JULY 2013 – NEWSLETTER

“Freedom is nothing else but a chance to be better.” – Albert Camus

By: Jessica Cook MS RD LD CDE (Director of Education)

The month of July is an exciting time for Americans to truly cherish the great nation we live in that provides us with

freedom. Not only do we have the right to vote and freedom of speech, but we also have choices when it comes to our own health. Everyday choosing which foods you consume and which way you prefer to be physically active ultimately leads to your choice to be healthy. When you choose to make health a priority in your life you feel better, look better and provide a positive role model to friends as well as family members. Americans have opportunities to make healthy decisions everyday with our vast food supply, available outdoor activities and access to health education and that is the beauty of living in a country in which we are free. Please enjoy this month’s issue of Healthy Living with Diabetes and explore which choices you have when it come to your healthcare.

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Invokana: A New Approach to Type 2 Diabetes

By: Dr. Barry Horowitz

Twenty years ago, we used to diagnose diabetes by testing the urine for sugar. In addition, before the advent of glucose meters, the control of diabetes would also be assessed by using a dipstick in the urine for sugar. So sugar in the urine is bad, right?

Not so fast. Invokana is the first drug to market of a new class of medications to treat type 2 diabetes called SGLT2 inhibitors. It turns out that the kidney will filter sugar back into the bloodstream up to a blood sugar of around 180. Since non-diabetics have blood sugars below this, they never have sugar in the urine. However, diabetics start spilling sugar into the urine when their blood sugars are very high.

Invokana blocks the kidneys ability to filter sugar back into the bloodstream, so more sugar will be released into the urine and thus sugar is removed from the blood. Studies have shown that on the average, Invokana can lower the A1c (3 month average sugar) by over 1% compared to placebo and that fasting and post-meal sugars are significantly reduced. In addition, Invokana causes significant weight loss and reduction in blood pressure.

The medication comes in 100 mg and 300 mg tablets and is dosed once daily in the morning. It should not be used in patients with severe kidney disease, but can be used with mild or moderate kidney impairment. The most common side effects with Invokana are excessive thirst (2-3%) and urination (4-5%), along with urinary tract infections (4-6%) and yeast infections of the genitalia (more common in women than men).

So, while it might seem counter intuitive, we can now actually sweeten your urine as a means to controlling your diabetes. As always, you should discuss whether Invokana is appropriate for you with your PBDES endocrinologist.

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Summertime Diabetes Management

By Rosemarie Steinsapir, MS RD LD CDE

If you live in South Florida it can seem as though every day is a summer day. But when temperatures really soar into the 90’s and humidity is unbearable, your diabetes management may need tweaking. Here are a few reminders for all of us, and especially for those who are trying to control blood sugar.

1. Diabetes is a dehydrating disease. Even without the disease, it can be hard to stay hydrated during the summer, but keep in mind that with diabetes, the disease itself will dehydrate you. If your blood sugar moves out of control (not within goal), you are already dehydrated. Dehydration is deadly. Thirst, confusion, dry skin, poor turgor and frequent urination are all common symptoms of dehydration. If your blood sugar is above your goal range, immediately start drinking water. Aim for 12 oz of water every 30 minutes until your urine is clear and pale. Test your blood sugar more frequently when you are dehydrated. If you are working outside make it very brief and keep your water bottle right next to you to stay hydrated.
2. The effect of alcohol is two-fold on diabetes: it dehydrates and lowers blood sugars several hours after intake. It can be the one factor that throws everything else out of control. Try to forgo alcohol or keep intake minimal during the warmer months.
3. Fruit Season is upon us. July is the month for the big US watermelon harvest, along with all of the berries, and pineapples from June. Remember, some fruit exacerbates high blood sugar, such as watermelon and pineapple. You don’t have to give them up entirely, but keep your portion sizes small. Berries are the better choice as they are lower in sugar content. Keep portion sizes between ½ cup and ¾ cup.
4. Travel Time. If this is your month to travel, be sure you wear your ID bracelet. Also, make sure your medications are stocked and ready to go. If you need a letter from your doctor for airline security or insulin pens and needles, have that ready in advance. If you travel by car, always have extra water bottles, snacks and hypoglycemia treatments within reach in the back seat area.
5. Hurricane Season is well under way by now. Two supplies come to mind that are different for the diabetic person: extra water and extra medication. This also includes extra pins/needles, antibiotic cream for cuts and scratches, sunscreen and bug repellant.
6. Skin is your largest organ and can be easily breached by vicious mosquitos during the summertime. An infected mosquito bite can turn ugly quickly. The rule of thumb is infection within 48 hours, gangrene within 96 hours. Regardless of the temperature, always wear shoes and exam your skin. If any cut, bite, or opening doesn’t close within 24 hours, have it seen at your emergency room or physician’s office. If the physician’s office offers you an appointment for 2 days later, go to the emergency room.

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Have a great summer this year and stay safe!

Interested in meeting with a certified diabetes educator?

Here at Palm Beach Diabetes & Endocrine Specialists, we offer the opportunity for you to meet one on one with a certified diabetes educator to discuss personal blood sugar history, diabetes medications, hypoglycemia, blood glucose monitoring, sick day guidelines, hyperglycemia and more. Each meeting with a certified diabetes educator is one hour and is individualized to meet your specific diabetes management plan. Certified diabetes educators can help pinpoint common diabetes care misinformation, help with blood sugar spikes, assist you in injecting medications, insulin adjustments and educate you on how to prevent complications of diabetes. So if you are interested in gaining more knowledge about diabetes management from an expert, consider making an appointment today!

To reserve an appointment with one of our certified diabetes educators today please call our scheduling department at (561) 513-5100. Most insurance plans cover diabetes self-management education therapy if you have a diagnosis of diabetes. We look forward to seeing you soon!

Remember it’s your choice to manage your diabetes!

At Healthy Living with Diabetes, we want to ensure that you are satisfied with all services received. We also would like your input on educational workshops that you would like us to offer, information you would like to read about in our Healthy Living with Diabetes Monthly or feedback on any workshop that you may have attended.

You can contact the director of education personally by email: jcook@PBDES.COM or leave a message at (561) 513-5100. We would love to hear from you!