Genesys Conducts Diabetes Care seminar

Grand Blanc, MI – “Achieving excellence in diabetes care,” a one day seminar offered by Genesys on Wednesday, Nov. 10, is designed for nurses, physicians and other health care providers who manage patients with diabetes.

This full day of lectures by specialists in the field of diabetes takes place from 8 a.m. to 4 p.m., at Genesys Conference and Banquet Center in Grand Blanc Township.

Goal of the seminar is to provide clinicians with additional tools to manage patients with diabetes by using safe practice strategies, incorporating microvascular and macrovascular prevention and treatment strategies, and implementing strategies that support patient adherence to medical recommendations.

A total of 6.25 CME credits are available.

The course schedule includes the following:

Inpatient management: RIP sliding scale insulin
Jamal Hammoud, MD, chief of Endocrinology at Genesys

Outpatient insulin management
Lowell Schmeltz, MD, chief of Endocrinology at DMC Huron Valley-Sinai Hospital in West Bloomfield

Special management conditions
Michael Valitutto, DO, internist and diabetes specialist at Borgess Center for Diabetes Care in Kalamazoo

Preventing macrovascular and microvascular complications

Speakers TBA.

Cost of the seminar is $75 for physicians; and $50 for retired physicians, nurses and other health care providers.

To sign up for “Achieving excellence in diabetes care,” call Genesys at 810-606-6527 or register online at www.genesys.org/CME.

Genesys Conference and Banquet Center is located on the Genesys Regional Medical Center – Health Park campus in Grand Blanc Township (Holly Road at Baldwin).

Henry Ford Hospital Performs First Intestine Transplant in Michigan

Detroit, MI – The first intestine (bowel) transplant in Michigan was performed on a 50-year-old patient from Port Austin by physicians at Henry Ford Hospital.

The 11-hour surgery was performed on August 21 and 22. The composite multivisceral transplant procedure included transplant of the patient’s small bowel, stomach and pancreas.

Only a few centers in the United States offer intestine transplants and Henry Ford is the only one in Michigan with a program.

The patient, Brent Patterson, who suffered from short bowel syndrome as well as insulin-dependent diabetes, had been waiting for a transplant since April.

Patterson previously had six bowel procedures in a year to treat his intestines, damaged from Crohn’s disease and poor blood supply, and was no longer able to absorb the nutrients his body needed.

“I got so tired, my immune system was low and I would have to eat nonstop just to get enough nutrients,” says Patterson.

Every night by 8 p.m., Patterson had to hook himself up intravenously for fluids to prevent dehydration. He was constantly at high risk for intravenous infection and multiple hospital admissions. He was also on an insulin pump for his diabetes. Five years earlier, he had a kidney transplant; his wife, Elizabeth, donated her kidney.

Since his intestine transplant, he is off of intravenous nutrition and on a combination of tube feedings and his own nutritional intake by mouth.

“I can’t believe it – it is a whole new world,” says Patterson. “I am not even a diabetic anymore.”

The Henry Ford transplant surgical team included Marwan Kazimi, M.D., director, Small Bowel and Multivisceral Program, and Marwan Abouljoud, M.D., director, Henry Ford Transplant Institute

Dr. Kazimi explains that Patterson should have very few physical limitations: He will have to be careful with his dietary choices, especially for first few months, and make sure he stays well hydrated. Risk of rejection or infection with certain viruses is highest in first few months, and he will be monitored closely for these.

“It is our hope that he will return to fully functional status, including work and hobbies, if he so desires, and that he will never need intravenous nutrition or insulin again,” says Dr. Kazimi.

The electrician/journeyman loves to rebuild race motors and is looking forward to getting back to work on his ’74 red Nova and spending time with his wife and son.

“While still rare, intestine transplant is much more successful than in the past, partly due to improvements in technique and patient selection, and partly due to refinements in our understanding of immunosuppression and opportunistic infections,” says Dr. Kazimi. “It is now a viable option, and anyone with short gut syndrome, chronic intravenous nutrition or fluid needs, or certain gastrointestinal disorders such as poor motility may be a candidate.”

“It is an option many weren’t even aware of because it wasn’t available in Michigan until now,” says Dr. Kazimi.

