Welcome to the Rite Aid Diabetes Newsletter

1. Recipes of the month
2. FREE TRIAL OFFER!
3. Have Diabetes. Will Travel.
4. Pep in your step.
5. New Medication News.
6. Eat breakfast, lower your cholesterol.
7. Will Cross Story.
8. Live "Ask the Pharmacist" Chat Sessions
9. On your feet.

Recipes of the month

The recipes provided by DiabeticCooking Magazine were specially selected for people with diabetes. All are based on the principles of sound nutrition and follow ADA guidelines, making them perfect for those with diabetes and their entire families. If you are interested in a risk free trial offer from Diabetic Cooking, click here.

Although the recipes are not intended as a substitute for medically approved meal plans for individuals with diabetes, they contain various amounts of calories, fat, cholesterol, sodium and carbohydrates that will fit easily into an individualized meal plan designed by your physician, certified diabetes educator or registered dietitian, and you.

Each person’s dietary needs are different. It is impossible to create a single food plan that works for everybody. That’s why we have included a complete nutritional analysis with each recipe. Then, no matter what your dietary goals are, you have the information you need to choose the recipes that are right for you.

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Have Diabetes. Will Travel.

Heading out of town? Leaving your troubles behind? Off on an important business trip? Whenever you travel, your diabetes comes along with you. And while having diabetes shouldn’t stop you from traveling in style, you will have to do some careful planning. Here are some diabetes travel tips from the National Diabetes Education Program.

Plan ahead. Make sure you:

• Get all your immunizations. Find out what’s required for where you’re going, and make sure you get the right shots, on time.
• Control your ABCs: A1C, Blood pressure, and Cholesterol. See your health care provider for a check-up four to six weeks before your trip to make sure your ABCs are under control and in a healthy range before you leave.
• Ask your health care provider for a prescription and a letter explaining your diabetes medications, supplies and any allergies. Carry this with you at all times on your trip. The prescription should be for insulin or diabetes medications and could help in case of emergency.
• Have wearable diabetes identification in the languages of the places you are going to visit.
• Plan for time zone changes. Make sure you’ll always know when to take your diabetes medicine, no matter where you are. Remember: eastward travel means a shorter day. If you inject insulin, less may be needed. Westward travel means a longer day, so more insulin may be needed.
• Find out how long the flight will be and whether meals will be served.

Pack properly.

• Take double the amount of diabetes medication and supplies that you’d normally
  need. Better safe than sorry.
• Keep your insulin cool by packing it in insulated bag with blue ice.
• Keep snacks, glucose gel or tablets with you in case your blood glucose drops.
• If you use insulin, make sure you also pack a glucagon kit.
• Make sure you keep your medical insurance card and medical insurance emergency number handy.
• Don’t forget to pack a first aid kit with all the essentials.

Some things to keep in mind if you are flying.

• Plan to carry all your diabetes supplies in your carry-on luggage. Don’t risk a lost suitcase.
• Keep your diabetes medications and emergency snacks with you at your seat -- don’t store them in an overhead bin.
• If the airline offers a meal for your flight call ahead for a diabetic, low fat or low cholesterol meal.
• Wait until your food is about to be served before you take your shot. Otherwise, a delay in the meal could lead to low blood glucose.
• If no food is offered on your flight bring a meal on board yourself.
• If you plan on using the restroom for insulin injections, ask for an aisle seat for easier access.
• Don’t be shy about telling the flight attendant that you have diabetes -- especially if you are traveling alone.
• When drawing up your dose of insulin don’t inject air into the bottle (the air on your plane will probably be pressurized).
• Because prescription laws may be very different in other countries, write for a list of International Diabetes Federation groups: IDF, 1 rue Defaeqz, B-1000, Belgium or visit www.idf.org. You may also want to get a list of Englishspeaking foreign doctors in case of an emergency. Contact the American Consulate, American Express, or local medical schools for a list of doctors.
• Insulin in foreign countries comes in different strengths. If you purchase insulin in a foreign country, be sure to use the right syringe for the strength. An incorrect syringe may cause you to take too much or too little insulin.

Some things to keep in mind on a road trip.

