DDiiaabbeetteess BBiitteess October, 2012

Integrated Diabetes Services presents a quick synopsis of the latest diabetes

discoveries and happenings. Send your comments or questions to:

info@integrateddiabetes.com*

*this e-mail goes to office administration. To reach Gary Scheiner directly, e-mail

gary@integrateddiabetes.com. To reach Karen Franey, e-mail

karenf@integrateddiabetes.com For Jennifer Smith, e-mail Jennifer@integrateddiabetes.com.

Special thanks to MJ Scheiner for our “bites” logo!

©Copyright 2012, Integrated Diabetes Services LLC

333 E. Lancaster Ave., Suite 204

Wynnewood, PA 19096

(610) 642-6055

(877) 735-3648

Fax: (610) 642-8046

www.integrateddiabetes.com

www.type1university.com

In This Issue

Dexcom G4 Now Available! …2

News Youz Can Use …4

App Rap …6

New Product Feature …9

Events of Interest …10

The Diabetes Store …11

How to trial a CGM …12

Trivia Question …12

Halle-Freakin’-Lujah!

G4 Is Finally Here

After who-knows-how-many months and years of waiting,

Dexcom has announced the FDA approval of the G4 Platinum

Continuous Glucose Monitoring System. Compared to its predecessor, the Dexcom 7+, every aspect of the G4

is “new and improved”. The sensors are smaller and sport a more streamlined insertion process. The

transmitter is much more robust – emitting a signal that travels 20 feet or more. And the receiver is slimmer

and features a bright, full-color LED screen. Several new customization options are built into the receiver,

pertaining particularly to the high/low alert features. The receiver is also more water resistant – something I

can appreciate having accidentally dunked and fried my share of 7+ receivers. New web-based downloading

software is also in the works.

In pre-release studies, G4 performed extremely well. Compared to laboratory glucose values, G4’s MARD

(Mean Relative Absolute Difference) was only 13% – a value that is far and away the best in the industry.

Fingerstick blood glucose meters, incidentally, are only required to be below 15% MARD. The sensors

performed particularly well in a hypoglycemic and near-hypoglycemic range, with more than 80% of values

within 20% of the lab measurements. Sensor longevity – something that Dexcom is famous for – continues to

be a strength. Sensor accuracy was found to be as good on day 7 as on day 4, and 94% of sensors were able to

perform beyond the standard seven day life cycle.

On the downside (we can’t have everything!), the G4 transmitter is only warranted for 6 months, compared to

12 months for the 7+ transmitter. This is due to the greater power consumption needed for the wider

transmission range. Also, G4 should to be calibrated only when glucose levels are in a relatively steady state.

G4 is priced at $1200 plus the cost of the disposable sensors. For those who currently have a Dexcom 7+

system that is still in warranty (purchased in the past year), the cost is $399. For those who purchased since

September 1, 2012, an upgrade to G4 will be provided for free.

Dexcom is currently taking orders for G4, with shipment expected to begin before the end of October. Given

the high demand for G4, there may be a bit of a wait to reach the sales department, and shipment may take a

few weeks extra. But hey… if anything is worth the wait, this certainly is! Lord knows we’ve waited long

enough.

For more information, visit www.Dexcom.com/G4Platinum. To place an order, call Dexcom toll-free: 877-339-

2664.

To see a video demonstration of the new Dexcom G4 Platinum CGM, visit here:

http://www.dexcom.com/sites/dexcom.com/files/videos/dexcom-g4-platinum-

overview/dexcom-g4-plaintum-overview-universal.m4v

(Advertisement)

Introducing the latest in glucose sensing technology

Dexcom proudly presents the Dexcom G4 PLATINUM

Now in color and better than ever.

Dexcom® is excited to announce the continued innovation of the Dexcom Continuous Glucose Monitoring (CGM) system

by introducing Dexcom G4™ PLATINUM. With modern design and exceptional accuracy, the Dexcom G4 PLATINUM

provides enhanced user conveniences and sensor performance that customers have long associated with Dexcom.

Continuing our vision of patient-centric solutions, the Dexcom G4 PLATINUM brings the first, large color CGM screen to

life, along with other user-friendly features and remains the only system with a sensor approved for up to 7 days of wear.

By more seamlessly integrating into people’s lives, Dexcom anticipates continued improvements in patient compliance

and retention that is already the highest among CGM companies.

