I spoke with Martha Weintraub, fellow Fit4D colleague and cardiovascular dietitian, about unique foods that help your heart.

1.  Eat More Beans!

What’s special about beans? Soluble fiber can help lower cholesterol and stabilize blood sugar. Because beans and lentils are a great source of soluble fiber, eating them more often may help with both cholesterol levels and blood sugar management.  Ideally we would include beans every day, but 3-4 times per week is more realistic for most people.  

3-4 times per week is more than what most people are eating currently.  Can you give a few ideas of ways to include beans? Try having an entrée that includes beans such as chili or a bean burrito, add a variety of beans to green salads, choose soups with beans or lentils, hummus with veggies, soy nuts or edemame.

How exactly do beans help your heart? Put simply, the bile in the digestive tract, which is made from cholesterol, binds to the fiber and is eliminated from the body with the undigested fiber.  The body makes more bile by taking cholesterol from the blood, and the net effect is that cholesterol levels are lowered.

2. Eat Fat Too!

What types of fat are best? There are certain fats that are heart healthy like canola oil, peanut oil, and olive oil, nuts, seeds, avocado and olives.

Why are these important?  When you substitute healthy fats for some of your carbs or bad fats (saturated fats like the fat in meat, cheese, and butter), cholesterol levels may go down.

How much fat is best?  30-35% of your calories is usually a good idea.  This means if you are eating about 2000 calories you want around 60-70 grams of fat or, if you eat about 1500 calories, you will need 50-58 grams of fat each day.  You want as much of this fat as possible to be the heart healthy type of fat.

If someone doesn’t want to count grams of fat how do they do this? Include a small amount of heart healthy fat at every meal or snack. You can do this by substituting a handful of nuts for crackers, using an olive oil or canola oil based salad dressing, using peanut butter on toast, or adding chopped almonds or walnuts to your oatmeal.

3. Eat an Anti-inflammatory Diet. 

Why does this help? When people have inflammation in their body, the lining of their arteries can be inflamed which increases the risk of heart disease. When cholesterol oxidizes it is more likely to form plaque in the artery.

What is an anti-inflammatory diet? Antioxidants from food are some of the best anti-inflammatories. Studies show that when people try to get antioxidants from supplements they don’t work as well. Fruits, vegetables, fish and olive oil are some of the best sources of antioxidants. Each color of fruits and vegetables represents a different antioxidant the plant has produced. So try to include 3-5 different colors every day. Examples would be kale, blueberries, cantaloupe, onions, green tea, and tomatoes—fresh or frozen they are all great choices.  Sugar and refined flour products (like white flour, white bread, white rice, etc.) can actually increase inflammation, so it’s best to limit these foods. Instead, choose whole grain products like brown rice, whole wheat bread, oatmeal, etc.

I talked with Jami Klein fellow Fit4D colleague, CDE and person with type 1 diabetes on her perspective around the challenges of living with diabetes.

What’s your biggest challenge about your diabetes?

The hardest part about diabetes is that it never goes away.  I deal with my constant companion (diabetes) by making sure it’s a priority. I take care of my diabetes first (checking blood sugar, taking insulin, counting carbs) then I can enjoy life with diabetes in the background.   Diabetes is definitely a part of my life but I don’t let it run my life. That means (for me) checking my blood sugar 10-12 times per day or wearing a CGM.

What do you mean about putting in the background?

It’s more about planning ahead so I can get ahead of my diabetes. If I am going to go play with my son I check my blood sugar first so know I can prevent a low. So if we are on a bike ride I don’t have to interrupt this special time.  I take care of my diabetes first and then don’t have to think about my diabetes for a while.  Also, not dwelling on each and every individual number but instead being happy with the overall picture that day. So if I have highs and lows but overall know my blood sugar was in target—that was a good thing. I used to feel bad about a high but now I look back and try to find out the reasons why so I can prevent that high next time.

How do you handle the everyday challenges of diabetes?

Having a support system for me is key. My best friend has diabetes and my family is supportive and there when I need them. This is very comforting to me.  Diabetes is 24/7 and never goes away. Just knowing there are people that care when I am having a tough day makes a difference. I make sure the people in my support system know about me and my diabetes so when I need to lean on them they know what to do and are able to help in the best way possible.  Along the way I’ve learned to stop fighting diabetes – it’s much easier to embrace the stuff that comes with diabetes than constantly fight it.  Don’t get me wrong – there are days I wish I didn’t have to deal with diabetes – but overall I try to maintain a positive attitude.

You keep your A1C in the 6 range. How do you do it?

