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Attention. Before we begin our seminar: in 2008 Ferron and Stenna Andersen established
the Andersen Diabetes Fund here in our college for the purpose of assisting students doing
research on diabetes. That fund has made possible rewarding of the Andersen Diabetes Research
Award. We are pleased to announce that Megan Nuttall is the first recipient of that reward. Megan,
would you come forward. Megan is an outstanding student majoring in both Physiology and Developmental
Biology and Biochemistry. Megan is the recipient of the most prestigious scholarship at BYU:
the Thomas S. Monson Scholarship. She's doing research in a lab with Dave Thompson on the
LKB1AMP-activated protein kinase signaling system which has become a target for development
in pharmaceuticals to treat diabetes. We congratulate you Megan. Megan. We've asked Megan
to offer the opening prayer. Our dear Heavenly Father, we thank thee for
this day and for all thy many blessings. We thank thee for this opportunity to study here
at BYU and to grow and progress every day, to become more like thee, little by little.
We thank thee for the opportunity to be in the seminar today, and we pray that we can
benefit more and learn, just a little more and receive more enlightenment, enlightenment
about thy will and thy creations, Father, and we thank thee for our many blessings and
pray that thy Spirit may accompany us throughout this day. And we say these things in the name
of thy Son, Jesus Christ, amen. We're pleased to have with us today Ferron
and Stenna Andersen. Will you stand, Andersens. We're greatly appreciative of the donations
that they've made to begin this fund. Thank you.
We're pleased to have as our seminar speaker today Dr. Steve Edelman, who is a professor
of medicine in the Division of Endocrinology, Diabetes & Metabolism at the University of
California San Diego. He is also affiliated with the VA healthcare system of San Diego,
serving there as director of the Diabetes Care Unit in the VA hospital. He graduated
as valedictorian of the University of California Davis Medical School, received his internal
medicine training at UCLA, and completed the endocrinology fellowship at the Joslin and
Lahey Clinics in Boston. He's also won a research fellowship at UC San Diego. Dr. Edelman has
strong interests in education and patient advocacy. He's the founder and director of
Taking Control of Your Diabetes, a not-for-profit organization dedicated to informing
and empowering people with diabetes to become actively involved in their healthcare. He's
been active academically publishing more than 200 articles and five books. He's won numerous
awards for teaching and humanitarianism including the American Diabetes Association 2009 Outstanding
Educator in Diabetes award. Dr. Edelman is a shining example of one who lived by the
motto on the sign at the entrance to BYU campus: Enter to learn, go forth to serve. He's shown
that one person can make a difference as he has assisted literally thousands of patients
in better coping with their diabetes. Will you welcome Dr. Steve Edelman.
Thank you very much for that nice introduction. I didn't think you would leave me any time
for my presentation. I'm happy to be here--my first time, I think, to BYU--I'm exciting.
I get a little tour here on. I get to hear the Tabernacle Choir practice tonight, and
I have lots of Mormon friends--some of which are here today because they came here when
they were an undergraduate--I appreciate being able to speak to all of you.
This lecture is not a heavy-duty, basic science lecture. It'll be quite a different type of
lecture. Talking about really some of the important aspects of how you can help people
with diabetes, and it's not just drug development and developing devices, it's really trying
to get people with diabetes to put that higher on their own priority list. How many people
know someone or have diabetes yourself? Raise your hand. There you go. Hopefully you'll
pick up stuff. It's not a lecture to take notes on so just kick back and relax and I'm
probably going to take the whole time, but I'm going to stay here afterwards as long
as I need to if there's any questions. The other major point of the lecture is that we
also have to educate the providers that take care of these people because many of the providers
don't understand how hard it is to live with diabetes and they label their patients as
non-complex, and then they develop an attitude toward their patients, and it sets up a really
bad, negative, catch twenty-two situation. Through the years of working with the adversity,
with professionals, and then this not-for-profit organization, I've come to realize that some
of most important things that we can do to improve diabetes care is really to educate
and motivate people with diabetes to take a more active role with their condition.
Just to give you a little bit of where we're going in terms of the epidemic of diabetes,
this slide shows the prevalence of diabetes in 1990, and in states that are white: that
means there's no data yet back in those days. The darker the blue, the higher the percent.
