Families with Diabetes 2020 Families with Diabetes Including Special Medical Device Chart for Your Pet

COMPLIMENTS OF YOUR HEALTH MART PHARMACY PLEASE TAKE ONE

INVESTIGATE. INFORM. INSPIRE. FAMILIES WITH DIABETES 2020 FAMILIES WITH DIABETES INCLUDING SPECIAL MEDICAL DEVICE CHART FOR YOUR PET

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INVESTIGATE. INFORM. INSPIRE.

Publisher / Editor-in-Chief Nadia Al-Samarrie ADVISORY BOARD Contributing Editor Patrick Totty ENDOCRINOLOGY ADVISERS PUBLIC HEALTH EDUCATION DOCTOR OF NURSING Creative Director Susan Pinkerton Richard K. Bernstein, ADVISER PRACTICE MD, FACE, FACN, CWS, Frederick S. Mayer, RPh, Jane Je rie Seley DNP MSN Advertising Sales & Business Development Nadia Al-Samarrie FACCWS MPH. MPH GNP CDE BC-ADM CDTC [email protected] Diabetes Center President, PPSI/PCDE FAADE FAAN Mamaroneck, NY San Rafael, CA Dr. Kathleen Pal yo DNP Accounting “Matt” Mathewson Nancy Bohannon, BC-ADM PUMP THERAPY ADVISER MD, FACP, FACE Online Media Coordinator Spencer King PUBLIC HEALTH EDUCATION Monteagle Medical Center Bruce W. Bode, MD ADVISER Circulation Miranda King San Francisco, CA Atlanta Diabetes Association [email protected] Atlanta, GA Frederick S. Mayer, RPh, MPH. Daniel Einhorn, MD, FACE President, PPSI/PCDE Medical Director PSYCHOSOCIAL ADVISER San Rafael, CA Scripps/Whittier Diabetes Institute William H. Polonsky, PhD, La Jolla, CA PUMP THERAPY ADVISER CDE Diabetes Health O ce Bruce W. Bode, MD Allen B. King, MD, FACE, CDE Clinical Professor of Psychiatry P.O. Box 1199, Woodacre, CA 94973-1199 Atlanta Diabetes Association Medical Director University of California Phone: 415-488-4526 Atlanta, GA Diabetes Care Center San Diego, CA Website: www.diabeteshealth.com Salinas, California PSYCHOSOCIAL ADVISER PHARMACY ADVISERS Subscription Services: Peter Lodewick, MD William H. Polonsky, PhD, CDE Please visit our website at diabeteshealth.com and click on the “subscribe Now” link in the upper Medical Director John R. White, Jr., PA, Clinical Professor of Psychiatry right hand-side, or you may email us at [email protected], or send $30.00 for a 1-year Diabetes Care Center Pharm.D, University of California subscription, $45.00 for a 2-year subscription, or $60.00 for a 3-year subscription to the address above. Birmingham, AL Professor, San Diego, CA Dept. of Pharmacotherapy, College PHARMACY ADVISERS Copyright ©2020 by King’s Publishing, Inc. All rights reserved. Alan Marcus, MD of Pharmacy South Orange County Washington State University John R. White, Jr., PA, Diabetes Health is published quarterly by King’s Publishing, Inc. P.O. Box 1199, Woodacre, CA 94973-1199 Endocrinology Spokane Pharm.D, ISSN# 1550-2899 Laguna Hills, CA Spokane, WA 99210-1495 Professor, Dept. of Pharmacotherapy, College Robert J. Tanenberg, Buy a Friend a Subscription of Pharmacy MD, FACP EXERCISE ADVISERS United States: 4 print issues: $30.00 or more or 6 digital issues: $11.95 Washington State University Professor of Medicine, Section of Kris Berg, EdD Spokane Update Your Address Endocrinology Professor, Physical Ed. Dept. Spokane, WA 99210-1495 Send address changes to Diabetes Health, P.O. Box 1199, Woodacre, CA 94973-1199. Brody School of Medicine, East University of Nebraska at Omaha Carolina University Omaha, NE EXERCISE ADVISERS Reprint Requests: Greenville, NC Kris Berg, EdD Please send e-mail to: [email protected]. Sheri Colberg-Ochs, PhD Professor, Physical Ed. Dept. Reproduction in whole or in part is prohibited without prior written consent. NEPHROLOGY ADVISER Associate Professor of Exercise University of Nebraska at Omaha Science Mission Statement Robert C. Stanton, MD Omaha, NE Chief of Nephrology Old Dominion University Diabetes Health is the essential resource for people living with diabetes—both newly diagnosed and Sheri Colberg-Ochs, PhD Joslin Diabetes Center, Norfolk, VA experienced—as well as the professionals who care for them. We provide balanced expert news and Associate Professor of Exercise Assistant Professor, Science information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of Harvard Medical School PEDIATRIC EDUCATOR Old Dominion University new products, research, treatment options, and meaningful lifestyle issues. Boston, MA ADVISERS Jean Betschart Roemer, Norfolk, VA Letters to the Editor NEUROPATHY ADVISER MSN, RN, CPNP, CDE PEDIATRIC EDUCATOR Send letters by e-mail to [email protected]. or mail letters to: Editor, P.O. Box 1199, Children’s Hospital of Pittsburgh ADVISERS Woodacre, CA 94973-1199. All letters and e-mails should include the author’s full name, address, and Aaron Vinik, MD, PhD Director, Pittsburgh, PA home telephone number. Letters may be edited for clarity and length. Publication of advertisements and Jean Betschart Roemer, Diabetes Research Institute MSN, RN, CPNP, CDE product pro les does not necessarily constitute endorsement of a product or service by this organization. Denise Richards,MSN, Eastern Virginia Medical School FNP, CDE Children’s Hospital of Pittsburgh Information in Diabetes Health is in no way intended to initiate or replace your healthcare professionals’ Norfolk, VA Mass. General Hospital for Children Pittsburgh, PA therapy or advice. Pediatric Endocrinology Boston, MA Denise Richards,MSN, DIABETES EDUCATION ADVISER Subscription Problems or Updates: FNP, CDE email [email protected]. Gary Arsham, MD, PhD Mass. General Hospital for Children California Paciﬁ c Medical Center Pediatric Endocrinology Boston, MA San Francisco, CA

