EXPERT ADVICE, NUTRITION TIPS, GREAT RECIPES & MORE! SUMMER 2011 diabetes FREE you® COPY There’s a way to stay well. SUMMER GRILL RECIPES BOOST YOUR BRAIN HEALTH

MEDICARE PART B SPECIAL PULL-OUT

A TRIBUTE TO BASEBALL LEGEND AND DIABETIC HERO RON SANTO 19402010 editor’s letter

Dear Readers: EDITORINCHIEF Michael Wolf, PharmD The Walgreens Diabetes & You Summer issue brings Director of Merchandising, Diabetes Care you healthy-living tips for the warmer weather. Our Walgreen Company article “Keep Cool” helps you protect yourself when it EDITOR gets hot and/or humid, and “Ask the Expert” from the Martha M. Funnell, MS, RN, CDE Joslin Diabetes Center answers common summer-related Research Investigator, questions about travel, what to wear and keeping your Michigan Diabetes Research and Training Center, diabetes supplies safe. Summer is a great time to be more University of Michigan, active, so check out the new, national walking program Ann Arbor, MI called Walk with Walgreens in our “What’s New at PUBLISHER Walgreens” article. Jonathan B. Jarashow H. Crimson Inc. We also focus on senior health with a special Medicare Pharmacy Publications Part B pull-out section after page 20, and we feature a tribute to baseball legend Ron EDITORIAL BOARD Santo, 1940-2010, a nine-time All-Star third baseman for the Chicago Cubs. Santo also Linda R. Bernstein, PharmD made his mark with the Illinois chapter of the Juvenile Diabetes Research Foundation, a Clinical Professor, School of Pharmacy group for which he raised more than $50 million during his lifetime. University of California, San Francisco President, Vita Media Corporation

The Steak & Potato Kebabs with Creamy Cilantro Sauce recipe on the cover is just one Amy Campbell, MS, RD, LDN, CDE of the delicious summer grill recipes in this issue. Our other tempting dishes are Grilled Education Program Manager, Diabetes Management, Salmon & Zucchini with Red Pepper Sauce, Grilled Lamb Chops with Eggplant Salad and Joslin Diabetes Center, Mexican Grilled Corn. Boston, MA Andrea D. Collaro, PharmD, CDM If you are a health care provider, we’d be happy to send you additional, complimentary Walgreen Company, copies for your offi ce (U.S. addresses only, no P.O. Boxes, one shipment per address). Clinical Assistant Professor, Department of Pharmacy Practice, Walgreens customers can contact us at [email protected] to receive an University of Illinois at Chicago electronic version of the magazine. Virginia Peragallo-Dittko, APRN, BC-ADM, MA, CDE As always, we invite you to share your questions or comments. Director, Diabetes Education Center, Our contact information is below: Winthrop University Hospital, Mineola, NY

Walgreens Diabetes & You Joy Pape, RN, BSN, CDE, WOCN Diabetes Health Education Consultant, 200 Wilmot Road, MS # 2243 New York, NY Deerfi eld, IL 60015 Janis Roszler, RD, CDE, LD/N Or send e-mail to: 2008-2009 Diabetes Educator [email protected] of the Year (AADE)

Don Zwickler, MD Chief of Endocrinology, Sincerely, Good Samaritan Hospital, Su ern, NY LEARN MORE ABOUT DIABETES AT

www.walgreens.com/diabetes www.LillyDiabetes.com Michael Wolf, PharmD Director of Merchandising, Diabetes Care Walgreen Company

For past issues of Diabetes & You, or for the Walgreens Diabetes Newsletter, visit walgreens.com and click on health info Published May 2011 by H. Crimson Inc. Copyright © 2011 by H. Crimson Inc. (845) 426-7612. All rights reserved. No part of this publication may be reproduced in any form or by any means without the prior written permission of the publisher or Walgreen Co. Walgreens is not responsible for typographical errors and does not necessarily warrant, approve of or endorse any of the information or carry any of the products contained in this publication. Customers are encouraged to seek professional advice before changing a diabetic treatment regimen.

4 Summer 2011 DIABETES & YOU diabetesyou

There’s a way to stay well. 25 summer 2011 diabetes care nutrition 8 WHAT’S NEW AT WALGREENS 16 MAY I TAKE YOUR ORDER? Walk with Walgreens program swings into action, Don’t let your diabetes keep you from enjoying new products available at Walgreens. the company of good friends at mealtime. 12 FACING CHANGES 25 SUMMER GRILL RECIPES As you age, you may face new problems Steak & Potato Kebabs with Creamy Cilantro Sauce, that come from changes in your life. Grilled Salmon & Zucchini with Red Pepper Sauce, Grilled Lamb Chops with Eggplant Salad and 14 ASK AN EXPERT Mexican Grilled Corn. Diabetes Questions & Answers. 31 FISH: GOOD FOR YOUR HEART AND MIND 22 RESEARCH UPDATES Tips to help you add  sh to your weekly meal plan. To consume less food, visualize your eating before you eat; metformin: the diabetes wonder drug. 32 BOOST YOUR BRAIN HEALTH WITH SMART EATING 23 KEEPING COOL The brain gets overlooked when it comes Take care to protect yourself—especially to food and nutrition. on very warm days and when it is humid. 36 NATURAL PRODUCTS: ARE THEY FOR YOU? 29 I JUST DON’T HAVE THE TIME Natural products and vitamins may help you Ways to take care of yourself that don’t take manage your diabetes. extra time.

34 A MORE COMFORTABLE NEEDLE The newest needles are shorter, thinner and feature article more comfortable than previous needles. 19 REMEMBERING “THIS OLD CUB” 38 UPDATE YOUR STORY BASEBALL LEGEND RON SANTO, Success can be as easy as changing 19402010 the story you tell yourself Ron Santo, a beloved icon and nine-time All-Star each day. third baseman for the Chicago Cubs, was also a member of the Cubs broadcast team until the end of his life and made his mark with the Illinois chapter of the Juvenile Diabetes MEDICARE Research Foundation, a group for PART B which he raised more than $50 SPECIAL million during his lifetime. PULL-OUT AFTER PAGE 20 diabetes care what’s new at

By Jonathan Jarashow There’s a way to stay well.