I test my blood sugar often, enter all carbs and blood sugars into my pump, wear a CGM, and embrace the good, bad and ugly of diabetes as part of my life. The first time I felt I had a good grasp of what was really going on with my blood sugars is when I started wearing a CGM. I was able to test how certain foods and different activities impacted my blood sugar. I now know that cereal doesn’t work for me–my blood sugar skyrockets after I eat cereal. I tried everything to make cereal work—I tried different cereals (high fiber, whole grain, etc.), different carb ratios, tried giving my insulin up to 45 minutes before eating, and square and dual wave bolus. I like cereal but it just doesn’t work well with my body, so I changed my breakfast.

What advice would give to others with diabetes?

I’ve only been a diabetes educator for 5 of the 24 years I’ve had diabetes. So I didn’t always have the knowledge I have now.  I was able to figure out how to get my A1C in the 6s before I was a diabetes educator and so can others.  It’s important to know your own body and figuring out what works best for you—anyone can do this. I truly believe anyone can get control of their diabetes with the proper knowledge and passion to learn how diabetes affects their body.  You need to take charge of being your own advocate.   Don’t cheat yourself by not taking care of your diabetes. Also, just because you are taking good care of your diabetes doesn’t mean you have to like it—it’s OK to hate your diabetes. So the bottom line is to take your medications, check your blood sugar, lean on your support system when you need to, communicate with your healthcare provider to stay on track with your diabetes (do it but…you don’t have to like it).

According to the Institute of Medicine, 1.5 million preventable medication errors occur each year in the United States. One of the key steps in empowering your lifestyle with diabetes is your awareness about related medications. Here are some tips to help you effectively manage your medication regimen:

Know your medications. Keep an updated list of all prescription medications you are currently taking with you at all times. Also include any over the counter (OTC) medications you may take such as cough and cold products, pain relievers, and antacids. Don’t forget to include any vitamins, supplements, and herbal products as well.

Use one pharmacy. This can be a difficult task in the age of managed healthcare. Many insurance plans require their members to use a mail order pharmacy in order to pay lower co-pays, and some plans even require mail order if you want to utilize your pharmacy benefits at all. An exception to this rule is typically an acute medication, such as an antibiotic used to treat an infection.

When you fill a prescription for an acute medication at your local pharmacy, be sure to provide the pharmacist with your list of current medications (see above). This can avoid any potential drug interactions between the maintenance medications you get in the mail and the acute medications you get at your local pharmacy.

Get organized. If you require multiple medications to manage your diabetes, it can be difficult to remember when to take what. It’s all too easy to skip doses or accidentally take an extra dose because you mistakenly thought you forgot. Pillboxes that are labeled with the day of the week are an invaluable tool to avoid missing a dose or taking extra doses. Fill them up at the beginning of the week, or buy several so you have a month’s worth of pillboxes to help keep your dosing schedule on track.

Clean house. Your healthcare provider may have to adjust the dose of your medication many times over the course of your treatment. When that happens, it’s important to separate old medication from your current medication. Leftover antibiotics should always be discarded. Medications should not be flushed down the toilet or washed down the drain. Doing so is harmful to the environment. To learn how to properly dispose of medications, check out www.dontflushyourdrugs.net.

Written by Brett Douglas, PharmD

Anything is Possible!

By David G. Weingard

August 21, 2012

“Anything is Possible” – that is the Ironman motto.    I have watched people complete the race pushing through tremendous physical pain, emotional stress and coping with chronic illnesses.

Yesterday, I completed my 4^th Ironman triathlon and 3^rd one while living with Type 1 diabetes.    I didn’t just complete it – I smashed my previous race times into the dust.     One of the things that makes me most proud is that I finished almost an hour faster than my first Ironman, when I was 13 years younger and didn’t have to concern myself with testing my blood sugars twenty times during the race nor the energy fluctuations with low/high blood glucose.

A brief background:   an Ironman race is a triathlon consisting of a 2.4 mile swim, 112 mile bike ride and a 26.2 mile (marathon) run.   It usually takes years to adapt the body to handle this distance and requires a year buildup of training capped by an intensive eighteen week cycle.

Here is how I did this with diabetes.    I share it so that people coping with their own diabetes may know that while life with diabetes is filled with challenges – Anything is Possible!.

Thursday, August 16, my wife Andrea and I drove into Mont-Tremblant, a Canadian town 2 hours north of Montreal.    On the way into town, we saw many people on bikes riding the hills with quad muscles the size of trees.   I forgot that the 2500 people racing had flown in from around the world and represented an incredible fit and well trained group.    I started to panic and self-doubt crept in.   After all, I had a broken wrist that kept me out of the pool for six weeks of training and another two weeks lost due to a recent ear infection.    I also hadn’t trained in mountains like this (Mont Treblant is a ski area).

I started to use the mental tools that I knew I would need.   I had put a triathlon calendar on my wall at work and every morning had written down all of my training.   I pulled the calendar from my bag and realized that I was trained, everything would be OK.    Also, a really good French dinner with wine admittedly helped.

