WHO

Dr. Steven Edelman, MD

Founder and Director of Taking Control Of Your Diabetes (TCOYD)

POINT OF VIEW

Education, Self-Empowerment, Self-Commitment

Tell us about your experience with diabetes.

I’ve had diabetes since I was 15, and I decided at a young age that I wanted to be a diabetes specialist to help other people.  I went to UCLA undergrad and came out to UCSE in 1987.  As an endocrinologist, I run the VA intensive diabetes care clinic and a UCSB care clinic, and TCOYD.

What motivated you to start Taking Control Of Your Diabetes, or TCOYD?

As a caregiver specializing in diabetes, despite the evidence, it was tough to educate doctors.  I felt the most effective way to help patients was to establish a system that helps to educate them directly.  That is the emphasis of the organization.  There was hardly any education going on at that point.  It was hard to raise money for, and it was not a prominent issue.

What do you see as the biggest issue right now in the diabetes landscape that you feel needs to be addressed?

I still think there is a very minimal amount of education and access to education.  If you have Type 1 diabetes, there are things you can’t get as easily to support you in your everyday life.  Health care does not cover some essential necessities that patients need, forcing them to either figure out how to get them on their own or go without.  People are not getting enough access to what they need.  My hope is to inspire people to go to their caregiver, if they need to get a medication or particular device, and ask them how to get it.  I see patients getting denied too much by insurance companies, and I want to help diabetes patients take their health into their own hands.

What is something that is working right now in terms of patients taking control of their needs?

When patients fight the system constructively, we begin to see results.  When an insurance company turns down a glucose monitor for someone, this is something they have to go through the appeal process for.  This is time-consuming, but if they continue to go through that process consistently, the insurance companies begin to listen and understand that they have to make a change in order to avoid the hassle.  They will finally stop and make the change.  Doctors are spending little time on this, because they have so little time.  So patients need to empower themselves to do this and know if they do they are making a huge difference for themselves and others within the diabetes community.

They also have to work on getting their doctors on their side.  Doctors are so busy, but patients need to be persistent.  Patients can also go to their insurance company directly.  The last step is to suggest getting legal representation.  People have to be proactive and their own best advocate.

What is one program that TCOYD has to help diabetes patients learn to become their own advocates?

We have a lawyer speak at every one of our conferences.  He has diabetes and he does two workshops per day from getting insurance to negotiating with the department of motor vehicles, to anything a patient needs to know.  It’s very powerful for our community to be able to ask him these questions and get answers that move them to the next steps of stepping into their power.

What is one thing you want the diabetes community at large to take away from reading this interview?

One thing I want people to know is that knowledge is power.  They need to know more than their caregiver.  The more they trust and practice this, the more progress they will make toward leading the lives they deserve to lead, as well as motivate others to do the same.

How do your social media efforts help you in talking with your community?

We have a pretty active website and social media and we have the Edelman Report every week.  We are also starting Season 2 of Extreme Diabetes Makeover, which we’re really excited about.  It’s pretty easy to find those in need, and we have a lean and mean organization that can act on our ideas pretty quickly, which is a luxury.

What do you think about the Fit4D Pathways as a way to help larger groups of diabetes patients obtain the support and education they need on an individual basis?

We have to use any tool we can to help people get educated.  Anything, there are no boundaries when it comes to this.  So this is a very powerful and great tool to be shared, no questions about it.

Interviewed by Alexis Fedor, Fit4D Online Marketing Manager

WHO:

Jillian Prior, Development Manager, ADA NJ

POINT OF VIEW:

Improving Education Locally and Nationally

Fit4D spoke with Jillian Prior, Development Manager, ADA NJ, who has an amazing position developing programs with ADA NJ, allowing her to work on a local level while staying in the know about what is happening nationally as well.  Her insight on the topic of education informs us of the importance having local centers for diabetes control.

Tell us about what you love about your role with ADA NJ.

I am the development manager, which means I handle our gala events, social media, sponsorship proposals and our office website.  It’s a mix between development and web planning.  I love it because it’s always fresh and I get to work with different thought leaders.

Our office works to raise money for events and programming.  We have a small office with an African American section; Latino section and schools outreach section.  We just added Native American programming as well.