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Families With Diabetes

INVESTIGATE. INFORM. INSPIRE. In This Issue

16 6 FEATURES 16 Managing Your Pet’s Diabetes DEVICE & MEDICATION UPDATE • According to the American 12 Smart Insulin Delivery Pen Veterinary Medical Association, 6 You’ve Just Been Diagnosed • Insulin pens are one of the best ideas around 1 percent of dogs who with Type 2: Five Things to ever to come down the pike in the reach 10 years of age will develop diabetes world. Keep in Mind diabetes. • It doesn’t matter whether your 24 Successfully Juggling My Family 14 Two Answers to Extremely doctor looked you in the eyes with Severe Hypoglycemia a kindly gaze when he dropped the and Job • Diabetes patients have witnessed bomb, or he just told you straight • In hindsight, Brianna wasn’t many technological leaps forward with no preliminaries: “ You have surprised because there is through the years—blood glucose diabetes.” diabetes on her father’s side of the monitors, long-lasting insulin. family. Her paternal grandfather 10 The Genetic Component to and her aunt were both type 1. 20 Medical Devices for Dogs and Children with Diabetes 26 My Diabetes Tribe Cats with Diabetes • Nadia's personal history with • The latest on diabetic devices for • Scientists at the University of diabetes. Virginia have developed an your pets. inexpensive test that can detect a 28 A Message for Moms and Dads genetic predisposition for type 1 • In 1992, at the age of two, my 22 The New and Improved diabetes, the variety of diabetes little girl was diagnosed with type Insulin Pumps that most often manifests in 1 diabetes. I have stood in your children and adolescents. parenting shoes. I asked the same 30 Type 2 Medications questions you do. • One recent theory about how type 2 diabetes arises is that disruption COLUMNS MEET LANCE™ PULL OUT in the circadian rhythm—the See the pull out inside for education Making a Di erence body's inner "clock"—aff ects on Health Mart® brand products what has been called metabolic including money saving coupons! 5 Letter From the Publisher syndrome, the collection of risk • Families with Diabetes factors that often lead to diabetes and cardiovascular disease.

4 www.DiabetesHealth.com / DIABETES HEALTH Making a Difference

families with Diabetes (both the 2-legged and 4-legged kind)

a hypoglycemic episode is so dire that you go and whomever conventional treatments may not be Wherever you talk to it becomes enough to avert a coma or a life-threatening Nadia Al-Samarrie was apparent that family is probably the most circumstance? important treasure in anybody's life. Ask not only born into a family the college kid away from home for the fi rst And pets! "Managing Your Pet's Diabetes" with diabetes, but also time, or the soldier stationed thousands of on page 16, and "Medical Devices for Dogs married into one. miles from home. Even the most glamorous and Cats with Diabetes" on page 20 off er She was propelled at a or well-heeled people breathe a sigh of relief solid, insightful, and immediately useful young age into “caretaker and relaxation when they can leave the world information for addressing what can at fi rst mode,” and with her behind and return to their families. be a very puzzling, very challenging situation: knowledge of the scarcity How do you treat a family member who can't of resources, support, and For people with diabetes, families are crucial. talk and tell you his symptoms or say that understanding for people They provide the warmth, the loving support, something's wrong? and the genuine concern that only those with diabetes, co-founded closest to them can provide. Managing If you are newly diagnosed as having type Diabetes Interview–now diabetes is a tough slog made much easier 2 diabetes, our contributing editor Patrick Diabetes Health magazine. when loved ones are there to help. Totty has some useful, hard-won advice to Nadia’s leadership off er in, "You've Just Been Diagnosed with has spanned 30 years, The theme of this issue of Diabetes Health Type 2: Five Things to Keep in Mind" on establishing the magazine is families—and pets—with diabetes. (We page 6. It's reassuring to know that as you as a preeminent consumer include dogs and cats because so many gain experience managing your diabetes and professional resource. of us genuinely regard our four-legged your confi dence in your own ability to do so companions as members of the family.) increases considerably. Under her reign- DiabetesHealth.Com was Three of our featured articles directly address Don't miss our update on "The New and named " Best Diabetes Blog the challenges and rewards of family life when Improved Insulin Pumps" on page 22, "Insulin for 2019" by Healthline and a member has diabetes: "Successfully Juggling Delivery Pens" on page 12, and "Type 2 Diabetes Health magazines My Family and Job" on page 24; "My Diabetes Medications" on page 30. was named one of the top Tribe" on page 26; and "A Message for Moms 10 magazines to follow and Dads" on page 28. Each article has a The Meet Lance Pull-Out inside this issue in the world for 2018 by slightly diff erent take on the family theme. o ers some great advice for people just Feedspot Blog Reader. starting their journey managing diabetes, A very important feature article is "The as well as some very useful Health Mart Genetic Component to Children with brand coupons. Diabetes" on page 10. Another is "Two Answers to Extremely Severe Hypoglycemia" nadia Al-samarrie, founder, Publisher, on page 14. Where do you turn when Editor-in-chief

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You’ve Just Been Diagnosed with Type 2: Five Things to Keep in Mind

Patrick Totty about diet, exercise, and medications. But at this moment of mental disarray, chances are what your doctor says to you will sound just been diagnosed like noise. Understand that it’s going to take You’ve with type 2 diabetes. some time for you to properly absorb the tsunami of information that will now start It doesn’t matter whether your doctor surging your way. looked you in the eyes with a kindly gaze when he dropped the bomb, or he just told The second source of information you’re go- you straight with no preliminaries: “you have ing to reach out to so you can get a grasp on diabetes.” type 2 is the Internet. You’ll scour sites like this, and the Mayo Clinic’s, and the American If you’re feeling shell-shocked Diabetes Association's. there’s another crucial right now, it’s a perfectly nor- thing you must-do if mal reaction to the news that It’s a good move. Starting a systematic you are going to be has just turned your life upside search for facts is a signifi cant fi rst step. (and feel) successful down. Not only do you have at managing your this new stress added to your Now, there’s another crucial thing you diabetes: Become life, but you also have to fi gure must-do if you are going to be (and feel) as informed about out how to deal with it. successful at managing your diabetes: Become as informed about your diabetes your diabetes as Most likely, you’re starting as your doctor and the other healthcare your doctor and the from scratch and don’t know professionals you’ll be dealing with. other healthcare much about the disease. Your professionals you’ll be fi rst source of advice will be That sounds absurd, doesn’t it?. After all, dealing with. your doctor, who will tell you your doctor, endocrinologist, and certifi ed

