Diabetes Basics:Tuning up Your Skills

Take this true-or-false quiz to see what you know
By Tracey Neithercott with Erika Gebel, PhD
As any sympathetic diabetes educator will tell you, things aren’t always black and white when it comes to diabetes management. Sure, there are practice guidelines and recommendations for ideal care, but people are imperfect and sometimes life throws you for a loop. Which is why many educators have realistic expectations.

In fact, after getting the skinny on eight oft-repeated self-care tenets, you may be surprised at how flexible diabetes management really is. Plus, you’ll take away some basic knowledge you may have forgotten since you were diagnosed. And experts say everyone could use a refresher now and again. “Medications change. Recommendations change,” says Dawn Sherr, RD, CDE, a diabetes educator with the American Association of Diabetes Educators. “It’s always good to brush up … every few years.”

① True or False?
“The exchange lists for diabetes is the best meal plan.”
Truth: Carb counting is more precise, and the plate method is easier.

Tip #1

Get familiar with portion sizes by using measuring cups while eating at home.
In the past, most people with diabetes followed the exchange system meal plan. Here’s how it works: Nutritionally similar foods are grouped into categories—carbohydrate, fat, and protein—and then into subcategories such as meat, fruit, and starches. Each food on a given subcategory list is interchangeable with the rest, so you could exchange a half cup of corn with eight animal crackers or a quarter of a bagel. You can eat “free foods,” which have 5 grams of carb or fewer and are under 20 calories, as often as you like without worry.

Though there’s little math involved in the exchange system (compared with carb counting), educators don’t often recommend it. “I can’t remember the last time I thought of the exchange system,” says Janet Zappe, RN, MS, CDE, a nurse and diabetes educator at the Diabetes Research Center at the Ohio State University Wexner Medical Center. That’s because carbohydrate counting allows for more precise insulin dosing and the plate method is even easier to understand than the exchange system. The plate method allows one quarter of a 9-inch plate for lean protein, one quarter for grains or starches, one half for nonstarchy vegetables, and a serving each of fruit and lean dairy on the side. Plus, both give people with diabetes more freedom in their meal planning than the exchange system does.

Does that mean you should drop the practice if it’s working for you? Not necessarily. “It’s important to understand that the plan you’re on is specific to you, and yours might be entirely different [from someone else’s],” says Amber Wilhoit, RD, LDN, CDE, CPT, a registered dietitian and diabetes educator with the University of Florida Diabetes Center of Excellence. That said, you may want to talk to a diabetes educator or registered dietitian about whether a different meal plan may be more effective for you.

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See-Through Brain Tissue Promises to Advance Autism Research

In a dramatic breakthrough, researchers have developed a method for rendering brain tissue transparent. They then used fluorescent chemicals to highlight three-dimensional networks of brain cells and fibers to study their connections.

“This feat of chemical engineering promises to transform the way we study the brain’s anatomy and how disease changes it,” said Tom Insel, M.D., director of the National Institute of Mental Health.

Thanks to post-mortem donations, Autism Speaks Autism Tissue Program was able to provide the Stanford University researchers with the brain tissue of an individual affected by autism. Using it, they traced the paths of individual nerve cells and their connections.

In addition, the Stanford University research team rendered an entire mouse brain transparent. By highlighting its nerve connections, they created a three-dimensional “tour” of an intact brain. (Watch embedded video above.)

Next the researchers hope to accomplish the same feat with an intact human brain. They call their technique CLARITY, for “Clear Lipid-exchanged Anatomically Rigid Imaging/immunostaining-compatible Tissue Hydrogel.” In essence, it replaces the brain’s light-blocking fat with a transparent hydrogel.

“CLARITY has the potential to unmask fine details of brains from people with brain disorders without losing larger-scale circuit perspective,” said National Institute of Health Director Francis Collins, M.D., Ph.D.

The researchers also demonstrated that immunological and genetic tests can be performed repeatedly on the same stained brain tissue. This is crucial for autism and other brain research that depends on scarce postmortem donations.

