Diabetic Friends Action Network (DFAN) Online Diabetes Newsletter - June 1996 Edition June is the month for flowers, pools, barbecues and suntans. It's also a month of oppressive heat. If you're going to be outside take special care of your diabetes supplies. Keep your insulin in a place where it will stay cool. Don't put it right next to the ice in your cooler or it might freeze. There are cases available that will allow you to keep your insulin, syringes and other diabetes supplies in a safe place during the summer. If you can't find any at your local pharmacy try to get a copy of Diabetes Forecast and look in the ad section. Our weight loss club now has 106 members so far and I'm happy to say that it's still growing! If you need to lose weight or would like to maintain your weight why not join our free weight loss club? Our daily club e-mails include a phrase for the days, motivation, information, and daily club news. We also have weekly club files, recipes, and a club project that will help you with your diabetes management plan in some way. If you're interested in joining or would like to receive a sample club e-mail send your request to: BELVE@AOL.COM We have no articles or poems for next month's newsletter so if you'd like to send one in please don't hesitate. It can be fiction or non-fiction. Your story can be happy, sad, angry, fearful or any other emotion you'd like to share with out readers. This newsletter depends on your stories. Your story or poem can be five words or five hundred. It's up to you. Send your stories or inquiries to: BELVE@AOL.COM Our text file offers have been a great success so and we'd like to thank all of you who requested them. This month we are offering the following files for upload to your e-mail box: File #1: Chromium & Diabetes File #2: Diabetes & Vascular Damage (Diabetic Complications) If you'd like to read any of these files please specify that you want the "June Files". State if you want "#1", "#2", or "both". Send your request to: BELVE@AOL.COM One more thing. Last month my computer crashed. About 80 e-mails got deleted so if you requested to be taken off the distribution list or requested an e-mail address change please send me another e-mail and you'll be removed. Also if you were on the weight loss club distribution list and stopped receiving club e-mails please let me know so I can add you back to the list. _____ARTICLE_____ /BLAMING NO ONE I wasn't used to "being a diabetic" so when I was told I had to go see a dietician I was happy that I would finally be learning something about what I could and couldn't eat. I was scared too, but that had to be put on the back burner. It was time to get some of the knowledge I needed. My father was with me for this visit with the dietician. At that time he had Type II diabetes for about five years. He was coping with it very well. My Dad was the first diabetic I had known personally so I was relying on him a lot. We were a bit early so the dietician wasn't at her office. My Dad and I made small talk while we waited. Finally the dietician arrived and she started to tell me about how what I ate would have a great influence on my diabetes control. I spent about a half hour with her learning everything from how to prepare my meals (very little frying, low-fat foods, etc...) to what I should eat when my blood sugar went low. The conversation then moved on to how I got diabetes. This wasn't on my mind much because I was too busy being nervous about things. The dietician explained to me that my diabetes was passed down to me from my Dad. When my Dad heard that he really got upset. He asked, "What do you mean I made her get diabetes?". The dietician went on to explain how diabetes is passed from the parents to the children. My Dad just got more upset. He said, "I didn't give her diabetes!" I could tell that if I didn't get my Dad out of that room things might get out of hand. So the visit was cut short and we left. I didn't think about what happened for a long time. Then one day I started wondering how my Dad must have felt. To feel that he had been "blamed" for giving me this disease that no one wants to have. "Blamed" for giving me this disease that brings daily challenges into my life that sometimes leaves me in tears. The dietician and I didn't blame my Dad for anything. Yes, some of his genes may have made me susceptible to getting diabetes but it isn't anything that he did deliberately. He has diabetes too so I know he would never want me to have to go through what he's gone through. My Dad hasn't always told me what I wanted to hear. Sometimes I don't agree with the choices he makes. But I do know one thing. I know he isn't the one to "blame" for me getting diabetes. No one is to blame. _____ARTICLE_____ LOSING WEIGHT FOR BETTER CONTROL A weight reduction plan can be another "tool" you can use in your diabetes management plan. Yes, losing weight can help you just as much as insulin, oral medications, and blood glucose testing strips. Losing weight isn't easy for anyone to do and when diabetes is also involved it can bring new challenges and obstacles to your weight reduction plan. Although it can be difficult to lose weight there are things you can do to help shed some pounds so you can feel better and get your diabetes under better control. First, always make sure the weight reduction plan you want to use is approved by your doctor. There may be certain foods you're not supposed to eat or certain exercises you're not supposed to do. For example, people with retinopathy should stay away from weightlifting since they could re-injure their eyes. So check it out with your doctor FIRST. Linda shares, "The first thing my doctor and I discussed after diagnosis was weight loss. Our next appointment will be totally dedicated to weight loss." If you were overweight prior to being diagnosed with diabetes the fact that you have diabetes might be the only incentive you'll need to lose weight. For some Type II