Friday, August 17, Andrea and I go for a short swim in the lake.  It is cool and refreshing even with our wetsuits.   We test the bikes out while on a short ride and begin to get organized.

Saturday, August 18, packing all the stuff together for racing an Ironman with diabetes took me over 3 hours (and I had already packed for the trip!).    I needed to consider every contingency.    What if my insulin pump sets came out – as sometimes happen after the swim and pulling off the wetsuit – I would need several sets in my body.  I also packed insulin pens, needles, and multiple meters, backup upon backup of everything.   Of course, also swim, bike and run clothes!

I wore a Continuous Glucose Monitor (CGM) for the days leading up to the race to help me stabilize my blood sugars.   I find that tapering / resting the week before the race causes me to need much higher basal rates that are challenging to predict.    I don’t wear a CGM during the race as I am disconnected from it for close to 2 hours during the swim.  As the CGM needs calibration after 45 minutes or alarms go off, it is not helpful to me in this situation.

Sunday, August 19, race morning, wake up 4:45 AM.   Stick with the food and insulin plan practiced for months and learned over the last 12 years from trial and error.    Drank an electrolyte drink with 1:15 insulin to carb ratio.   Most triathletes will eat a breakfast prior to the race.  I don’t do this as I want a minimal amount of insulin in my body as I swim (to avoid lows).Pump up bike tires, wetsuits on, take an extra .2 bolus and leave my pump with my bike where I will go after the swim.     Race start 7 AM.

 

A great tip from triathlon coach Neil Cook from Asphalt Green Triathlon Club:   As long as your effort stays within 10% than your training for the swim and bike – you will have the energy needed for the run.   Said a different way, race as you trained!

I stuck with that plan and finished my swim at 1:45

I stuck with that plan and finished my swim at 1:45 which was quite good considering my swim training challenges.   I “plugged” into my insulin pump and took my 3 units of insulin to cover my first round of food  and the time that I was disconnected.   I had set my basal rate with an extra unit for the first three hours to cover the rest of the food on the bike at  a rate of 17% of normal.   On my 7 ½ hour bike I ate 2400 calories and 600 grams of carbs.   I spaced it out during each hour and didn’t go low once.

A tip I share is to pack wipes to clean off fingers that may get sticky/dirty to get accurate BG readings.

I have a meter mounted between my aero bars and tested six times on the bike.meter mounted between my aero bars

meter mounted between my aero bars

Each of the 56 mile bike loops had 12 miles of big hills at the end of each loop – with  12% inclines.  Needless to say that I was glad when that section of the race was done!

It started to rain as I finished the bike and transitioned to the run.  My clothes and shoes got wet.  Luckily  it stopped after 30 minutes and was as able to get to 13 miles before the sky opened up again and it poured!    Besides the cool temperatures and wet clothes, I had to figure out how to test my BG.   I didn’t have anything to dry my hands.   Fortunately, a volunteer gave me some tissues and I was able to test.

During the run, I did go down to 60 and up to 220 though otherwise stayed in the mid-100s.I ran the entire way and posted a 5:06 marathon run after the swim and bike. I am still not clear how I did it, though I was able to stay totally centered in the moment, not concerned how many miles were ahead or how much I had already done physically that day.  That focus kept me going to and despite the rain and darkness as we ran through the woods (it was nighttime for the 2nd loop of the run).

My Final Race time 14 hours and 39 minutes!

My final race time was 14 hours and 39 minutes!  And my blood sugar was a near perfect 135. As I ran the last few yards and crossed the finish line, all I could think about is that Anything is Possible!

Credits to my incredible support team:

The diabetes educators at Fit4D, who are dedicated to improving the lives of people with diabetes.  I learn endless diabetes and life strategies from them on a daily basis.

 Jackie Fehrenback, Physical therapist who taught me the value of core strength training and dug her elbows into my quads for months to loosen them up.

Cecil Hedigan, (917) 903-4609 the best acupuncturist in New York City, who replaced my physical energy,chi and released the muscles strained form training.

Asphalt Green triathlon team and its great coaches and team. Special thanks to Laura and others who cheered me on throughout the race and my mentor, Dan Schiemel.

My wife Andrea, who trained with me and shared the monk-like lifestyle for the last 6 months.   She had her own incredible race day and completed the course in record time.

My boys. Steven, Daniel and Jacob who shared their teenage youth with me and their unlimited energy.

And the rest of my family and friends who shared their support, wisdom and friendship..

Improved medication adherence will require changes in the ways health care is delivered.

Tip to take away: Tailoring interventions to patient needs and attributes is one of several strategies that have been found to increase medication adherence.  For example, although it may not previously have been part of a typical healthcare consultation, taking time to explore possible obstacles a patient may have to complying with medication recommendations may increase the likelihood that the recommendations will be followed.