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diabetes educator have studied for years to learn about and understand as much as possible about diabetes-a disease the ancient Greeks were writing about as long as 2,500 years ago. How are you going to match their insights and knowledge? years for its adverse eff ects to reach the point where they create serious health prob- The answer is in the description: your lems. That means you have time to experi- diabetes. ment with diet, exercise, and medications to understand which combination of them When fi rst diagnosed with type 2 diabetes, works best to slow down and sometimes most people share general symptoms: insu- even halt-the advance of the disease. lin resistance and high blood sugar, an often-sedentary lifestyle, or too much weight, 2. technology is on your side— But despite all that we or an unhealthy diet. The tools for managing and medi- have in common, we are cating type 2 have come a long all unique. How each of But despite all that we have in common, we way over the past 30 years. Blood are all unique. How each of us responds to glucose meters are lightweight, ac- us responds to a change a change in diet, or medications, or exercise curate, and covered by almost all in diet, or medications, or will be diff erent. There is no one-size-fi ts-all health insurance plans. Drugs such exercise will be diff erent. therapy for type 2. Finding that “custom fi t” as metformin and sulfonylureas are there is no one-size-fi ts- for your type 2 will be your main task over relatively inexpensive and eff ective all therapy for type 2. the next few months. in managing the early stages of type finding that “custom fi t” 2. Later, if you need to start taking Here are fi ve things to keep in mind as you insulin, there are eff ective manmade for your type 2 will be begin dealing with and managing your dis- insulins to choose from, with more your main task over the ease: in the pipeline. Incredible thin- next few months. needle technology has made self- 1. time is on your side-Diabetes is called injection virtually pain-free-stings, a “progressive disease” in that it often takes yes, wincing pain, no.

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cure. In the fi rst instance, you’ll probably be invited to buy a book, product, or seminar as the price for fi nding out how to reverse type 2. 3. there's a scientist in you that can look for patterns— One simple fact about us In the second, when you read reports about humans makes almost every one of us a closing in on a cure, take them with a grain scientist: We detect patterns better than any of salt. Good researchers are very tentative other creature on the planet. Our ability to about how they describe possible break- observe is second to none. Bring that ability throughs. However, public relations people to bear on managing your diabetes. Track and fundraisers aren’t so reluctant. Their your blood sugar numbers with how much goal is to cover their bosses in glory or shake you eat, exercise, and medicate. It takes a the tree for more grants and funding. Just month or two to detect consistent keep that in mind. Good researchers patterns, but when you fi nd them, are very tentative they will help you immeasurably in 5. Don't be intimidated— You're going to about how they dealing eff ectively with type 2 and be inundated with new terminology and surrounded by people who know a lot more describe possible building the confi dence that you can. about diabetes in general than you do. But breakthroughs. 4. Be alert and resist pie in the in anything we do for the fi rst time, we're However, public sky— Now that diabetes is on your novices. It takes a while to get up to speed. relations people and mind, you’ll start noticing a lot more As you do, remember the advice above: fundraisers aren’t so discussions and advertisements You’re trying to learn as much as pos- reluctant. their goal is about it. It’s like when you buy a new sible about your diabetes, which is to cover their bosses car-you suddenly notice how many something you'll become expert at soon enough. Others may have greater medical in glory or shake the of your car’s make are on the road. knowledge of your condition, but you tree for more grants Be wary of claims from people or or- will have a fi ne-tuned, hard-won intimate and funding. Just ganizations that say they know how understanding of your unique version of keep that in mind. to reverse diabetes or are “close” to a type 2.

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Feature

the Genetic component

to children with Stephen S. Rich, director of the Center for Public Health Genomics at the University of Diabetes Virginia and leader of the team that developed the test, has said it would likely cost Tanya Caylor around $7. Periodic follow-up testing for at the Univer- antibodies associated with type 1 diabetes Scientists sity of Virginia costs around $75. Earlier this fall, Rich said have developed an inexpensive test that can his team had recruited about 2,000 children detect a genetic predisposition for type 1 for a more extensive study of the tests’ ef- diabetes, the variety of diabetes that most fectiveness. often manifests in children and adolescents. The stakes are enormous because nearly Identifying this genetic risk doesn’t enable half of all children who develop type 1 dia- doctors to prevent or cure type 1 diabetes. betes don’t realize they have diabetes until But the earlier it’s caught, the less likely it is hospitalized with diabetic ketoacidosis, a to be life-threatening. Studies with immu- condition that puts them at risk of coma and notherapy drugs have also demonstrated even death. the potential for delaying the onset of the disease. In one study presented over No single gene is responsible for elevating the summer at the American Diabetes As- a child’s risk of developing type 1 diabetes; sociation’s 79th Scientifi c Sessions in San investigators have dis- Francisco, at-risk participants who took the the American Diabetes covered dozens of gene drug teplizumab were signifi cantly less likely Association says that in type 1 variations that can con- to develop type 1 diabetes for seven years tribute to an increased diabetes, children must inherit than participants who took a placebo. susceptibility to type 1 some genetic susceptibility diabetes. The test devel- The American Diabetes Association says from both parents. Even then, oped at the University that in type 1 diabetes, children must in- genetics alone is not enough to of Virginia looks at all herit some genetic susceptibility from both cause type 1 diabetes. Because those known gene vari- parents. Even then, genetics alone is not most people who are at risk do ants; scientists say that enough to cause type 1 diabetes. Because not get diabetes, researchers the test detects about most people who are at risk do not get dia- want to fi nd out what the 90 percent of the known betes, researchers want to fi nd out what the environmental triggers are. genetic risk. environmental triggers are.

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One possible trigger might be related to cold weather. Type 1 diabetes develops more often in winter than summer and is more common in colder climates. Another trigger might be viruses. Perhaps an infec- tion that has only mild eff ects on most peo- The risk factors the Mayo Clinic cites, in addi- ple triggers type 1 diabetes in others. tion to weight, inactivity, and family history, include: Early diet may also play a role. Type 1 diabetes is less common in people who were • Ethnicity. People of certain ethnicities breastfed and in those who fi rst ate solid — including African-Americans, Hispan- foods at later ages, according to the ADA. ics, Native Americans, Asian-Americans, and Pacifi c Islanders — are more likely to The role genetic inheritance plays in type develop type 2 diabetes. Scientists don’t 2 diabetes is more variable, ranging from know precisely why some ethnic groups about 30 percent to 70 percent. As in type appear to be more susceptible. 1 diabetes, the most apparent evidence not long ago, type for the role of inheritance is found through • Age and sex. Many children develop 2 diabetes was studying how often identical twins develop type 2 diabetes at the start of puberty. type 2 diabetes. Adolescent girls are more likely to de- called “adult-onset velop type 2 diabetes than are adoles- diabetes.” the Not long ago, type 2 diabetes was called cent boys. increasing incidence “adult-onset diabetes.” The increasing inci- of type 2 diabetes dence of type 2 diabetes among children • Birth weight and gestational diabetes. among children and and adolescents is likely related to a rise in Low birth weight, as well as having a adolescents is likely obesity in young people. mother who had gestational diabetes related to a rise in during her pregnancy, are both associ- The Mayo Clinic notes that researchers don’t ated with a higher risk of type 2 diabetes. obesity in young completely understand why some children people. develop the condition, and others don’t, As is the case with adults who have type even when they have similar risk factors. 2 diabetes, the Mayo Clinic counsels par- But knowing the risk factors and steering ents that helping children cultivate healthier children toward healthier living is a sound lifestyles can reduce the need for medica- preventative prescription. tion to control diabetes.