If the state is in red, it's more than six percent of the population. That's 1990. Here's
the year 2000. You can see we've come a long way in terms of the prevalence in instances
increasingly dramatically. Not only in United States, but also around the world. Here's
2010 when we have ten percent of the population. If you're a bean counter, and you're worried
about the healthcare dollar, it's estimated over 218 billion dollars a year to take care
of people with diabetes. Here's the issue: Most of this money goes into taking care of
the end-stage complications--heart, tags, drugs, amputations, dialysis; we call that the end-stage--and very little money
is put towards education and prevention which can prevent these end-stage complications,
and that's the problem with our healthcare system. You're forced to pay for someone who
goes into kidney failure, but you're not forced to educate them early on when they're healthy.
This just came out from Centers for Disease Control: if the prevalence continues as it
is today, then in the year 2050 one third of the population is going to have diabetes.
This the way I look at it since I like football. This whole stadium, if this was 2050, this
is the amount of people that would have diabetes in that stadium. It's a pretty serious condition,
and we're seeing not only an increase in adult-onset type II diabetes, which is the most common
type, but we're also seeing a dramatic incidence in type I diabetes, which is the type I have.
I'll talk a little bit more as we go through. We hear all these horror stories about diabetes.
Yes, it is the leading cause of heart disease, kidney failure, blindness, and amputations.
These are the statistics that we hear. People with diabetes get pretty scared when they
hear these things, but what they don't point out is that it's poorly controlled diabetes.
No one talks about what well controlled diabetes is the leading cause of, and the answer is
absolutely nothing. It's really an important message. Diabetes is a treatable disease,
but it's also not an easy disease to live with, and the requirements that the healthcare
profession puts on people with diabetes--it's a long laundry list--and that's the issue many
of the professionals don't understand, and that's when they develop an attitude towards
their patients; then there's a lot of emotional barriers that get in the way if you have diabetes.
One thing I'm noticing about BYU: there's a lot of Mac users here, so that's good.
We've had a lot of advances in the years: we've had meters: glucose meters; we have pumps: insulin
pumps; insulin pens; designer insulins where we tweak the normal insulin to make it work
faster or longer. Despite many advances, diabetes control is still poor in this country, and
it's been estimated that well over fifty percent of the people with diabetes are not reaching
their goals for control. Their blood sugars are not at the desirable range, the blood
pressure's not good, the cholesterol's not good. Why can't we get there? There's a whole
list, and this not an exhaustive list, this is just things that I've thought about for
years. One thing is there's delayed diagnosis of diabetes, and public unawareness--that's
a big deal--there's poor diabetes care. I think the best way to describe it is uninformed
caregivers and bad healthcare policies. I've never met a doctor or a nurse practitioner
that went into medicine because they don't like patients, they don't want to help people.
The problem is they're uninformed. They're not uncaring, they're just not knowledgeable
about all the advances in diabetes. There's lack of effective prevention and treatment
strategies as I talked about earlier, and there's a lot of disparities in care and access
to care. You can have the best devices and drugs in the world. You can't get them because
you're poor, you don't have insurance, or your healthcare plan is too restrictive. What
good is all the research that we put into developing these tools? A big part of what
I'm going to talk about today is there's lack of patient education, motivation, and self-advocacy.
This is a condition where people who have diabetes have to live with it 24/7, and they
need to be the most educated than anybody, including their healthcare team. The healthcare
team helps them manage their diabetes, but they have to be the most knowledgeable.
In 1995 I started an organization called Taking Control of Your Diabetes, and I wanted to
give you a little story about it, historical background, and bring you up to our professional
Making a Connection program. I have to show you my high school ID card because I got diabetes
in 1970--this is the most embarrassing part of the talk--there's me in high school. I came
down with diabetes. I had all the classic symptoms of type I diabetes--used to be called
juvenile onset and at first: urination, weight loss--it was something that I didn't know anything
about. This slide is from 1970. I scanned this from the educational booklets that I
got. This is how they managed diabetes. First off, look at this diet: steak with a bunch
of fat on the outside, whole eggs, canned green beans, whole milk, and Wonder bread.
That was the diet, and, of course, pills and insulin. As a fifteen year old boy I'm sitting
in this class, a diabetes education class in the hospital. Most people with diabetes
were the adult-onset; we call type II. I'm in this room, a pretty ignorant and na?ve
teenage, and then about thirty overweight adults and they're talking about diabetes.