What are some projects ADA NJ is working on right now?

Our annual golf outing is coming up at the end of June.  It’s held at the Cherry Valley Country Club and is a great way for our sponsors to get to know each other.

Another big project is our Latino and Hispanic initiative called Diabetes From Head To Toe held in New Brunswick in November.  It’s a health-screening event, where hospitals come in for health exams and eye and foot exams.  We have educational modules with various speakers and sessions teaching the guests about diabetes management.  Prevention is such a huge piece to what we do.  This year is our third conference.  Around 800 people attend from Northern NJ, Staten Island and Pennsylvania.

What do you stress most in terms of prevention?

We stress prevention by teaching people about healthy living choices and the importance of exercise in their daily lives.  Many patients are not aware of the fact that they’re in control of their own health.

What do you see as the most pressing issue right now in the diabetes community on a local level?

I really think it is education.  Making people aware of the risks of diabetes.  We work with a lot of hospitals in the area, and we feel that if one knew more about how they acquire diabetes they wouldn’t be in the position they are in today.  It’s not necessarily that they are going to be diagnosed if they have pre-diabetes, so they are more in control of turning that around so they don’t acquire it.  79 million people across the US have pre-diabetes, which is defined as having A1C of 5.7 to 6.4.  A big part of how we are getting those numbers down nationally and locally is about a month ago we had a day called National Diabetes Alert Day.  We wanted everyone to take the diabetes risk test.  We worked with all of our corporate partners in order to get these tests into all of their databases.  We went to health fairs and it was available in Spanish and in English.

Why is the Latino community at such great risk?

There is a lot of research still to be done to determine why certain ethnic groups are at higher risk of developing diabetes.  Some theories include genetic factors, diet and preventive health care access.

What do you like most about the Fit4D Pathways?

It seems like you work hand in hand with patients on how to manage diabetes that health care providers aren’t able to do which is great.

What is a good way for people to seek the help they need?

Many hospitals have Diabetes Care Centers for people to meet with endos instead of a regular physician.  Certain care centers are accredited by the ADA.  We can promote that standard of care to patients, which is through our national office, not our local office.

How can people get involved with ADA NJ?

People can get involved through our programs and events.  We have walks and bike events, which allows the community to become a part of raising money for research and advocacy programs.  You can see our list of events through our website diabetes.org/nj.

Following us on Facebook and Twitter are the best ways as well.  We want it to be a source where people can get their diabetes news through Twitter.  We also have info filtered in about what our office is doing locally.  Facebook is all about our local office, and we include recipes and fitness tools as well.  People can find both links on our site.

Interviewed by Alexis Fedor, Fit4D Online Marketing Manager

Who:

Scott Johnson, person with type 1 diabetes, diabetes advocate

Owner and creator of scottsdiabetes.com

Point of view

Advocating diabetes through social media.

Scott K Johnson, diabetes advocate and blogger talked with us about his passion to help the diabetes community through social media

What would you say is working well with your social media outreach and what’s the most enjoyable part for you?

It’s exciting to see so many people getting involved. People feel comfortable and safe sharing their stories. Every person that shares their story is actively changing how others view their diabetes and   now there are wonderful examples online of people living great lives with diabetes.

I started writing my blog late in 2004 and the fact I am still active in the community is exciting. There are a lot of channels with social media and it’s important to invest in the channels where you feel you get value.   I get a lot out of it—what I’m doing helps me and others.  That attitude is contagious in the diabetes community– for anybody that is in some way or another interactive in the social media community (patients, bloggers and industry).

I was diagnosed with type 1 at the age of 5. At that age you can’t cope emotionally what the diagnoses is or what it means.  I still consider myself a person that is growing and maturing.  The exercise of writing out how I am feeling  (that exercise) is powerful for me. Even if I was just writing in journal that would even be helpful. Now sharing this adds another layer of enjoyment for me.

Your blog is very positive and honest. I like that approach.

I always want to find some positive angle in my blog.  Sometimes the positive part is just about being real.

With diabetes you almost get this feeling like diabetes perfection is possible but it’s not about perfection. I like people to feel empowered and not alone in what they are feeling.

What topics would you like addressed through social media in the near future?