www.DiabetesHealth.com / DIABETES HEALTH 11 Medical Device Update smart insulin Delivery Pen Diabetes Health Staff

These days, smart-pen manufacturers have added some wonderful new features to their medical devices. These include tracking doses, so that users know at what time these days, smart- pens are one of the they injected themselves, the dosage and pen manufacturers Insulin best ideas ever to how much medication is left. have added some come down the pike in the diabetes world. wonderful new They can be preloaded so that users know They can also communicate with your exactly the amount of medication they're smartphone, which means that you not only features to their injecting. They're simple and easy to use: can create your own data fi le but also send it medical devices. Put the pen up against the injection spot to your healthcare provider or people close these include and press a button to send a medication to you who need to be kept updated on tracking doses, so on its way. your diabetes therapy. that users know at what time Their simplicity and reliability make it There are even "bolus advisers" that can rec- they injected much easier for visually impaired diabetes ommend how much bolus insulin to inject patients to trust that they are receiving based on your prior smart pen communica- themselves, the correct dosages. Sighted people with tions with your smart phone and diabetes dosage and diabetes cannot see the needle, which database; a useful feature since titrating how much eliminates the visual clue that leaves some one's way to fi guring out ideal dosage can medication is left. patients feeling reluctant to inject. be frustrating.

Smart Insulin Delivery Pen Manufacturer Product Product Information Reusable InPen from Companion Medical, the rst FDA-cleared smart insulin pen paired with an intuitive diabetes management app - giving you more insights Companion Pen than ever before. Medical Injector InPen from Companion Medical, the rst • Calculates and automatically logs new doses • iHealth Smart FDA-cleared smart insulin pen paired with an • Shares your data easily with your healthcare • One Drop Chrome intuitive diabetes management app - giving provider • One Touch Verio® Flex you more insights than ever before. • One Touch Verio® Sync Imports glucose data from: Smart insulin pens o er several • Accu-Chek® Aviva Connect Data can be shared with: advantages over conventional diabetes • Accu-Chek® Guide • Glooko pen or syringe injections: • AgaMatrix Jazz Wireless 2 • Dexcom Clarity • Tracks active insulin and displays it directly • Contour Next One • Tidepool on your smart phone • Dexcom G5® • Or any app that supports insulin data from • Sends dose reminders • Dexcom G6® Apple Health

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Medication Update

Two Answers to Extremely Severe Hypoglycemia GVOKE™ and BAQSIMI™: Two Important New Solutions to Glucagon Delivery Diabetes Health Staff

now, for people who want the certainty of seeing the glucagon go in the body and patients have pushing it in with their thumb. Diabetes witnessed many • GVOKE HypoPen (single-use auto-injector), technological leaps forward through the available starting in July 2020, for people years—blood glucose monitors, long-lasting who want the certainty of an injection, but insulin; insulin pumps offering don’t want to see the needle. Diabetes patients the person with diabetes more have witnessed flexibility and the ability to be dis- GVOKE is not recommended for people many technological creet. The latest breakthrough is who have weak adrenal glands or have leaps forward one that addresses a fundamental glucagonoma or insulinoma. concern every person with diabe- through the tes has: What happens if I experi- BAQSIMI Nasal Glucagon years—blood ence a hypoglycemic episode so low The other glucagon breakthrough is glucose monitors, that conventional treatments like BAQSIMI, a nasal powder produced by Eli long-lasting glucose tabs aren’t enough to save Lilly. It is delivered through the nose but insulin; insulin me? with no need to inhale. When it comes pumps offering into contact with nasal membranes, the person with There is now a new answer: BAQSIMI is absorbed instantly into the GVOKE, a new form of glucagon bloodstream. Baqsimi is not recommend diabetes more that is radically different than tra- for people who experience weak adrenal flexibility and ditional glucagon kits. GVOKE is a glands or have glucagonoma or insulinoma. the ability to be liquid glucagon that is premixed, discreet. prefilled and premeasured. That Another advantage of BAQSIMI is it can be means no reconstitution in the taken if a user has nasal congestion or cold. moment of an emergency. And, it’s room- Both forms of glucagon offer the first truly temperature stable for 24 months. novel approaches in years to glucagon delivery. Check with your local pharmacist GVOKE comes in two forms: about their availability and a more detailed • GVOKE PFS (pre-filled syringe), available discussion of how to use them.

14 www.DiabetesHealth.com / DIABETES HEALTH Glucagon Treatments for Severe Hypoglycemia

Carbs Form (in Calories Product Name/ Doses Temperature Where (Injection/ grams) per Indications for Use For More Information Manufacturer Available for Storage Available Nasal) per Dose Dose

Injected 0.5mg and N/A N/A Used to treat very low Store in room Available Xeris 1mg blood sugar (severe temperatures with a Pharmaceuticals hypoglycemia) in pediatric between 68º F to prescription GvokeTM PFS and adult patients with 77º F up to at pharmacy diabetes ages 2 years and 24 months. retailers (Pre-Filled Syringe) www.GvokeGlucagon.com above Do not nationwide. ( 877) 937-4737 Gvoke HypoPenTM refrigerate. (Auto-Injector) - available July 2020

Dry Nasal 3mg N/A N/A Used to treat very low Store in Available Spray blood sugar (severe temperatures with a BAQSIMI hypoglycemia) in people up to 86º for prescription Eli Lilly with diabetes 24 months. at pharmacy www.baqsimi.com Glucagon Nasal ages 4 years and above. Refrigeration is retailers (800) 545-5979 Powder not required. nationwide.

Injected 0.5mg and N/A N/A Used to treat insulin Store in room Available 1mg coma or insulin reaction temperatures with a resulting from severe between 68º F t o prescription hypoglycemia (low blood 77º F up to at pharmacy sugar). Give Glucagon if 24 months. retailers Eli Lilly the person is unconscious, nationwide. www.glucagoninfo.com Glucagon having a seizure, or if (800) 545-5979 repeated administration of sugar or sugar-sweetened product does not improve the person's condition.