I was thinking that--you know--I look at this slide, and all I could stare at was this needle
right here. How big it is, you know? I remember one thing from that class: That ketchup has
a lot of sugar, and, well, I remember that because I like to put...I use a lot of ketchup
on my French fries. I was thinking even back then that this wasn't the best learning situation
because they lumped everybody together; and I thought: for gee, there had to be a better
way. When I first got diabetes, it was pretty archaic. This was my urine test kit where
I would pee in a cup, put five drops urine, ten drops water, and then you put a glucose
tab in there, and it would basically turn all kinds of colors, and you would hold it
up to a chart, and the only thing you put in your log book was +1, +2, +3. And don't
forget, whatever sugar shows up in your urine, was in your blood three hours prior. Very
archaic. They didn't have any glucose meters; and nowadays I'll show you pictures of modern
glucose meters where you can put a strip in a device like this, and get a blood sugar,
an actual number, in five seconds. We didn't have the A1C test. The A1C test is a very
important test that we use in clinic--I'll refer to it a lot during today's talk--it's
a blood test that tells us what the average blood sugar has been over the past three months.
You can't test your blood sugar every minute. We use that to monitor how people are doing.
At that time, when I was diagnosed, no one really told me what the goals of control were
for, and they didn't tell me why it was important, so over time--I did everything right in the
beginning, I weighed my food out, my mother was very involved in my care--but as time went
on my control slipped. This is another picture of me when I was diagnosed with diabetes.
People say this is me, Spanky over here. My control started to slip. I used to go to my
doctor who was just a general physician, nice guy, didn't know anything about diabetes,
and every three months I'd go in, they'd check my urine for glucose 'cause they didn't have
the A1C test, and he'd say the same thing to me every time, "Steve, you're doing fine.
I'll see you next time." I realized that I wasn't doing that well because when your blood
sugars are high you get thirsty and you urinate a lot, and I was a counselor at this boys'
camp. Guys at boys' camps do crazy things, right? We had a contest, and for lack of a
better word, this contest was called the *** contest. Typical boys' cares: Who can urinate
for the longest period of time? We had a stopwatch. No seriously, I figured that was probably
overkill. I won this contest week after week 'cause my control was so bad, and next time
you go to the restroom think about this: I urinated one strain for one minute and fifteen
seconds because my glucose was so out of control. I knew it was, but my doctor would say the
same thing to me every time. One time I went right before my visit I went to Winchell's
Donuts and I wanted to test him. I ate six donuts. I went, I turned in my urine, and
I tested it in the bathroom with my little kit--it turned black in about two seconds meaning
it was just packed with sugar--so I'm sitting in the room, and he comes in, and he has this
little clipboard like he always did, and he looked at it, and then he looked at me, he
said, "Steve"--he had the results of my urine test and my blood test, he drew my blood for
the glucose--he said, "Steve, you're doing fine, I'll see you next time." I realized
that he didn't really know any better. He didn't make any changes, and that was the
last time I ever saw him 'cause I was smart enough to realize that: Hey, I'm out of control,
and he wasn't really doing anything different. Now the sad part about this is that for the
first ten years of living with diabetes, my control was really bad: Blood sugars must've
been two, three hundred consistently, and as a result I developed complications. This
is a slide of what it looks like if you're a diabetic and you have a vitreous hemorrhage.
High blood sugars over the years cause diabetic retinopathy--that's a whole topic of another
seminar--and when I had a vitreous hemorrhage; you bleed into your vitreous of your eye,
and that's how the vision looked. Luckily, the blood settles, and you get your vision
back most of the time. That's the bad news. The good news is: When I was an undergrad
at UCLA, I ran into some very good doctors who got me in good control, and my problems
have stabilized. Luckily my vision's stable and I can still drive. My friends say I'm
a bad driver, but I still can see the signs. I went to UCLA, I ran into some very good
doctors, then I went to medical school at UC Davis. I remember sitting a physiology
class, and the professor says, "Fifteen percent of all diabetics die of kidney disease fifteen
to twenty after diagnosis." And I noticed all my classmates were kind of looking at
me. You know, giving me some visual sympathy, which I didn't like. That was a point where
I said, Okay, I'm going to dedicate my career to improving care for people with diabetes,
specifically on the education part. I was the valedictorian. Just to let you know 'cause
I feel guilty about this: it wasn't because my grades were the highest; my classmates voted
who they wanted to give the lecture. I got voted, so I was valedictorian. I was using
my Darth Vader crocs, and it was a lot of fun. I went to the Joslin Clinic where I specialized
in diabetes--that's where I did part of my fellowship--anybody who really wanted to become
a diabetes specialist went to the Joslin Clinic. There I am with my big fro right there. Then
I came on the faculty at UCSD. Now at this time was a famous study. It was a government-funded,
ten-year, 140 million dollar study called the Diabetes Control and Complication Trial.