Article summary:  Although it has been found previously that improved medication adherence can lead to improvements in health outcomes and reductions in health care costs, studies have found that as many as half of patients do not totally comply with medication adherence.  This seems to correlate to out of pocket costs, lack of coordination of health care among providers, and individual patient attributes.  The authors examine services provided by three health care delivery systems that have shown improved medication adherence and resulting decreases in health care cost per patient.  The successful health care systems focus strategies such as tailoring interventions to patient needs, offering follow-up and patient support, leveraging information technology and sharing patient data among health care providers.

The authors conclude there are four primary needs to improved medication adherence:

1. Addressing patient financial barriers by measures such as reducing copayments or offering frequent financial incentives for adherence
2. Making data infrastructure a priority through investment in health information technology (HIT) and data sharing
3. Payment reform:  suggested strategies include shifting from fee-to-service to rewarding better patient outcomes, writing goals for medication adherence into performance measures for health care providers and facilities, and creating inducements for investing in improved medication adherence by those groups who will benefit financially from the resulting reduced health care costs such as the insurance companies
4. Screening and assessment to identify those patients at greatest risk for non-adherence such as screening patients for depression or assessing for patients with a history of non-adherence

As new health care policies are being implemented and current practice is being examined for efficacy, now is the time to look at improving medication adherence as a method to improve health outcomes.

Reference: Cutler DM, Everett W. Thinking Outside the Pillbox — Medication Adherence as a Priority for Health Care Reform.  N Engl J Med 2010; 362:1553-1555.

Article available online at: http://www.nejm.org/doi/full/10.1056/NEJMp1002305

124×150″ src=”http://fit4d.com/wp-content/uploads/2012/08/abrahamson_52_rdax_124x150.jpg” alt=”Martin J. Abrahamson, M.D.” width=”124″ height=”150″ />

Martin J. Abrahamson, M.D.

Who:

Martin J Abrahamson, MD. Joslin Chief Medical Officer

www.joslin.org

Point of view:

Managing diabetes now and in the future

1. What are you most proud of regarding your position at Joslin?

I’m proud of being able to work with a team of very dedicated professional, administrative and support staff. It’s a privilege to be able to serve as the Chief Medical Officer for a world-renowned diabetes center. Joslin is the biggest diabetes research center and provider of diabetes care and education in the world and prides itself on providing the best diabetes care to the people it serves.

2. What are some of the biggest challenges that face people with diabetes? Why?

Elliott Joslin [the founder of the Joslin Diabetes Center] said the biggest challenge for people with type 1 diabetes was learning to think like a pancreas. People living with type 1 must figure out the connection between their insulin, food, and exercise, and need to check their blood sugar every day. There have been huge medical advances made but this balancing act is still an enormous challenge for people and one they can’t stop facing daily.

For people living with type 2 diabetes, the biggest challenge is modifying their lifestyle. So many people could be better controlled if they made some lifestyle changes. There are medical treatment guidelines, but the physician’s challenge is to get to understand the individual patients which includes their behavior, what motivates them, their goals, what they are able to achieve, and when they are ready to make behavioral changes. The physician must also use medications wisely, not only to improve glucose control, but to reduce all cardiovascular risk factors. The physician must understand each patient as a unique individual. At Joslin, we practice a team approach to care because no single provider can have all the skills necessary to help people in so many ways. Our teams include physicians, nurses, nurse educators, dietitians, and exercise physiologists–all CDE’s. We also provide programs designed for specific needs such as an intense education “tune-up”, weight management, mental health issues, or early signs of medical complications. We also have programs for children, the elderly, women planning pregnancies, and multicultural groups whose needs differ. We embrace the entire spectrum of diabetes and its related complications.

3. What do you think will change in the future regarding caring for the diabetes patient?

I think the delivery of care will change. Elliott Joslin created the team approach to diabetes care and trained the first diabetes educators. They would go into people’s homes to teach them to care for themselves. Then it became more cost effective for patients to come to the physician’s office for treatment. Now we can actually go back into the patient’s home by leveraging technology. This is what I believe is needed for the delivery of care for people living with chronic medical conditions. Being able to virtually treat patients at home through smart phones or through web-based programs will make a huge difference. Patients can download information, send their data and questions to their health care providers, and we can make recommendations right away. In the past, patients might have about four encounters, or about two hours, a year with their diabetes care providers. But people live with diabetes 24 hours a day, 365 days a year. With technology we can engage with the patient as often as needed, make interventions in treatment sooner, and help people feel they are not alone when it comes to managing their chronic conditions.

Virtual care would enable people who don’t have access to medical care to be receive care anywhere in the world. People everywhere should have access to good information about diabetes care, nutrition and exercise and this would assist doctors in areas with limited resources.