Injected 0.5mg and N/A N/A Used to treat very low Store in room Available 1mg blood sugar (severe temperatures with a hypoglycemia) caused by between 68º F to prescription insulin use. A GlucaGen 77º F up to at pharmacy injection should be given if 24 months. retailers Novo Nordisk www.GlucagenHypoKit.com the person is unconscious, nationwide. Glucagen (800) 727-6500 is having a seizure, or is disoriented and unable to eat sugar or sugar- sweetened products.

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Bricker knows the diligence involved in successfully managing diabetes is worth it. Both dog and owner have lived longer, healthier managing Your Pet’s lives than their doctors initially expected. “It probably helps that I know what to watch Diabetes for,” the Bluff ton, Ind., woman says. Tanya Caylor According to the American Veterinary Medi- cal Association, around 1 percent of dogs When her dog Taser began drinking and who reach 10 years of age will develop urinating excessively, owner Linda Bricker diabetes. Estimates for cats range from 1 suspected her dog has diabetes. in 50 to 1 in 500. The good news is that pet diabetes is managed with many of the same How did she know? Taser’s symptoms were techniques humans use. similar to what Bricker experienced when she was diagnosed with diabetes. The earlier diabetes is diagnosed in your pet, the better. Symptoms to watch for, besides Unfortunately for Bricker, her increased thirst and urination, include: According to the American diagnosis came after a blood Veterinary medical sugar reading of 1100 sent her • Cloudy eyes (especially in dogs) into a diabetic coma. Then 13, Chronic or recurring infections of the skin Association, around 1 • she was not expected to live. and urinary tract percent of dogs who • Weight loss, regardless of appetite reach ten years of age Fifty-nine years later, Bricker will develop diabetes. has not only learned to live Owners should consider spaying female dogs Estimates for cats range with diabetes, but she’s also diagnosed with diabetes; veterinarians say from 1 in 50 to 1 in 500. helped her dog do so as well. this reduces hormonal changes that make the good news is that diabetes harder to manage. (For reasons that For the past six years, Bricker are not understood, diabetes develops in fe- pet diabetes is managed has fed Taser, now 13, a low- male dogs twice as often as male dogs.) with many of the same carb dog food, administered in- techniques humans use. sulin injections twice-daily, and made sure she gets exercise. continued on page 17

16 www.DiabetesHealth.com / DIABETES HEALTH www.DiabetesHealth.com / DIABETES HEALTH 1 2 www.DiabetesHealth.com / DIABETES HEALTH www.DiabetesHealth.com / DIABETES HEALTH 3 4 www.DiabetesHealth.com / DIABETES HEALTH www.DiabetesHealth.com / DIABETES HEALTH 5 6 www.DiabetesHealth.com / DIABETES HEALTH www.DiabetesHealth.com / DIABETES HEALTH 7 8 www.DiabetesHealth.com / DIABETES HEALTH www.DiabetesHealth.com / DIABETES HEALTH 9 10 www.DiabetesHealth.com / DIABETES HEALTH www.DiabetesHealth.com / DIABETES HEALTH 11 12 www.DiabetesHealth.com / DIABETES HEALTH www.DiabetesHealth.com / DIABETES HEALTH 13 14 www.DiabetesHealth.com / DIABETES HEALTH

Feature

continued from page 16

Dogs generally are diagnosed with type 1 diabetes, in which the pancreas no longer makes insulin. Cats are more often diagnosed with type 2 diabetes, in which the body can’t use the insulin it produces. How- ever, the diff erence between the two types in pets is less clear than it is in humans. found that Royal Canaan does a better job of stabilizing Taser’s blood sugar. Diabetic Though people with type 2 diabetes are pet food is high in protein and fi ber because usually started on oral blood-sugar drugs fi ber tends to digest more slowly. rather than insulin, those types of drugs don’t work well in cats, according to the Cor- Not everyone is comfortable pricking their nell University Feline Health Center in Ithaca, pet’s paw or ear to get a blood sample. N.Y. For this reason, both cats and dogs are There are many diff erent pet-specifi c blood- usually prescribed insulin to treat diabetes. glucose monitoring kits available, such as the Alpha TRAK 2 Blood Glucose Monitoring Your veterinarian may prescribe human Starter Kit (around $42 online) or recombinant insulin or Vetsulin, porcine- the VetMate Blood Glucose Moni- not everyone is comfortable origin insulin with the same amino acid toring System (around $39 online). pricking their pet’s paw or sequence as in canine insulin. This type of Human blood glucose meters ear to get a blood sample. insulin is now available in pen form (around should not be used, as they can there are many diff erent $152 for a VetPen starter kit online), with a give inaccurate readings in pets, pet-specifi c blood-glucose memory that tracks previous dosing times which have a diff erent concentra- and amounts. Always use the type of insulin tion of glucose in their blood. monitoring kits available, prescribed by your veterinarian. such as the Alpha trAK 2 Bricker relies on urine test strips Blood Glucose monitoring Bricker buys Taser’s insulin at at a local phar- to indicate whether Taser’s blood starter Kit (around $42 macy, using a prescription from her vet. She sugar is under control. online) or the Vetmate Blood estimates that each bottle lasts about two Glucose monitoring system months. According to the Drake Center, a (around $39 online). veterinary hospital in San Diego, Dog food for Bricker’s 12-lb. pooch costs $28 it’s not necessary to measure your a bag and lasts about seven weeks. She has pet’s blood glucose in between quarterly used Science Diet in the past but has since vet visits if you monitor your pet’s weight,

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be more challenging to engage in exercise, consider toys that encourage hunting-style play. appetite, fl uid intake and urine output. One way to tell if your pet’s diabetes is under Melissa Toetz encouraged her diabetic cat, control is to check for glucose in the urine. Goliath, to go up the stairs in her home to There are pet-specifi c urine test kits on the boost his exercise. Thanks to vigilant care, market, such as the Coastline Global Check- including diabetic cat food and regular test- up Kit At Home Wellness Test ing of his urine, Goliath’s type 2 diabetes melissa toetz for Dogs (around $13 online). eventually was stabilized, he was able to get encouraged her However, human urine test off insulin entirely. The 26-pound kitty ulti- strips available at any phar- mately lived to age 13, which is within the diabetic cat, Goliath, macy work just fi ne. normal range for an indoor cat. to go up the stairs in her home to boost his If your pet isn’t showing Because both Taser and Bricker have type exercise. thanks to signs of high blood sugar, the 1 diabetes, they will remain insulin-depen- vigilant care, including Drake Center recommends a dent for life. diabetic cat food and quarterly blood glucose test regular testing of his performed by a veterinarian. If Though Bricker adores “her baby,” she glucose is detected in the urine avoids giving Taser treats because she urine, Goliath’s type for two consecutive days, how- knows that would only hurt her. Instead, 2 diabetes eventually ever, it’s time to call the vet. much as she’s learned to satisfy her cravings was stabilized, he was For both dogs and cats, daily with a single 15-carb plain cake doughnut, able to get off insulin exercise helps burn off excess she’s taught her family to give Taser only entirely. blood sugar. Because cats can meat and veggies as table scraps.