What this trial was meant to prove: If we go through the effort of lowering the glucoses
in our patients with diabetes compared to those where we did not, could there be a difference
in complications of diabetes? Could we reduce eye, kidney, and nerve disease? Up until then
there was several studies; they were smaller. But you know, American medicine, you have
to prove everything with a double-blind to see what control trial. This study
clearly showed that if you lowered the glucose in people with diabetes you could make a major
impact. That was 1993. This is actually a brochure of the first conference that I put
on for medical professionals, but things weren't happening at the community level fast enough.
Caregivers were not changing their practice habits even though we had the solid evidence
that they really should try to get their patients' blood sugars better.
What were some of the barriers? Managed care was just starting to hamper proper medical
care in a major way. I'm not sure if the U.S. had much managed care up here in this area.
As a caregiver, I was fairly helpless in trying to fight the system because they didn't really
care about caregivers, they could just get doctors anywhere. They just wanted to get
their "covered lives," and there was very little education directed to the people living
with diabetes. I think in 1995, all the education's going towards professionals, and to educate
patients was kind of unheard of at that time. It was very slow. Remember that it takes ten
to fifteen years to develop a good drug for diabetes, and then the major teaching institution
--like UCSD, BYU--would educate the caregivers, and then each caregiver had a
certain number of patients in their practice that they would try to influence. Many caregivers,
once they get past the residency, it's been shown it's very difficult to change their
practice habit. You can come up with the best studies and drugs in the world, if the caregiver
doesn't go to continuing education program, if they don't change their practice habits,
then their patients unfortunately don't get the benefit of these advances. This was, I
thought, too slow a process. I decided that, in 1995, we should all take the important
messages of living well with diabetes directly to the people most affected, and those are
the people living with diabetes, so I started this organization--this is the brochure of
our very first conference in 1995--and we really wanted to focus on education, motivation,
and self-advocacy, and since then we've developed it into a national organization. This is the
mission statement: Guided by the belief that every person with diabetes has the right to
live a healthy, happy, and productive life, TCOYD educates and motivates people with diabetes
to take a more active role in their condition. This is really where the rubber meets the
road. You've got to get folks to put diabetes high on their priority list. This is just
a quick picture to show that we just finished, last Saturday in Tucson, our 125th national
conference. We've increased the number of conferences. Each year we try to go to new
cities. We come back to the same cities a couple years in a row. We also try to lead
by example: We try to get the local doctors there to put on their own program 'cause we
can't be in every city every year. It's quite an expensive process, and as a not-for-profit
it's hard to raise money to put on these programs. These are the important themes of the organization,
and this is slides I use when I'm talking to patients: that you have the main responsibility
for taking control of your diabetes; you are your own best advocate; and be smart and be
persistent. Once again, getting people to take ownership of their condition was the
challenge, and that's not easy. I'll tell you what: I've never met a patient with diabetes
who did not want to live a long and healthy life. Yet things get in the way. There's a
lot of emotional barriers: fear, guilt, anxiety. There's socio-economic financial barriers
as well. This is the brochure just from last Saturday, April 2 in Tuscon, and we wanted
to refine the program through the years, and I want to tell you some of the secrets. This
is just a picture. We get large crowds. We had close to a thousand people at this conference
in Tuscon. Here are some of the keys to a successful model. We have a strong emphasis
on motivation and removal of the emotional barriers. That's key. If you don't remove
those emotional barriers early, peoples' minds aren't open to bringing in information. Strong
and clear messages: how to live healthy with diabetes. And then we have these big general
sessions like you just saw and individual workshops, and I'll show you some of those
as we go through. Well-defined and attainable goals: you have to be really careful about
not asking for everything too quickly, and really focusing in on the standards of care,
and these goals have to be clearly stated, and in the morning, in the general session,
everyone's together, we don't have time for Q and A, and that's why we have individual
sessions in the afternoon where we have hands-on sessions and meet the experts sessions where
people can talk about their own issues. We have a target audience: people with diabetes
and very importantly their significant others, because these are the folks that are supporting
them through the system. We have clear action plan: participants are guided to make realistic--and
that's underscored--realistic commitments to their health that day. Even if it's as simple
as I'm going to walk around the block as my first step for starting exercise. Here's pictures
of the general session. I always give the opening session; it's pretty much an overview
of the day. I talk about general issues in diabetes. Very strong and clear messages;
you can't miss that one right there. Well-defined and realistic goals, and I'm big believer
in humor whether I teach undergraduates at UCSD, or the medical students, or patients,
I'm big believer that humor leads to information retention. It's much better than boring lecture
work--puts you to sleep--and then we have great information. The information I give is about
the science, but I try to give it in a way where people pay attention. I'll show you
some of the slides I use with the patients. This is just a picture of several glucose
meters. These are the meters where you prick you're figure, you get a little drop of blood,
and you put it on a strip, and they typically give you a result in five seconds, and they're
pretty accurate. This is a big message to the people living with diabetes. One of the
big barriers of care is that people do not test their blood sugars as much as they should.