The demographics of diabetes in the world – the majority of people have type 2 diabetes but the social media community is type 1. It would be great to have more people type 2 diabetes involved.  So many people don’t realize that social media is out there.

What’s the best approach to do this—get people with type 2 diabetes involved in social media?

This is the million dollar question!

What do you think is the most important topic right now in the world of diabetes?

I recently had an opportunity to talk with Jeff Hitchcock from Children with Diabetes.  The FDA is slowing down when it comes to approving new diabetes technology. The United States is a second class country as far as  new technology and type 1 diabetes.  It should be our responsibility to work with those in political office to put pressure on the FDA to get approvals and our voices heard.

What trends do you see currently in the diabetes landscape that are working to help people stay on track with and better health and lifestyle choices?

Social media is incredible powerful.  There are so many types of people to help – emotional, fitness, diet. Although…. because it’s social media you need to be careful and discerning about the information you and advice you get.

I think there needs to be an easy way to record and make sense of all the information and numbers and non-quantifiable effects for diabetes. A helpful way to keep track of everything that doesn’t add a lot of burden to your day and how does that tool make value out of what you are putting into it. There  are millions of tools avail but I haven’t seen one that can do that.

Is there anything else you would like to share?

Just that I think we have a lot of resources to help people with online but we need to help them offline too.

Blog: scottdiabetes.com

Twitter:  @scottkjohnson

Facebook: http://www.facebook.com/scottkjohnson.diabetes

Interviewed by Sherri Isaak, MS, RD, CDE, BC-ADM,  Fit4D Director of Content Development

WHO:

Armando Triana, Product Manager for Enterex

POINT OF VIEW:

Working to create healthier lifestyles and practices

Armando Triana believes in his product based on proven results from their diabetes community at large.  Understanding the value that Enterex adds to the diabetes community in terms of providing a healthier choice for a consistent diet is incredibly inspiring and useful for everyone living with diabetes.

What have you learned while there about how Enterex is helping people with diabetes?

The one really basic concept of how to use our product, which comes down to the one questions, how do I manage diabetes?  There is a lot of information out there.  We created a product that matches as closely as possible what the diabetic diet should look like.  No sugar, less carbs, protein and minerals that a person needs so when they’re not sure what to eat they can fit this right into their daily meal plan.  It’s like a milkshake, very nice tasting, which is one of the best comments we get.

What issue do you see as the most prevalent right now in the diabetes landscape?

The biggest issue I believe is the rising rate of diabetes, and the rise of obesity.  The amount of information a newly diagnosed diabetic needs to know is quite lengthy.  Most people don’t have the luxury of knowing what they need to know, and we want to help make that easier.  When a diabetic has to make a food choice it can be difficult to choose what to eat based on what’s in it.  Even with labeling it’s difficult to decipher what’s really in a product.  We have formulated Enterex to match what a diabetic should have.  It’s nice for individuals who are not always trying to control what to eat, but might not be eating enough.  In addition, older people tend to lose their appetite.  Enterex ensures they get all the vitamins they need without having to make a big meal.

What do you think of the fit4d pathways?

I’m a big believer in face-to-face, one on one.  I think it’s very important to have people working with a person to help them in a personal way to manage their diabetes better.

What changes is Enterex helping to achieve?

From a clinical perspective that either a diabetic has a glucose control problem, this helps control the glucose.  We know how bad it is for an average person to have high glucose control, but this helps the management in hospitalized patients especially.

How do you obtain feedback from your community?

We travel a lot and we visit with a lot of the communities, making it easier to see how our product is working.  For those who have not tried it, I encourage them to test it out.  Because it tastes really nice.

Learn more about Enterex Products

Interviewed by Alexis Fedor, Fit4D Online Marketing Manager and Debby Johnson, RD, LD, CDE, Fit4D Senior Clinical Director

WHO:

Daniel Lorber, MD, FACP, CDE

POINT OF VIEW:

Increased education and resources, first and foremost

Dr. Lorber, Medical Director of the Diabetes Care and Information Center of New York, Flushing and board member of Diabetes Care, talked with us about his experience with patients over the years, which has driven his desire to stress the need for education to government agencies and health care providers, and basically everyone involved in the diabetes community at large.

Since you have worked with and sat on the board of Diabetes Self-Management, what changes or trends have you noticed in diabetes patient education?