18 www.DiabetesHealth.com / DIABETES HEALTH www.DiabetesHealth.com / DIABETES HEALTH 19 Medical Device Update for Pets

medical Devices for Dogs and cats with Diabetes Tanya Caylor

in seconds. Thanks to patented technology, this pet glucose meter requires a tiny blood BlOOD GlucOsE mOnitOrs: sample of only 0.3 µL, making it a less pain- CareVet Blood Glucose Monitoring Kit costs ful testing experience for your pet. around $42. Kit includes a meter, 10 test iPet PRO strips, a 3-volt battery, one lancing device, Advocate Pet Test Blood Glucose Monitoring Blood Glucose Monitoring System one control solution, a quick start guide, and System for Dogs and Cats costs around $50. a comprehensive instruction manual. Kit includes a blood glucose meter, carrying case, 25 PetTest strips, 25 twist top lancets, Advocate Pet test Blood VetMate Glucose Moni- control solution, lancing device, 2 AA batter- Glucose monitoring toring System for Dogs/ ies, and an instructional DVD user's guide. system for Dogs and Cats costs around $39. It Meter has 400-test memory and can give cats costs around $50. has a measuring range of averages over seven, 14, and 28 days. Kit includes a blood 10-600 mg/dl; provides results within 5 seconds. The iPet PRO Complete Glucose Monitoring glucose meter, carrying It features an illuminated Kit costs around $71. The kit includes every- case, 25 Pettest strips, 25 LCD and hygienic test strip thing you need to begin at-home monitor- twist top lancets, control ejection. ing with your pet: meter, lancets, lancet solution, lancing device device, test strips, user guide, and carrying 2 AA batteries, and an AlphaTRAK 2 Blood Glu- case. There’s also a logbook to help you instructional DVD cose Monitoring Starter track your pet’s blood sugar readings. user's guide. Kit costs around $42. Fea- tures include an auto on/ urinE tEst DEVicEs off option for faster testing and an easy-to- Coastline Global CheckUp Kit at Home Well- use three-step process that provides results ness Test for Cats costs around $13. It aids

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lin pen designed specifi cally for use in cats in urine collection; detects certain kidney and dogs with diabetes. Similar to human conditions, UTIs, and blood in the urine, as insulin pens, VetPen is an automatic insulin well as the presence of glucose indicating delivery pen that makes giving your pet in- diabetes. sulin injections quicker, more comfortable and accurate. This kit comes with an auto- Coastline Global CheckUp Kit at Home Well- matic insulin delivery pen, a travel pouch, UltiGuard® Safe Pack ness Test for Dogs costs around $13. It aids a needle remover, a dose selector adaptor, Dispense and Dispose of Insulin Syringes in urine collection; can detect certain kidney a release button extension, and instruc- conditions, UTIs, and blood in the urine as tions for accurate administration. VetPen well as the presence of glucose indicating should only be used with 2.7 ml diabetes. Vetsulin cartridges, and Vetsulin coastline Global cartridges are designed only to checkup Kit at Petnostics Urine Collector costs around $15. be used with VetPen and 29G/12 Home wellness Hand-tool that makes it easier to collect MM pen needles. (Cartridges are test for Dogs costs your pet's urine. For use with any urine glu- sold separately). around $13. it aids cose test strips, sold separately. in urine collection; The Owen Mumford Petfi ne can detect certain PawCheck P-Scoop Dog Urine Collector Autoject 2 Injection Aid De- costs around $10, features a telescoping vice costs around $35. This auto- kidney conditions, handle, and can be used with cats as well. injector helps control the depth utis, and blood in For use with any urine glucose test strips, of your pet's insulin injection the urine as well sold separately. and includes a visible indicator as the presence of that shows when the injection glucose indicating insulin DEliVErY DEVicEs is complete. It fi ts most 1.0 ml, diabetes. VetPen Starter Kit for Dogs and Cats costs 0.5 ml, and 0.3 ml fi xed needle around $152 online. VetPen is the fi rst insu- syringes.

www.DiabetesHealth.com / DIABETES HEALTH 21 Insulin Pumps

The New and Improved Insulin Pumps Diabetes Health Staff

as the backpack-sized 1964 device), questions about their overall reliability, and cost. There was also the problem of insulin: Insu- lin at that time was not nearly as effective or 1964, "insulin pumps" were long lasting as today's bolus insulins. Until the human hand and brain. Users checked their blood sugar level, drew Pump technology is still expensive com- a certain amount of insulin into a syringe— pared with the more common tech devices often times it was an educated people with diabetes use, such as blood glu- Today's insulin guess—then injected themselves. cose meters or smart pens that relay dose pumps are small and Maybe the most trying part of the and time data to smartphones or PCs. Units discreet—so discreet routine was the needle stick. The can range in cost from $4,500 to more than that only their users daily round of sticking needles $6,000. Supplies and related add-ons can into the skin was a dreary, often cost several hundred dollars per month. For- know they are wearing painful, affair. tunately, for many people, their health insur- one. Their sturdiness ance can cover most if not all of the price. and reliability are The first insulin pump, introduced strides ahead of in 1964, never reached market. Today's insulin pumps are small and dis- earlier devices, and The device was so large and creet—so discreet that only their users know when coupled with bulky that it had to be carried in a they are wearing one. Their sturdiness and continuous glucose backpack—a turnoff to anybody reliability are strides ahead of earlier devices, who might have been a candidate and when coupled with continuous glucose monitors, they form to own one. By 1983, however, the monitors (see page 14), they form the basis the basis of what can insulin pump had become small of what can be called an artificial pancreas. be called an artificial enough to be a viable product, pancreas. followed by an implantable device Three manufacturers are in the US market: in 1984. Tandem Diabetes Care, with its t:slim X2™; Medtronic, with its MiniMed 670G™ and Drawbacks to pumps at that time included MiniMed 630G™; and Insulet with its bulkiness (although nowhere nearly as big OmniPod™.