• The Biggest Loser® Walk with Walgreens program swings into action Meal Bars and Shakes. The Biggest Loser® is go a long way toward with Walgreens. “It’s a partnering exclusively reducing the risks of great way for people to with Walgreens to provide heart disease, cancer become more aware of a nutritious on-the-go and diabetes. the importance of every alternative for people step they take, how easy Not only does walking serious about losing weight it is and how rewarding it promote health bene ts and maintaining a balanced lifestyle. The can be in improving your such as losing weight, but Biggest Loser® Meal Bars and Shakes are health and helping Cheryl Pegus, Walgreens designed to help you save.” chief medical o cer, satisfy hunger and are noted that walking is rich in protein,  ber a great way to relieve and vitamin D. They stress. In fact, walking is are made with natural recommended by many ingredients and have In April at its Times treatment specialists to no added sugar. Find Square store in New York help relieve depression, them in the diet aisle at your Walgreens City, Walgreens launched and it also helps people store in convenient on-the-go packaging. Walk with Walgreens, with many health a new healthy living Watch The Biggest Loser Tuesdays 8/7c conditions, including To live The Biggest Loser lifestyle, go to initiative as part of heart disease and www.biggestloser.com. The Biggest Loser® Walgreens Way to Well arthritis. & ©2011 NBC Studios, Inc. & Reveille LLC Commitment™. “Walk with Walgreens inspires Justin Tuck, star • The Smart Health Pedometer people to take the small defensive end for the Heart Rate Watch is a heart rate steps that lead to a well New York Giants, was monitor, digital watch and step counter, life, making walking a part of the launch all-in-one. It has a large, easy-to-read even more rewarding,” as was actress Alison display and all three key features are said Kim Feil, Walgreens Sweeney, host of “The accessible with a press chief marketing o cer. Biggest Loser,” author of Walk with Walgreens of a single button: spokesperson Alison Sweeney “We’re creating a The Mommy Diet and a a digital watch, a simple, national walking well-known proponent To sign up for the Walk digital pedometer that movement—walk, log, of healthy living and with Walgreens accurately measures get rewards. It’s another lifestyles. “As a working program online, go to your steps and an way we’re educating and mom with a hectic walgreens.com/walk. EKG-accurate heart engaging our customers schedule, I make  nding Registration also is rate meter that uses to help them stay well time to walk every day available in the photo patented technology and live well.” Feil pointed a top priority,“ said area at any Walgreens to measure the out that 30 minutes of Sweeney, who is also a store or by texting electrical impulses sent out by your walking each day can spokeswoman for Walk “WALK” to 21525. heart each time it beats.

• The BD Ultra-Fine™ Nano Pen Needle is clinically proven to be as e ective as longer pen needles for people of all sizes who have diabetes. Seventy-two percent of those who tried the new Nano Pen Needle preferred it over their current pen needle. It is ideal for patients looking for a more comfortable injection experience—especially those new to injection—and allows for a single-handed, no-pinch technique, which gives more patients the option to inject in their upper arm and buttocks. The Nano is so short, patients can inject in areas that have less fat, like the outer thigh.

8 Summer 2011 DIABETES & YOU diabetes care changes FACING By Linda Bernstein, PharmD

the risk of diabetes grows with age s you age, Plan healthy meals you may 1Make healthy food choices 25% 12,000,000 face new to maintain your best weight. Nearly 25% of Americans More than 12 million Aproblems that To do this, plan ahead so you age 60 and older have people age 60 and older come from can avoid skipping a meal or diabetes. have diabetes. changes in your grabbing a high-fat or sugary life. You may have snack instead of a healthy to live on a fi xed one. Avoid foods high in fat blood glucose meters on the what foods, drugs and other income or may and sugar, and try to include market. Ask your Walgreens actions to avoid while using not be able to eat a variety of healthy foods pharmacist about ones that the medicine. Make sure your as well as you did in your diet such as fruits, are easy to use, have easy-to- health care team knows all in the past. You vegetables, fi sh, and lean cuts read screens or talk to you of the drugs you take, both may no longer of meat, whole grains and with a special voice option. prescribed ones and over-the- be able to drive low-fat dairy products. Bake Also fi nd ones that use the counter products. Don’t take to doctor’s offi ce or broil rather than fry your least amount of blood, are any new medicine if you don’t visits or may have foods. Eat modest portion lightweight, are covered by know how it will affect your trouble walking. sizes at home and when you your insurance and provide diabetes control or whether You may fi nd it eat out. Ask your health care phone or online support. they may interact with a harder to take provider or a dietitian to help medicine you already take. care of yourself you create a diet that works Take your medicines Make sure you have all of and may live for you. If you have trouble 3 as directed your medication needs met far from family getting to the market, cooking There are many types of when you travel, and keep and friends. or paying for the foods you medicines used to treat at least three days of extra Work together need, ask for support from diabetes. Once your health supplies on hand in case with your family members, friends or care team chooses the best any problems arise. caregiver and community help groups. ones for you based on your your diabetes health needs, be sure you Keep active team, which Check glucose levels know how to use them 4 Ask your health care team may include 2 Check your blood glucose properly. Know the name, what type and how much your healthcare often to help avoid very high what it is used for, how to activity is best for you. Activity provider, a and low levels. This will help take it, what side effects to will help you keep your dietitian and you control your diabetes. watch for and what to do if glucose level in check and is your Walgreens There are many types of they should occur. Also ask a great way to lower stress. pharmacist—and follow these 4 daily tips to help diabetes care throughout the year you maintain a • Get yearly • Have your kidneys checked, • Care for teeth, • Get a yearly  u shot, and if you healthy diabetes eye exams. along with your blood gums, skin are over 65, you may need lifestyle. pressure and cholesterol. and feet. the pneumonia vaccine.

12 Summer 2011 DIABETES & YOU diabetes care

I am taking a trip Q to Europe alone. How can I best take ASK AN care of my diabetes when I’m traveling?

A Having diabetes expert shouldn’t stop you from visiting new and exciting By Joyce Lekarcyk, RN, CDE places. The best piece of advice is to be prepared. Now that summer What happens First, pack double the is here, can to my diabetes Hot weather amount of diabetes supplies Q Q can aff ect and medications that you I wear sandals? during hot weather? will need during your trip in your diabetes your carry-on luggage. Bring Sandals and other open- Hot weather can present A A supplies, too extra food in case of missed toed shoes don’t provide certain challenges for or delayed meals. Granola enough protection from people with diabetes. If your Never store bars, sandwiches, crackers, rocks, glass or other sharp blood glucose is not well ❶ insulin in direct fruit and yogurt are good objects that could be in the controlled, you are at risk sunlight or in the choices. Since you’ll be sand, on the pavement or for becoming dehydrated glove compartment fl ying to a different time even on the fl oor. Everyone when the thermometer of your car. zone, ask your healthcare with diabetes needs to rises. Keep your cool this provider about how to take protect their feet from summer by heeding the Heat may cause ❷ your diabetes medicines. If injury. However, you likely following hot-weather tips: insulin to work sooner you take insulin or certain can wear sandals as long than usual, so check • Slow down. If it’s really diabetes pills, be sure to as you don’t have any loss your glucose more hot, skip or limit your always carry a treatment of sensation in your feet often when you are activities for the day. for low blood glucose, such or have any history of foot outside for long as glucose tablets or juice. problems, such as cuts, sores • Dress for summer periods of time. Wear comfortable shoes or ulcers. If you do wear with light-colored, Keep your meter and socks and check your sandals, be especially sure lightweight clothing. ❸ test strips away feet frequently for blisters; to check your feet every • Drink plenty of water or from heat, too. get treatment if even minor day for signs of injury. other no-calorie drinks. foot problems develop. Ask your ❹ Wear medical identifi cation • Go easy on alcohol. Walgreens pharmacist and carry emergency about products that Having diabetes • Exercise in cool or air- contact information. can protect your conditioned places Finally, tell people you shouldn’t stop you diabetes supplies from or at times of the day travel with that you have extreme temperatures from visiting new when the temperature diabetes and explain how (hot or cold). and exciting places is coolest, such as early to recognize low blood morning or late evening. glucose. Bon voyage.