I mean, who likes to prick their fingers? Nobody. But it's important to learn how lifestyle
affects their diabetes, and the medications. Here's the joke. Living with diabetes myself,
on all these advertisements why are the numbers always so normal? And then I show this slide.
I dare a company to come up with an advertisement that looks like this, and then a voice then
comes up and says darn. How about little sayings that pop up like: What did you eat this time?
Or here's my kids' favorite one: Oh that's why you're acting irritable. They were happy
to say it. They go, "Dad, go check your blood sugar," and I'll blow up, gave the fruit, you know. I'm not making light of it you know. To be serious about,
your home glucose monitoring is not just measuring and recording your values, it's really knowing
what to do with a number, and then taking action to correct it. I'll tell you what:
If someone tells you to test your blood sugar four times a day, every time you test it it's
high, but you haven't been given the tools to do your own self-management or to react
to that buildup, you don't want to test either. Who wants to test four times a day to see
how bad you're doing? That's where the key comes in. I want to show you this guy's log
book. The numbers circled in red are all ending in zero. You see this person has three 144s
in one week. There's no food or blood, all the numbers are written with the same color
pen, and the funny part about this is this clinic was on the eighth, and on the ninth
you can see there's a number, this is in the future, and crossed it off, so he was making
up the numbers, and he went past the date and goes whoops, and he crossed it off, and
didn't think I was going to notice. It turns out that we have this test called the A1C.
His A1C was fifteen percent meaning that his average blood sugar over the past three months
was 300. He was making up the numbers. We call it dry labbing. A normal doctor would
say this guy's a liar, he's a noncompliant, makes up his numbers, he doesn't care about
his diabetes. What's happening here is the doctor should really look at himself and say
hey, I don't think I've developed a good enough patient-provider relationship that this patient
either did test, or the numbers were so high he was ashamed to tell the truth at the doctor-patient
visit. A lot of this goes on. This patient's testing. Look at the blood that he's wiping
on the sheet. If you look at these numbers, his morning numbers are the highest of day.
Lunch and dinner aren't that bad. As a provider I'm trying to educate patients to say okay,
don't just test and bring it in and say here, here's my result. You need the test for yourself
primarily, and look at these numbers and say hey, my morning numbers are high. Patients
have been trained to adjust their nighttime insulin to help out with that, but if you
haven't been, at least say okay, my numbers are high in the morning, my next clinic visit
isn't for four months, I'm going to call up and talk to someone on the phone to get in
earlier because I notice there's a problem, and that's what taking control of your diabetes
is all about, is to test for yourself primarily. Just to let you know there's a lot of cool
glucose meters. This is a Korean cell phone that's also a glucose tester. Here's a brand
new thing that'll be coming out. It's called the BG Star. This is an iPhone, and this little
device is the first medical device approved by Apple. It snaps on the bottom, you put
your glucose strip in there, and then you can test your blood sugar. Of course, the
number's normal, on the advertisements. This is called the bare USB. You can see it's a
glucose tester, of course the blood sugars pretty good, and this sticks into your computer
and gives you a nice software program to help you analyze your blood sugars, so it's not
just looking at your log book anymore. There have very nice software programs, and there's
a whole bunch of iPhone apps for that too. My daughter comes home with this picture and
says, "Hey dad, look at this cool phone. It's got a rotary dial." She thought that was the
coolest thing. She's never seen that before. She's a freshman at University of Washington,
Seattle. I really want her to come here. The tuition's way cheaper. This is a huge advancement.
Huge, huge, huge. This is a monitor which I have called the continuous glucose monitor.
You put a little sensor under your skin. You do it yourself. You snap on a transmitter,
and every five minutes I get a new blood sugar. You can put in your high and low alarms that
alert you if you're getting too high or too low. You could have a severe low blood sugar
while you're driving, get in a car accident. Unfortunately, people pass away if they pass
off low blood sugar, and they don't have help. It happens; not very frequently. This also
gives you a number, and it gives you a trend arrow. It has very sophisticated software
that looks at the rate of change, and can tell you which direction you're going. Then
you think about this: if you check your blood sugar at one point in time, it says 160; you
don't know if you're going up, you don't know if you're going down. I think this is one
of the greatest advances for insulin using patients since the discovery of insulin. I
don't go anywhere without my continuous glucose monitor. This is the setup. This is the applicator.