• Don’t leave your medications in the trunk, glove compartment or near a window - it might overheat.
• Bring extra food with you in the car in case you can’t find a restaurant.

General traveling tips.

• Stay comfortable and reduce your risk for blood clots by moving around every hour or two.
• Always tell at least one person traveling with you about your diabetes.
• Protect your feet. Never go barefoot in the shower or pool.
• Check your blood glucose often. Changes in diet, activity, and time zones can affect your blood glucose go in unexpected ways..

You may not be able to leave your diabetes behind but you can control it and have a
relaxing, safe trip. To learn more about controlling your diabetes, visit the National Diabetes Education Program at www.ndep.nih.gov.

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Pep in your step

SPECIAL OFFER! For a free foot care guide from the National Diabetes Education Program, click here.

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New medication news.

By: Michelle Seifert, Rite Aid Drug Information Specialist

On April 28, 2005, a new medication for type 2 diabetes received approval from the United States Food and Drug Administration (FDA). Byetta™ (or exenatide- generic name) can now be used in people with type 2 diabetes who still have high blood sugar levels, even though they are taking one or more oral medications.  People starting exenatide therapy must continue at least one of their medications including metformin or a sulfonylurea (or both), as exenatide should only be used in addition to these oral medications. 

Exenatide belongs to a new class of medications called incretin mimetics.  Exenatide mimics the action of a hormone called incretin which is found naturally in the body.  Incretin stimulates the production of insulin when blood sugar levels are elevated.   

Side effects of exenatide include nausea, vomiting, dizziness, feeling jittery, headache, diarrhea, and acid stomach.  Hypoglycemia or low blood sugar is also possible when exenatide is used along with a sulfonylurea.  It may be necessary for your doctor to lower the dose of your sulfonylurea to avoid this side effect.  Additionally, exenatide may actually reduce the amount of food you eat, your appetite, and your weight. 

Exenatide should not be used by people who have severe stomach problems or problems with food digestion due to its ability to slow the movement of food through your stomach.  Also, people with an allergy to exenatide or any of its ingredients, people with severe kidney disease, dialysis patients, and pregnant or breast-feeding women should not use exenatide. 

Exenatide is delivered by injection and is available in a prefilled pen in two strengths, 5mcg and 10mcg per dose.  The pen is preset to deliver the exact dosage necessary.  Exenatide should be administered twice a day 60 minutes before your morning and evening meals and should never be taken after a meal.  If you accidentally miss a dose, skip it and take your next dose at its regularly scheduled time.  Each pen contains 60 doses, so it will provide enough medication for 30 days.  Exenatide should be kept refrigerated at all times and should never be frozen. 

For more information on exenatide injection visit www.BYETTA.com or call the 24 hour customer service department at 1-800-868-1190.

References:

1. Byetta website by Amylin Pharmaceuticals, Inc.  2005 [cited 2005 May 2][15 screens].  Available from:  www.byetta.com
2. Eli Lilly and Company.  Press release: Amylin and Lilly Announce FDA Approval of Byetta™ (Exenatide) Injection.  2005 April 29 [cited 2005 May 2][7 screens].  Available from:  URL:  http://newsroom.lilly.com/ReleaseDetail.cfm?ReleaseID=161886

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Eat breakfast, lower your cholesterol

By: Dani Dolin, Rite Aid Pharmacist and Diabetes Care Specialist at Store 2605 in Kingwood, West Virginia

You’ve heard it from Mom.  You’ve heard it from your doctor.  “Breakfast is the most important meal of the day.” A recent study published in the American Journal of Clinical Nutrition gives evidence that maybe they’re right. 

In this study, ten young, healthy women were divided into two groups.  One group ate breakfast between 7:00 and 8:00 am and the other did not eat until 12:00 – 1:00 pm.  Both groups had a chocolate-covered cookie between 10:30-11:00am.  For breakfast, the women ate whole grain cereal with 2% milk.  They had their normal lunch and dinner with two additional snacks for the rest of the day.  The women ate this way for 2 weeks, had a 2-week break, and then switched groups. 