14 Summer 2011 DIABETES & YOU

nutrition

❺ FILL UP WITH WATER AND SOUP may I Many people enjoy a tall glass of water before they begin to eat their meal. A take bowl of broth-based soup is also a great way to start your meal. Drinking liquids, your especially warm liquids, can help you feel less hungry so order? you may end up eating less. ❻ CUT BACK ON PORTIONS By Janis Roszler, Americans love super-sized RD, CDE, LD/N food portions. Restaurant owners know that and are happy to provide diners with large food amounts that are usually high in fat and calories. diabetes ❶ CHOOSE WHERE TO EAT ❸ HAVE IT YOUR WAY When your meal arrives, eat meal plan is Help decide where to eat Don’t be shy about asking the amount that is right for Amade up of healthy when you go out with your to have your meal prepared you and have the server wrap foods in portion spouse or friends. Your dining in a way that suits you best. up the leftover food to take sizes that are partners may not think about These days, many people make home. Or order a single entrée your diabetes when they pick requests when they go out to and share it with a friend. measured to meet a restaurant. Suggest a place eat, even if they don’t have your special needs. that offers all types of foods diabetes. Your request won’t be ❼ LIMIT YOUR ALCOHOL Unlike a quick so you can select foods that fi t the fi rst or the last that your If your doctor agrees that it weight loss diet that in your meal plan. A fried fi sh server receives, so don’t be is OK for you to drink, you may last only a few place offering little else is not afraid to call him or her over can enjoy some alcohol with weeks or months, as good a choice as a restaurant to discuss your options. Ask your meal. Just be sure to have most people with that has a nice salad bar, soups for an extra portion of steamed something to eat with your diabetes hope to eat and many entrée options. veggies in place of French drink to help keep your blood healthy for the rest fries. Or ask if an item can be glucose level from dropping of their lives. ❷ CHECK THE MENU broiled or baked instead of too low. And remember that AHEAD OF TIME fried. Feel free to ask the server alcohol is a source of calories. To do that, many Try to get a copy of the to put your salad dressing on Don’t let your diabetes stop going out to restaurant’s menu before the side rather than on the keep you from enjoying the eat. They fear they you go so you can plan your salad so you can better control company of good friends at will be tempted order before you leave home. the amount you use. Don’t mealtime. Take care of your by the items on That gives you a chance to worry: It really is OK to ask. diabetes needs, make healthy the menu or at consider what is best for you menu choices and have fun. the buff ets and to eat without any pressure. ❹ BE THE FIRST TO ORDER make the wrong You won’t be swayed by When you and your dining The American Diabetes food choices. While what other diners eat and partners arrive, be the fi rst Association recommends that eating out can you’ll be less tempted by to place your order with the men limit their alcohol intake foods that may be displayed waiter. If you do that fi rst, to no more than two drinks present certain or featured as specials. To you will be less likely to per day and women limit their challenges, here get a copy of the menu, call change your mind when you drinking to one or fewer drinks are some tips for and ask the eatery to fax or hear what your fellow diners each day. One alcoholic drink is a staying true to email you a copy or visit the plan to eat. Select what is 12-ounce beer, 5 ounces of wine your plan while restaurant’s website where right for you to order and or 1½ ounces of vodka, whisky, eating out. the menu may be posted. let the others do the same. gin or other distilled spirit.

16 Summer 2011 DIABETES & YOU feature article

remembering “this old cub”

on Santo, a beloved icon and nine-time All-Star third baseman for the Chicago Cubs, died at age 70 from complications of bladder cancer Ron Dec. 3, 2010. Santo retired in 1974 after having lived with type 1 diabetes during his whole career, which began in 1960. He was a Chicago Cub for all but one season and in 1990, he joined the WGN Radio/Cubs broadcast team and was with the team until the end of his life. Santo also made his mark with the Illinois chapter of the Juvenile CREDIT: MICHAEL MAUNEY MICHAEL CREDIT: Diabetes Research Foundation, a group for which Santo raised Baseball Legend more than $50 million during his lifetime through the Ron Santo Walk to Cure Diabetes. Walgreens, the o cial pharmacy of the Chicago Cubs, is proud to have been on Ron's team in his tireless e orts to help  nd Ron a cure for juvenile diabetes.

A LEGENDARY BASEBALL PLAYER Santo was an excellent Santo power hitter who also won 1940-2010 Ron Santo was the color commentator By Jonathan Jarashow for Chicago Cubs’ radio broadcasts

Summer 2011 DIABETES & YOU 19 feature article

fi ve consecutive Gold EVERYDAY couldn’t properly manage Glove awards for fi elding DIABETES CARE his diabetes: “My dad was excellence, making him Santo injected insulin in extra innings and he was a likely candidate for the into his stomach every playing every inning with Major League Baseball day before breakfast. Jeff the same energy all the Hall of Fame. He came Santo, his older brother, way up until the end. He especially close to election Ron Jr. and younger sister, was a strong-willed, blue in 2007, but his dream Linda, didn’t understand collar ballplayer the fans was never realized during much about their father’s loved because he took the his lifetime. We recently diabetes; they just knew game very seriously and spoke with Santo’s son, Jeff, there were insulin bottles in he always took the time to PHOTO COURTESY OF THE CHICAGO CUBS CHICAGO THE OF COURTESY PHOTO who made a documentary the refrigerator. Since they sign autographs. He was about his father’s life called didn’t have blood glucose a hard-nosed player, but “This Old Cub,” available meters in the 1960s, during as a broadcaster, he was a at ThisOldCub.com. Jeff Santo’s playing days, Santo fun-loving fan who would gives us a glimpse of Santo’s would simply take candy feel the pain of the loss and inspirational life with bars to the clubhouse, have great joy with the win. diabetes in his personal just in case he had a low Ron Santo in his playing He took all his hardships life and on the fi eld. blood glucose reaction. Jeff days for the Chicago Cubs so well—having diabetes, remembers his father always losing his legs, getting DIABETES DIAGNOSIS taking good care of himself: live as long as anyone else. cancer. He was a warrior.” Santo found out he had He ate healthy foods, his Jeff recalls his father would Jeff talks about a dramatic type 1, or juvenile diabetes, favorite drink was TAB, the sit down and talk to just event from the 1969 in 1958 at the age of 18, sugar-free cola, and he kept about anyone with diabetes. baseball season that typifi ed right after signing his fi rst his body in good shape. He would tell young kids Santo’s life: “One night, he professional contract. He Santo retired when not to be afraid of their clicked his heels because went to the library to learn he didn’t feel physically diabetes and say: “You can he was so excited that they more about the disease capable of going further accomplish anything. I won a game from behind, and read that the life and he felt if he had better became an All-Star, so don’t and it was shown on the expectancy for someone managed his diabetes, he think this is going to slow WGN news that night. The with his condition was might have played a few you down. But you have to next day, Leo Durocher, only 25 years. In addition, more years—he was only watch yourself. You have to the manager, said that after his doctor told him he 34 when he retired. accept that you have this every win he should do wasn’t sure if he would be disease. If you don’t, it’s this same victory click—he able to stay in the Major INSPIRING PEOPLE going to hurt you. But if should jump up and click Leagues with diabetes. But WITH DIABETES you accept it, you can live his heels. The fans loved it. Ron was determined to Santo often spoke to groups a normal life and do great And that became the cover play professional baseball of people with diabetes things. Think about that of ‘This Old Cub’ on the and wouldn’t let anything and was an inspiration to during any adversity in life. DVD. He’s jumping up in get in his way. Santo thousands of people with When you accept it, you get left fi eld clicking his heels didn’t know much about the condition over the through it.” after they won a game. And diabetes during his career, years. He emphasized the that represents the spirit and very few people other importance of eating right, DIABETES AND of him because he lost his than the team doctor taking care of yourself, BASEBALL legs after having both of knew of his condition keeping your blood glucose Ron Santo lived until them amputated below the since Santo feared if the within range and taking 70—not a very old age knee: the right in 2001 and information were to come your medication. He these days, but Jeff said the left in 2002. He didn’t out, he would be forced conveyed that with today’s it was a lot longer than have his heels anymore, so into retirement. However, technology and healthy his father expected, given that became our spirit… on “Ron Santo Day” at living, you can expect to the many years that he for the movie.” Wrigley Field in 1971, Santo revealed his struggle with Ron Santo often spoke to groups of people with diabetes and conveyed that,with diabetes to the public. today’s technology and healthy living, you can expect to live as long as anyone else.