diabetics losing weight is all that is needed to get their blood glucose levels down closer to normal range. That can be a powerful incentive to slim down. When asked if it was easier for her to lose weight after she was diagnosed Linda says, "Actually, I have found it easier to lose weight since I was diagnosed. I now have an added incentive to lose weight. Now I know weight loss will make me healthier and if I don't drop the pounds I am putting myself at increased risk." You may also need to deal with some emotional issues in order to lose weight. You may have eaten for years eat because of stress, anger, or sadness and you'll have to find another way to deal with these emotions besides eating. Finding another outlet for these emotions may be difficult but it's worth the effort. Pat, a Type II diabetic who has been overweight most of her life says that she had to learn how to cope with anxiety and tension without eating, "Fat and sugar were my consolation friend when I was hurting from the pain of the day, whether it was pain from stress or some other emotional pain. I could always eat a big bowl of ice cream and find myself humming a happy tune." Losing weight can be thought of as a complete lifestyle change that will last for the rest of your life. Don't think of it as something you only have to do for a limited amount of time. If you want to lose weight and get your diabetes under control, your new weight reduction plan must be in effect constantly and consistently every day from now on. Ken, who has dealt with Type II diabetes for six years also has heart disease. He has reached his goal weight and shares, "I was overweight for ten to fifteen years. When I was diagnosed with diabetes, I began to watch both my sugar and carbohydrate intake and added regular exercise. But I believe the exercise made the difference." Ken walks for thirty to forty-five minutes daily, (weather permitting) and also uses a stationary bike and cardio-machine (exercise machine). You're not a robot so don't expect yourself to do everything right. There will be times when you make a mistake and eat something that's not on your mealplan or you may not exercise for a day or two. The trick is to get back on your plan as soon as you can. Don't be too hard on yourself. Yes, you made a mistake but you don't have to let that small mistake foul up your entire weight reduction and diabetes management plan. Carolyn has had problems exercising and drinking water, "I sometimes have problems eating more than I should at a meal. Sometimes I'll sneak a piece of chocolate after dinner, when I'm out of exchanges for that meal. At least it's sugar-free chocolate. And there are times when I'm not honest with myself about it. But I am getting better about it." Carolyn is working on losing weight to help control her diabetes, "I don't have an option to lose weight. This is not a diet but a change in lifestyle. By getting in better shape my diabetes is under control and I hopefully will have a longer life." Carolyn has been a Type II diabetic for five months. There may be times when you find yourself or others sabotaging your weight loss efforts. If you find yourself skipping meals, that may lead to overeating when you finally have your meal. If you're making excuses for not exercising, try not to miss too many days before you start exercising again. If members of your family are constantly offering you foods that aren't on your meal plan, explain to them that you're trying to lose weight and they can help you a great deal if they don't offer you any off-limit-foods. Once you explain your goals to your family and friends you might even find that they try to help you. Barb, from Westminster, Colorado says, "Having diabetes has helped me lose weight. It actually helps in that people don't try to make me eat sweets. They tell me not to eat things! They're nosy, but caring." If you're thinking about using a commercial weight loss service, such as Jenny Craig, etc.., there are a few things you should think about. Make sure the commercial weight loss service you choose knows how to help a person with diabetes lose weight. Diabetics have special needs that must be taken into account when planning a weight reduction plan. For example, a non-diabetic might be told to never eat candy. A person with diabetes might have to eat candy in order to treat a low blood sugar reaction. There are also certain exercises people with diabetes can and cannot do depending on whether or not they are suffering from diabetic complications. Helen, a Type II diabetic used Weight Watchers prior to being diagnosed, "I did well while I was on the program but I haven't gone back." Helen is still trying to lose weight and recognizes her progress as well as what she needs to work on, "I'm writing everything down but I still tend to skip meals, and then overeat. Exercise is also a problem for me due to a back injury." If you go to a commercial weight loss service and they can't convince you that they know how to help a person with diabetes don't use that service. Here's one specific question you can ask a commercial weight loss center before you decide to use them: Question: Do you have specific weight reduction plans for people with diabetes? If they tell you "Yes", ask to see the plan and check it out with your doctor BEFORE you sign up. If they say "No", walk out the door. You may have heard about the Phen/Fen diet which uses medication to help people lose weight. These medications, Phentermin and Fenfluramine have given some people great results. Tony has been overweight all his life. "I've had Type II diabetes for about five years. A couple of months ago I heard about Fen/Phen and it sounded good, so I tried it. A combination of getting older and complete inactivity was becoming more and more annoying and I thought losing weight would help." Tony lost weight using Fen\Phen but had to stop using it, "I lost nine pounds the first week, two pounds the second, and one