“The history of neuroscience discovery has been paved, in large part, by innovations in the preparation of brain tissue for research,” said Rob Ring, Ph.D., Autism Speaks vice president of translational research. “However, the ability of CLARITY, and innovations like it, to create new knowledge on the origins of disease will remain dependent on the availability of quality brain tissue from affected individuals.” Dr. Ring oversees Autism Speaks ATP program.

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Living Well with Food Allergy: Putting Risks and Fears into Perspective

By: Dr. Hemant Sharma

The New York Times Magazine published an article last month called “The Allergy Buster” that has generated much discussion about food allergy and excitement for potential treatments under study. The article brought much-needed attention to food allergies, and its intent was clearly to help others better understand and empathize with those living with food allergies. However, some in the food allergy community have expressed concern that certain aspects of the article may have the unintended consequence of actually increasing anxiety and misunderstanding.

The discussion around this article has become a wonderful opportunity to explore with our patients their concerns about the real risks of food allergy, their hopes for a cure, and their understanding of where things stand in that search for a cure. Since you may have some of the same questions, allow me to review some key perspectives and hopefully find common ground on which we can all agree.

Those living with food allergy are all too aware of the risks of accidental food allergen ingestion. However, we strive to provide our patients a balanced approach, where we encourage vigilance at reducing those risks, but work to prevent that from evolving into debilitating anxiety. This requires a clear understanding of the real risks of food allergy.

One area fraught with ambiguity for patients is food allergen labeling laws. The Food Allergen Labeling and Consumer Protection Act (FALCPA) does not permit any of the eight major food allergens to go unlabeled as ingredients, regardless of the quantity present. However, what is very troublesome to families is that FALCPA is silent on the issue of cross-contact.

Cross-contact can and does sometimes occur in manufacturing. There is no guidance given to manufacturers as to when a precautionary label (often referred to as a “may contain” warning) should be included. Fortunately, efforts are under way by the Food and Drug Administration (FDA) to help reform how manufacturers use these precautionary statements.

Another important point of discussion raised by the Times article is the true risk of anaphylaxis due to skin exposure to food allergens. In the Spring 2013 issue of Allergic Living, Dr. Scott Sicherer addresses this question (pages 24-25), explaining that anaphylaxis from skin exposure is very unlikely because the skin barrier prevents the protein from entering the blood system. So, for most with food allergy, playing a game with a ball that had briefly contacted an allergen would not be expected to pose a significant risk of anaphylaxis.

Also of concern to patients was the reference in the Times article to a mortality rate from food anaphylaxis of 1 per 1,000 for “severely allergic” children. It is critical that patients understand that this figure was derived by comparing the estimated number of food allergy deaths in the U.S. to the number of annual emergency department visits for food anaphylaxis. Another approach favored by many puts the risk at more than 100 times lower, or five to 10 per one million. This approach has the advantage of making the comparison to the total food allergy population in the U.S.

Undoubtedly, even one death from food allergy is a tragedy because it could have been prevented. For those with food allergy, it is important to understand that this risk can be significantly decreased by exercising vigilance in avoiding food allergens and always having access to epinephrine.

Another area of discussion after the Times article revolved around the emotional toll that food allergies can take on families, particularly when severe allergic reactions have been experienced in the past. Our goal is always to help families work through their fears and arrive at a place where affected children feel safe and in charge of their allergies.

Certainly, the psycho-social impact of food allergy is real and, as research is beginning to demonstrate, often detrimental. But there is help, and fear should not be accepted as the norm for those with food allergy. For times when anxiety becomes overwhelming, a counselor, psychologist, or psychiatrist can teach specific coping mechanisms.

While no one would choose to have a food allergy, some of our young patients have gained great empowerment from their experience – a sense that if I can manage my food allergies, I can do anything. So, as the name “Allergic Living” epitomizes, a balanced approach is important to ensure that having a food allergy does not prevent one from truly living.

The Doctor Trying To Solve The Mystery Of Food Allergies

No one is certain why food allergies are on the rise. By now nearly 15 million Americans have a food allergy, ranging from moderate to severe. One of every 13 children has one. Nuts, soy, milk, egg, wheat and shellfish are some of the foods that most commonly set off allergic reactions. In some cases, the reaction can be so severe that it results in the throat swelling up and closing, leading to death. For a child with a severe food allergy, every meal that isn’t made under appropriate supervision can be hazardous.