Virtual care should of course always be complemented with face-to-face contact with providers, but fewer visits to the doctor’s office would reduce the wait time for many other patients to be seen.

4. What are your ideas and thoughts about keeping people on track with their medication regimens?
We have tools that potentially can help us be on top of things more effectively. Medication adherence is a huge challenge for people. More frequent contact with a health care provider, either in person or virtually, would hopefully increase adherence.

There are many new medications coming on the market and safety is always paramount. With continuing advances in medications, the question is how to pay for new medications. We can justify their use if we know they are effective. We can deliver diabetes care less expensively and more effectively with new technology. To reach more people living with diabetes, we need to help physicians identify the most difficult to manage patients and provide resources virtually.

5. What else would you like to share with the diabetes community?

We have a huge opportunity to make a difference in the lives of people living with diabetes. Health care providers sometimes feel they are on a continuous treadmill when patients continue to struggle, but we need to remember that every time we see a patient we are making a difference in someone’s life.

WHO

Amanda Sheldon

Director of Public Relations and Social Communication Medtronic, Inc.| Diabetes

http://www.facebook.com/#!/medtronicdiabetes

http://www.loop-blog.com/

www.medtronicdiabetes.com

twitter: @MDT_Diabetes

POINT OF VIEW

Medtronic’s role in helping people with diabetes through social media

What is Medtronic doing with social media and diabetes?

Medtronic had a recent Facebook launch in April 2012.  We share ways and ideas to live a better life with diabetes. Facebook users get their questions answered and share personal moments and stories about living life with diabetes.

We’ve had a blog called THE LOOP for about 1 1/2 years which includes conversations about living diabetes, managing it with technology and one day, closing the loop with an artificial pancreas. We’ve also had a twitter account since October 2011.

Our current social media strategy is around providing tips and resources for the pump and CGM.  The goal is to offer the perspective of people with diabetes living different lifestyles in a healthy way to help others with diabetes relate and be inspired.  Advanced features and content topics are based on the questions received by our 24/7 call center (1-800-646-4633). In addition, we keep everyone informed of advances in science and research. For example, research on the artificial pancreas is often discussed.  We also discuss global advocacy and volunteerism, such as updates from Medtronic’s CMO Dr. Francine Kaufman as she visits diabetes camps in Haiti and other countries across the globe.  The goal is to help people across all ages.  It is open to readers internationally but since the focus is on the United States English is the primary language.

What is the biggest challenge you feel people with diabetes are facing today?

How to maintain diabetes control on a day-to-day basis.  There are barriers, both in terms of access as well as awareness.

What is the goal of Medtronic social media?

It is a great opportunity for people with diabetes to help other people with diabetes connect and share.  Medtronic supports these efforts through social media but it is the people with diabetes that really drive the communication.  There is no question too big or too small and it is a great platform to share feedback.

Is there anything else that you would like to share?

We would love to hear from people with diabetes about how companies, such as Medtronic, can further support the diabetes community. We are open to anyone sharing this through comments on any of our social platforms.

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

255

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WHO

Cherise Shockley

Founder of Diabetes Social Media Advocacy and Co-Host of DSMA Live

http://diabetessocmed.com/

POINT OF VIEW

Passion to help people with diabetes through social media

What are you doing in the world of social media?

I’m the founder of DSMA–Diabetes Social Media Advocacy. We connect people with diabetes and empower them to feel comfortable to talk about their diabetes. It started about 2 years ago when I was watching the #hcsm health chat on twitter. I had an aha moment! I thought it would be great to moderate a twitter discussion with diabetes. We started the first chat (#DSMA) every Wednesday at 9 pm shortly after and then went on to hold the blog talk radio show, DSMA Live. We are going start a Spanish version of the talk radio mid July. We also started the DMSA blog carnival where you take a question around diabetes, and bloggers blog about that topic.

What is working well for you in the world of social media and why?

This is working well because I engage the community. I am humble and know what is going on and know what the community wants. I do my best to be resourceful, if I don’t know the answer to the question I find out the answer.

The most successful part for me personally is watching the community grow. So many people don’t know about diabetes. People are saying that they like the support and it’s is priceless to hear that you have changed people’s lives. It’s hard to judge which is part is most successful within our DSMA efforts.

What are you most proud of?

My connection with Simon through DSMA. Simon is our largest DMSA supporter and believes in it. He found DSMA as an effort to get help and support for his diabetes. He lives in Australia and decided to come to America to meet all of people that have affected him through DMSA. He worked 80-120 hours per week to save money for his trip. He went to LA, I drove to Kansas City and several others went to meet to meet him too. We had dinner and I didn’t live until 2 am.

What was it like to meet him?