20 Summer 2011 DIABETES & YOU Trim:7”

BRIEF SUMMARY OF PRESCRIBING INFORMATION —————— WARNINGS AND PRECAUTIONS —————— HIGHLIGHTS OF PRESCRIBING INFORMATION • Dose adjustment and monitoring: Monitor blood glucose in all These highlights do not include all the information needed to use patients treated with insulin. Insulin regimens should be modified LANTUS safely and effectively. See full prescribing information for cautiously and only under medical supervision (5.1) LANTUS. • Administration: Do not dilute or mix with any other insulin or ® solution. Do not administer subcutaneously via an insulin pump or LANTUS (insulin glargine [rDNA origin] injection) solution for intravenously because severe hypoglycemia can occur (5.2) subcutaneous injection • Do not share reusable or disposable insulin devices or needles Initial U.S. Approval: 2000 between patients (5.2) • Hypoglycemia: Most common adverse reaction of insulin therapy ———————— INDICATIONS AND USAGE ———————— and may be life-threatening (5.3, 6.1) LANTUS is a long- acting human insulin analog indicated to improve • Allergic reactions: Severe, life-threatening, generalized allergy, glycemic control in adults and children with type 1 diabetes mellitus and including anaphylaxis, can occur (5.4, 6.1) in adults with type 2 diabetes mellitus. (1) • Renal or hepatic impairment: May require a reduction in the Important Limitations of Use: LANTUS dose (5.5, 5.6) • Not recommended for treating diabetic ketoacidosis. Use intrave- ————————— ADVERSE REACTIONS ————————— nous, short-acting insulin instead. Adverse reactions commonly associated with Lantus are: • Hypoglycemia, allergic reactions, injection site reaction, lipodystro- —————— DOSAGE AND ADMINISTRATION —————— phy, pruritus, and rash. (6.1) Trim:4.875” • The starting dose should be individualized based on the type of To report SUSPECTED ADVERSE REACTIONS, contact sanofi- diabetes and whether the patient is insulin-naïve (2.1, 2.2, 2.3) aventis at 1-800-633-1610 or FDA at 1-800-FDA-1088 or • Administer subcutaneously once daily at any time of day, but at the www.fda.gov/medwatch. same time every day. (2.1) ————————— DRUG INTERACTIONS ————————— • Rotate injection sites within an injection area (abdomen, thigh, or • Certain drugs may affect glucose metabolism, requiring insulin dose deltoid) to reduce the risk of lipodystrophy. (2.1) adjustment and close monitoring of blood glucose. (7) • Converting from other insulin therapies may require adjustment of • The signs of hypoglycemia may be reduced or absent in patients timing and dose of LANTUS. Closely monitor glucoses especially taking anti-adrenergic drugs (e.g., beta-blockers, clonidine, upon converting to LANTUS and during the initial weeks thereafter. guanethidine, and reserpine). (7) (2.3) —————— USE IN SPECIFIC POPULATIONS —————— • Pregnancy category C: Use during pregnancy only if the potential —————— DOSAGE FORMS AND STRENGTHS —————— benefit justifies the potential risk to the fetus (8.1) Solution for injection 100 units/mL (U-100) in • Pediatric: Has not been studied in children with type 2 diabetes. • 10 mL vials Has not been studied in children with type 1 diabetes <6 years of • 3 mL cartridge system for use in OptiClik (Insulin Delivery Device) age (8.4) • 3 mL SoloStar disposable insulin device (3) See Full Prescribing Information for PATIENT COUNSELING IN- ————————— CONTRAINDICATIONS ————————— FORMATION and FDA-approved patient labeling Do not use in patients with hypersensitivity to LANTUS or one of its A Revised: 04/2010 excipients (4) GLA-BCPH-AS-APR10 Rx Only research updates thinking about the newest By Richard Jackson, MD your food? wonder drug is Director of Medical Aff airs Healthcare Services think again over 50 years old Joslin Diabetes Center Food is often on our minds and this If you have type 2 diabetes, you Boston, MA may be a good thing. Researchers should probably be taking metformin. have found that if we eat when we Metformin is derived from a common are not thinking about our food herb, French lilac (also called goat’s rue) (that is, when we are distracted), and was  rst used clinically in 1956. we eat more. Eating lunch while It wasn’t until 1998, however, that its playing computer solitaire or eating e ects came to be truly appreciated, dinner with a group of lively friends when it was used in one part of the large is enjoyable. The downside is that United Kingdom Prospective Diabetes we tend to eat a little more. On Study (UKPDS). Compared to other the  ip side, a di erent group of treatments for type 2 diabetes, including researchers had people visualize pills and insulin, metformin was found eating a particular food and to do to reduce heart disease and mortality in this 30 times in a row. The people addition to improving glucose control. were then allowed to eat as much Recent studies have shown that people of the food as they wanted. Those with diabetes who take metformin are who had visualized their eating also less likely to develop cancer. Add in beforehand ate less food. Think the fact that it is safe and inexpensive more, eat less. and voilà!—the  rst newest/oldest wonder drug.

