Office worker looks at the camera with expression of fear as he opens a file folder at his desk

Don’t Freak Out!
10 Things to Know If You’ve Been Diagnosed with Type 2

1. No, It Probably Isn’t a Mistake

When first diagnosed, many people find it difficult to believe. They think it must be a terrible mistake, believing that perhaps another test is needed or thinking maybe it will just go away. This is a very natural response to the shock of receiving the diagnosis. Unfortunately, it is very likely that your diagnosis is real and diabetes is here to stay. You’re now part of the very large and growing club of people with diabetes – a club, we understand, that you would prefer not to join!

 2. The Good News Is, This Isn’t Your Grandmother’s Diabetes

With 21st century technology and care, we now know you can live a long and healthy life with diabetes. The diagnosis of diabetes is NOT a death sentence. Terrible outcomes, like blindness, amputations and kidney problems, are largely preventable. Thanks to modern medicine, people developing diabetes today have an excellent chance of living long, healthy lives, free from serious complications. With good care and attention, you can be one of those people.

Here are a few things you can do right now to set yourself up for success:

Get on a Diabetes Warranty Program

Just like you take your car in for regular tune-ups, we recommend you include the following as part of your “regular health maintenance” program:

  • Have an A1C test (at least twice a year) to measure your average blood sugar levels over the previous 2-3 months
  • Get a yearly dilated eye exam from an eye specialist who is knowledgeable about diabetic eye disease
  • Get a yearly kidney function test
  • Keep a close eye on your feet, especially if you have neuropathy or a lack of sensation, and have your provider inspect them at least once a year (more if you have neuropathy).
  • Have your blood pressure checked every time you see your provider, and your cholesterol checked annually (more frequently if your levels are high).
  • See your dentist twice per year for regular cleanings and prevent tooth and gum disease by brushing and flossing every day, not just one week before you go to the dentist!

Learn all you can about diabetes…knowledge is power!

Attend one of our in-person conferences (click here for the 2018 schedule!), explore our online video library here, check out our extensive blog archives here or grab a copy of Dr. Edelman’s 5th edition of Taking Control of Your Diabetes by calling our office at 800-998-2693.

3. Diabetes Is Not Your Fault

Don’t blame yourself for developing type 2 diabetes, and don’t let anyone else blame you either. It is not caused by laziness or a lack of will power. Eating sweets didn’t do it. Type 2 diabetes is a genetic disease. And when you have these genes, certain factors – like being overweight – can trigger it. More and more people are becoming heavier and developing type 2 diabetes because most jobs now require little physical activity, life is more stressful, and too many foods tempt us that are high in calories, large in size and much too convenient. Your genes and the environment are the major culprits, but that doesn’t mean you are now helpless to protect your health. So read on!

4. Ignoring It Won’t Make It Disappear

You can’t feel diabetes when it is out of control, so you may think you don’t need to worry about it. But diabetes ignored and left unmanaged can cause damage to your body. Yes, odds are good that you can live a long, healthy life with diabetes, but only if you are working to control it now, not sometime later. So see your doctor regularly, take all of your medications, stay active, and learn more about the foods you eat. For your health, get involved in your own diabetes care.

5. Knowing Your Numbers Should be Your First Step

To manage diabetes, there are so many things you will be advised to do and change. No wonder it can feel so overwhelming. You can’t do everything at once, so where should you start? Begin by making sure the critical diabetes tests are being done and that you, not just your doctor, know the results.

After all, you can’t know what to do differently if you don’t first know how you’re doing. At the very least, find out about your blood pressure, cholesterol and A1c numbers. You need to know what your numbers mean and what you and your doctor can do to get, or keep, those numbers in a safe range.

Check out the videos below for more info:

What Should My Target Blood Pressure Be?

What’s an A1c and Why Is It Important?

What the Heck is a Lipid Panel?

Goals for each test will vary for everyone individually, and will depend on your current health and your health history, so be sure to discuss your results and your personal goals with your healthcare provider.

6. No, You Won’t Be Limited to Eating Nuts, Twigs and Birdseed!

You can still eat your favorite foods, just not all at once. Boring diets are no longer necessary and there is no need to deprive yourself. However, attention to the size of your meals is critical. You will also need to learn more about the contents of the food you typically eat (carbs, fat and calories), which foods you should eat more or less of, and how those foods affect your blood glucose and overall health.