Demonstrated clinical benefits of CGM include:

• Improve HbA1c levels without increasing hypoglycemia3

• Ability to reduce glycemic excursions4,6

• Improve time spent in ”target levels” or euglycemia5

• Reduce frequency and time spent in hypoglycemia5

http://www.youtube.com/watch?v=FAvQSkK8Z8UDexcom, Inc. |

6340 Sequence Drive | San Diego, CA 92121

Product Support 1-888-738-3646 | www.Dexcom.com

News Youz* Can Use

(*Philly for “you all”)

More Good News on Degludec

Degludec is a new super-long-acting insulin that produces a very flat basal profile in the bloodstream when

taken on a daily basis.

In a recent study, Type 1 diabetes patients who took a combined formulation of degludec and aspart

(Novolog/NovoRapid) at dinner, with just aspart at other meals, had better nighttime BG control than patients

on basal-bolus therapy with detemir (Levemir) as the basal insulin. Patients in the degludec group needed

fewer injections and had 37% fewer episodes of nighttime hypoglycemia compared to the insulin detemir

group. There were no differences in Health-Related Quality of Life or lab measurements, or in adverse events.

Dr. Irl B. Hirsch, who led the study stated , "While it is important this was shown… I don't believe a co-

formulation will become the standard of care in this population where we generally prefer more flexibility

with the prandial (mealtime) insulin." Dr. Hirsch added, "We can't comment how this co-formulation would

perform with tighter levels of glucose control and A1C levels less than 7%. Nevertheless, for some type 1

patients who may do better with a co-formulation of degludec with insulin aspart, the same benefit of

reduced nighttime low BG can be expected."

Novo Nordisk is hoping to market the degludec/aspart combination as Ryzodeg and has submitted the product

for regulatory review in North America, Europe, Japan, South Africa, India, Australia, Brazil, and Russia. In

June, the U.S. Food and Drug Administration extended its review period for Ryzodeg.

Walking after Eating Lowers Glucose in Healthy People and Diabetes Patients

Walking or other light exercise after meals may reduce glucose levels by more than half in both healthy people

and type 1 diabetes patients. Dr. Yogish Kudva led a study at the Mayo Clinic in Rochester, Minnesota. He

found that even minimal activity sustained for 30 minutes (such as walking at a

leisurely 1.5 MPH pace) lowers post-meal glucose concentrations.

The results are from a larger study on patterns of postprandial glucose tolerance.

Dr. Kudva and his team studied 12 people with type 1 diabetes and 12 healthy

controls. For three days and four nights, the researchers monitored the

participants' diet and calorie intake, physical activity and glucose levels in a

controlled environment. Implanted continuous glucose sensors measured glucose

levels, and triaxial accelerometers (motion sensors) reported body positions and

movement.

The participants walked after two of their daily meals and sat after a randomly designated third meal. The

researchers reported data for the glucose measurements taken 4.5 hours after eating. At that interval, healthy

people had 13% higher glucose levels after inactivity compared to when they walked.

The diabetes patients had 45% higher glucose after inactivity compared to when they walked (p<0.001).

Substituting other activities such as washing the dishes after a meal could have similar effects to walking, the

researchers suggest in their paper.

Dr. Kudva mentioned that, "In general, walking improved glucose after about 10 minutes with the

improvement lasting until five minutes after such activity ceased." He added, "The improvement in glucose

was about 30 mg/dl or 1.75 mmol/L. Since we have multiple glucose measurements over an extended period

of time, we can only provide approximate numbers."

Type 1's Have a Fat-Burning Advantage

Researchers may have discovered a new advantage for type 1 diabetes patients. According to research presented at the

American College of Sports Medicine's (ACSM) 58th Annual Meeting, people with diabetes may burn more fat than

those without the disease during exercise.

A research team from the University of Montana studied fat and carbohydrate oxidation rates in 29 individuals with

Type 1 diabetes. Study participants were tested for aerobic capacity and the type of fuel the body burns during

stationary cycle or treadmill exercise performed to exhaustion. Researchers recruited an age- and gender-matched

group of people without diabetes to serve as the control.

For all participants, metabolic data was recorded every two minutes during exercise. Blood glucose was recorded before

and after exercis. Carbohydrate and fat burning were calculated at 50, 60, 70 and 80 percent of aerobic capacity.