22 Summer 2011 diabetes care

be very drying. You will feel Make sure that the lids less tired and jet-lagged if you are tightly closed on your stay hydrated. Be sure to keep pill bottles to protect all of your medicines, your them when it is humid. meter and its strips with you on the plane and not in your PROTECT YOUR checked bag. The temperatures ❸ METER AND STRIPS in the luggage compartment For the most accurate results, KEEPING vary a great deal and can be store your meter at room either too hot or too cold. temperature. Most companies Plus, keeping your supplies recommend that meters be with you prevents problems kept between 40 and 86º. High if your luggage gets lost. altitudes can also affect your meter. Humidity can damage your strips, so store them in KEEP YOUR MEDICINES the original bottle and make ❷ COOL AND DRY cool sure the lid is on tight. By Martha Funnell, MS, RN, CDE It is safe to store your insulin at room temperature as long PROTECT as it is less than 86º in the ❹ YOUR SKIN room. If it is hotter than s winter DRINK PLENTY that in your house, keep • Wear a hat and sunscreen ends, the ❶ OF FLUIDS all bottles of insulin in the when you are outside to Alonger days Keeping hydrated is one of the refrigerator. If cold insulin protect your skin. Along and the appeal most important things you stings when you take it, you with the risk of skin cancer, of sunshine can do to keep yourself safe can roll the bottle between sunburn is a physical motivates many in the summer. Some people the palms of your hands to stress and can raise your people to spend fi nd their blood glucose levels warm it slightly before taking blood glucose levels. more time outside are higher when it’s hot and your dose. Avoid storing your and to become humid. Drinking plenty of • As part of protecting insulin on a windowsill or a more active. If you sugar-free fl uids is one way your skin, you need to counter in direct sunlight. have diabetes, to fl ush the extra sugar from protect your feet. Be Don't leave your insulin being more active your body and to keep your sure to put sunscreen on in your car for any period can make it easier blood glucose levels on target. the tops of your feet if of time. The inside of a car to keep your If you exercise outside in the you are at the beach. and especially the trunk can blood glucose summer, carry a bottle of water quickly go over 100º on a hot • Wear shoes at the beach and levels in your with you. This is true even if day. Most of the time, you can when swimming in the sea. target range. But you are working in your yard keep your insulin pen or vials Use common sense about as with so many or garden. Drink enough fl uid in your purse or pockets when wearing sandals and make things in diabetes, to replace the amount that you are away from home sure they fi t well and give you do need you lose by sweating. One and will need them. When you the protection you need. to take care to sign that you are dehydrated taking a long car trip in the • If you have neuropathy protect yourself— may be cramps when you are summer, keep your insulin or any numb areas on especially on exercising. Other signs are in a cooler, but do not put your feet, shoes that offer very warm days dry mouth and lips, needing it in ice or allow it to touch more protection and and when it is to urinate less often and dark an ice pack. If insulin freezes support than sandals will humid. If you are urine. There is no set amount at all, it no longer works. be a safer choice. traveling this of water or other liquids you summer, you also need to drink, but if your DID YOU KNOW? need to make urine is clear and pale yellow, plans to keep you are well hydrated. SPF 15 SPF 30 your medicines You will also need extra A sunscreen with SPF 15 blocks If you are very fair or and other fl uid if you are taking a long about 93% of the harmful rays and is burn easily, you may supplies safe. airplane fl ight. The air can enough protection for most people. need to use SPF 30.

DIABETES & YOU 23 recipes grillsummer recipes Steak & Potato Kebabs with Creamy Cilantro Sauce ½ cup packed fresh cilantro leaves, minced 2 tablespoons red- wine vinegar or cider vinegar 2 tablespoons reduced-fat sour cream 1 small clove garlic, minced 1 teaspoon chili powder ½ teaspoon ground cumin ½ teaspoon salt, divided 8 new or baby red 4 servings potatoes 1¼ pounds strip steak, 1. Combine cilantro, vinegar, sour and onion chunks onto 8 skewers. Grill, turning trimmed and cut cream, garlic, chili powder, cumin and once or twice, until the steak reaches desired into 1½-inch pieces ¼ teaspoon salt in a small bowl. Set aside. doneness, about 6 minutes for medium. Serve 2 poblano peppers, the kebabs with the reserved sauce. or 1 large green 2. Preheat grill to high. bell pepper, cut 3. Place potatoes in a microwave-safe container. NUTRITION INFORMATION Per serving: into 1-inch pieces Cover and microwave on High until just tender 272 calories; 9 g fat (3 g sat, 4 g mono); 1 teaspoon extra- when pierced with a fork, 3 to 3½ minutes. 65 mg cholesterol; 17 g carbohydrates; virgin olive oil 30 g protein; 2 g  ber; 368 mg sodium; 1 large sweet onion, 4. Toss the potatoes, steak and pepper pieces 786 mg potassium cut into 1-inch with oil and the remaining ¼ teaspoon salt in a chunks large bowl. Thread the potatoes, steak, peppers Dietary exchanges: 1 starch, 4 lean meat

Summer 2011 DIABETES & YOU 25 Grilled Salmon & Zucchini with Red Pepper Sauce ⁄ cup sliced almonds, toasted ½ teaspoon freshly ground ¼ cup chopped jarred roasted pepper, divided red peppers 1¼ pounds wild-caught salmon ¼ cup halved grape tomatoes fi llet, skinned and cut or cherry tomatoes crosswise into 4 portions 1 small clove garlic 2 medium zucchini, or summer 1 tablespoon extra-virgin olive oil squash (or 1 of each), halved 1 tablespoon sherry vinegar or lengthwise red-wine vinegar Canola or olive oil cooking spray 1 teaspoon paprika, 1 tablespoon chopped fresh parsley preferably smoked for garnish ¾ teaspoon salt, divided 4 servings

Grilled Lamb Chops with Eggplant Salad 1 medium eggplant (about 1 pound), ¼ cup chopped fresh parsley 1. Preheat grill to medium-high. peeled and sliced into ¼-inch 2 tablespoons chopped fresh mint 2. Spray both sides of eggplant and rounds 1 tablespoon extra-virgin olive oil onion rounds with cooking spray. Grill 1 medium red onion, sliced into 1 teaspoon salt, divided the vegetables, turning once, until ¼-inch rounds Pinch of cayenne pepper browned on both sides, 2 to 3 minutes Canola or olive oil cooking spray 8 lamb loin chops, 1-1½ inches thick, per side. Transfer to a cutting board. Juice of 1 lemon trimmed (1½–1¾ pounds total) When cool enough to handle, chop the ¼ teaspoon freshly ground pepper eggplant and onion and combine in a medium bowl with lemon juice, parsley, mint, oil ½ teaspoon salt and cayenne. 4 servings 3. Meanwhile, sprinkle lamb chops with pepper and the remaining ½ teaspoon salt. Grill the chops until browned on both sides and cooked to desired doneness, about 4 minutes per side for medium. Serve with the eggplant salad.

NUTRITION INFORMATION Per serving: 231 calories; 11 g fat (3 g sat, 6 g mono); 68 mg cholesterol; 11 g carbohydrates; 23 g protein; 5 g  ber; 648 mg sodium; 627 mg potassium Dietary exchanges: 2 vegetable, 3 lean meat, 1 fat

26 Summer 2011 recipes

1. Preheat grill to medium. 2. Process almonds, peppers, tomatoes, garlic, oil, vinegar, paprika, ¼ teaspoon salt and ¼ teaspoon pepper in a food processor or blender until smooth; set aside. 3. Coat salmon and zucchini (and/or summer squash) on both sides with cooking spray, then sprinkle with the remaining ½ teaspoon salt and ¼ teaspoon pepper. Grill, turning once, until the salmon is just cooked through and the squash is soft and browned, about 3 minutes per side. 4. Transfer the squash to a clean cutting board. When cool enough to handle, slice into ½-inch pieces. Toss in a bowl with half of the reserved sauce. Divide the squash among 4 plates along with a piece of salmon topped with some of the remaining sauce. Garnish with parsley, if desired.