Dr. Kazimi explains patients with intestinal failure are considered candidates for transplant when other treatments, such as parenteral nutrition (intravenous replacement of nutrients) are unsuccessful. He says the most common causes of intestinal failure are short bowel syndrome that results from extensive bowel surgeries due to inflammatory bowel diseases, a chronic inflammation of the digestive tract, blood clots in the major veins that lead to the intestine, or major abdominal trauma.

Many people with short bowel syndrome, like Patterson, are dependent on total parenteral nutrition to supply their daily nutrition. Administered in the hospital or at home, intravenous nutrition usually requires a central venous catheter, which can lead to chronic infection. Over time, the intravenous nutrition solution also carries risk of complications such as venous thrombosis and liver conditions like hepatotoxicity, steatohepatitis, fibrosis and cirrhosis.

There are three types of intestine transplants including:

• Isolated Intestine Transplant for patients with short bowel syndrome and no liver disease.
• Combined Liver-Intestine Transplant for patients with short bowel syndrome and irreversible intravenous nutrition-induced liver disease.
• Composite Multivisceral Transplant for patients with short bowel syndrome requiring intestine, stomach, pancreas and/or liver transplantation; patients with portomesenteric thrombosis and liver disease; or patients with neuroendocrine tumors metastatic to the liver.

“Implementation of new techniques and technology requires several levels of preparation of such a program for patient safety and better outcomes,” says Dr. Marwan Abouljoud, director of Henry Ford Transplant Institute, which has had a liver transplant program since 1989.

“The field of transplantation has been progressing rapidly with many technical innovations that help people in need of such new procedures.”

Nationally, 180 intestine transplants were performed last year in the U.S. and there are currently 249 people waiting for a transplant, according to the Gift of Life Michigan. The first successful intestine transplant was performed in 1987 in Kiel, Germany.

Three other patients in Michigan are waiting for intestine transplants at Henry Ford.

SJMO to Host Metabolic Nutrition and Weight Management Classes

Pontiac, MI—St. Joseph Mercy Oakland (SJMO) will hold a Metabolic Nutrition and Weight Management classes at 7:15 p.m. on the first and third Mondays in March 2010 in the hospital’s Franco Communications Center, 44405 Woodward Ave., Pontiac.  Hosted by the SJMO Metabolic Nutrition and Weight Management Program, the classes will be held March 1 and 15.

Class topics include:

• · “The Facts About Fats: ‘Mediterranean Style,’” March 1
• · “Protein Power…and Risks,” March 15.

Tom Rifai, MD, Medical Director of the Metabolic Nutrition and Weight Management Program at SJMO, will conduct the classes.  Dr. Rifai is Clinical Assistant Professor of Medicine at the Wayne State University School of Medicine and chief medical advisor to the Pritikin Longevity Center in Avenutra, Fla.

He is board certified by the American Board of Physician Nutrition Specialists, which recently named him to a three-year, at-large position on its board of directors, and the American Board of Internal Medicine.  His specialties are nutrition, prevention of chronic disease, weight management, nutritional and medical management of insulin resistance, Type 2 diabetes, hyperlipidemia and obesity.

“With the increase in obesity in our country and community, it is extremely important that we educate individuals how to take better care of their health,” said Jack Weiner, SJMO President and CEO.  “These classes will guide people toward that end by telling them how to eat healthier and manage their weight.”

The fee is $50 per class.  Each registered person may bring a guest at no charge.  Free parking is available on the north side of the hospital, adjacent to the Franco Center and Medical Office Building. The classes are open to the public.  A new series will begin in April.

To register or for more information, call the SJMO Metabolic Nutrition and Weight Management Program, 248-858-2475.

The Metabolic Nutrition and Weight Management Program at St. Joseph Mercy Oakland is an integrated, educational medical program for those looking to control their metabolic issues related to insulin resistance and obesity through dedication to nutrition, physical activity and overall lifestyle change.

Genesys Announces Free Mini-Medical School Classes

Grand Blanc, MI – Back by popular demand, Genesys Learning Institute announces a new semester of free mini-medical school classes for the public – an opportunity to learn more about your health from Genesys medical experts.

Classes are designed to help you become a more educated health care consumer, and also help alleviate concerns you may have about medical conditions that affect you or your family.

Classes begin Monday, March 1, and are held at the Genesys Conference and Banquet Center (on the Genesys Regional Medical Center – Health Park campus in Grand Blanc Township) from 6 p.m. to 9 p.m., every Monday evening through April 5.