The experience for me was to put everything in perspective. To see these people come together all because of diabetes was an emotional thing. I didn’t get a chance to talk with him as much as I wanted when we met and towards the end I gave him a hug. He said, “I am alive because of you.” Even when he wanted to give up on his diabetes it was because of DSMA that he didn’t give up.

What is the biggest issue in the world of diabetes?

Health literacy for one and other is physician and patient interactions. More interaction with the patient is needed. The physician needs to explain what is going on with the patient’s diabetes, more discussion of medications is needed as well as the media stigma behind diabetes and what causes diabetes. People with diabetes (we) don’t ask the questions we need to ask and need we need to become self-advocates for our health. The doctors could be more transparent and need realize not everyone understands health terminology. Healthcare providers need to talk in language that patients understand.

What tools and resources are missing for people with diabetes?

Another issue (my personal opinion) is there are so many people in underprivileged areas that don’t have access to the diabetes online community. I would love to use the tools we have learned and help people that are not online. It would also be great to have doctor’s offices with patient representatives to talk to the person with diabetes. They need a patient liaison so they don’t feel alone when they leave the office.

What do you think of the concept of personalized Fit4D pathways?

It makes sense and I think it would be helpful. Like you said everyone has a different path. Whether they are trying to manage diabetes while going to college or having a different situation. It really sound like you’re hitting the hammer right on the nail with the Fit4D pathways.

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

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WHO
Cherise Shockley
Founder of Diabetes Social Media Advocacy and Co-Host of DSMA Live

http://diabetessocmed.com/

POINT OF VIEW
Passion to help people with diabetes through social media
What are you doing in the world of social media?
I’m the founder of DSMA–Diabetes Social Media Advocacy. We connect people with diabetes and empower them to feel comfortable to talk about their diabetes. It started about 2 years ago when I was watching the #hcsm health chat on twitter. I had an aha moment! I thought it would be great to moderate a twitter discussion with diabetes. We started the first chat (#DSMA) every Wednesday at 9 pm shortly after and then went on to hold the blog talk radio show, DSMA Live. We are going start a Spanish version of the talk radio mid July. We also started the DMSA blog carnival where you take a question around diabetes, and bloggers blog about that topic.
What is working well for you in the world of social media and why?
This is working well because I engage the community. I am humble and know what is going on and know what the community wants. I do my best to be resourceful, if I don’t know the answer to the question I find out the answer.
The most successful part for me personally is watching the community grow. So many people don’t know about diabetes. People are saying that they like the support and it’s is priceless to hear that you have changed people’s lives. It’s hard to judge which is part is most successful within our DSMA efforts.
What are you most proud of?
My connection with Simon through DSMA. Simon is our largest DMSA supporter and believes in it. He found DSMA as an effort to get help and support for his diabetes. He lives in Australia and decided to come to America to meet all of people that have affected him through DMSA. He worked 80-120 hours per week to save money for his trip. He went to LA, I drove to Kansas City and several others went to meet to meet him too. We had dinner and I didn’t live until 2 am.
What was it like to meet him?
The experience for me was to put everything in perspective. To see these people come together all because of diabetes was an emotional thing. I didn’t get a chance to talk with him as much as I wanted when we met and towards the end I gave him a hug. He said, “I am alive because of you.” Even when he wanted to give up on his diabetes it was because of DSMA that he didn’t give up.
What is the biggest issue in the world of diabetes?
Health literacy for one and other is physician and patient interactions. More interaction with the patient is needed. The physician needs to explain what is going on with the patient’s diabetes, more discussion of medications is needed as well as the media stigma behind diabetes and what causes diabetes. People with diabetes (we) don’t ask the questions we need to ask and need we need to become self-advocates for our health. The doctors could be more transparent and need realize not everyone understands health terminology. Healthcare providers need to talk in language that patients understand.
What tools and resources are missing for people with diabetes?
Another issue (my personal opinion) is there are so many people in underprivileged areas that don’t have access to the diabetes online community. I would love to use the tools we have learned and help people that are not online. It would also be great to have doctor’s offices with patient representatives to talk to the person with diabetes. They need a patient liaison so they don’t feel alone when they leave the office.
What do you think of the concept of personalized Fit4D pathways?
It makes sense and I think it would be helpful. Like you said everyone has a different path. Whether they are trying to manage diabetes while going to college or having a different situation. It really sound like you’re hitting the hammer right on the nail with the Fit4D pathways.
Interviewed by Sherri Isaak, MS, RD, CDE, BC-ADM, Fit4D Director of Content Development

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WHO

Dr David L. Katz, MD, MPH

Founder at National Exchange for Weight Loss Resistance

Editor-in-Chief at Childhood Obesity

Chief Science Officer at NuVal

President & Founder at Turn the Tide Foundation

Director, Integrative Medicine Center at Griffin Hospital

Director at Yale Prevention Research Center

POINT OF VIEW

Using lifestyle to help manage and reduce risk of chronic disease

You are involved in an amazing amount of different causes. What do you enjoy most about what you do?

