Taking Control of Your Diabetes (Santa Clara, September 15th, 2007)
The Taking Control of Your Diabetes (TCOYD) Conference was held on September 15th 2007, in Santa Clara, CA. From Hawaii to Minneapolis, our very own advisory board member, Dr. Edelman and his team hold about a dozen TCOYD meetings every year - the biggest one in San Diego (on December 8 this year). The Santa Clara meeting was labeled by diabetes veterans as providing "reestablished focus in a positive and affirming way" while neophytes said they "learned more today than (they) ever knew was available." About 1500 people attended and most break-out sessions were filled to capacity.
Dr. Edelman lamented the statistic that 92 percent of Europeans were using insulin pens compared to only 12 percent in the U.S., saying, "If you are not using a pen, you are in the dark ages." Sadly we also realized this while attending the EASD conference - many more type 2 patients in Europe take insulin at all, for a start!
Still on devices, he described continuous glucose monitoring as the biggest advance in type 1 diabetes therapy since the discovery of insulin. It provides an important step toward the artificial pancreas for diabetes. Stem cell research/gene therapy, however, could also provide a potential cure one day he says. Dr. Edelman himself has type 1 and we always listen closely to everything he says about diabetes since we know he has an extra incentive to be in the loop!
He ended his presentation on a poignant quote from Larry Verity, an exercise physiologist: "If you cannot find time for exercise, you will have to find time for disease." He recommended yearly dilated eye exams (retinopathy) , cholesterol panels (LDL, HDL and triglycerides), and regular visits to the dentist (tooth and gum disease).
Dr. Polonsky's presentation was aptly titled "Psychological Secrets for Effective Self-Management." The bottom-line message was that diabetes is tough and it is not inhuman to make mistakes - give yourself a break! At diaTribe, we know as well as you do how important it is to find a balance between managing diabetes intensively and having a life outside of diabetes.
Dr. Polonsky likened diabetes management to a job that involved a lot of work, with minimal vacation time and pretty bad pay - boy can we relate to that! He emphasized that diabetes was not a death sentence and elegantly corrected the notion that diabetes is the leading cause of blindness, amputation, and kidney failure. He pointed out that it is poorly controlled diabetes that causes these complications. "Well controlled diabetes is the leading cause of nothing." He quoted Sir William Osler, who is reputed to have said, "The easiest way to live well is to develop a chronic disease and take good care of yourself." In Joslin's 50-year Medalist Study of groups of people who were diagnosed with diabetes 50-60, 60-69 or >70 years ago, researchers suggest that individuals with such long duration of type 1 diabetes may be protected from, or show slower progression to, diabetic retinopathy. The study showed that about 50 percent of the 50-60 year diabetic duration had retinopathy - 44 percent and 27 percent respectively for the 60-69 and >70 years of diabetes. Almost 50 percent of all groups had no significant microvascular complications. These statistics strongly support the idea that a diabetes diagnosis is not necessarily a prediction of severe complications.
Dr. Polonsky described the use of smaller plates as a creative way to monitor and control food intake. He added that focusing on other things - like television - while eating often leads to mindless over-eating. Additionally, it is important to make healthy foods easily accessible and keep the junk stashed away - if not out of the house completely. Learn more about his practice at the Behavioral Diabetes Institute.
Ruth Spirakis, a CDE and dietitian, advised diabetes patients to spread carbohydrate intake throughout the day - we know this will help us avoid spikes, though it's hard to schedule! She emphasized moderation over elimination (okay, good - we weren't considering elimination anyway!) and urged patients to ask for low-fat or whole grain substitutions while eating out.
Dr. Wargon drew attention to the need for proper foot care for patients. He recommended a foot check on every doctor's visit, checking shoes before wearing them, and avoiding home remedies and "bathroom surgery" for foot problems.