NUTRITION INFORMATION Per serving: 281 calories; 13 g fat (2 g sat, 7 g mono); 66 mg cholesterol; 8 g carbohydrates; 32 g protein; 2 g  ber; 599 mg sodium; 874 mg potassium Dietary exchanges: 1½ vegetable, 4 lean-meat, 1 fat

Mexican Grilled Corn 2 tablespoons low-fat mayonnaise 2 tablespoons nonfat plain yogurt ½ teaspoon chili powder 4 ears corn, husked 4 tablespoons fi nely shredded Cotija or Parmesan cheese 1 lime, quartered

1. Preheat grill to medium-high. 2. Combine mayonnaise, yogurt and chili powder in a small bowl. 3. Grill corn, turning occasionally, until marked and tender, 8 to 12 minutes total. Spread each ear with 1 tablespoon of the sauce and sprinkle Recipes adapted from with 1 tablespoon Cotija or Parmesan. Serve The Simple Art of EatingWell 4 servings with lime wedges. Cookbook, by Jessie Price NUTRITION INFORMATION Per serving: & the EATINGWELL Test 100 calories; 2 g fat (1 g sat, 0 g mono); Kitchen (© 2010 by Eating 2 mg cholesterol; 20 g carbohydrates; Well, Inc., published by The 4 g protein; 2 g  ber; 118 mg sodium; Countryman Press). Available 282 mg potassium at your local bookstore, online at eatingwell.com or by Dietary exchanges: 1 starch, 1 fat calling 1-800-233-4830.

DIABETES & YOU 27

diabetes care

✔ Find a reason to take care of you You may be so busy “taking care of business”—your loved ones, your work, your home, you name it—that you think you don’t have any time to take care of you. Ask yourself, “Why is it important for me to take care of my diabetes?” It may be that you want to have more energy and feel better today so that you can continue to take care of business. Or, it I just don’t may be that you want to do all that you can to have the prevent complications so you are able to see your grandchildren grow up or have a good quality of life in your later years. Whatever the reason for you, it helps to keep it in your mind time when you feel too rushed By Joy Pape, to take care of yourself. RN, BSN, CDE, WOCN, CFCN ✔ Make a plan If time really is the issue, then one idea for saving time is to combine a new behavior with something you already do. When you pair an old and a new behavior, you may fi nd it is easier to remember and doesn’t take much more time.

✔ List what you want to do to manage ou may fi nd MAKE TIME TO MANAGE your diabetes yourself thinking, YOUR DIABETES Don’t try to do everything Y“I just don’t have time at once. Choose to work to do what it takes to ✔ Be honest (Identify the problem) on one thing at a time. manage diabetes.” Ask yourself, “Is it that I don’t have time? Or, is that I don’t Turn the page for tips on True, it does take time. want to, or I don’t like to?” Identifying the true problem is how to make time for the The good news is, the fi rst step for solving the problem. If the problem is that 7 Self-Care Behaviors of there are ways to take you truly don’t want to, then that is the problem you need Diabetes identifi ed by the care of yourself that to work on solving. If lack of time is not the true problem, American Association of don’t take extra time. then time-saving tips probably won’t help you. Diabetes Educators (AADE).

Summer 2011 DIABETES & YOU 29 diabetes care

HOW TO MAKE TIME FOR: and  gure out what is causing the your medicine up for a week or more. If problem right away. Once you identify you take your medicine before breakfast ❶ Healthy Eating. If you don’t have the problem, you can save time in and at bedtime, keep your morning time to cook, purchase quick-to-prepare the future by what you’ve learned. medicine on your kitchen table, and healthy foods such as bagged salads, your bedtime meds at your bedside. ❹ Being Active. Add some oomph chopped vegetables, cans of salmon and to your everyday activities. When ❻ Monitoring. Make it easier to check rotisserie chicken. Keep these items in the you are cleaning, turn on some your blood glucose and your blood house so there is always something you lively music you love. Dance while pressure by keeping your supplies in a can grab and  x in a hurry. you are cleaning. Get up and move handy place so you don’t have to spend ❷ Healthy Coping. When you have a during commercials. Step in place time looking for them. If you check your negative thought,  ght it with a stronger when you are talking on the phone. blood glucose before meals, keep your positive thought. For example, if your When you are sitting down, rather meter in your kitchen. If you check it negative thought says, “I’ll never have than ask someone else to bring you when you are out, keep it in your purse T time to do all there is to do to manage something, get up and get it yourself. or pocket. Or get two meters, one for my diabetes,” replace it with a positive home and one to carry with you. ❺ Taking Medicine. Ordering and thought such as, “I may not be able to do setting up your medicine can take some ❼ Reducing Risks. Whenever you everything, but I will park further from the time. Save time by asking your Walgreens wash your feet, apply moisturizer, or put store today and get a little more exercise.” pharmacist if you can purchase your on or take o your stockings or shoes, ❸ Problem Solving. If you  nd that medicine every 3 months rather than look at your feet. This way if you notice your blood glucose levels are too high every month. Buy one or more pill boxes any changes, you’ll recognize them or too low, stop what you’re doing labeled with the days of the week, and set and take care of them right away.

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© 2011 Energizer Energizer, Energizer Bunny design, card and label graphics and other marks are trademarks of Energizer www.facebook.com/EnergizerBunny nutrition f ish good for your

he American heart and mind Heart Association ❷ JUMP START By Janis Roszler, RD, CDE, LD/N Tsuggests that adults YOUR DAY eat fi sh at least twice Fish isn’t just for If you can’t use it that CHOOSE READY a week. A serving dinner. Try some night, wrap the fi sh ❻ COOK IN A MADE ITEMS equals 3.5 ounces herring or a few slices up and store it in the ❺ HEALTHY WAY WITH CARE of cooked fi sh or of smoked salmon coldest part of your Grilling, baking, Many pre-cooked ¾ cup of fl aked fi sh, for breakfast. Tuna or fridge for no longer poaching and broiling fi sh dishes have a lot salmon salad make for than a day or two. such as canned tuna are four healthy ways of fat and calories a protein-rich lunch. or salmon. Here are to prepare fi sh. If you that you don’t need. BE PATIENT some tips to help ❹ choose to grill it, coat Most ready-made VISIT YOUR Busy fi sh markets you add fi sh to your ❸ it lightly with a small fi sh sticks and fi sh GROCERY FREEZER attract many buyers weekly meal plan: amount of heart- patties are made Frozen fi sh is great and sell their supply healthy oil, such as with types of fi sh but don’t buy it if of fi sh quickly. Don’t CHOOSE WELL canola or olive oil and that are not rich in ❶ it has frost or ice get upset if you must Look at and smell wrap it in aluminum healthy omega-3 fatty crystals or if its wait in a line for a your fi sh before you foil before you put it acids. They may also package is open or while. The fi sh at a buy it from your local on the grill. This will contain saturated or torn. Frozen fi sh busy store isn’t sitting market. When fi sh help keep it moist. trans fats that are not shouldn’t be refrozen. around for long. is caught, it is at its Most fi sh needs only good for your heart. freshest. Once it is a few minutes of Canned fi sh is taken from the water, what fi sh is best for me? grilling per side and a good choice. it will start to lose will keep cooking for Depending on where Oily types, such as tuna, lake trout, some color and slowly a bit longer after you you live (and your herring, salmon, mackerel, albacore tuna begin to smell “fi shy.” remove it from the budget) fresh fi sh and sardines, are rich in heart-healthy Choose fi sh with grill. If you’d rather may not always be an omega-3 fatty acids that strengthen clear eyes, a healthy broil your fi sh in the option. Canned fi sh, your heart and mind and do the color with some oven, add a sauce or such as tuna, salmon, following vital things for your body: color in the gills, marinade to keep it and sardines, can and a mild, sweet, • Lower your level of unhealthy moist. Just be sure also give you heart- ocean-like smell. blood fats (triglycerides) to keep an eye on healthy omega-3 fatty The fl esh should be • Possibly lower blood pressure it as it cooks. Most acids and protein. fi rm and shiny. Fresh • Reduce your risk of stroke and recipes suggest specifi c Canned salmon is blood inside the fi sh death from heart disease cooking times, but also high in calcium. or in its veins is a • Improve your brain function thinner pieces will Buy canned fi sh good sign that your take less time to cook packed in water, as • Boost your mood and reduce depression fi sh is still fresh. than thicker ones. opposed to oil.