Dr. Kari Nadeau is one of the scientists at the forefront of food allergy research. She directs the Stanford Alliance for Food Allergy Research, SAFAR, at Stanford University School of Medicine. She’s an associate professor of allergies and immunology at the school and the Lucille Packard Children’s Hospital, and is currently conducting a clinical trial testing a technique for desensitizing children with multiple severe food allergies.

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Cocoa offers more than antioxidants for Alzheimer’s protection

By Kathleen Blanchard RN on April 13, 2013 – 8:20am for eMaxHealth
Alzheimer’s Disease Current News

Scientists report cocoa in chocolate can protect the brain from neurodegenerative diseases like Alzheimer’s and Parkinson’s’ in ways that were previously unknown. The health benefits to the brain come from more than antioxidants, found for the first time. Coca stops brain cells and from dying at a cellular and molecular level.

The new research shows antioxidants in the cocoa and chocolate offer health protection by activating important pathways at a cellular and molecular level.

The study that comes from the Sbarro Health Research Organization, Temple University, Philadelphia, Pa., Lombardi Cancer Center, Georgetown University and the University of L’Aquila in Italy finds cocoa activates a neuroprotective pathway that has a direct effect on preventing the death of neurons – brain cells that transmit information through electrical and chemical signals.

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Living With Diabetes

How to Get Help

The American Diabetes Association is committed to ending discrimination against children and adults with diabetes by providing information and assistance to people with diabetes and their advocates. We use a four-step process to end discrimination: educate, negotiate, litigate and legislate.

I need help with a discrimination problem – what can I do?

If you are being discriminated against because of your diabetes at work, at school, by the police or in correctional institutions, or in public places, you can request assistance from the American Diabetes Association.

The first step to request assistance is to call us at 1-800-DIABETES (800-342-2383). A representative from the Association’s Center for Information and Community Support will send you a packet of information and a form to request help from one of the Association’s legal advocates.

The discrimination information/assistance form can be mailed, e-mailed, or faxed to you, and you can return it to us via mail, e-mail or fax. Once we receive the form, a legal advocate will contact you to discuss your situation.

It’s important to send in a form so we can help you. The form helps us gain information about your situation – and do any necessary research before speaking with you – so that we can provide the best assistance to you.

Please note: requesting assistance from the American Diabetes Association is not the same thing as filing a complaint, and submitting a discrimination form does not stop the clock on any legal deadlines. Click here to find more information on filing administrative complaints, lawsuits and the timelines for taking such action.

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Jan 18, 2013
Miami Ink’s Darren Brass had been living the rock start lifestyle but slowed it down a bit when his Type 1 diabetes and friends saw that his diabetes was having a hard time keeping up with the late nights, drinking, and not so careful monitoring.

Watch how Type 1 Darren turned his partying attitude around without taking the fun out of life. He lives a healthier and physically active life to control his Type 1 diabetes! Staying in control of your diabetes doesn’t mean you can’t live life to the fullest, it’s all about management!

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Allergic or Not? Middle School Students Design App That Tells You

April 9, 2013 | 8:00 AM | By Katrina Schwartz
Responding to worries that school is not preparing students for the jobs of the future, there’s been a concerted effort lately to emphasize the importance of learning STEM subjects.

President Obama made a pitch for STEM in his State of the Union address this year saying, “we’ll reward schools that develop new partnerships with colleges and employers, and create classes that focus on science, technology, engineering and math — the skills today’s employers are looking for to fill the jobs that are there right now and will be there in the future.”
Congressman Mike Honda from California recently introduced two pieces of legislation to Congress focusing on STEM: One would create an office of STEM education to help coordinate between schools, while simultaneously creating a research arm to fund development of education technology; the other bill would offer in-house STEM coaches to schools, helping them integrate concepts into the curriculum.