Researchers found that skipping breakfast was associated with higher total and LDL (bad) cholesterol than those who ate breakfast.  Although the women’s weight did not change much, those who omitted breakfast consumed more calories throughout the day. Overtime, it is likely that those increased calories would lead to weight gain.  Those who did not eat breakfast had higher insulin levels and were less sensitive to the effects of insulin.  When the pancreas gives off insulin after a person eats, the insulin helps to bring the glucose (sugar) from the meal into the cells where it is either stored or used as energy.  High levels of insulin and decreased insulin sensitivity can mean that the body is becoming “resistant” to insulin and cannot use it properly.

This study is interesting because it shows just how important breakfast is.  Although this isn’t a “diabetes study,” there are plenty of lessons to learn.  We know that diabetes and high cholesterol go hand-in-hand.  Diabetes is definitely related to insulin resistance and also to weight gain.  Each of these conditions is a risk factor for heart attack and stroke.  In this study, those who skipped breakfast had worse cholesterol, insulin resistance, and ate extra calories that could lead to weight gain.  And the study was only for 2 weeks!  Eating breakfast daily may be a great way to help control your cholesterol, glucose levels, and waistline without taking another medication.  The risk of heart attack and stroke may be lowered in the process!

So maybe Mom and the doctor were right.  Although more research needs to be done and longer studies conducted, this study should motivate people with and without diabetes to eat breakfast.  In this study, the women had bran flakes with 2% milk.  You could try a different whole grain or fiber cereal- oatmeal, Cheerios, or Fiber One for example.  Try 2% milk, or even skim milk.  Remember that cholesterol and heart disease are big threats to people with and without diabetes.  Another study suggests that eating breakfast lowers your fat intake for the day- also helping to reduce your risk.  Cereal is cheap, quick, and easy to make.   Tomorrow morning, make a date with your bowl and spoon.

References:

1. Hamid R, Farshchi HR, Taylor MA, Macdonald IA.  Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women. American Journal of Clinical Nutrition. 2005;81:388-396.

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Will Cross Story

Will Cross stands 28,700 feet up at the magnificent South Summit of Mount Everest, the culmination of weeks’ worth of bottomless crevasses, pinnacles of ice and roaring crosswinds - simply the most challenging climb an adventurer could face. Reaching the South Summit of Everest involves facing grueling conditions including dangerous icefalls, extreme cold and low levels of oxygen in the air. By any stretch, completing this ascent is a significant accomplishment for all types of climbers.

But for Will Cross, who has been living with diabetes for nearly 30 years, it is an extraordinary triumph. By fulfilling his dream of being the first person with diabetes to reach the South Summit of Mt. Everest, Will Cross is making history.

Will learned he had type 1 diabetes as a nine-year-old schoolboy in England. A rambunctious, active child, Will was told upon diagnosis that he would no longer be able to participate in sports or physical activity the way he always had. Like the millions of other people living with type 1 diabetes, Will would now have to inject the insulin he required to process glucose into energy.

Though initially devastated by the news, with the help of his family Will learned how to administer injections and control his glucose levels with diet and exercise. At age seventeen, he discovered “Operation Raleigh,” an outdoor adventure program launched by HRH Prince Charles, the Prince of Wales. Although clearly stated in the application, “If you have diabetes…do not apply,” Will persisted, writing Prince Charles directly, lobbying for the opportunity to join and was rewarded by receiving special permission to apply. When project coordinators saw that he was able to manage his diabetes, making him essentially no different from anyone else, Will was accepted into the program, thus launching his life-long interest and career as an extreme adventurer and climber.

Fast-forward twenty years. Will Cross is now a father of six and the man behind the NovoLog® Peaks and Poles Challenge, which involves summiting the highest peaks on all seven continents and trekking to the North and South poles. To control his blood glucose levels, Will uses NovoLog insulin aspart (rDNA origin) injection, an insulin product manufactured by Novo Nordisk, a global healthcare company and a leader in diabetes care. On the mountain and at home, Will uses the NovoLog FlexPen® to administer his insulin. While not climbing, he also uses a pump. 