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Feature

successfully Juggling my family and Job

Claire M. Lynch

careful about what she eats and tests her blood sugar levels often. “I don’t like to guess about my blood sugar levels,” Brianna says. “Testing them several four years old times a day is the best way to know She was when Brianna exactly what’s going on, then I adjust my Derksen’s parents took her to a doctor’s medication accordingly.” appointment. Various tests now 24, Brianna takes novolog were run and the results came Her highest A1c was 11.2%, and now it’s for her short-acting insulin back as type 1. dropped significantly. “Maintaining a low-carb diet has gotten to be routine,” and lantus for her long-acting In hindsight, Brianna wasn’t Brianna explains. “Drinking plenty of insulin. she is careful about what surprised because there is water each day is important, plus I she eats and tests her blood diabetes on her father’s side include some exercise and take my sugar levels often. “i don’t like of the family. Her paternal medication as prescribed. It’s going well.” to guess about my blood sugar grandfather and her aunt were levels,” Brianna says. “testing both type 1. She and her husband, Howie, are lifelong them several times a day is the residents of Michigan. They have a Now 24, Brianna takes young son who hasn’t started school best way to know exactly what’s Novolog for her short-acting yet, so whenever the weather is good, going on, then i adjust my insulin and Lantus for her Brianna takes him for long walks in the medication accordingly.” long-acting insulin. She is fresh air.

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Brianna, a homemaker, is employed part- time doing machine work in a tool and die shop. “Working about 30 hours a week gives me the chance to get out and focus on my job,” Brianna notes. “I get to learn new things and be with coworkers.”

She has also joined some support groups for people with type 1 diabetes near her in and take care of Brianna, a homemaker, home. “They are a good place to talk with yourself. Be proactive. is employed part-time people about any concerns I may have,” Ask for help if you doing machine work Brianna says. “When we’re discussing need it. Diabetes different issues, I get ideas about how to is manageable and in a tool and dye shop. best manage my type 1, and I also make you can live a long “working about 30 suggestions to others. The best part pain-free, happy and hours a week gives me about being in a support group is I feel content life if you the chance to get out encouraged about forging ahead and do the right things. and focus on my job,” staying on track. I get inspired.” Staying on track is key, Brianna notes. “i get to but once you get into learn new things and Her tips for other people with diabetes? a good routine, know “After your diagnosis, don’t wait to plug it can be done.” be with coworkers.”

www.DiabetesHealth.com / DIABETES HEALTH 25 Feature

my Diabetes tribe Nadia Al-Samarrie

“I ate a lot of sugar when I was younger.” I told him, “Stop blaming yourself. There is no correlation between type 1 diabetes and overeating sugar.” It made me sad to think that he believed he was at fault for has been a part his diagnosis. Diabetes of me since the 1970s. Both my grandmothers had type 2 In 1987 I married a man with type 1 diabetes. Their education was limited to diabetes. He was diagnosed at the age of “don’t eat sugar.” What did they 17. Managing his chronic illness took center in 1987 i married a man learn? Sugar causes diabetes, stage. He purchased a home testing glucose with type 1 diabetes. He a myth that many people meter that he fi rst saw on a cruise ship. was diagnosed at the still believe today. The excess After that, he always tested his blood sugar. weight gain from sugar can Knock on wood: He has had diabetes for 45 age of 17. managing his cause a diabetes diagnosis, not years now with no complications. chronic illness took center the sugar alone. stage. He purchased a In 2002, we took a family vacation to the home testing glucose Last summer, I was at a island of Kauai in Hawaii. At the luau, my meters that he fi rst saw diabetes conference in San former husband tested his blood sugar. A on a cruise ship. After Francisco. After the meetings, family sitting next to us had a young son with type 1 diabetes. They were happy to that, he always tested his I took a Lyft ride home. My driver was a twenty- meet us. Seeing a family man with type 1 blood sugar. Knock on something type 1 who was diabetes gave them hope. We normalized wood; he has had diabetes diagnosed with diabetes at diabetes. The mother turned to her son for 45 years now with no the age of 8. He shared with and said, “Look, you can have a family complications. me that he blamed himself for someday.” Until they met us, they doubted his diagnosis. “Why?” I asked. the possibility.

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Fast forward to the 1990s, my mother was diagnosed with type 2 diabetes. Eight years after that, my brother shared the same diagnosis. Fortunately for them, I became their advocate. My brother had not slept concerned about having high blood sugar. through the night for years, with bathroom Confused by their email, I wrote back, runs in the middle of the night disrupting asking, “Do you have diabetes?” “No,” the his sleep. I recommended that he see a person replied, “I had pre-diabetes.” He physician, inquire about the eﬃ cacy of his went on to say that he has lost 100 pounds current diabetes prescription. He called me with intermittent fasting and staying recently i had later to say that he was prescribed insulin, on a 40 to 60 grams of carbs per day and for the fi rst time in years, he could sleep diet. His weight loss also contributed someone email me through the night. to being able to work with his health asking for advice on care team to reduce and eventually their 5.5% A1c. they My mother, on the other hand, feared a eliminate his diabetes medications. were concerned about hypoglycemia episode. When her blood having a high blood sugar was closer to the 140 mg/dL range, Why am I bringing this up? sugar. confused by she felt she had a low blood sugar. I Connecting with other people can their email, i wrote suggested testing her blood sugar when make a big diff erence in how you she feels her blood sugar may be low. She feel. Look for people to join your back, asking, “Do you learned that her blood sugar is not as low as diabetes tribe. One small health tip have diabetes?” “no,” she thought. can change your life. People who are the person replied,” i successful in managing their diabetes had pre-diabetes.” Recently I had someone email me asking are inspiring. Their success becomes for advice on their 5.5% A1c. They were our hope.

www.DiabetesHealth.com / DIABETES HEALTH 27 Feature

A message for moms and Dads

Diabetes Dad Let me start with the last question fi rst. I just found out that my daughter is pregnant. at the age of two, In July of this year, she will give birth. She In 1992, my little girl was and her husband could not be happier. We diagnosed with type 1 diabetes. I have are a close second on that happiness. She stood in your parenting shoes. I asked the just graduated with her FNP (Family Nurse same questions you do. Practitioner) and will open her practice. Do you see the trend occurring? Her life was I wondered if she would have a normal a simple philosophy. If she wanted to do life in school? Would she date? Would she whatever it was, we not only encouraged her have friends? Could she go to do everything and anything she wanted there is an equalizer to to parties? Could she trick but helped map a roadway to get there. your child's life ahead or treat? Could she ever be with diabetes. that allowed to go anywhere There is an equalizer to your child's life without her mom or me? ahead with diabetes. That equalizer is equalizer is education. Would she get a driver's education. Learn everything you can about learn everything you can license? Would kids make this disease. Social media is an excellent about this disease. social fun of her? Would she be place to chat, but it is not the baseline for media is an excellent embarrassed about her your knowledge. There is no shortcut either. place to chat, but it is diabetes, and tell no one? Read, learn, ask questions, ask again, read not the baseline for your Would she graduate from again, and read more. Find out the correct knowledge. there is no college? Would she get a answers from professionals. job? Would she do what she shortcut either. read, wanted to do? Would she be Become a sponge. Absorb everything. Give learn, ask questions, ask looked upon as damaged your child every opportunity to forge the again, read again, and goods or ever get married? life they want. When our daughter wanted read more. Would she ever have kids? something, we fi gured out a way to say yes.