Here is the mini-medical school schedule. You can sign up for as many classes as you would like. All are free.

March 1
Diabetes and obesity
Jamal Hammoud, MD, endocrinologist at Genesys

Kidney disease and diabetes
Manjit Grewal, MD, nephrologist at Genesys

March 8
Nutrition for diabetic patients
Ann Batchelor, Genesys registered dietitian; and Jamie Karn, RN, Genesys diabetes educator

Exercise for diabetic patients
Ruth Anne Harmes, certified exercise instructor, Genesys Diabetes and Nutrition Learning Center

March 15
Stress management and depression
Heather Kirkpatrick, PhD, psychologist, Genesys Behavioral Science

Peripheral artery disease/varicose and spider veins/aneurysms
Thomas Shuster, DO, peripheral vascular surgeon at Genesys

March 22
Alzheimer’s Disease warning signs
Gerry Lincoln, program director, Michigan Regional Alzheimer’s Association

Heart bypass surgery
Marc Silver, MD, Genesys cardiothoracic surgeon

March 29
Sleep apnea
Clark Headrick, DO, pulmonologist and medical director of Genesys Home and Hospice Care

Crohn’s disease
Justin Miller, DO, gastroenterologist at Genesys

April 5
Hip and knee replacement
Frederick Schreiber, DO, orthopedic surgeon at Genesys

Minimally invasive spine surgery
Avery Jackson, MD, neurosurgeon at Genesys

To register for these classes, call the Genesys Learning Institute at 810-606-7725.

University of Michigan-Flint graduate students will receive one graduate credit for attending the entire winter semester of classes (paying usual graduate education fees). For details, call 810-606-7725 or check with the university.

SJMO to Host Nutrition Classes

Pontiac, MI—St. Joseph Mercy Oakland (SJMO) will hold a series of nutrition classes at 7:15 p.m. on the first and third Mondays in February and  March 2010 in the hospital’s Franco Communications Center, 44405 Woodward Ave., Pontiac.  Hosted by the SJMO Metabolic Nutrition and Weight Management Program, the classes will be held Feb. 1 and 15 and March 1 and 15.

 Class topics include:

• · “The Essentials on Carbs:  How Do Veggies, Fruits, Legumes, Dairy and Whole Grains Compare?” Feb. 1
• · “Salt (aka Sodium): Pressure, Bones and Stones…Maybe Cancer Too?” Feb. 15
• · “The Facts About Fats: ‘Mediterranean Style,’” March 1
• · “Protein Power…and Risks,” March 15.

Tom Rifai, MD, Medical Director of the Metabolic Nutrition and Weight Management Program at SJMO, will conduct the classes.  Dr. Rifai is Clinical Assistant Professor of Medicine at the Wayne State University School of Medicine and chief medical advisor to the Pritikin Longevity Center in Avenutra, Fla.

He is board certified by the American Board of Physician Nutrition Specialists, which recently named him to a three-year, at-large position on its board of directors, and the American Board of Internal Medicine.  His specialties are nutrition, prevention of chronic disease, weight management, nutritional and medical management of insulin resistance, Type 2 diabetes, hyperlipidemia and obesity.

“With the increase in obesity in our country and community, it is extremely important that we educate individuals how to take better care of their health,” said Jack Weiner, SJMO President and CEO.  “These classes will guide people toward that end by telling them how to eat healthier and manage their weight.”

The fee is $75 per class.  Each registered person may bring a guest at no charge.  Free parking is available at the Franco Center.  The public is invited.

To register or for more information, call the SJMO Metabolic Nutrition and Weight Management Program, 248-858-2475.

The Metabolic Nutrition and Weight Management Program at St. Joseph Mercy Oakland is an integrated, educational medical program for those looking to control their metabolic issues related to insulin resistance and obesity through dedication to nutrition, physical activity and overall lifestyle change.

Diabetes’ Youth Ambassador Spreads His Message to Detroit

One look at Christian Stokes, 18 and he looks like any excited and energetic freshman heading off to college for the first time. But talk to this Minnesota native, and you quickly learn that his life has been anything but a cakewalk to the Halls of Ivy.  Diagnosed with Type 1 diabetes when he was just 15 months old, Christian has never experienced a day without syringes, insulin and blood-glucose meters.