You can’t separate education from everything else in this area.  The tremendous increase in obesity, the changes in insurance costs and plans and the need to take care of health issues sooner make the whole issue of patient health maintenance complex.  We are dealing with many more people who have diabetes, a small number of specialists, a slightly larger number of educators but not enough and a system that does not yet entirely respect the need for education.

What do you see as a possible solution to this problem?

It’s about decreasing this epidemic by starting at the beginning. Teaching kids how to exercise, parents how to feed their kids properly, teaching school boards that cutting recess and after school activities is entirely the wrong direction.  The diabetes epidemic is a public health issue rather than a medical issue.  At a time when we’re seeing more people with diabetes, we simply don’t have enough resources.  Fewer patients have been coming to the doctor because of the costs, but a lot of people are trying to do what they can to create a healthy life for themselves.  Certain groups are working toward alleviating this problem.  Sanofi, for example, just sent me a great list with very little branding on it, which I thought was extremely admirable.  But we need to do more starting with taking health education seriously.

What approach do you think is best to take right now in order to improve the issue of patient adherence?

The most important issue is people need to understand that diabetes does not fit the typical American paradigm.  I don’t treat diabetes at all, I teach patients how to treat their own.  The solution is to get the word out in a positive way that your health is in your hands.  The problem is that by the time we get a diagnosis, patients are already firmly wedged in the American theory that a pill can fix it.  But the reality is that people need to take responsibility for their own health and this is an indication of how off-track we are with that.

What do you think is the best time for an adherence program to be administered to most effectively keep patients adhering to their necessary protocol?

Over and over and over again.  I can’t stress that enough.  Certainly for newly diagnosed patients, but from there, over and over.  This is a marathon disease, not a sprint.  Educating and problem solving teaching people to problem solve along the way is essential.

What do you think about the concept of the Fit4D Pathways as a tool to help create better patient adherence?

Particularly with the advantage in technology, we can provide a number of opportunities and ways to reach people, which I think is great.  But I think that the new methods need to be tested and we can’t be so afraid to try them out in order to get a good measurement on their outcome.  People have to decide what kinds of outcomes they can measure and why.  We spend a lot of money on health care and it needs to be spent efficiently.  Anything we want to try needs to have built-in outcome measurement to see if it works.

What news do you want to share right now with the diabetes patient community?

Don’t expect medication to be the answer.  Each patient needs to understand how to use their medication but also understand that it really is up to them to take care of their own diabetes.  The most important point is that this is your diabetes and you can do something about it.

Dr. Lorber received the Outstanding Physician Clinician in Diabetes award from the American Diabetes Association in June 2009.  This award is presented to an individual who has made outstanding efforts in diabetes care and is recognized as a highly regarded clinician and educator with more than 10 years of distinguished service.  He speaks frequently at different hospitals on the topic of diabetes care.

Interviewed by Alexis Fedor, Fit4D Online Marketing Manager

WHO

Dennis Urbaniak

Vice President, U.S. Diabetes at Sanofi US

POINT OF VIEW

Changing the diabetes landscape from the outside-in

Talking with Dennis Urbaniak helped us realize how committed the team of Sanofi US is to connecting directly with diabetes patients in order to create a healthier, more educated community.  Sanofi is not just working locally, but globally, from the outside-in, to better understand and analyze the needs of the diabetes world at large.  In doing so, they are working to create change in a way that no other pharmaceutical company has done before.

What makes you most excited about your role at Sanofi?

I’m most excited about the fact that we’re working on a completely different approach, beyond the molecule, to a broader view of diabetes.  We’re looking at this as more of a systems moderating service, where we are letting patients tell us what works for them.  It makes sense to us as a more relevant system that lets us learn better what works for patients, which helps us understand how to best serve them.  Everyone at Sanofi is aligned with this approach.  We are all fully committed to this shift, and have a strong commitment to change in this area of direct outreach and communication.

What trends do you see currently in the diabetes landscape that are working to address the current issues of patient adherence and better health and lifestyle choices?