“This is very different from other school projects because it’s a real world thing.”
Some schools are already integrating STEM throughout their curriculum. A team of eighth graders at Hampstead Academy, one of 10 winners of the Verizon Innovative App Challenge, for example designed Chow Checker, an app to help people identify ingredients they are allergic to in food. The app allows users to either scan the bar code on a food item or use the search bar to find an item. Any ingredients the user has an allergy to shows up in red. The app also has a news feed and a personal profile, giving it the feel of a social networking site, a feature that also sets it apart from other food allergy apps. The news feed gives people who suffer from food allergies a way to share their personal experiences with one another, said student Sarah Miller-Bartley.

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Bullying of Children with Food Allergies – How You Can Help

Bullying of Children with Food Allergies – How You Can Help
by Karen Stickler, PsyD, MA

If nearly 35 percent of children aged 5 and older with food allergies are bullied[1], how can we prepare our children and keep them safe?
Bullying is common among children with food allergies, and is associated with lower quality of life and distress in children and their parents. Bullying victims can be at increased risk for suicide. In addition, bullying of children with food allergies using food allergens can result in potentially life-threatening allergic reactions.[2] As parents, teachers, and medical professionals, it is our obligation to help our children navigate through the joys and perils of life. Above all else, we want to keep our children safe. Bullying, therefore, should not be tolerated under any circumstances.

Together we can -and should – proactively advocate to prevent, and to swiftly deal with bullying of our children. There are ways to be proactive in dealing with bullying A few ways in which you can help include talking about bullying; describing ways in which one may be bullied; working on a safety plan with your child; and familiarizing yourself with the signs and symptoms of bullying.

Talking about Bullying with Your Child

What exactly is bullying? Definitions of bullying vary; one definition by StopBullying.gov, defines bullying as “unwanted, aggressive behavior among school aged children that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time.”[3] Long before your child may become the victim of bullying, it’s important to talk with him about it. When talking to your child, you will need to use age appropriate language to explain what bullying is.

You will also need to explain why children with food allergies may be at risk for bullying. Oftentimes, kids are bullied when they are perceived as different from their peers. Living with food allergies differentiates children from the ‘norm’ and immediately puts kids at risk for being bullied. This may or may not be true given how the community (school, religious institutions, sports, and other recreational groups) perceives food allergies and whether or not they understand the real physical reactions one can have to the allergen(s).

For children with food allergies, bullying may take on a new dimension. It has been reported that some children have been taunted by other children using allergens, such as touching the allergic child with the known allergen, contaminating their food, or throwing the allergen at them.[1] Let your children know that these behaviors are not acceptable, and shouldn’t be tolerated. Validate their feelings and experiences, and teach them to inform an adult who can intervene.
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Progress in Treating Depression and Diabetes

“Depression makes everything more difficult,” says Scott Strange, 49, of Kansas City, who was diagnosed with type 1 diabetes in 1970 and has struggled with depression since childhood. “I ignored my diabetes for four decades.” Though he took insulin, he avoided carb counting, blood glucose measurements, and all the other daily practices that help keep people with type 1 healthy.

No one says living with diabetes is easy, but adding depression to the mix can turn taking care of yourself into an overwhelming burden. Depression is common, too, affecting 1 in 6 Americans, and some studies suggest the rates are higher in people with diabetes. There is a silver lining, though. New approaches that treat diabetes and depression give hope that these dual burdens can be lifted.

Not Happy Together
People with type 2 diabetes are at a 54 percent greater risk of developing depression than those without type 2, according to a 2008 study in the Journal of the American Medical Association. The study also found a modest association between depressive symptoms and the development of type 2. “It’s clear that depression is a risk factor for diabetes, and there is evidence that it goes in both directions,” says Jeffrey Gonzalez, PhD, assistant professor in the Diabetes Research Center at the Albert Einstein College of Medicine. “It’s difficult to say which comes first. It’s a ‘chicken or egg’ problem.” The link between type 1 diabetes and depression is even less clear, as few studies have focused on this question.

Researchers are exploring both biological and behavioral underpinnings to explain the relationship between diabetes and depression. On the biological side, depression is linked with changes in hormone levels, the nervous system, and the brain that may increase blood glucose levels. These biological changes could potentially trigger diabetes or worsen blood glucose control in those with the condition.

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