Will Cross understands the meaning of the word “perseverance,” and is determined not to let diabetes limit his goals or his life-long dream of reaching the highest peaks in the world. He is on his way to becoming the first person in the world, living with diabetes to summit all seven peaks and poles, and the first American to ever accomplish this feat—with or without diabetes.  

Along with Will, there are 18 million people in the United States living with diabetes, with over 5 million of those people walking around undiagnosed. Ultimately, Will wants to show others with diabetes that they do not have to be defined by their disease: he wants to prove that there are no diabetics -- only people who happen to have diabetes -- and that those with the condition who manage it successfully can go on to accomplish any dream.

NovoLog^® is indicated for the treatment of adult patients with diabetes mellitus, for the control of hyperglycemia. Because it has a more rapid onset and shorter duration of action than regular human insulin, NovoLog^® should normally be used in regimens together with an intermediate- or long-acting insulin, and injection of NovoLog^® should immediately be followed by a meal. NovoLog^® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to NovoLog^® or one of its excipients. Hypoglycemia is the most common adverse effect of insulin therapy, including NovoLog^®. For additional information, please visit www.novolog.com.

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Live "Ask the Pharmacist" Chat Sessions

Rite Aid and the American Diabetes Association are proud to announce a new service for people with diabetes and their caregivers. A series of on line live chats will feature Rite Aid Pharmacy experts to answer your questions about diabetes. Please feel free to post your questions at any time before or during the actual live chat, which will take place on the first Thursday of every month at 1:00PM EST. Click here to pose a question.

Rite Aid pharmacists are specially trained in diabetes care. They can answer your questions about medications as well as general questions about your diabetes.

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On your feet

By: Lorie Widdup, Pharm.D., CDE
Rite Aid Pharmacist and Diabetes Care Specialist at Store 926 in Waynesburg, PA

People who have been diagnosed with diabetes are more likely to experience a loss of sensation in their feet, a condition known as neuropathy.  Both neuropathy and poor circulation may lead to a variety of foot problems including cracked heels, callus formation, dry skin, foot deformities, and diabetic foot ulcers. Through daily foot examinations it is possible to lessen the severity of these conditions or possibly prevent them altogether. 

The incidence of foot ulcers and the potential complications that occur as a result of them are considered to be the most common cause of hospitalization among people with diabetes.¹  Approximately 15% of all patients with diabetes will experience a foot ulcer in their lifetime, and these ulcers most often occur in patients over the age of 40.²  Non-healing foot ulcers are responsible for up to 85% of all foot amputations.  Clearly, it is essential for people with diabetes to perform a daily self-foot exam to prevent the onset of such complications. 

Below are some helpful hints in practicing daily foot care:

• Examine feet daily for signs of blisters, corns, calluses and redness.
• Wash feet daily with warm water and gentle soap.  Avoid soaking feet in hot water, and dry feet well-especially between the toes where fungal infections may develop.
• Apply lotion once feet are dry, avoiding the area between the toes to prevent fungal infections.
• Trim nails straight across; avoid cutting around the corners or the side of the nails.
• Avoid removing corns or calluses without the aid of a podiatrist or physician.
• Ensure that shoes fit properly and avoid going barefoot.  Wear closed-toed shoes or slippers.
• At every visit to your physician, remove shoes and socks for foot inspection.
• Get in touch with your physician if any of the following occur:

• Infected or ingrown toenails
• Open sores on the foot that are not healing
• Changes in skin color or appearance
• Swelling of the foot or ankle area
• Dry cracks in the skin

Most importantly, strive for good blood sugar control by taking medications as prescribed and eating a healthy diet.  Blood sugars in the range of 70-140mg/dL are optimal for preventing future complications.

References:
1).  Mayfield J, Reiber G, Sanders L, Janisse D, Pogach L. Preventive foot care in people with diabetes. Diabetes Care.  1998;21(12):2161-2177.

2).  Wound Facts & Prevention:  What are Diabetic Foot Ulcers?  Organogenesis Inc Web Site 2003.  Available at:  www.apligraf.com/content/woundfact_woundover_aboutdfu.htm.

3).  Terrie Y.  A Pharmacist’s Guide to the Care and Management of Diabetic Foot Ulcers.  Pharmacy Times. 2204;30:74-79.

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