It takes literally thirty seconds to put in. You put it in and some people put their abdom,
I put mine in my upper thigh, sometimes I do my abdomen, and then this applicator comes,
you snap in the transmitter. This is just an example of advances in modern technology,
and this makes living with diabetes so much easier. The other reason I wanted to show
you this picture is because that's me. You don't believe me, huh? I don't think there's
a single person with diabetes that's on insulin, especially type I, that would not benefit
greatly. Here's the intrigue: doctors don't know about it, doctors are afraid of it 'cause
they think it's too much information, and patients don't know about it. It's professional
and patient inertia, and this what we try to overcome at these conferences.
Other issues that we bring out at these conferences is that people with diabetes have to be in
a maintenance program, just like for cars, and we always talk about the ABCs, and it's
not just A1C which is glucose, it's getting on an aspirin, getting the blood pressure
and cholesterol. That's true with every American. Every American should be really concerned
about their blood pressure and cholesterol. We talk about how to prevent blindness. It
just comes down to the simple fact: Get a yearly dilated eye exam, and you will not
go blind; you may have some visual problems. Why is screening so important? Because there
are no symptoms of diabetic eye disease until there are advanced stages. Any condition that
doesn't lead to symptoms--no pain or swelling--you're not going to go the doctor because you don't
feel anything, and that's why screening is so important. Cholesterol has no symptoms,
high blood pressure has no symptoms, early eye disease has no symptoms. I can almost
guarantee everybody that if you go to the eye doctor once a year, get a dilated eye
exam, you will not go blind. That's a big issue; that's scary for a lot of people. Same
with our kidneys. Get a yearly test of your kidney function. There's all these fancy tests,
I don't have to get into details, but once again there are no symptoms of kidney disease
in the early stages. Sometimes what these patients have to do, and I have to do, is
urinate in a jug for twenty four hours, it's called twenty four hour urine collection,
and the issue is you have to keep the urine cold for twenty four hours, otherwise the
test is inaccurate. Usually they try to pick a weekend where they're at home, and you've
got to keep the jug in the fridge, and I always tell people you have to label your jug very
carefully. My kids come in and they drink right out of the container. That'll serve
them right. People with diabetes get a lot of tooth and gum disease because there's natural
bacteria in our mouths. If your sugars high, people get really bad cavities, they get very
bad periodontal disease. I tell them, this is my recommendation, tooth
and gum disease are common--this is the actual slide is used--brush twice a day, floss once
a day, at least one week before and after you go to the dentist. Don't you guys get
motivated? Otherwise you're going to look like that. Some of the other issues in diabetes--I'm
just picking real specific ones--this concept in this slide is for people with type II,
that their therapy may change over time even if they're doing everything right in terms
of diet and exercise, they may need lifestyle and one pill, they may need other medications,
they may eventually need insulin, and this is scary for a lot of people with type II.
That's another people. I've told you people aren't testing their blood sugars enough,
and people with adult onset of type II diabetes, when the pills stop working they have to go
on insulin, and getting a type II fifty, sixty year old person to take an injection is really
tough, and there's ton of push back, and they have all these fears about insulin, and just
the pain of these needles. One of the things that we did, as part of the Taking Control
of Diabetes, we started a program called extreme diabetes make over, and this is a reality-based
documentary that's going on, it's showing right now, I'll give you the website, but
I want to tell you about a few of these folks. Renee is someone with type II diabetes, but
what we did was we screened people at our conferences to be on this five month program
where we video tape the whole program, and they had to have requirements: your diabetes
had to be out of control--your A1C was really high--and you had to have the desire to get
better. And these people were not hard to find. We exposed them to the dream team of
an educator, an exercise physiologist, a diabetes specialist, very important clinical psychologist,
to get through the emotional barriers, and a dietician. I wanted to show you this short
video clip that describes the program. We've talked about a program like extreme
diabetes make over for a long time at TCOYD. Our idea was to follow a small group of people
with poorly controlled diabetes, both type I and type II, from all walks of life, for
a significant period of time like five months, and have them work with a dream team of diabetes
care professionals. We wanted to see if combining care, focus, and commitment, can help change
them in ways to get their diabetes under control. We also thought that if we filmed the process,
we could share it with others in ways that might help them control their diabetes, and
to realize that their struggles are not uncommon. It's really just about getting activated,
and the definition of that for me is getting educated, motivated, and empowered to take
control of your diabetes, and here's the website for our organization. It's also being shown
on realage.com which is a big health and wellness website started by Dr. Oz, and we follow these
people over five months. Back to Renee. She's fifty five years old. She's got multiple medical
problems. Look at her A1C's 11.6 meaning that her average blood sugar is 290. We had to
start her on insulin. In the office she didn't have a big problem with it, she didn't seem
like she was afraid, so she brings back her high-definition home flip-cam that we gave
all the participants to do their home video dairies to talk about things when they had
successes and failures. We download her camera, she leaves, and then we watch it later on,
and this was a tremendous learning point for myself when I saw what she was going through
at home. I was totally unaware. Started insulin three days ago. Anyway, I
took the insulin, woke up at 3 AM because I was so excited to see my blood sugar, and
it was 176, so yeah! It was coming down because normally it's up in the two hundreds or so,
so I couldn't wait to go back to bed, to wake up in the morning, and take it again, so that
morning I woke up, took my blood sugar, and it was 208. I was very disappointed. Very.