But the daily requirements that accompany this disease did not deter Christian from the desire to live a life like any normal child. So rather than wallow in his condition, he chose to live a life just like his peers and thus began playing sports in school. But unlike them, playing Christian’s favorite sports like wrestling and football required that he had to constantly check his blood-sugar levels, administer insulin when necessary and ensure that during and after his workouts, he was properly nourished. If he didn’t keep close tabs on his health, he risked serious consequences. It is this real threat of severe hypoglycemia and other diabetic complications that deters many diabetic kids from engaging in sports. But not Christian.

During his teenaged years, he was very active in the local chapters of the American Diabetes Association (ADA), educating kids and parents about the disease and encouraging his peers to be active, eat well and stay healthy, in addition to being a devoted athlete. Just this past January, Christian was awarded the prestigious nomination by the ADA as the organization’s National Youth Advocate (NYA), a title coveted by many but given to just one.

As part of his year-long post, Christian has been traveling all over the country speaking to millions of Americans about diabetes in addition to urging government officials on the need for increased federal funds to support diabetes research.

According to the ADA, nearly 24 million adults and children in the U.S. – including more than 927,000 Michigan adults – have been diagnosed with diabetes, and another 57 million have pre-diabetes. Both Type I and Type II diabetes are characterized by too much sugar in the blood, which over time can lead to heart disease, stroke, nerve damage and amputations, blindness and kidney disease. Type I diabetes develops when the body’s immune system destroys pancreatic cells that make the hormone insulin that regulates blood sugar. Type II diabetes, which in the past been a disease of overweight or obese middle-aged adults, has been striking U.S. children and adolescents with increasing frequency. Children who develop Type II diabetes are typically overweight or obese according to the Centers for Disease Control.

“I want to encourage all youth to become aware of how their actions and behaviors impact their health,” says Stokes. “It doesn’t matter if you have Type I or Type II diabetes, I want to encourage everyone to get out there and exercise. Even though it may be challenging, the rewards are great.”

And that is just what he is going to do in Detroit. In order to raise awareness among Michigan residents, Christian will speak at the American Diabetes Association’s 2009 Detroit Diabetes EXPO presented by Walmart on September 19 at the Michigan State Fairgrounds.

The Detroit Diabetes EXPO will feature: how-to product demonstrations; free health screenings; healthy cooking and exercise demonstrations; exciting workshops; an interactive Youth Zone for kids of all ages; a Senior Zone and a variety of guest speakers from the medical community, who will cover topics relevant to those with diabetes.

To avoid serious complications and related health issues, people with diabetes can take advantage of information and services like those provided at EXPO to lower the risk.  As early diagnosis and treatment of diabetes is critical, access to important resources could mean the difference between struggling with diabetes and successfully managing the disease.

The event and parking at the State Fairgrounds is free and open to the public and will be held from 9 a.m. to 3 p.m.

For more information on diabetes or the event, please visit www.diabetes.org/EXPO or call toll free at 1-800-DIABETES (1-888-342-2383).

You can read more about Christian on his blog at .

Diabetics: An Eye Exam Can Save Your Sight

By William Tasman, MD

In the U.S., diabetic retinopathy is a leading cause of vision loss among adults often during their most productive years. It causes up to 24,000 new cases of vision loss each year.

What does diabetes have to do with my eyes and what is Diabetic Retinopathy?

Diabetes can harm your vision, or even cause blindness. With diabetes, your body does not use and store sugar properly. High blood sugar levels damage capillaries, small blood vessels connecting arteries and veins. The damage to the vessels in your eyes is called diabetic retinopathy.

What is diabetic retinopathy?

Diabetic retinopathy is the eye disease people with diabetes get most often. It is a major but preventable cause of blindness in adults in the U.S. The retina at the back of the eye sends the pictures of what we see to the brain. Diabetic retinopathy harms the blood vessels in the retina. These weakened vessels leak fluid, fatty material, or blood. Abnormal new blood vessels may develop on the surface of the retina, the inside lining of the eye responsible for sight, where they can lead to bleeding. The longer you have diabetes, the more likely you are to get diabetic retinopathy.

How do I know if I have diabetic retinopathy?

You might not know. There are often no signs when you first have the disease. In the early stages when treatment is most effective, your vision will not change much and you will not feel any pain. The best time to treat diabetic eye disease is before you have any symptoms. Eye check-ups should be yearly if no retinopathy is present. Patients with diabetic retinopathy may be requested by their ophthalmologist to come in at more frequent intervals.

