. The condition can cause “a wide, wide variety of symptoms,” Marrero adds. Classic signs include sweatiness and a sense of warmth; lip tingling or numbness; confusion; and a change in mood.

3. Digestive woes If you’re experiencing stomach issues such as nausea, vomiting and diarrhea, you may not think about the effects they could have on your blood glucose levels, but you should. Dr. Michelle Cassara, a diabetes specialist at Lutheran Medical Center in Wheat Ridge, Colo., says some patients even stop testing their blood glucose while experiencing digestive upset. If they’re not eating much, they assume there’s no point in tracking their levels. But, as Cassara explains, nausea, vomiting and diarrhea can cause dehydration, especially in people who use insulin. (Be aware: Even something as simple as working out in the yard on a hot day can make diabetes patients dehydrated, she says.) And dehydration affects the body’s ability to transport insulin, which may cause glucose levels to spike.

Diabetes Diagnosis:


4. Nightmares

While recurring dreams about losing your teeth or showing up for school without your clothes can be interpreted in a variety of ways, waking up at night with sweats or nightmares may be a warning sign for diabetes patients. “(This) can be an indication that your blood sugar may be too low,” says Cassara. “I ask all of my patients if they’re waking up at night. Nightmares, in particular, can be linked to being hypoglycemic.” If you’re having bad dreams — and if that’s unusual — test your blood glucose the next time one wakes you up, and then speak with your doctor.

5. Crankiness

Sure, we all have grumpy moments — when someone cuts us off in traffic or jumps in front of us in line — but sudden changes in mood can signal a bigger problem for diabetics. If you find yourself “chewing on things” that normally wouldn’t bother you, says Marrero, you may want to check your blood sugar. Elevated glucose levels can make you feel more irritable. And be aware that low blood glucose can make you act oddly, too, says Weisenberger. You may seem confused or appear drunk. Educate family, friends and even co-workers on what to do if you start showing these signs.

6. Blurry vision People who have undiagnosed diabetes, or whose diagnosed diabetes isn’t being controlled properly, may experience blurry vision. This is an indicator that your blood glucose is too high. The high glucose levels in the bloodstream eventually raise the glucose level in the fluid in the eyes, causing distortion. Fortunately, unlike other vision problems that can be caused by diabetes, such as retinopathy and glaucoma, the blurry vision that can be caused by very high glucose levels is usually reversible. Once glucose levels are closer to normal, the fluid in the eye returns to normal and the distortion goes away.

While many of these symptoms will come and go, you need to be aware of increases in intensity levels. Patients often tell Cassara, “Most of the time I’m OK, but sometimes my feet tingle or my vision is bad.” That “sometimes” may be a sign your blood glucose is reaching extreme highs or lows. “Make sure that you’re touching base with an educator routinely, as you progress through diabetes through your life,” says Cassara, adding that your body and treatment needs change over time.



7. Varied symptoms

Diabetes Diagnosis:


FOR PROFESSIONALS Make sure your patients with diabetes have a gluose meter and know how to use it properly as part of their treatment regimen, says Dr. Michelle Cassara, a diabetes specialist. While the tool is integral to diabetes management, “not everybody gets one. Not everybody wants to use one,” she says. The device can help patients GLUCOMETERS determine whether a symptom they’re determine the approximate experiencing is due to dangerous very concentration of low or very high glucose levels. glucose in the blood.

Don’t overlook or dismiss signs that your patient’s or loved one’s diabetes treatment is off course.



Accompany your family member to doctor and diabetes educator visits, and bring a list of symptoms you’ve noticed. Even if the patient doesn’t mention them, you can raise your concerns. Then make sure you understand any changes to the treatment plan. “We write everything down for folks,” says Cassara. She advises making an extra copy of provider’s instructions for out-of-town family members in case the patient calls them with questions.


See a Certified Diabetes Educator® (CDE®) Certification makes a difference. Find a CDE near you today. Visit

for more information.

The Who, What, When, Where, and Why Many health professionals can help you learn to manage your diabetes, but the one you want to see is the health professional who has taken the extra step to become certified in diabetes education. Take control today—ask your primary care provider for a referral to a Certified Diabetes Educator (CDE). Who are Certified Diabetes Educators? CDEs are health professionals who have demonstrated their knowledge and skill in diabetes self-management education providing at least 1,000 hours of patient education, passing a rigorous exam, and maintaining this highly respected credential in the health care industry. What do CDEs do? A CDE is your partner. They work with you to develop a plan and provide the tools you need to manage diabetes on a daily basis.