There is still a trend of what I call chaos.  Within health care companies, everyone is talking about diabetes in some way, which is causing confusion for patients because there is too much information to sort through.  They’re not sure what is important for them to know, so it becomes very challenging for patients to understand what they need.  The second is an ongoing explosion of tools being developed, which I think can be leveraged more effectively and accurately.  Because of these two factors, it’s important to spend time with people to see what best works for them and then use that information to create better programs.

The concern around providing care for the future is that there are not enough providers to meet the amount of care necessary.  This calls for us to do more work on alternatives.

Sanofi has established an active presence online through Social Media that is reaching an incredible amount of people in the diabetes community.  What would you say is working well with your social media outreach?

We’ve been very committed to make this a listening and dialogue engagement that we’re deeply committed to.  We don’t view it as a promotional vehicle.  It has helped us a lot in terms of knowing people personally.  Using these vehicles as ways to have dialogue and to listen.  Based on our listening engagement, it helps us know what discussions are on people’s minds.  That has been very effective so far.  We’ve received an organic acceptance from the diabetes community, which makes us see how we’re earning credibility and trust, which we value.  We want to continue to get a better firsthand understanding of what people need us to bring forward, so we’re focused on gathering this new information.

What topics would you like to specifically be able to address through social media in the near future?

First, we know that diabetes is driven locally based on available resources in particular areas.  We have a lot to learn about how to translate solutions to a local level.  What can be perceived as simple things that aren’t being addressed, we can and want to help with.  The second piece is how to help connect all info out there to some kind of meaningful feedback loop.  What is going to be meaningful to that person in living with diabetes, and how we can share that info back and forth with those people.  We want to reinforce the positive and understand how to continue to drive that plan over time.

In terms of innovation to create better patient adherence, what is Sanofi currently focused on to help bring innovative solutions to the forefront?

Our focus now is on outside-in thinking.  If you look at the traditional approach from a pharmaceutical point of view in the past, the majority of programs have been failures.  99% of those efforts were all drug and brand focused.  All you have to do is spend a little time with someone to find that it is not the top priority of an individual to think about what drugs he or she takes.  That said our approach now is to reach out to different communities of experts to establish more comprehensive relevant solutions that address true needs instead of a particular drug.

What do you think about the concept of the Fit4D Pathways as a tool to help create better patient adherence?

I think it’s a great concept.  The times I’ve had to listen to David and learn more about the company is very much in line with some of these things I’m speaking of.  It’s a practical and comprehensive view to make a real difference.  How you demonstrate that we’re making that difference over time and share that with people involved is really important and gives it a greater chance to succeed.

What do you want to share right now with the diabetes patient community?

I’d like to share that our commitment at Sanofi is one that is long-term and deep beyond our traditional approach.  We’re deeply committed to working with partners, experts in other areas, in order to connect the right people together with heavy input from diabetes community.  By working this way we know can change the diabetes landscape in the US.

Visit the Sanofi blog, Discuss Diabetes

Like the Sanofi Facebook Page

Follow Dennis on Twitter

Interviewed by Alexis Fedor, Fit4D Online Marketing Manager and Debby Johnson, RD, LD, CDE, Fit4D Senior Clinical Director

WHO

Kathleen Gold, RN, MSN, CDE

Director of Outreach and Education for the Diabetes Research And Wellness Foundation

Editor of Diabetes Wellness News

Manager of diabeteslocal.org

POINT OF VIEW

Fostering behavior change for patients with diabetes.

Kathleen Gold, Director of Outreach and Education for the Diabetes Research And Wellness Foundation at www.diabeteswellness.net, talked with us about her passion for working on prevention within the diabetes community in order to help develop healthier lifestyles for patients in every community.

Tell us about your role with the Diabetes Research and Wellness Foundation?

I answer non urgent questions from our diabetes help line at 1-800-941-4635.  I’m the Editor of Diabetes Wellness News and manage diabeteslocal.org.  I also volunteer through the foundation for a free clinic in Washington DC.

Can you tell us more about your hotline?

It was started in 1997 to answer questions for people with diabetes.  We get about 100 calls per month around many different issues anything from  general questions  about diabetes  to diabetes services.  I  spend between 5 minutes to one hour with each caller.  It’s great to make a difference. I recently helped one patient that couldn’t afford her medication so I connected her with a pharmacy in her area so she could start taking her medication again.  I referred her to Publix since they have a special diabetes program  that provides Metformin to people that can’t afford it free of charge

What’s the purpose of diabeteslocal.org?