Here are a few recipes and resources to explore:

Chef Robert Lewis, the Happy Diabetic Chef

Diabetes Daily

Diabetes Strong

Diabetes Self Management Magazine

Diabetic Foodie

7. Not Taking Your Prescribed Medications Is a Dangerous Thing to Do

From the first day of a diagnosis, most people require medications to keep diabetes in check and maintain good health. Many people worry that taking medications might be bad for their health as well as too costly. Yes, there are diabetes medications that have negative side effects, but these are typically outweighed by the positive benefits to your long-term health. To stay healthy, your goal shouldn’t be to take fewer medications, but to make sure your numbers (A1c, blood pressure, and cholesterol) are in a safe range. Talk about the pros and cons of medications with your doctor, and ask about other options, especially if they are too bothersome or expensive. Then you can make an informed decision.

8. Protecting Your Heart Should Be Your First Concern

Heart disease is the major health concern for people with type 2 diabetes. Attention to lowering the risk for heart problems is the main reason why people with diabetes are living longer than ever. According to scientific studies, the most important areas to address, in order of importance, are smoking, blood pressure, cholesterol, A1c, and fitness. Talk to your doctor about your risk and what you can do.

9. Focus on Developing a Healthier Lifestyle, Not Weight Loss

Increasing your fitness and choosing healthier foods (for example, more fruits and vegetables, smaller portions, and less saturated fats) will have a bigger impact on your diabetes and heart health than losing weight. This is good news, since weight loss can be frustrating and difficult. Of course, exercising more and making smarter food choices may lead to a lower weight over time. But keep the focus on improving your health, not just improving your weight.

10. Don’t Do Diabetes Alone

Life with diabetes is just easier when you have people in your life cheering you on. Good diabetes care takes attention and effort, and you may at times feel overwhelmed, discouraged, isolated or even burned out. Your motivation can be sapped by the stresses of daily life or even problems with depression, which are common in people with diabetes. To protect yourself, make sure you identify at least one person in your life who will support you and your efforts to manage diabetes. It could be anyone: a family member, good friend, trusted healthcare professional, or support group. Also, find a doctor you really trust, can be honest with, and feel is on your side. Living well with diabetes is always easier when someone you like and respect is cheering for you.

Here are a few ways you can involve people you love, or find new friends in the DOC (diabetes online community) who totally get you:

Finding Support When You Have Diabetes Burnout

The Online Diabetes Community

With all of the information, medications and resources we have today, people with diabetes have an excellent chance of avoiding serious complications and can live a long, healthy, and happy life!

 

From the Behavioral Diabetes Institute and TCOYD

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Diabetes and Mindfulness

It’s time to face the facts people, living with diabetes can be VERY overwhelming and that’s nothing new to all of you out there living day in and day out with type 1 and type 2. Right? RIGHT!

So, with that being said, it’s pretty common to experience difficult emotions and when you have those difficult emotions, (i.e. feeling as though you want to give up, throw something against the wall, cry like a baby, or just yell at whoever happens to be around because you are so darn frustrated), it’s normal to spend a lot of time and energy TRYING to make yourself FEEL better.

Can you guess what the most common strategy people use to try and make themselves feel better? AVOID! AVOID! AVOID! Are you one of those people? Do you watch hours of mindless TV? Let’s remember though, that there is certainly an appropriate time and place for marathon Netflix watching, but back to the subject at hand, if you find yourself sleeping excessively, or exercising like a maniac, binge eating or drinking chances are you are probably playing the “avoidance game,” and no one wins at that game. Maybe you don’t manage your blood sugar levels because doing so brings up feelings and emotions you just don’t want to have to deal with and that’s completely understandable and really common.

So how well do these avoidance strategies actually work? Well, let us tell you that watching Netflix all weekend and eating three bags of Doritos Jacked 3D Bacon Cheddar Ranch isn’t going to make you feel amazing in the long-run. Chances are you probably aren’t doing things that are important to you, like spending time with your family and friends and managing your diabetes.

Dr. Mark Heyman, Psychologist, PhD, CDE and a type 1 suggests that you should not avoid your uncomfortable diabetes related emotions, but instead to simply observe them. By doing this it may actually help you focus less on your negative feelings and have more freedom in your life. Some of you may be calling BS right about now but stick with TCOYD and Dr. Heyman for a second.

Dr. Heyman is talking about something called mindfulness and unless you’ve been living under a shroud of Netflix shows for the last five years, you’ve probably heard this term before.

Mindfulness means paying attention on purpose, in the present moment, and non-judgmentally, to what are you are experiencing.

In other words, observing the thoughts, emotions and physical feelings you are having right now, without avoiding or judging them. The goal of mindfulness is not to make you feel a certain way (e.g., relaxed or happy), but to give yourself the space to just notice your present experience.