When should I consult a CDE? Ask for a referral to a CDE today and during the transitions of important life stages. Ongoing support from a CDE helps you take control and build the skills that can help you feel your best. Where can I find a CDE? The National Certification Board for Diabetes Educators (NCBDE), the organization administering the CDE program, offers an online CDE locator service. Visit to find a CDE near you. Why should I see a CDE? Successful diabetes self-management involves knowledge about a broad range of topics such as what to eat, how to take medication as directed, fitting in exercise and coping with stress. It’s not easy to gain all of the necessary knowledge alone. With the help of a CDE, you can learn how to effectively manage and improve your health.

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Teen Challenges Caregivers face unique concerns when the patient is an adolescent


hen Jacob Hudson, 15, of Cincinnati, found out he had type 1 diabetes almost three years ago, his family’s world turned upside down. “It’s hard,” says his mom, Jessica Hudson, “because my husband, Don, and I work all day and then we get up twice a night to check on Jacob and make sure his blood sugar hasn’t dropped too low while he’s sleeping. We’re really tired.” Raising a teenager can be difficult


under the best of circumstances. Add “When you’re a person with type 1 the constant and life-threatening diabetes, you’re locked into a lifestyle demands of type 1 diabetes — when that you probably wouldn’t have your body produces no insulin, requirchosen,” says David Marrero, president ing constant vigilance to keep of health care and education glucose levels even — and you for the American Diabetes have a prescription for famAssociation. “For a parent to ily tension and conflict. The have a kid with diabetes is Centers for Disease Control very challenging, and it can and Prevention estimate that be difficult to get teens to do 18,436 youth are diagnosed what they need to do.” of U.S. teens with type 1 diabetes each Kids may engage in risky have diabetes year, which affects about 1.25 or prediabetes behaviors, such as not million Americans. following prescribed – Pediatrics Journal




TO INCLUDE THE SCIENCE SUPPORTING LOW CARB IN THE DIETARY GUIDELINES releases its dietary guidelines designed to help Americans make healthy food choices. While these dietary guidelines are well-intended, clearly something isn’t working. It is estimated that at least 50 percent of Americans today have diabetes or pre-diabetes, according to a recent Journal of the American Medical Association article. In the past 30 years, adult obesity rates have doubled, and according to The Trust for America’s Health Report, they are projected to rise to 50 percent by 2030. The government needs to ensure that quality science — including the robust research that backs a low-carb lifestyle approach — determine our dietary guidelines. Sign this petition and demand for change, combatting the diabetes and obesity health crises!


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GET EDUCATED TOGETHER. The Hudsons have included Jacob in every education class they’ve taken, so he’s learned everything they’ve learned about type 1 diabetes. “Teens don’t like it if you tell them you know more about them than they do,” Jessica Hudson says, noting the strategy has reduced tension.


HELP TEENS PREPARE to be independent in college and adulthood. “We want our son to be able to go away to college and take care of himself,” says Jessica Hudson. The couple encourages Jacob to check his own blood sugar, even at night.

HOOK YOUR CHILD UP WITH A TEEN SUPPORT GROUP. Hudson recommends encouraging your teen to join a type 1 teen group, which you can find through the diabetes association. “Jacob belongs to a group, and they go bowling together, they eat out. … They talk about the challenges of diabetes, the equipment, the symptoms, and he’ll talk to them about stuff he won’t talk to us about,” she says.

NORMALIZE DIABETES. Haley Maurice, 17, of Phoenix, has been open about her diabetes at school and with friends since she was diagnosed at the age of 7. “We told her she has nothing to be ashamed of and she is not defined by diabetes,” says her father, Daniel Maurice. As a result, Haley’s friends and teachers have been educated about the disease, and she’s very comfortable giving herself insulin shots when she’s with her close friends.


of people with diabetes have type 1. Because this form is usually diagnosed in children and young adults, it used to be known as juvenile diabetes.

— American Diabetes Association

TAKE ADVANTAGE OF NEW TECHNOLOGIES. Besides continuousglucose monitors, insulin pumps and other devices that are simplifying management, there are tools that allow parents to obtain information about their teen’s blood sugar through cloud computing, which enables convenient, on-demand access to a shared pool of resources. The Maurices are currently negotiating with Haley about using this tool when she goes to college next year. “The new technology makes us feel confident that she will be able to manage her diabetes on her own,” says Haley’s mom, Erika Maurice.