It’s a website created for individuals with diabetes, their caregivers, and healthcare professionals to support their diabetes self-management through the use of appropriate, local community resources.  Sometimes we as healthcare professionals aren’t even aware of all the resources within our geographical area.  All of our resources are submitted and reviewed by a healthcare professional. Overall, we make sure to connect people with diabetes and professionals with the best diabetes resources.

What do you think is the most important topic right now within the world of diabetes?

Prevention.  It’s all about behavior change and determining what you can do to be healthy.  In fact, that’s what diabeteslocal.org does.  It helps connect people to the best resources for them to be healthy and continue to make lifestyle changes.  It also works for many chronic diseases—from weight management to complications resulting from diabetes.

Interviewed by Sherri Isaak, MS, RD, CDE, BC-ADM, Fit4D Director of Content and Community

Written by: Martha Weintraub, MPH, MSW, RD
Fit4D Nutrition Coach

There is quite a bit of media controversy over the use of the glycemic index (GI) for blood sugar management and weight loss.  People familiar with the GI often have very definite ideas about its usefulness in making food choices but they don’t necessarily agree about this topic.  Whether you’ve been part of this debate, are curious about the glycemic index, or have never heard of this concept before, it would be a good idea to be well informed about what the GI is and how it is best used.

What exactly is glycemic index and glycemic load?

• The GI ranks how quickly 50 grams of a carbohydrate food raises blood glucose compared to either sugar or bread.
• Foods with a high GI will be absorbed more quickly and have a bigger impact on blood sugar levels than foods with a lower GI.  Although this sounds like it should be a clear cut measurement, it can be affected by how processed the food is, how much protein, fat, and soluble fiber the food contains, how long the food is cooked, and what other foods are eaten at the same time.
• The biggest problem with the GI is that it is based on the effect of 50 grams of carbohydrate from a particular food, even when a normal serving may be nowhere near 50 grams.  Carrots are an example of the confusion that can arise from this issue.  One GI entry for carrots lists their GI as 92, an extremely high ranking on a scale of 1-100.  However, a typical serving of carrots contains only 5-6 grams of carbohydrate, so eating the equivalent of 50 grams of carbohydrate would mean eating over 2 pounds of carrots at one meal.  Few people would be able to say that carrots were responsible for their high blood sugar or weight gain.
• The glycemic load (GL) was developed to avoid some of this confusion by accounting for the amount of carbohydrate consumed in a typical portion of each food.  For example the GL of a typical serving of carrots varies from 1 to 6 depending on preparation method, but any GL less than 10 is considered a low score, with less impact on blood sugars.

What are the official recommendations regarding using the Glycemic Index for glucose management?

The American Diabetes Association recommends that the GI and GL may provide some benefit in blood glucose management over the use of total carbohydrate alone.

Can the GI or GL have benefits other than glucose management?

• Evidence for the benefit of using the GI and GL is not yet clear.  A low-GI diet has been found to improve A1c and reduce blood sugar lows compared to a high-GI diet and may improve insulin sensitivity (how efficient the body is at using insulin).
• There is growing evidence that a low-GI diet can help with weight management as well as limited evidence that it can help improve cholesterol levels and cardiovascular disease risk as well as, but these are not yet clearly supported by research.  

How can I use the glycemic impact of foods in meal planning?

Examples of high-GI foods (rated 70 or higher) that are likely to have more of an impact on blood sugar include:

• white bread, bagels
• corn flakes, instant oatmeal
• shortgrain white rice, rice pasta, macaroni and cheese from mix
• Russet potato, pumpkin
• pretzels, saltine crackers
• melons and pineapple

A low GI meal plan is one based on vegetables and fruits, lean protein, low fat dairy products, beans and legumes, nuts and heart healthy oils, and whole grains.  Examples of low GI foods (55 or less) include:

• 100% stone-ground whole wheat or pumpernickel bread
• oatmeal (rolled or steel-cut), muesli
• pasta, converted rice, barley, bulgar
• sweet potato, corn, lima/butter beans, peas, legumes and lentils
• most fruits, non-starchy vegetables (including carrots)

Foods such as animal protein and oils have no carbohydrate so have no GI ranking.  Other high fat foods may also have a low GI ranking because of the fat they contain, such as some ice creams and pastries, but that doesn’t mean they’re nutritious additions to your meal plan.