Making a difference! On a day to day basis it seems pretty hard but overall as I look at the array of activities I’m involved in I feel like I am helping people overturn the tide of obesity and type 2 diabetes. I want to feel good—we’re all a little selfish that way. I feel good when I see the programs that I’m working on are reaching people and helping them lead better lives. The value in recognizing the selfishness is that many of us want to do good and help others. And it helps us to choose the things we really love, it motivates us. It’s important to fall in love with your career choice and my career has evolved in doing that.

What do you think are the biggest challenges facing people with diabetes?

First we have a world that makes it easy to develop diabetes, difficult to avoid and challenging to managing. Type 2 is mostly a lifestyle disease; there was none of this in children before obesity. Diabetes requires for you to swim upstream with a society that markets all the wrong foods and makes activity difficult. We don’t have a culture that enlightens healthy lifestyles. We shouldn’t have to work so hard to avoid type 2 diabetes–we have established a cultural norm in developing diabetes. Besides lifestyle challenges, people also have challenges with blood glucose control and hypoglycemia and the consequences of complications—which is really the hardest part of dealing with diabetes.

Where do you see us in 10 years regarding managing diabetes and obesity?

I like to compare the different things we are doing to stacking levees to prevent flooding. Every policy and activity is a sandbag in a levee. I am always a little careful about being too optimistic since we don’t always agree on what constitutes a good idea to make progress in this area. For example, Bloomberg’s idea of decreasing drink sizes, there is a lot of controversy here as well as different opinions. Every time we take a step forward we get knocked back. We can build the levee together. Our inability to have civil dialogue, talk to others and be persuaded is the enemy here.

If we get out of one another’s way we can make a difference, we have the knowledge. 90% of all diabetes would go away we just have to turn the knowledge we have into the power of what we do. The only thing in the way is us.

What tools do you think would help people with diabetes succeed or adhere to their diabetes self-management programs?

Physical activity daily that fits in no matter what and good food choices. Programs that we have developed or those that others have developed can be used. The averages shopper is mystified; every package is a commercial. Sugary cereals say whole grain, added vitamins and you think it is a good choice. It’s confusing and even if you have the time you might not be able to figure it out. I devoted years of my life to the NuVal® system. It is a simple nutritional value scoring system based on a scale of 1-100. The higher the score the more nutrition. It’s in 1700 supermarkets. A study was done in Harvard with NuVal, the higher the average NuVal score the lower the risk of diabetes. This is an extremely powerful tool and evidenced based system to reduce risk of chronic disease.

We need to create strategies for physical activity every day. We send kids to school all day and physical activity programs are getting cut. ABC for Fitness© (Activity Bursts in the Classroom) is a free program that is used for schools across the county that helps kids be active throughout the day. A-B-E for Fitness (Activity Bursts Everywhere) is for adults and provides a free video library of activities. We have to be clever since fitting in physical activity is challenging. Overall when people use their feet and forks better they will see their diabetes control improve.

What do you think of the concept of the Personalized Fit4D Pathways©?

It sounds great. Knowledge is also power– if it gets used. I would completely endorse it–sounds like a one stop shop. If you can be guided to a system like that it will make a difference for people. The power of lifestyle trumps all but in the modern world it takes skills and takes power to learn how to use lifestyle.

Anything else you would like to share?

Please visit www.turnthetidefoundation.org for our resources. We try to make the sand bags in the levee free. Also please see our Unjunk Yourself video.

Also, I see two critical issues here. In order to prevent diabetes we need the world to change. If you have diabetes or have a family member with diabetes you need to find tools you can use and find a healthcare professional to help empower you.

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

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WHO

Mike Boyle

Managing Editor and Webmaster of diabetescare.net

POINT OF VIEW

Education leads to stronger communities and hope

What do you find most fulfilling about your role at Diabetescare.net?

I came to diabetescare.net in July 2010 when the website hadn’t launched but had started its build. It’s a site that is 100% philanthropic, funded by Robert Schwartz. He has been in food manufacturing for over 35 years and this is his way of giving back. It’s free to use and there is absolutely no advertising. I helped build the content, working with the board, and I now focus on driving traffic through social media in order to publicize the website globally. Our biggest audience is in South Asia, India and Pakistan and the United Kingdom. We have it in 52 languages.

My interest in this project was solely because members of my family have diabetes. I have a background in radio and publishing, having programmed and was on the air in radio stations in NY and Philadelphia for almost 30 years. I started doing internet work for radio stations. When the economy turned, I lost my job. I found this opportunity because it fit my skill set.