To really understand mindfulness, you need to experience it, and practice it regularly. We encourage you to do a short (about 5 minutes) mindfulness exercise (courtesy of UCLA’sMindfulness Awareness Research Center) to help you get a better idea about what we mean. Click here to get started.

Learning how to be mindful can take some practice, and it can be especially difficult to pay attention to experiences in the present moment when you are busy doing everything necessary to manage your diabetes, not to mention your every growing to-do list, your kids, your spouse. It’s even more challenging to pay attention to the present moment without judgement – and who hasn’t beaten themselves up over a high or low blood sugar? Even though it may not be easy, mindfulness can be something you can try to help you manage difficult diabetes-related emotions.

Let’s take a minute and think about what you may get out of being more mindful with diabetes. First, you may learn something new about yourself. You may see that even though it is not always easy, you can handle having uncomfortable thoughts emotions around your diabetes. You may even find that experiencing these thoughts and emotions are not as bad as you thought it might be. It also may be easier to do the things that are important to you but you have been avoiding. While these feelings may still be uncomfortable, you may find that mindfulness makes it harder for them to control your behavior. Mindfulness can allow you to choose your behavior, rather than letting your emotions choose it for you.

Dr. Heyman suggests some great methods that you can use in order to start being more mindful with your diabetes, take a look!

Mindful eating

As you eat, notice any thoughts you have about your food. Are you looking forward to eating it? Are you feeling guilty about eating it? Are you worried about what the food will do to your blood sugar? Take some time and notice the different sensations you experience as you eat. How does the food feel on your lips, your tongue, as you swallow? What does your food taste like? What is the temperature? The texture? How spicy is it? Just notice, without judgment, what you experience as you eat your meal. Try eating one meal mindfully and see what you notice and learn.

Mindful glucose monitoring

Before you check your blood sugar, notice your thoughts. Do you think your blood sugar is high, low or in range? How does this make you feel? Content? Discouraged? Notice what it feels like to prick your finger. Notice the all steps involved in putting the drop of blood on the strip. When you see the result, notice your response. Are you surprised? Proud? Frustrated? Once you have the result, just take a minute and observe what you just experienced – not from a place of judgment, but from one of curiosity.

Finally, try not to get discouraged (and if you do get discouraged, notice that feeling without judging it!) and remember that being mindful takes practice. As you practice mindfulness, keep in mind that the goal isn’t to make your thoughts and feelings go away, but to notice them. Whatever you experience, mindfulness gives you the space to observe your thoughts and emotions while not letting them control you. Being mindful can help you make decisions based on what’s important to you, rather than as reactions to your thoughts and feelings.

Jon Kabat-Zinn sums up mindfulness nicely when he says ‘You can’t stop the waves, but you can learn to surf.’

 

Content provided by:

Dr. Mark Heyman, Psychologist, PhD, CDE

Dr. Heyman is affiliated with the Center for Diabetes and Mental Health in Solana Beach, CA. He has lived with type 1 diabetes for over 15 years.

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Ozempic: Sugar Coated Success or the Best of Its Kind?

By Candis Morello and Parisa Karimian

In December 2017, Ozempic (semaglutide) received U.S. Food and Drug Administration (FDA) approval for the treatment of adults with type 2 diabetes (T2D).

Combined with eating healthy meals and regular activity, Ozempic may be used alone or with other diabetes medications. Ozempic is the 4th once-weekly glucagon like peptide-1 receptor agonist (GLP-1 RA) medication to enter the market after Bydureon (exenatide extended release), Trulicity (dulaglutide), and Tanzeum (albiglutide). Ozempic is expected to be launched in the U.S. by the spring, shortly before Tanzeum’s discontinuation from the market due to issues with sales. Ozempic sets itself apart from other once-weekly GLP-1 RAs by demonstrating the quickest and greatest effect in reducing blood glucose and body weight in studies. In addition, a pill version of Ozempic is now under evaluation in clinical trials.

How Does Ozempic Work?

Similar to the other once-weekly products, Ozempic is a GLP-1 RA. Even though it is synthetic, it acts similarly to the hormone GLP-1 naturally produced by the body that is deficient in people with T2D. It promotes the pancreas to release insulin (only when glucose values are elevated), makes people feel fuller faster so they tend to eat less, and reduces the amount of glucose made by the liver. Overall glucose concentrations are better controlled throughout the day and after meals, and most people lose some weight.

How is Ozempic Used?