Can I delay retinopathy by keeping my blood sugar under control?

A recent national study showed that strict control of blood sugar can delay the onset of retinopathy and can slow the progression of early cases. All diabetics should strive for good control of their blood sugar because some patients, even those with more advanced diabetic retinopathy, might delay the progression of the disease if their blood sugar is maintained at a reasonable level. Others, however, will see a progression of the disease even if their blood sugar is normal or near normal. Weight control is also extremely important.

How do you diagnose it?

In most patients, the ophthalmologist can diagnose diabetic retinopathy during a routine eye examination by dilating the pupils and looking inside the eye.

How do you treat it?

Laser surgery is often recommended. Multiple laser treatments over time are sometimes necessary.

Is it safe for a woman with diabetic retinopathy to become pregnant?

Most diabetic women can have a baby without an increase in retinopathy. In some patients, however, the retinopathy may worsen. It is recommended that all patients be monitored frequently during pregnancy.

Does high blood pressure affect the eyes?

Some studies have shown that patients with high blood pressure are more likely to have retinopathy. However, since high blood pressure alone can damage the eyes, heart, kidneys, and brain, patients should keep their blood pressure under control and have it monitored regularly.

Should a person with diabetic retinopathy exercise?

There is no convincing evidence that exercise increases bleeding of the retina. Moreover, exercise is important not only for general well being, but also for controlling blood sugar levels. Each patient should continue routine exercise unless he or she notices hemorrhages frequently during exercise, and should consult their personal physician to make sure that there are no medical reasons that would prohibit exercise.

If you have diabetes, it is important that you have your eyes examined by an ophthalmologist annually.

William Tasman, M.D , is an ophthalmologist at Wills Eye Hospital in Philadelphia, Pennsylvania. Dr. Tasman is also a member of the Advisory Board of Directors for the Foundation of the American Academy of Ophthalmology.

Ask the Doctor: December 2007

Question: My doctor just told me I have diabetes. He told me to take special care of my feet. How should I do that? – D.V., Grand Blanc

Answer: If a doctor has ever said you had an elevated blood sugar level (diabetes) – even just once when you were pregnant – you are at risk for diabetes. About 15.7 million people (5.9 percent of the United States population) have the disease. Nervous system impairment (neuropathy) is a major complication that may cause you to lose feeling in your feet or hands. This means you won’t know right away if you hurt yourself. This problem affects about 60 to 70 percent of people with diabetes.

Foot problems are a big risk. Like all diabetic people, you should monitor your feet. If you don’t, the consequences can be severe, including amputation, or worse.

Minor injuries become major emergencies before you know it. With a diabetic foot, a wound as small as a blister from wearing a shoe that’s too tight can cause a lot of damage. Diabetes decreases your blood flow, so your injuries are slow to heal. When your wound is not healing, it’s at risk for infection. As a diabetic, your infections spread quickly because your blood sugar becomes high and that slows down the cells in the body that fight infections.

If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror. Feel each foot for swelling. Examine between your toes. Check six major locations on the bottom of each foot: The tip of the big toe, base of the little toes, and base of the middle toes, heel, outside edge of the foot and across the ball of the foot. Check for sensation in each foot.

If you find any injury – no matter how slight – don’t try to treat it yourself. Go to a doctor right away.

Tips for Taking Care of Your Feet:

• Wash your feet every day with mild soap and warm water. Test the water temperature with your hand first. Don’t soak your feet. When drying them, pat each foot with a towel and be careful between your toes.

• Use quality lotion to keep the skin of your feet soft and moist – but don’t put any lotion between your toes.

• Trim your toe nails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, see your doctor.

• Don’t use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet. Don’t put your feet on radiators or in front of the fireplace.

• Always keep your feet warm. Wear loose socks to bed. Don’t get your feet wet in snow or rain. Wear warm socks and shoes in winter.

• Don’t smoke or sit cross-legged. Both decrease blood supply to your feet.

Tips About Shoes and Socks:

• Never walk barefoot or in sandals or thongs.

• Choose and wear your shoes carefully. Buy new shoes late in the day when your feet are larger. Buy shoes that are comfortable without a “breaking in” period. Check how your shoe fits in width, length, back, bottom of heel and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don’t wear the same pair everyday. Inspect the inside of each shoe before putting it on. Don’t lace your shoes too tightly or loosely.

• Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.

Foot Deformities

When your feet lose their feeling, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced “sharko”) foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn’t hurt.

A doctor may treat your diabetic foot ulcers and early phases of Charcot fractures with a total contact cast. The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot’s movement and supports its contours if you don’t put any weight on it. To use a total contact cast, you need good blood flow in your foot. Your doctor monitors it carefully. The cast is changed every week or two until your foot heals.

A custom-walking boot is another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe.

Gadgets & Gear: November 2007

In honor of National Diabetes Month I thought I’d review some of the blood glucose monitors out on the market. Fortunately, I don’t have diabetes and have never had to use one of these increasingly sophisticated devices, but many people in the US (about 20 million at last count) do need one – though about a third of those don’t know it yet.

Now, I will do a lot for our readers but I was not about to turn myself into a human pincushion to test the whole gamut of monitors on the market. It really wouldn’t accomplish much anyway since we are all aware that it gets easier, especially with alternate site testing – more on that later. So why do this article at all? Well, even though using these blood glucose meters (BGM) may be pretty straight forward, there is a dizzying amount of meters on the market (over 25). Each has different features and it may be hard to decide which is best for you. So what I hope to do with this article is to explain what all those features are and highlight some of the most popular meters on the market.

Now many people with diabetes didn’t even get to pick out the meter. For most, the doctor or nurse came into the room and handed you one. The doctors are supplied these meters from the manufacturers to give out to the patients for free. Before you get thinking that these meter manufacturers are so nice for giving out free meters to people; it’s really business. It is not unlike how inkjet printers are sold well below their actual cost, since the manufacturers know they will more then make up for the loss on the front end when you go to buy the ink (which for some systems can cost more than said printer).

With blood glucose meters you are going to have to buy their testing strips and that is where they make their money (2-3 strips per day for the rest of your life adds up to a lot). Even if your doctor doesn’t hand you one, virtually all insurances will cover one, and if you really don’t like the one you are given, you can actually pick one up at a pharmacy without a prescription (though you do need a prescription for the strips).

So what are some factors to consider when choosing a blood glucose meter? Here is a quick list of some different items to compare and what they mean to you.

Size: This one is easy. Is the meter (and its test strips and the lancet to draw the blood) easy to carry around? Virtually all of these meters have a case to carry all of these items together or you just may want to stash items where you most commonly test (i.e. home and the office).

Battery: Important but most likely not a deal-breaker. Some units use easily replaceable AAA batteries while others use a watch type battery. The only issue is if you really need to do a test and it conks out on you and there is not a pharmacy around.

Testing Time: This is an easy one. How long do you like to wait for your results? Most meters run anywhere from 5-60 seconds. A shorter time is probably better if you test a lot in public and don’t want to draw a lot of attention to yourself, but it has no bearing on the quality of the results.

Sample Size: How much blood do you want to give up each time you test? Me? I like keeping as much of my blood as I can. In the past, meters required quite a large drop of blood but now you can get away with as little as 0.3uL (microliters) and with very few meters requiring over 1.5uL. The advent of these smaller sample volumes helps prevent a lot of extra pokes due to unproductive pricks.

Alternate Site Testing: Again, due to the reduced amount of blood required, people are now able to poke themselves in places other than their fingertips. These other locations (like further up the arm) tend to be less sensitive and will hurt a lot less. There is still some question as to whether the blood drawn from alternate sites will accurately reflect sudden changes in blood glucose levels. Either way, you should only use alternate sites if the device has been approved for it and your doctor agrees.

Meter Calibration: Every new batch of test strips you use will be minutely different than the previous batch and so to insure continuity of results, the new batch will have to be ‘coded’ into the meter. Many meters do not require any input from the user, while others will need you to input a code from the bottle, while others will require you to first use a test strip to calibrate the machine.

Download Capability/Memory: Virtually all meters have some memory; anywhere from 50 to 3000 of your tests. This allows you to track over time how well you are controlling your diabetes and combined with other information such as what you ate and did each day, can help you further control your diabetes. Many meters will also allow you to download all your test data to a computer to better help you manage the information.