pound the third. However, because of the dramatic decrease in weight loss and three side effects I quit taking Fen/Phen. My vision had become blurred, my feet ached terribly at night, and I only had one good night's sleep in all the time I was taking the medication." You may also want to find out about support groups for people who want to lose weight. It may be better to find support groups that have diabetic members so you'll have someone to talk to about your diabetes related weight loss needs and concerns. If you can't find any support groups for diabetics trying to lose weight join one for non-diabetics, but always adapt their goals and suggestions to your diabetes management plan. Try not to join a support group that gives you suggestions that would be detrimental to your diabetes control. Here are some things you can do when you start your weight reduction plan: 1) Clean out your cabinets - get rid of the foods you that aren't on your mealplans. If the rest of your family will eat these foods then put them on one side of the cabinet. Put your foods on the other side. 2) Make sure you have the correct snacks around the house - It's easier to eat the right snacks when they're readily available to you. Try to avoid snacks that are high in sugar and fat (if you're on a low-fat diet). Add them to your regular shopping list and keep them in the refrigerator and cabinet. 3) Choose your exercise realistically - make sure you choose and exercise that you LIKE to do (or you should at least be able to tolerate the exercise). If you know you don't like the outdoors don't go out and buy a bicycle which will end up sitting in the garage gathering dust. If you know you don't like to exercise in front of others don't buy a membership at a gym, etc... Walking is an exercise that most people can do and the only thing you need are some comfortable clothes and a good pair of walking shoes. 4) Start a food journal - write down everything you eat including single pieces of candy, sticks of chewing gum, "tastes" of food while you're cooking, and anything else you eat. Here's some advice from people with diabetes who are trying to lose weight to get their diabetes under control. Advice #1: Be sensible. Don't expect it to happen right away. Give yourself time - six months, a year, - but stick with it. I write my weight down so I can see it. I might even graph it. Also, don't let weight loss be your goal. Good control should be the goal. I live by my blood glucose readings. If they turn out high, I really pull in the reins. Advice #2: Just keep plugging away, if you are not losing the weight you want to make sure you are weighing and measuring your food. That is what will get me sometimes. Don't guess, be exact. Advice#3: Don't give up, and if you can get a family member or friend to help you and be supportive. Also try a new food or recipe at least once a week. Advice #4: "Exercise" Advice #5: The one piece of advice that I would give anyone, diabetic or not, who is trying to lose weight is not to get discouraged and not to get down on yourself for a mistake. We are all human. No one is perfect, so if you don't follow a plan exactly one day (or one meal) there is no reason to give up. Its just an incentive to continue to work hard at it. Instead of looking at the mistakes, look at all the positive things you've done. Congratulate yourself for walking only 15 minutes instead of saying I should have walked for half an hour. You did something and that's better than nothing. Advice #6: Set small goals. Start with a goal of "things" rather than pounds. For example, a goal of keeping a meal plan for a week. Then the next week set a goal of exercising each week. After these goals are met and instilled set a goal of losing one pound per week. _____POLL RESULTS_____ Last month's poll question asked: Have you ever felt ashamed or embarrassed to let your doctor know you've been getting high blood glucose results from your home testing? How did you deal with this problem? Here is a response we received: "I have always kept a log of BS readings (usually in a BM log book) and\I always show this to the Dr. Any particularly high values can usually be explained and I normally annotate the log with potential explanations: e.g. "Fred S. 40th birthday" or "pasta!". I find that this helps reduce any guilt feelings on my behalf and censure on the Dr's part associated with higher readings. The bottom line though, is that glycosylated hemoglobin is a more important indicator of control than spot readings recorded by me - fortunately my Dr. is well aware of this." GLOSSARY: Glycosylated Hemoglobin Test - a blood test that measures a person's average blood glucose level for the past 2-3 months period before the test. Also referred to as Hemoglobin A1C. _____THIS MONTH'S POLL QUESTION_____ Next month's issue of our newsletter will include an article dealing with food issues. Making friends and family realize that food isn't just something you can have whenever you want it can be a difficult task. Have you ever had to deal with a friend or family member who tries to get you to eat foods that aren't on your mealplan? How did you deal with the situation? All responses will be kept confidential. _____ARTICLE_____ 111 AND GOING STRONG! THERE'S STILL TIME TO HELP! The Lifescan offer the Meter Bank is currently taking advantage of ends 7/31/96 so there is STILL TIME to help someone with diabetes get a free meter. The free meter coupons received will be valid until 10/31/96 so they will still be able to be distributed after the Lifescan offer has expired. If you have any Lifescan Lifepoints and/or Lifescan fulfillment coupons please send them in to the Meter Bank as soon as you can. The Meter Bank has placed *111* meters into the hands of diabetics all around the world! This is a worthwhile cause so why not take the time to send in your Lifepoints? There is also an urgent need for Lifescan Free Meter Fulfillment coupons (in specially