Ozempic comes in easy-to-use prefilled disposable injector pens of either 0.5mg or 1 mg strengths. Since Ozempic has a long half-life (about seven days), it only needs to be given once per week. Select one day of the week (like Sunday, as an example) and make that your Ozempic day. To help you remember, you can mark your calendar or set a reminder alarm in your phone.

If you miss your day and remember within five days, administer it as soon as possible and set that day of the week as your NEW Ozempic day. If it is less than two days away from your next dose, wait the two days to administer.

Choose an administration site on your stomach (at least two inches away from your belly button), thigh, or upper arm. After uncapping the pen place the pen tip against your skin. Now, you are ready to press the injection button. Keep the button pressed down for 5-10 seconds to ensure complete dose delivery. Each week use a different injection site or rotate within that side. Each pen only contains four doses. Once empty, dispose the pen in a sharps container. New pens should be stored in a refrigerator, away from light in the original box.

 What Can You Expect?

Ozempic improves both fasting and post-prandial (after meal) blood glucose concentrations; however, based on its long-acting formulation, it has a stronger effect on fasting plasma glucose. You can expect your A1c to reduce by about 1.2- 1.8%, depending on the weekly dosage used. Ozempic, like other GLP-1 RAs, is associated with low risk of low blood glucose (hypoglycemia). One benefit of Ozempic is weight loss up to 13 lbs, which is considerably greater than reports from other GLP-1 RAs on the market.

Additionally, data from the clinical studies suggest that Ozempic reduces risk of cardiovascular problems including stroke and heart attack. Longer-term trials will confirm these benefits.

Like other GLP-1 RAs, a common side-effect of Ozempic is the slowing down of stomach emptying. In addition, mild to moderate stomach upset and nausea may occur. These symptoms usually go away within a few weeks from starting Ozempic. To reduce the indigestion symptoms, eat smaller food portions throughout the day.

Is Ozempic Right for You?

Before starting Ozempic, you and your provider will want to discuss your medical and family history. Specifically discuss if you have problems with your pancreas or kidneys, have a history of diabetic retinopathy, are pregnant or planning to become pregnant, have any history of severe gastrointestinal (GI) disease, thyroid cancer, or family history of thyroid cancer. Getting an annual dilated eye exam is also recommended. Also, be sure to inform your provider of all prescriptions, over-the-counter, and herbal medications that you are taking, to avoid any interactions.

The Bottom Line:

Compared with other GLP-1 RAs, Ozempic is a strong A1c reducer with the added benefits of moderate weight loss and possible cardiovascular protection. The results of future studies will provide clinicians with more insightful information of which once-weekly GLP-1 RA is best for each individual patient. Consult with your provider to see if adding Ozempic is the next beneficial step to reach your personal glucose goals.

 

About the Authors:

 Parisa Karimian, 4th Year Student Pharmacist at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences.

Candis M. Morello, Pharm D, CDE, FCSHP, FASHP, Associate Dean for Student Affairs at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, Clinical Pharmacist Specialist at VASDHS.

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TCOYD Online Workshop: Basal Insulin and Type 2 Diabetes

In this three-part online educational series, Dr. Steve Edelman, MD and Dr. Jeremy Pettus, MD cover Basal insulin, and how it can help people with type 2 diabetes.

Remember, don’t make any change to your diabetes treatment plan without the guidance of your healthcare provider.

PART I: What Is Basal Insulin and How Can It Help Me Take Control Of My Diabetes?

This activity is for people with type 2 diabetes, your caregivers, and others who are interested in learning about basal insulin.

In part I you will learn about:

  • How basal insulin works
  • The benefits you can expect from basal insulin therapy
  • Common fears people have about basal insulin therapy
  • The different kinds of basal insulin
  • The primary goal of treatment with basal insulin

 

 

 

 

 

 

 


PART II: How Do I Know If I Am on the Right Dose of Basal Insulin?

Once you and your healthcare provider have decided to begin basal insulin therapy, the next step is to determine the right dose for you. Each person’s basal insulin requirement is different, and it is affected by several factors.

In part II you will learn:

  • How to reach your goal number with basal insulin
  • How to titrate, or adjust, your dose of basal insulin
  • Self-titration methods you could use with your healthcare provider’s guidance

 

 

 

 

 

 

 


PART III: Your Diabetes Treatment May Change Over Time

Type 2 diabetes is a chronic condition that affects the way your body processes blood sugar (glucose). When you have type 2 diabetes, your body either doesn’t produce enough insulin, or it doesn’t use insulin properly.

In part III you will learn the basics of type 2 diabetes:

  • The causes
  • It is a chronic condition that progresses over time
  • As your diabetes progresses, your treatment may change