How can the GI help with menu planning?

• Let’s look at Carla, a young woman living with diabetes, who was ready to make some lifestyle changes.  Carla had been carefully counting her carbohydrates and limiting them to 60 grams at each meal, but was not happy with her blood sugar levels or A1c.
• She decided to use the GI list to see if it would help her manage her health more easily.  Below compares her usual breakfast to a GI alternative.

• Both breakfasts contained approximately 60 grams of carb, but the new menu was significantly lower on the GI.
• Carla noticed right away that her blood sugars before lunch decreased to within her target range and she saw an improvement in her A1c three months later.

Is there a downside to using the GI?

• Many people find they begin to limit their food choices to those lowest on the GI list, and for some people, the GI and GL provide more detail than needed.
• In fact, variety is essential for good health and we need to enjoy our food choices.
• Using the general description of a low GI meal plan as one based on vegetables and fruits, lean protein, low fat dairy products, beans and legumes, nuts and heart healthy oils, and whole grains, and avoiding processed foods and sweets, will result in an eating pattern that is low on the GI without having to constantly consult the list and check the numbers.

What’s the bottom line?

If you are looking for help in making healthy food choices, the GI or GL can be another tool to assist you in improving your meal plan and your blood sugar management.  If you are already choosing less processed, high fiber foods with lots of vegetables, you are likely to find that you’ve been following the guidelines for a low glycemic load meal plan without even realizing it!

Have you used the GI or GL in the past to help manage your blood glucose?  Did you find it helpful? We’d love to hear about your experiences!  Please share in the comments.

Where can I get more information?

For information from the American Diabetes Association about the Glycemic Index visit:

http://www.diabetes.org/food-and-fitness/food/planning-meals/glycemic-index-and-diabetes.html?keymatch=glycemic-index&__utma=1.251169791.1326575325.1326575325.1326575325.1&__utmb=1.1.10.1326575325&__utmc=1&__utmx=-&__utmz=1.1326575325.1.1.utmcsr=diabetes.org|utmccn=%28referral%29|utmcmd=referral|utmcct=/&__utmv=-&__utmk=207823762

http://clinical.diabetesjournals.org/content/29/4/161.full

www.glycemicindex.com

WHO

Dr. Jeanne Rosenthal, MD

Attending Surgeon of Retinal Service at the New York Eye and Ear Infirmary

Board Member of Diabetes Self-Management

POINT OF VIEW

Creating better education for diabetes patients

We had the pleasure of speaking with Dr. Jeanne Rosenthal, who, as Attending Surgeon of Retinal Service at the New York Eye And Ear Infirmary, is at the forefront of working with patients who are first diagnosed with diabetes.  Her insight into the need for increased patient education, especially at the beginning of a new patient’s change in lifestyle, sheds light on how important creating better adherence programs can be for the diabetes landscape at large.

What makes you most excited about your role on the board of Diabetes Self-Management?

Diabetes Self-Management helps encourage patients to take care of their own health, and get as much information as they can.  I think it’s very empowering.

A major current issue surrounding the health care industry is of diabetics developing health issues because they are unable to stay with their required protocol.  What to you see as the most effective potential solution to solving the problem?

I think there’s a lot of diabetic education not being done.  I think education is really the key to have patients truly understand what they should be doing, and then it’s a question of positive reinforcement.  Asking them every time how they’re doing, how their blood sugar is and how they are doing with their diet.   We’re so busy talking to patients who aren’t doing what they need to be doing we are missing giving positive reinforcement to those that are doing well, which creates something of a negative cycle.

Do you have some lines of advice for health care providers?

That’s really the big point. Doctors don’t have enough time to talk to patients and it’s really a shame.  Diabetics need a lot of time spent educating, and doctors don’t have enough time.  It’s a terrible thing, so education is really a necessity.  It just doesn’t work to see a patient and not take the time to talk.

Here’s an example.  I saw a patient in a clinic.  She was a lady who didn’t have a very long education, but she was not stupid.  She had been diagnosed recently, but didn’t have anything wrong with her eyes.  She was motivated to take care of herself.