Some fi sh may contain high levels of toxins. Try to avoid those that often have high levels of mercury, eat fi sh such as shark, swordfi sh and king mackerel. To limit your risk, vary your intake of fi sh and choose safely from those that are low in mercury such as shrimp, salmon, pollock, catfi sh and canned light tuna.

Summer 2011 DIABETES & YOU 31 nutrition

BOOST YOUR sardines are the best sources of fi sh oils. If you don’t like fi sh, talk with your health care provider about taking brain health a fi sh oil supplement. Tip: Try to eat fatty fi sh with smart eating Of course, just because you at least twice a week. You have diabetes doesn’t mean can eat canned tuna and By Amy Campbell, MS, RD, LDN, CDE that you’re going to have salmon if fresh fi sh is hard problems with memory or to fi nd or is too costly. You can keep your DIABETES AND A thinking. But why take the heart and blood HEALTHY BRAIN chance? No matter how old ❷ Eggs vessels healthy by As we age, we should all you are or how long you’ve Yes, eggs! Eggs are one of the eating a diet low in think about how to boost had diabetes, it pays to eat best foods there are. They saturated fat and our brain power. People with foods that will keep your not only contain protein sodium. You can diabetes may want to take mind and your body healthy. and vitamin D, eggs are rich keep your bones extra care to stay as sharp in choline. Choline is like and teeth healthy as they can. Why? Research FOODS THAT BOOST a vitamin and is needed by making sure to shows the following: 10 BRAIN POWER to form substances that get enough calcium • Adults who have had Luckily, foods that are good carry messages to and from and vitamin D. And diabetes for a long time or for your brain are also good brain cells and nerves. We to take care of your who had diabetes before for the rest of you. For also need choline to keep diabetes, you can age 65 have a higher risk example, many brain-healthy our organs, tissues and watch your carbs of memory problems. foods are also heart-healthy cells healthy. Beef, salmon, and your portions • Having diabetes puts and may lower the risk of cod fi sh, shrimp and milk to help keep your you at higher risk for having certain types of cancer. Put also contain choline, but glucose levels in a stroke, which can also your thinking caps on and egg yolks are a key source. a safe range. affect mental ability. make sure your eating plan And good news: eggs But not many • Mice with diabetes tend contains the following foods: are lower in cholesterol people think of to have less brain cholesterol than we once thought. choosing foods that than mice without diabetes. ❶ Fish oils There are only 186 mg of keep their brains Cholesterol helps with Also known as omega-3 fatty cholesterol in one large egg. healthy. Somehow, nerve signaling and may acids, fi sh oils are needed for Tip: Boil a few eggs at a one of the most be help prevent diseases brain growth during infancy time and munch on one as a vital organs in such as Alzheimer’s. and childhood. Adults need high-protein, low-carb snack. the body gets fi sh oils, too. These healthy overlooked when fats improve memory and ❸ Leafy greens it comes to food learning ability and may If nothing else gets you to and nutrition. prevent depression, mood eat spinach, maybe this disorders and will: spinach and other leafy dementia. Fatty green vegetables like kale, fi sh, such as salmon, collard greens, lettuce and tuna, mackerel, bok choy have plenty of B herring and vitamins that keep you from forgetting and may even help ward off Alzheimer’s disease. Tip: Drizzle washed kale leaves with a little bit of olive oil and add a sprinkle of sea salt. Bake at 350˚ for 10-15 minutes.

32 Summer 2011 ❹ Avocados ❻ Berries Avocados do more than Blueberries, blackberries walnuts, pecans, sesame just make guacamole. and strawberries are rich seeds, pumpkin seeds This creamy fruit is high in antioxidants, which and fl axseeds. They’re in monounsaturated can shield the brain from good mixed with just fat, a type of fat that’s damage. Blueberries may about anything. Watch good for your blood protect against dementia the portion, though, vessels and your heart. and Alzheimer’s disease. because these tasty treats Monounsaturated fat Berries also can protect are high in calories. can help lower LDL, or your memory and keep Tip: If you buy bad cholesterol, while you thinking clearly. fl axseed, grind them raising HDL, or good One cup of most types up fi rst. A coffee cholesterol. When you of berries contains bean grinder works keep your cholesterol between 15 to 20 grams well for that job. levels in a healthy range, of carbohydrates, so monounsaturated fat they can easily fi t into ❾ Curry powder can lower your risk of your meal plan. Curry powder is stroke or heart attack. Tip: Berries are great actually a blend of Like nuts and seeds, on cereal. Toss a few several spices, including though, avocados are into your salad, too. turmeric. Turmeric full of calories, so keep contains curcumin, your portion small. ❼ Green tea which is an antioxidant. Tip: Add a few Studies show that people Curcumin may help slices of avocado who drink at least two prevent some types of to your sandwich. cups of green tea every cancers and is being Mashed-up avocado OraMoist is a time-released patch that day are more likely to studied in humans to is a healthy change adheres inside the mouth and then slowly stay sharp and think see if it can prevent from mayonnaise. dissolves, moistening the mouth for hours. clearly than people Alzheimer’s disease. The xylitol, enzymes and lipids in the ❺ who drink little or no Tip: Sprinkle curry OraMoist patch lubricate the mouth— Whole grains green tea. Green tea powder into your so you get hours of relief, day or night. Eating whole grain foods may also protect brain favorite soup or stew can help with heart Free Trial Sample cells from damage for a kick of fl avor. health and may even 800-448-1448 from certain diseases, lower the risk of getting www.OraMoist.com such as Parkinson’s type 2 diabetes. Eating ❿ disease, as well as Cocoa powder whole grains also helps Enjoy your cocoa damage from stroke. to make sure that blood without all the guilt. MANUFACTURERS COUPON Tip: Instead of Expires 9/30/2011 fl ows to your brain. Cocoa powder is reaching for the afternoon Redeemable only at Lack of enough blood thought to contain coffee to perk you up, fl ow to the brain can even more antioxidants Item #542589 try a steaming cup of make it harder to think than green tea. Just 2 to green tea instead. clearly. Also, whole 3 tablespoons of plain grain foods are rich in ❽ cocoa powder may keep carbohydrates, which the Nuts and seeds blood fl owing to the Nuts and seeds are full of on brain uses in the form brain and help with nutrients that are good OraMoist of glucose for energy. memory and thinking. for your brain, such as Tip: Unsure if something vitamin E, B vitamins, Tip: Make your is a whole-grain food? zinc, magnesium, own cocoa with cocoa Look at the fi rst ingredient. unsaturated fat and powder, the sweetener It should be whole grain, omega-3 fatty acids. Most of your choice and such as whole wheat fl our, nuts and seeds are healthy skim milk or low- rolled oats or barley. choices. Try almonds, fat soy milk.