diets and insulin plans. In addition, the hormonal fluctuations and surges that are the hallmark of the teen years can affect the disease, says Dr. Steven Griffen, an endocrinologist and vice president of translational development for the Juvenile Diabetes Research Foundation, which funds type 1 diabetes research. Research shows that hormonal changes can induce higher blood glucose levels and insulin resistance, leading to complications. “A lot of parents are heavy-handed with their teens because of their fears,” says Marrero. “That’s understandable, but it can be counterproductive.” He encourages parents to relax a bit and understand that their teens will make mistakes. If you tell a child he can never have a candy bar, for instance, he may sneak one when mom’s not watching, and that could be worse than including it as a treat in an insulin and meal plan. The key is to teach teens to explore their food options with appropriate corrections. “Teens with type 1 diabetes can eat almost anything if they adjust with insulin properly,” he says, advocating a 3-to-1 rule: For every one time they indulge in a rich or sugary food, teens must properly correct for it and follow the healthier path for the next three times they eat. Perhaps the best advice for parents comes from parents who’ve been there. Here are some tips:


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FOR PROFESSIONALS WHEN YOUR PATIENT’S A TEEN, you can play a role in helping him or her take over treatment management in the transition to adulthood. Teens with diabetes need to have a plan, prepare early and play an active role in the treatment process, according to researchers at the University of Pittsburgh Medical Center who have studied the transitional process. (Providers can use The Endocrine Society’s “Provider Assessment of Patient Skill Set” to evaluate a teen’s readiness for taking on his or her own care.) Another key to success is to maintain continuity of care as a teen transitions from a pediatrician to an adult-care clinician. In a study of 1,507 young adults in

Ontario, Canada, those who transferred to a new adult care team with the involvement of their previous pediatrician were less likely to be hospitalized for diabetes complications than those who severed their relationship with their pediatric specialist. That means it’s essential for current providers to help teens who are going off to college or moving to a new city to manage care and stay involved until they’re settled. Dr. Steven Griffen of the Juvenile Diabetes Research Foundation recommends clinicians schedule a transitional visit with

high school seniors to discuss the continuation of care, risky behaviors such as alcohol use and other relevant issues. “This visit takes time, but it is so important for the teen with diabetes,” he says.

“I tell teens that diabetes is not a sprint — it’s a marathon,” says David Marrero, president of health care and education for the American Diabetes Association. “It’s a long-term condition that won’t go away.”



understand that this “is the toughest time of your life to manage your diabetes, and you won’t always be perfect. Your A1Cs won’t always be at goal, so give yourself a break and try and be safe.”

ABOUT A1Cs The test shows average blood sugar levels for the past two to three months.


Know treatment is getting easier with the wide array of medications and delivery vehicles now available, such as pens and pumps and continuous monitors. Dr. Steven Griffen of the Juvenile Diabetes Research Foundation tries to get teens to

What Does the Future Hold?

Smart new innovations could make diabetes management easier


iabetes patients are living longer, healthier lives and have access to far better detection tools, improved methods of treatment and reams of information about the disease and treatment options. “This is an exciting time in diabetes research and treatment,” says Jay Shubrook, director of clinical research and diabetes services at Touro University California. “We have many new classes of medications, which allow us


to individualize therapy for patients. Some of the most important advances coming soon are longer-acting insulins, very rapid insulins that make it easier to time medication with meals and smarter insulins that would allow a more physiologic release.” So what does the future hold for this disease that affects over 29 million Americans, or one in every 11 people, according to the Centers for Disease Control and Prevention? There are some exciting discoveries within reach.




Diabetes Diagnosis:

GENTLE MONITORING Today, the recommended method of glucose monitoring for most patients is still the annoying finger prick, says Dr. Laure Sayyed Kassem, an endocrinologist and assistant professor of medicine at Case Western Reserve University in Cleveland. But, that could change. Several innovative methods of monitoring blood glucose are under investigation. “None, to date, have been FDA-approved and are unlikely to be for quite some time because they are not accurate enough,” Sayyed Kassem cautions. But research is bringing these devices closer to reach reality.

“Diabetes is relentlessly progressive. Physicians need to anticipate this and provide early pharmaceutical interventions, progressively titrating therapy to stay one step ahead of this disease.”

The Dexcom G4 continually monitors blood glucose levels.


This summer, Google’s Life Sciences team announced a partnership with glucose monitoring company Dexcom to develop smaller, cheaper cloudconnected glucose sensors that could make finger sticks a thing of the past. Last year, they began testing a contact lens with a built-in bionic sensor that detects glucose levels. The lens was created by GoogleX developers, who also brought the world Google Glass.

A specialized laser that, when pointed at a person’s palm, measures the absorption by sugar molecules in the body. The laser, developed by researchers at Princeton University, uses mid-infrared light.

– Jay Shubrook, director of clinical research and diabetes services at Touro University California

A temporary tattoo extracts and measures the level of glucose in the fluid in between skin cells. The sensor was developed by nanoengineers at the University of California, San Diego. “Glucose monitoring is entering a transformative period. … Someday, we will see a new world where

patients and even their families can access real-time glucose data,” says Shubrook. “That data will be linked to our smart devices and potentially even our automobiles. This will increase safety for patients with diabetes and require fewer invasive interventions to get that information.”