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Sometimes the only reason is to say yes. Even if there are other reasons why it may not be a good idea, but one reason may know how blessed we are. We also outweigh the others every time. know that there was much work Become a sponge. Absorb by all of us to get here today. Your everything. Give your Then our son was also diagnosed at age child will get there too. Kaitlyn said child every opportunity to 13 in 2009. We learned all over again. We in an interview with a television forge the life they want. brought him up with no boundaries, only news station years ago, "Diabetes when our daughter wanted his imagination. Two years ago, his company is what I have. It is not who I am." moved him to their corporate headquarters. something, we fi gured out He was one of the youngest employees to And that same little girl who a way to say yes. sometimes ever be in his division. taught us years ago is the woman the only reason is to say who will make us grandparents in yes. Even if there are other No Boundaries. July. reasons why it may not be a

good idea, but one reason In July, my daughter will give birth to our For more articles on parenting and may outweigh the others grandchild. She has done every single diabetes, you can visit my Diabetes thing in life she has wanted thus far. We Dad FB Page. every time.

www.DiabetesHealth.com / DIABETES HEALTH 29 Medication Update

tions that could stimulate type 2s to increase their insulin output. The fi rst medicines to do so, the sulfonylureas, were potent to the point that users were warned about hypo- type 2 medications glycemia. Later, metformin worked to reduce the liver's glucose production, thus reducing Diabetes Health Staff the body's need for insulin.

Metformin and sulfonylureas, which are of- recent theory about how type 2 ten the fi rst medications doctors prescribe One diabetes arises is that disruption for newly diagnosed type 2 patients, are in the circadian rhythm—the body's inner now old standbys. Newer GLP-1 receptor "clock"—aff ects what has been called meta- agonists stimulate the pancreas to produce bolic syndrome, the collection of risk factors more insulin. The newest GLP-1 on the mar- that often lead to diabetes and cardiovascu- ket is Ozempic®—semaglutide. lar disease. Some researchers are even calling for the phrase "metabolic syndrome" to be DPP-4 inhibitors work by inhibiting the sGlt2 inhibitors replaced by "circadian syndrome." production of glucagon, insulin's opposite, off er a novel which can counter insulin's eff ectiveness discovery of insulin in the and lead to high blood sugar levels. The four approach to blood The early 20th century saved many DPP-4 brands are Januvia®, Nesina®, Ong- sugar control by people from death. At long last there was a lyza®, Jentadueto XR®, and Tradjenta®. stimulating the medicine that removed diabetes from com- kidneys to shunt parisons with such other "wasting diseases" SGLT2 inhibitors off er a novel approach to some glucose to as cancer and tuberculosis. blood sugar control by stimulating the kid- the urinary tract neys to shunt some glucose to the urinary instead of directing But as time went on, doctors noticed a pe- tract instead of directing all of it back into culiar thing about some people with diabe- the bloodstream. The four brands now on all of it back into tes: They were resistant to insulin. But how the market are Farxiga®, Invokana®, Synjar- the bloodstream. could this be? How could a diabetic person dy®, and Jardiance®. be resistant to the one thing that actually had restored hope to people with diabetes? There are three types of combination type 2 medications: 1.) a drug and (usually) metfor- The answer was to name a new type of dia- min in pill form; 2.) basal/bolus insulin injec- betes: type 2. Unlike type 1, which scientists tion combinations; 3.) and lately Xultophy® would later discover was a genetic disease, and Soliqua®, injectables that combine a type 2 was a form of diabetes that often basal insulin with a GLP-1. developed in reaction to sedentary lifestyles and unhealthy diets. Inhalable insulin is increasingly becoming The big ray of hope for type 2 was that peo- an option for patients with type 2 diabetes. ple who had it could still produce their own Inhaled insulins are fast-acting due to its al- insulin, but were strangely resistant to it. So most immediate absorption into the blood- research focused shifted to fi nding medica- stream.

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Make 2020 Your Best Health Improvement Year by Purchasing Your copy of "Sugar Happy" from Amazon today!

There are no known cures for diabetes. Nor is it reversible. You don't get diabetes from overeating sugar. But one thing is undeniable: Diabetes complications may be preventable through education. The more you know, the better off you are.

"Sugar Happy," the semi-autobiographical account of publisher Nadia Al- Samarrie, is close, personal, and compelling. Her family experiences with diabetes started from her childhood. Nadia shares her practical insights over the years in print and online columns, in podcasts and video shows. She is an internationally recognized diabetes patient advocate. "Sugar Happy's" nine chapters cover all the topics that concern readers who experience high blood sugars. From understanding diabetes to overcoming the fears, it can produce. You can expect to read workable, proven, concrete steps for reducing and controlling blood sugars. "Sugar Happy" provides clear, plainly written insights and advice to make 2020 your best year living with diabetes.

What Do Healthcare Professionals Say About Sugar Happy? “This is a wonderful new diabetes guide written by the editor/publisher of the highly- regarded Diabetes Health periodical. It is an easy-to-read paperback, especially for those recently diagnosed or those who wish to improve their current diabetes management. It benefi ts from the author’s substantial experience with diabetes in her family. The comprehensive approach oﬀ ers many tools to help - both devices and personal tips, plus moral support. —Gary Arsham MD Ph.D. FACP

This book gives the reader a personal perspective on not only living with diabetes but also caring for someone with this disease. It is presented in a simple, easy to understand format that oﬀ ers the emotional issues that both families and those with diabetes deal with daily. Kudos to Nadia for providing this information that is useful to both professionals and nonprofessionals alike. —Dr. Kathleen Palyo DNP BC-ADM

Order "Sugar Happy" from Amazon Go to amazon.com and input Nadia Al-Samarrie- Sugar Happy, in the dialog box at the top of the page. The "Sugar Happy" review and order form will pop Go to diabeteshealth.com to watch the video right up.