Six months later I saw her and she was drinking from a quart of orange juice.  She was so proud because she had given up soda, and was drinking natural products.  I had to tell her that it had as much sugar as soda.  I realized that her entire education up to that point consisted of a 1-page paper with some points on it.  I told her she needed to see a diabetes specialist to design a diet that she can live with.  She’s somebody whose doctor spent 5 minutes with her and didn’t give her the education she needs, and she’s extremely motivated.  I stepped in as her eye doctor, and told her she needed someone else to help her.

Patients need to realize that if their insurance companies cannot do for them, they need to be able to find help on their own.

What do you think is the best time for an adherence program to be administered to most effectively keep patients adhering to their necessary protocol?

Right when they are diagnosed.  We have to start with their education right then.  They need to understand the chemistry of how their bodies break down sugar.  Even if they are in good shape, they need to be on a healthy lifestyle program.  You can’t get away with not doing it for a while.  You have to do it right away.

What topics would you like to specifically be able to address in terms of cultivating better patient adherence in the near future?

Follow up.  The support of a group might help, or the support of an individual.  I think it’s different for all people.  It’s similar to weight loss.  One thing that helps one person might not motivate another.  A group may not motivate every person, because they do better with a personalized nutritionist.  People have to find something that works for them.

What trends have you seen occurring recently with your patients within the diabetes community?

The big trend of course is the insulin pump.  The patients on the pump tend to do really well.  They have better control of their sugar.  They also tend to be more gadget-oriented, and number-oriented.  People who enjoy fine-tuning their blood sugar get a lot out of it.  Overall they get positive reinforcement from the pump as well.

What do you think about the concept of the Fit4D Pathways as a tool to help create better patient adherence?

I think it’s a great idea.  A main problem I notice is dealing with patients at such varied levels.  Some patients don’t know anything about science, so talking about blood sugar and hemoglobin makes no sense to them.  Others are more educated, so being able to talk to them at different levels and within different pathways is a very good idea.

It’s very rigorous to change an entire lifestyle.  It’s extremely difficult to adjust to not being able to take a day off from staying on such a strict diet and lifestyle.

What news do you want to share right now with the diabetes patient community?

If you really do all this stuff, it’s definitely worth it.  It sure beats the alternative, which is a horror.  It’s difficult but it’s worth it.  All studies are showing that long-term stability is achievable.  It just takes a certain amount of effort, but the effort it completely worth it.

Interviewed by Alexis Fedor, Fit4D Online Marketing Manager and Sherri Isaak, MS, RD, CDE, BC-ADM, Fit4D Director of Content and Community

There are many healthy foods to choose from when planning your meals and grocery list.  Here’s our “Top 4”:

1. Dark green leafy vegetables such as spinach, kale, beets and mustard greens are jam-packed with vitamins and minerals and very little carbohydrate. Studies show people who eat leafy greens frequently may have a reduced risk of macular degeneration, a leading cause of vision loss. This is a great reason to fill your plate with these frequently.  Try adding them to soups and salads for an extra nutrition boost.
2. Sweet Potatoes and other deep orange vegetables such as carrots add lots of carotenoids, vitamin A and fiber to your diet.  Quickly fix a sweet potato by washing and placing on a paper plate in the microwave for 2-3 minutes – you’ve got a side dish prepared in a flash!
3. Blueberries, Strawberries and Raspberries are loaded with disease fighting antioxidants, vitamins and fiber.  Top a bowl of high fiber cereal with berries and skim milk for a delicious breakfast.  Or, serve a cup of mixed berries for dessert topped with a dollop of vanilla yogurt and a sprinkle of cinnamon.
4. Fish high in omega-3 fatty acids, such as salmon, sardines and trout keep your heart healthy and could help ward off depression. Prepare fish grilled or broiled and save some to add to a salad for lunch the next day.

For more information on planning healthy meals, go to:

http://www.diabetes.org/food-and-fitness/food/planning-meals/diabetes-meal-plans-and-a-healthy-diet.html

http://www.diabetes.org/food-and-fitness/food/planning-meals/diabetes-meal-plans-and-a-healthy-diet.html