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were published this summer in the Proceedings of the National Academy of Sciences. Further testing is required before human trials can take place, perhaps three to four years. For the past year, a new drugdelivery system called Encaptra has been tested in humans. The device, a capsule about the width of a credit card, can be implanted under the skin near the pancreas. Stem cells inside have been programmed to develop into the cells that help regulate blood sugar. Initial evaluations of the testing are expected late next year.

DATA DOES IT With more types of insulin on the market offering a range of action times — from rapid-acting effects to balance meals to a steady delivery of insulin throughout the day — there are more options than ever for managing diabetes with insulin. But discovering the perfect treatment course for an individual can sometimes require an extended

SO CAN WE CURE IT? The effort got a big boost this year when Google Life Sciences announced diabetes would be its first major target. With two major projects already under way, the company has hired immunologists, neurologists and nanoparticle engineers to work toward tech-centric solutions for the disease. Other research groups are experimenting with artificial pancreases, cell-based therapies and even a mini organ that mimics a native pancreas by sensing blood sugar and releasing an appropriate amount of insulin. While any promise of a cure at this point is premature, advocates and providers continue to reach for that goal. And it gets closer every day. THINKSTOCK

When it comes to insulin shots, Sayyed Kassem is quick to note what people needing them say: “Not fun.” “Apart from injections under the skin or delivery through an insulin pump, inhaled insulin is the only other viable method of delivery at mealtime. It is an option for diabetics without lung disease, who find it difficult to adhere to a complex regimen of multiple daily injections,” she says. But research is under way on a method for delivering life-saving medication: A “smart” insulin patch, developed by a team of researchers from the University of North Carolina in Chapel Hill and North Carolina State University in Raleigh, can sense the low-oxygen environment created by high-glucose levels and stimulate painless microneedles that deliver insulin. Results of a successful test in mice

process of trial and error. And even more challenging, the disease changes continuously. “Diabetes is relentlessly progressive,” says Shubrook. “Physicians need to anticipate this and provide early pharmaceutical interventions, progressively titrating therapy to stay one step ahead of this disease.” Helping with that process is the big data revolution. Smartphone apps such as One Drop and Glooko make it easier for diabetes patients to track glucose levels, food intake, insulin use and physical activity and make adjustments in real time. And the data being created by all of those users provide substantial opportunities for analysis that, in the future, could offer insights into the disease and treatment.


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FOR PATIENTS Stay up-to-date on advances in the field of diabetes by reading mainstream news and following updates from groups such as the American Diabetes Association, the National Institutes of Health, the Food and Drug Administration and other trusted sources. If a new treatment option seems like it could help you, mention it to your health care provider at your next visit.

FOR CAREGIVERS 63.3% of adults with diagnosed diabetes performed daily self-monitoring of blood glucose levels in 2010. – CDC’s Diabetes Public Health Resource


Though diabetes is largely a self-managed disease, you have an important role to play by listening to your family member’s complaints, fears, successes and hopes – and that may include discussions about new treatment options. Keep current in your knowledge of the field, and be a positive, informed advocate for your loved one when changes to treatment are proposed.


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Get Connected

Stay on top of diabetes news, research, policy issues and more through these leading organizations

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS DIABETES RESOURCE CENTER Educational tools enable member physicians to stay up-to-date on diabetes practice guidelines. The site also supports, a program that provides a patient-friendly overview of blood sugar management. USE IT TO: Keep up with the latest research into diabetes cause and treatment. CHECK IT OUT:

AMERICAN DIABETES ASSOCIATION A vast network of professionals, patients, families and volunteers working to improve the lives of those living with diabetes. The organization’s website, magazine, podcasts and e-newsletters provide a wealth of invaluable information. USE IT TO: Learn about the disease, causes, treatment, research, policy issues and more. The organization also hosts several events, including the Step Out: Walk to Stop Diabetes campaign and Diabetes EXPO health fairs. CHECK IT OUT: AmericanDiabetes Association @AmDiabetesAssn


DIABETIC CONNECT A social network of people and families living with diabetes. Includes forums for member discussions and content on treatments, news and recipes. USE IT TO: Connect online with others battling the disease; give and receive advice. CHECK IT OUT: DiabeticConnect @DiabeticConnect

NATIONAL DIABETES EDUCATION PROGRAM A partnership of the National Institutes of Health, the Centers for Disease Control and Prevention and more than 200 public and private organizations committed to diabetes awareness and treatment. USE IT TO: Understand diabetes; develop a game plan for living with the disease; help a loved one manage care. CHECK IT OUT: ndepgov @NDEP

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Diagnosis: Diabetes 2015