Anyway, the next day I took it again at 6 AM, and it was 230 again, and I'm still disappointed.
The bottom line is I must've told her five times we're starting off with a low dose,
we had to bring it up over time, don't be disappointed if it's not down the first day
you take the insulin, or the first week. It's amazing what you hear at the doctor's office
when they say you've got to start insulin and you don't hear anything else. I thought
that was pretty amazing. These are some of the clips that we show to professionals so
they know what's going on with their patients at home.
I'm not going to talk too much about this guy. He's a lawyer--I don't typically like
to help lawyers--of all seven participants he had the highest level of education, he
was the wealthiest, and he had access to the best healthcare, and was seeing a very prominent
endocrinologist in San Diego that I know well. Look at him. He had the worst control of anybody
in the entire group including one of the guys that I'm not going to talk about: he's a homeless
guy. Here's the smart, educated, wealthy individual, walking around with the worst control. How
do you figure that? He's a grandfather, he doesn't want to die early, and that's what
the whole issue is about diabetes: he just has put it low down on his priority list.
I usually finish my morning talk with a poem specifically written for people with diabetes,
and here it is: If you can be cheerful, ignoring aches and
pains, If you can resist complaining about your troubles,
If you can eat the same food every day at the same time and be grateful for it [which
is what we ask people to do], If you can understand when loved ones are
too busy to give you attention, if you can take criticism without resentment,
If you are always willing to exercise at a moment's notice, then you are probably the
family dog. Think about it. We should be more like our
pets. How 'bout this one? My dad's always my all-time favorite. Let me take you through
the rest of the day. The second lecture right after myself is a political psychologist,
and once again, if you don't get through those emotional barriers and take away the fear,
the guilt, anxiety, early, then these folks, their minds aren't as opened to pick up new
information. We have lectures on food, and this is one of the best lectures I've ever
heard: Are you what you eat or how much you eat? It turns out, when you have diabetes,
you can pretty much eat anything you want. It comes down to portion control and eating
the foods you like in moderation. You want a juicy hamburger? For God's sake have one
once in a while. This happens to be a five pound hamburger in a store in Cincinnati,
Ohio, and if you eat the whole thing in the first hour you get it for free. This is a
great thing to uplift. Diabetics aren't supposed to eat greasy, fatty foods like potato chips,
and I thought this was just perfect, and the crowd loves this commercial.
I like to make things simple. I tell patients: think of bright colors when you leave like
greens, yellows, and reds. It's very simple. At these conferences these folks are in the
majority, not the minority. This is lunch time. People sit with each other, they talk
with you and they realize that they're in a place where they're enjoying. They also
realize that diabetes crosses all socio-economic boundaries. The lunch time's very important,
and we decide with our caterers, the chef at the convention centers to decide this lunch
has to be good, but it has to healthy. Not all diabetic food should taste like cardboard.
At lunch time we have a motivational speaker, Billy Mills, very famous Native American,
he's the only American ever to win the gold medal, very big upset at the 2000 year race
in the 64th Olympic Games. He shows a video clip of the announcer where he did this huge
upset, he was a total no name, and chills go down my spine every time I hear him speak.