What do you find most rewarding about being able to reach such a broad audience?

We’re able to reach globally as many people as we have, and that there are so many people who need help. Everyday if you can reach out to one person or a group or organization to offer help, that is the biggest compliment to this job. Helping people has been most rewarding.

What do you see as the biggest issue right now within the diabetes communities as a whole?

The biggest issue is, if you break it down into Type 1, those folks are focused on the info about the artificial pancreas. They have an appetite about any information and research on their condition. Often they get really upset when articles don’t portray Type 1 education. Type 2 are often like a deer in headlights because they have just been diagnosed and don’t know what to do or how to get the right information. There is a lot of confusion out there.

The artificial pancreas is very interesting to me, as we have done quite a bit of research on it. I see there’s a lot of hope there.

What do you consider the most valuable aspect of diabetescare.net?

It’s a one-stop location where people can not only get the latest news on diabetes, and the news is written in a way that is not over anybody’s head. There’s a library of videos and recipes, a blood glucose tracker, forums, blogs, you can get everything here and rely on it. We pride ourselves on this. Also, no one will ever have to deal with advertising on our site. It’s a safe haven to spend all kinds of time and we will never try to sell you something. We are all about education and support.

What do you think about the Fit4D Pathways as a way to help people living with diabetes on a global scale?

I think it’s tremendous! When I look at the amount of coaches you have, spread across the country, it’s really amazing. We get so many questions from people everyday, and at the bottom of every article or video people can ask questions. And it takes an awful lot of time, which tells me people need one-on-one care.

Interviewed by Alexis Fedor, Fit4DOnline Marketing ManagerRich Text AreaToolbarBold (Ctrl / Alt + Shift + B)Italic (Ctrl / Alt + Shift + I)Strikethrough (Alt + Shift + D)Unordered list (Alt + Shift + U)Ordered list (Alt + Shift + O)Blockquote (Alt + Shift + Q)Align Left (Alt + Shift + L)Align Center (Alt + Shift + C)Align Right (Alt + Shift + R)Insert/edit link (Alt + Shift + A)Unlink (Alt + Shift + S)Insert More Tag (Alt + Shift + T)Toggle spellchecker (Alt + Shift + N)▼
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WHO
Mike Boyle
Managing Editor and Webmaster of diabetescare.net
POINT OF VIEW
Education leads to stronger communities and hope
What do you find most fulfilling about your role at Diabetescare.net?
I came to diabetescare.net in July 2010 when the website hadn’t launched but had started its build. It’s a site that is 100% philanthropic, funded by Robert Schwartz. He has been in food manufacturing for over 35 years and this is his way of giving back. It’s free to use and there is absolutely no advertising. I helped build the content, working with the board, and I now focus on driving traffic through social media in order to publicize the website globally. Our biggest audience is in South Asia, India and Pakistan and the United Kingdom. We have it in 52 languages.
My interest in this project was solely because members of my family have diabetes. I have a background in radio and publishing, having programmed and was on the air in radio stations in NY and Philadelphia for almost 30 years. I started doing internet work for radio stations. When the economy turned, I lost my job. I found this opportunity because it fit my skill set.
What do you find most rewarding about being able to reach such a broad audience?
We’re able to reach globally as many people as we have, and that there are so many people who need help. Everyday if you can reach out to one person or a group or organization to offer help, that is the biggest compliment to this job. Helping people has been most rewarding.
What do you see as the biggest issue right now within the diabetes communities as a whole?
The biggest issue is, if you break it down into Type 1, those folks are focused on the info about the artificial pancreas. They have an appetite about any information and research on their condition. Often they get really upset when articles don’t portray Type 1 education. Type 2 are often like a deer in headlights because they have just been diagnosed and don’t know what to do or how to get the right information. There is a lot of confusion out there.
The artificial pancreas is very interesting to me, as we have done quite a bit of research on it. I see there’s a lot of hope there.
What do you consider the most valuable aspect of diabetescare.net?
It’s a one-stop location where people can not only get the latest news on diabetes, and the news is written in a way that is not over anybody’s head. There’s a library of videos and recipes, a blood glucose tracker, forums, blogs, you can get everything here and rely on it. We pride ourselves on this. Also, no one will ever have to deal with advertising on our site. It’s a safe haven to spend all kinds of time and we will never try to sell you something. We are all about education and support.
What do you think about the Fit4D Pathways as a way to help people living with diabetes on a global scale?
I think it’s tremendous! When I look at the amount of coaches you have, spread across the country, it’s really amazing. We get so many questions from people everyday, and at the bottom of every article or video people can ask questions. And it takes an awful lot of time, which tells me people need one-on-one care.
Interviewed by Alexis Fedor, Fit4DOnline Marketing Manager
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