Other Features: Some meters have easy to read screens, while others hold all the testing strips in a disk or drum in the machine. Others have strips that may be more comfortable/easier to use. These vary radically between meters so you will have to see which features matter to you the most.

Please see the chart below for some detailed information on a few of the most popular meters.

As always, feel free to write to me about any questions you might have or if there is something you would like to see me write about. You can email me at jeff@healthandleisureonline.com.

Diabetes: Michigan’s Epidemic

With Hamdee Attallah, MD & Mary Riegle

The word epidemic is often thrown around to put fear in people’s heart. Oftentimes, we become immune to the term because it is used so often. However, for those in the healthcare industry, one disease is becoming an epidemic: Diabetes.

According to Mary Riegle of Michigan’s chapter of the American Diabetes Association, over 593,000 people in the Great Lakes State have been diagnosed with diabetes. Another 292,000 more have the disease, but have not yet been diagnosed. In fact, Riegle states that many people have had diabetes for 10 years prior to their first diagnosis.

According to the ADA, diabetes was the sixth leading cause of death in Michigan in 2004. It’s direct costs totaled $4.5 million dollars, with indirect costs due to lost work, mortality, restricted work days and disability totaled $2 billion.

So, why is Type II diabetes reaching epidemic proportions? The simple answer is lifestyle, says Dr. Hamdee Attallah, assistant professor of medicine at Wayne State University School of Medicine Endocrinology. Genetics aside, Dr. Attallah says the growing rate of diabetes among adults is directly related to poor lifestyle habits.

“The percentage of adults who are overweight or obese in the United States is over 60%, and unfortunately, that has not spared our population,” says Dr. Attallah. “As a result, the prevalence of diabetes in Michigan, and throughout the U.S., is increasing.”

Locally, Dr. Attallah says the diverse population in Michigan accounts for one of the reasons we are seeing high rates of the disease. “The urban, inner city population is primarily, but not exclusively, presenting with diabetes in a disproportionate amount compared to Caucasians,” says Dr. Attallah. “African Americans, Hispanics, Arab Americans and other ethnic groups have much higher prevalence rates.”

Dr. Attallah accounts the differences to a combination of factors including lifestyle, education, access to healthcare and finances. “It’s such an incredibly expensive disease. We need to figure out a way to treat it in a most cost-effective way, and find a way to prevent it. If we can prevent it, we won’t have to spend the money to treat it.”

Since everyone does not have access to healthcare, Dr. Attallah emphasizes that people should control the controllables. He recommends practicing good dietary habits, exercise programs, or increasing your activity level.

“Lifestyle changes can help prevent diabetes; particularly in people who are at high risk,” says Dr. Attallah. “Those in the ‘pre-diabetic state’ – where the glucose levels are elevated but not at diabetic levels – are the people we need to identify early and target them for prevention with both diet and exercise.”

There is no current medication to prevent diabetes, states Dr. Attallah. Medicinal therapies are only designed to treat the disease, not prevent it. The only standard recommended by the American Diabetes Association for preventing diabetes is diet, exercise and weight loss, he says. Simply stated: “There is no magic pill.”

The recently published Diabetes Prevention Study had pre-diabetic subjects who simply modified their lifestyle in the study. The results revealed that those subjects who had modest weight loss of 5-10 pounds reduced their risk of diabetes by 60% compared to those who did not diet and exercise, says Dr. Attallah.

Exercise can be as simple as a minimum of 35-40 minutes of brisk walking a day, 3-4 times per week, says Dr. Attallah. As one’s tolerability increases, so should the amount of exercise over time.

By controlling diabetes, patients can avoid a myriad of other complications such as cardiovascular disease, stroke, diabetic neuropathy, amputeeism. “I would refer to diabetes as a ‘syndrome’. It’s a myriad of different medical problems associated with the hyperglycemia of diabetes. It’s a syndrome of illnesses,” says Dr. Attallah.

With childhood obesity on the rise, Dr. Attallah and many physicians expect to only see Type II diabetes diagnosis to continue to rise. His hope is that people do the right things for themselves to help prevent this disease, and live a healthier, better life.

Dr. Attallah is an Assistant Professor of Medicine, Wayne State University School of Medicine Endocrinology, and on staff at DMC Harper University Hospital.

Mary Reigle is the Director of Special Events for the American Diabetes Association of Southeast Michigan and Northwest Ohio located in Bingham Farms, Michigan.

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