Della Reese. We have basketball stars in sports, and having an African American guy who has
diabetes: great role model for these young kids. This kid doesn't have juvenile onset
type I, he has adult onset diabetes at the age of eight. Both his parents have type II,
that's why they change the name from adult onset to type II. You can get any type of
diabetes at any age. This is the most motivational person I know. He's my patient, he's a Vietnam
vet, he spoke at Tucson last week. The title of his talk is Diabetes Saved My Life. That's
a picture of him when he was a platoon sergeant in Vietnam, and I don't have time to tell
you his story, but he was coming down with diabetes, he was getting sick. The people
at sick call said he was just trying to get out of action because he was afraid to be
killed, and they threatened to court marshal him. He lost about sixty pounds from
undiagnosed diabetes, and his whole platoon was ambushed, and everyone in his platoon
was killed. He passed out from undiagnosed diabetes; enemy thought he was dead, so they
put him in a body bag with all the other guys, they shipped him off to be identified, and
when they unzipped his bag, it's kind of a gruesome, sad story, but they found the guy
who unzipped him, and the first thing he noticed: there wasn't blood or body parts in the bag.
The guy...Urban was still breathing. From that point they got
him to a hospital, and he survived, and the title of his talk, Diabetes Saved My Life.
He's done tremendous things with his life. He's blind now, and he has a kidney transplant,
but agent Orange also accelerated his complications, but don't feel sorry for this guy. He runs
two not-for-profit organizations, and he's probably one of the most...he is the most
motivational person I know. We try to get people at lunch time, and they can talk to
afterwards, and give them motivation as well. We also have Nicole Johnson who was former
Miss America. Used to walk down the aisles that they do during their pageants with her
insulin pump. She brought diabetes out of the closet in a major way. We always have
legal people speak. This guy, Kriss Halpern, he's a type I diabetic. He's
also a lawyer specializing in rights, and we try to help people pick the best healthcare
system, learn how to constructively fight to get what they want, and now interpret the
new healthcare reform that are going on. Managed care was supposed to be about the equitable
distribution of resources. I'm really down on managed care as you can tell. I give lectures
all the time to these executives to try to get them to allow people with type I to get
devices like continuous glucose monitors which are not cheap, and I really feel like giving
them a gesture at these meetings; they're faces are turning red, I know what they're
thinking: this is going to bust our profits. The only slide I can show and get away with
is this slide, this one: Diabetes is not a rare disease, it's not an inexpensive one.
And then I show them this one. Once again, if you look at the famous people with diabetes,
look at this list. Once again, diabetes affects everybody; you can be a movie star. And I
always like this one, Ray Kroc, and one conference here I wanted to say he the founder of McDonald's,
and what came out was he is the founder of diabetes. That went over pretty good.
Some of the other workshops. These workshops are really meant to get to their individual
needs. I told you earlier that educating the type III diabetic, and I call them the person
living or caring about someone with diabetes, this a workshop just for the significant other.
It's tremendous because these folks, if they're not educated and motivated, then trust me
it's going to be a bad situation at home because they're going to bug them. We call them the
diabetic police. My kids always seem to be experts regarding my diabetes care. They say,
Dad, you can't eat that piece of chocolate cake, and I say okay, watch this. One of the
most important slides I can show you is the chances of a man winning an argument. The
dating period is fifty percent. The engagement period is thirty percent. Of course, the marriage
period it goes down to zero. After one of the conferences, and she said to me, how does
this relate to the animal kingdom. Here's the dating period. Here's the engagement period.
Sorry for all you guys out there, but just to warn you, this is the marriage period.
We get a bunch of podiatrists to do free foot exams. We get pharmacists to talk about medications.
You don't tell a patient about the drug they're taking why it is prescribed, what it does,
they're not going to take it. They're going to look for some herbal remedy with a bunch
of false claims from the vitamin store. We do eye screening. We also talk about exercise.
Anybody see what's wrong with this picture? We don't just give lectures. We used to give
lectures on exercise. That's boring, and who wants to hear about how exercise can make
you feel better. We actually have activities at the conference in the afternoon: Tai Chi, Zoomba, all kinds of stuff. We tell the
people how to use pedometers. That's one of the great motivation tools 'cause you can
compete with yourself; you can build up every single day. This is my elliptical stepper
at home. I belong to nice gym. I go there once a year to pay the dues for sure. I watched
San Diego beat BYU in the last game. For those of you have to go, go ahead. I've got about five more minutes.
This is how I use my stepper, every single day, there it is right there. There's a non-alcoholic
beer down there. Healthcare's really important. Tell patients the latest and greatest.
We have other not-for-profits show up, and we also bring the professional community together as well.
You try to bring Duke and UNC together during basketball season: it's pretty tough.
We pretty much end the day--and this is my last slide--with motivation comments from the co-directors,
and we try to leave people with some hope that they can actually do better with their diabetes,
and also we set up a system with our membership program to stay in touch. We have a newsletter,
we have a TV show. We try to get them to leave that day motivated. The big joke is:
they're so motivated at the end of the conference that they're actually happy they have diabetes.
Thank you very much for your time. That's it.