marked boxes of Lifescan strips). If you run across these fulfillment coupons please send them to Richard so he can use them to help more diabetics get free meters. If any of your family members or friends use Lifescan strips please let them know about the Meter Bank and the need for these fulfillment coupons. The Meter Bank also needs the following: Meter Coupons that sometimes can be obtained from Lifescan. These coupons are for the meter itself and are blue in color. New Unused Meter Information (to be added to the New Meter Database) This information will be used to match new unused meters with people who need them. Used Meter Information (to be added to the Used Meter Database) This information will be used to match used meters up with trade-in allowances and rebates offered by companies. Stamps & Envelopes There is a Meter Bank FAQ" available for the asking. This Frequently Asked Questions file will give you background information about the Meter Bank and the person who runs it. If you'd like to read this FAQ send a request to: xjmv62a@prodigy.com -or- belve@aol.com We'll get the FAQ right out to you (or your family and/or friends) so you can start participating! or if you'd like to write Richard directly send an e-mail to: batman@phoenix.net -or- arthur@tenet.edu The Meter Bank is using 50/50 Pharmacy to have the meters delivered to people. This pharmacy donates fifty percent of it's profits toward diabetes research. The Meter Bank is a way for you to help people with diabetes get new meters to help them with their diabetes management plan. Having a blood glucose testing meter plays a critical role in someone being able to control their blood glucose level. So why not help someone in a meaningful worthwhile way and donate to the Meter Bank. _____ARTICLE_____ AIDA is an interactive PC(DOS)-based freeware computer program aimed at insulin dependent (Type I) diabetics. It is intended to simulate the effects of insulin and diet on the blood glucose level. AIDA is only intended to be used for educational/teaching/demonstration purposes. The human body is complex and it is not possible for a program such as AIDA to accurately predict an individual patient's blood glucose levels. Dr. Eldon Lehmann, one of the authors states, "AIDA comes with 40 case scenarios which can be simulated as examples. Additional case scenarios can be added by users. AIDA also contains a very simple knowledge based system which can identify problems in the displayed case. A list of suggestions which might correct some of these problems can also be generated. This list is provided solely as a prompt to the sort of insulin dosage adjustments that users might like to try simulating with AIDA." For example you could simulate what would happen to a hypothetical patient's blood glucose profile if the carbohydrate content of breakfast was increased by 10 grams or if the supper time Humulin R dose was decreased by 4 units, or the injection time moved earlier or the meal time shifted later. The list of possibilities is endless - an infinite number of simulations can be performed with AIDA. NOTE: AIDA is not intended for individual patient glycemic prediction, individual patient management or therapy planning. Furthermore, AIDA cannot generate individual patient specific therapeutic advice. Changes in therapy should always be discussed with a doctor. A DFAN beta tester tried the program and shares, "While the text states that this is dos software it ran with no trouble under windows 3.1. I do have a big system (24meg. ram) and those with smaller systems may have to run it under dos. The graphics were stunning. I wish they had a way of printing them! I can do a screen capture but this is the long way around and again not everyone has this capability. To use this software effectively will require some computer skill and knowledge of diabetes that isn't universal. My overall assessment is: Good information, great graphics but a limited audience since some newly diagnosed diabetics might have a problem understanding it." AIDA could be a great tool to use in your diabetes management plan. So if you're a newly diagnosed diabetic download it anyway and give it a try. Knowledge is one of the keys to better control so use AIDA to increase your Diabetes IQ! System Availability ------------------- Both a demonstration version of AIDA and the full interactive program can be obtained free of charge from the Diabetes UK World Wide Web site on the Internet from: http://www.pcug.co.uk/~diabetes/aida.htm or by FTP (file transfer protocol) from: [site] ftp.win-uk.net [directory] /pub/users/diabetes/software [filename] aidainst.exe (full installation program 1.5Mb) or [filename] aidadem.exe (demonstration program 305Kb) For more information about AIDA please contact: aida@globalnet.co.uk _____CORRECTION_____ In last month's newsletter the incorrect information was given for subscribing to the Lehign diabetic listserve. Here's the correct signup information: To subscribe to the DIABETIC mailing list, send a mail message to: listserv@lehigh.edu Leave the subject line blank. Put the line: SUBSCRIBE DIABETIC Your name (where Your name is your name!) as the body of the message. You should get back a confirming message with more information about the list. Note that the list traffic is about 300 messages per week. Be prepared! You may want to consider receiving the postings in a daily "digest" format. The confirming message you receive once subscribed describes more about this option. _______________BACK ISSUES_______________ If you'd like to receive our list of back issues send an e-mail to: belve@aol.com This document (c) Copyright 1996, all rights reserved. Redistribution of this document is hereby freely granted so long as the document is redistributed in its entirety (here interpreted as all text which was not automatically generated by software as part of the distribution process); in particular, with attributions and this copyright notice.