DIABETES & YOU 33 diabetes care

THE BENEFITS OF SMALLER NEEDLES Long needles can be scary. There is also another problem when using a long needle to take shots of injected A MORE medicine and insulin. These medicines must be injected into comfortable the area right under your skin and above your muscles. Long needles make this more needle diffi cult, but the new, By Joy Pape, RN, BSN, CDE, WOCN, CFCN smaller needles deposit insulin in the proper area under the skin of adults 18 years and ohn has had type 2 said to his doctor, “You’re why you can’t take these older whether they are diabetes for seven right, I hardly felt a thing. medicines by mouth. Both slim, average weight, years. For the fi rst six Why did I wait so long?” insulin and the injected overweight or obese. Jyears he managed his GLP-1 medicines are blood glucose levels by WHY A NEEDLE? hormones that if taken by FEAR OF NEEDLES eating healthy, being You may wonder why you mouth would be destroyed Many people are afraid active and taking oral have to take a shot and by your digestive system. of shots. This fear can medicines. For the past hold you back from year, though, it seems managing your diabetes that no matter what well. However, the he does on his own to TIPS FOR USING PEN newest needles, used improve his numbers, NEEDLES WITH YOUR PEN for pen devices, are they remain high. 4 ❶ Use a new pen needle in the same area, at the shorter, thinner and John’s doctor told him each time you take a shot. same time of day. For more comfortable than either insulin or an Needles have a coating example, if you take a shot previous needles. This injected diabetes medicine that can wear off after the before breakfast, inject can help you get over might help him and first use, which can make it on the left side of your your fear and help you recommended he take the injection more painful. stomach. If you take a shot feel better. them with a device called A new needle is sharper. at dinner, inject it on the a pen, that looks like a Sharper needles enter your right side of your stomach. REACH YOUR TARGET writing pen, rather than skin easier, so you should When your blood a vial and syringe. John feel less pain. And, small, ❹ Don’t throw pen glucose level is closer to asked, “Doesn’t the pen thin needles can bend if you needles directly in the your target range, you use a needle?” “Yes,” his use them more than once. trash. Put them in a will most likely fi nd doctor answered. “But strong plastic bottle that you have more energy. there is a new needle ❷ Choose your pen your needle cannot poke You may also fi nd that for pen devices so small needle. There are several through. Make sure it has other problems improve (4mm) and comfortable, sizes and brands of pen a cap so your needles too—if your vision is my patients tell me they needles that can work will not fall out. Do not blurry, for example, it hardly feel it.” John trusted with your insulin pen. recycle this container. may improve. Or if your his doctor and agreed to You can also ask your feet or fi ngers tingle take an injected medicine. ❸ Change injection Walgreens pharmacist due to high glucose, After using the pen device sites. If you take more how to dispose of your the tingling may with the new needle, he than one shot a day, inject pen needles safely. go away.

34 Summer 2011 DIABETES & YOU nutrition

TIPS HOW DO I KNOW IF Q FOR USING THE PRODUCT IS SAFE? NATURAL Watch out for products 7 natural PRODUCTS WISELY: A that claim to have the answer or the cure for ❶ Read up about the diabetes. As of today, there supplements you plan is no cure that you can to use. products ❷ Think about what you buy in any store or from are they for you? the Internet. While some hope to achieve when of these products may be you take these products. By Janis Roszler, RD, CDE, LD/N harmless, they may not ❸ If you and your work well or may cause health care team feel that Many people with diabetes look to natural products problems when you take some of these items are and vitamins for added help with their diabetes. them with other medicines.  ne for you, start with And with good reason—some of these products can Walgreens carries a line of a single product—do be very helpful. But some can make your diabetes vitamins and supplements not begin with more called Finest Natural. medicines less eff ective or harm you. Before you than one at a time. These products have try any such products, ask these questions: ❹ Keep track of how passed many tests that you feel when you use the check their quality, safety item and decide if it does Q DOES THIS and purity and they are what you expect it to do. PRODUCT WORK? “pharmacist recommended.” ❺ Follow the label Some companies quote After all, you only hear Finest Natural brand guidelines. Do not stories from people who from those for whom it supplements can be A take a larger dose. loved using their product. worked. Instead, look one of the many tools

But these stories are not the for a note from a reliable you use to help manage ❻ Make a record of the best source of information. member of the health your type 2 diabetes. natural products you care community. Doctors, Talk with your provider or use, their brand names, dietitians and pharmacists Walgreens pharmacist about ingredients, doses taken know how to check whether a natural product and the dates you started. products to see if they work. is safe for you and is a good ❼ Report any side value for your money. e ects to your health care provider and stop using any item if you begin to have problems or side e ects.

36 Summer 2011 DIABETES & YOU diabetes care

When Frank’s doctor and other DOES YOUR STORY KEEP YOU UPDATE members of his healthcare team asked FROM REACHING YOUR GOALS? him to try a new task, he was sure he Take these next steps and would fail. He truly believed he was see what happens: unable to stick to anything. But was that really true? I met with Frank and Who are you? Describe yourself your asked him to list a few things he does and tell your story. Such as this: often. “I am a person who can’t stop Here is his list: eating.” ✔ I go to work each day. story ✔ I attend church Sunday Now, take your story and prove it mornings. wrong. On a piece of paper, list the times when you do stop eating, such as By Janis Roszler, RD, CDE, LD/N ✔ I call my mom every few days while you are on the phone, in the car, to see how she is doing. at a concert, at church, in a library or ✔ I brush my teeth a few times f you have a hard time at the doctor’s offi ce. If you are able to each day and fl oss before bed. stop eating sometimes, you are able to reaching your current health ✔ I kiss my wife as I go out stop eating at other times also. You can I goals, don’t worry. Success the door each morning. stop if you feel it is important to do so. can be as easy as changing the Frank completes these tasks regularly, Now, correct your story to tell without fail. He does them because he story you tell yourself each the real truth about yourself: thinks they are worth doing. So that day. Take Frank, for example. is the real fact: He can stick to certain “I am a person who can stop Every day, Frank told himself actions and get them done. He just eating when I want to.” the same story: “I can’t stick doesn’t realize he is a doer. Once he sees this, he can be much more Frank made some changes and you to anything. I’m hopeless. I open to trying the diabetes care can too. Don’t take a huge step, but don’t exercise, I don't follow actions he knows are choose one task. For example, use your my diet, I don’t always take important and really meal plan for breakfast only. Once you wants to do. do that for several days, add lunch to my pills, and often forget your list. Then you can say you are a to check my blood person who uses a meal plan. glucose. My health team What kind of story do you tell yourself each day? Is it a correct one? should stop helping Does it help you or does it hinder you me. They should from meeting your goals? Don’t let the save their advice for story you tell yourself keep you from caring for your health. Create a new someone who is able story that can help you be in charge to do what they say.” of your diabetes and feel good about yourself and what you can do.

38 Summer 2011 DIABETES & YOU