Results suggest that, at the same relative intensity, Type 1 diabetics oxidize more fat and less carbohydrate than non-

diabetics. Prior to, and throughout exercise, diabetics had higher blood sugar levels and slower carbohydrate burning

than their non-diabetic counterparts; however, diabetics did have the advantage in fat burning. Fat oxidation was

consistently higher in the diabetic group.

Charles Dumke, Ph.D., FACSM, lead author of this study said, "The results are significant in that despite elevated blood

sugar values, Type 1 diabetics appear to oxidize fat at greater rates," said Dumke. "This is perhaps to compensate for

their lack of endogenous insulin production. Insulin is a powerful hormone in the control of fuel utilization. Since Type 1

diabetics rely on exogenous insulin administration, they also control their muscles' fuel selection during exercise. Our

pre-test instructions of a two-hour fast likely resulted in lower basal levels of insulin in the Type 1 diabetics."

App Rap:

Lilly Glucagon Mobile

Lilly Diabetes recently launched the FREE Lilly Glucagon

Mobile App to educate those who support people living with

type 1 diabetes. This interactive app is available on the iTunes

store for iPhone and iPad devices and provides caregivers,

diabetes educators, and school nurses with visual and audio

emergency instructions, as well as tools to track locations of

glucagon kits and alerts for expiration dates.

People with type 1 diabetes who experience severe

hypoglycemia (low blood sugar) during insulin treatment may

require glucagon, a hormone produced in the pancreas to raise

blood sugar levels. Diabetes patients should ensure that their relatives and close friends know that if they

become unconscious, immediate medical help must be sought. Use of this app may be an easier way to teach

more family members how to use the kit if/when needed.

For more information, go to www.lillydiabetes.com.

Making The Rounds – Gary & Jenny Online

Even when we’re not working, we’re working to get the word out.

Our own Jenny Smith was recently featured at Insulin Nation (insulinnation.com) in an article appropriately

entitled “Baby (and insulin) On Board.” (Yes, Jenny is expecting!!!) The article was based on an interview

and written by Ginger Vieira, Type-1 powerlifting champion and author of “Your Diabetes Science

Experiment.” It can be found at http://www.insulinnation.com/insulinnation/2012issue6#pg18.

Insulin Nation connects people with diabetes who use insulin, particularly those who use insulin pumps and

continuous glucose monitors. It features people living well with diabetes, combining text, video and

slideshows to tell their stories. and offers specific practical information to those on an insulin regimen.

Gary has also been busy during his “time off”. He was quoted extensively in an article on continuous glucose

monitoring written by friend and colleague Hope Warshaw. It appeared in Diabetic Living’s online magazine:

http://www.diabeticlivingonline.com/monitoring/blood-sugar/continuous-glucose-monitoring/?page=1.

Diabetescare.net also featured Gary following an “Up-Close” interview conducted by Clinical Content

Coordinator, John Parkinson. Published on September 28, 2012, the story “Filling the Primary Care Gaps with

the Emerging Role of Online Diabetes Education” uses a Q & A approach to describe the pioneering role being

played by Integrated Diabetes Services and Type-1 University. Photos of Gary with clients and some

background on the development of the practice are included. To access the full interview, go to

http://www.diabetescare.net/content_upclose_detail.asp?id=446580

Meet Suite D!

Home of the Official OmniPod Blog

Insulet is excited to announce the launch of the new, official OmniPod blog: Suite D!

Suite D was built to feature voices of people like you who want to share how they're living life to the fullest

each day. The site will host guest bloggers with a wide variety of perspectives - ranging from high-performing

athletes to parents who care for a child with diabetes to young people learning to be more independent in

their diabetes care.

It is also a place you can visit to find:

• Inspiring stories from other people with diabetes

• Helpful diabetes management tips

• Coverage of diabetes-related news and events

Suite D helps to focus on managing diabetes in ways that leave more room for you to enjoy what you love in

life. The door is always open so come on in and check it out...and spread the word!

The Suite D blog can be found at: http://suited.myomnipod.com/about/

Bayer CONTOUR® NEXT LINK Meter

In September 2012, Medtronic and Bayer

launched their newest meter, the CONTOUR®

NEXT LINK Blood Glucose Meter. Readings from the

CONTOUR NEXT LINK are transmitted via radio signals to Paradigm and Revel pumps (models 522, 523, 722

and 723) as well as the Guardian Real-Time CGM System. The CONTOUR NEXT LINK will be sent to all

NEW/REPLACEMENT pump customers from this point forward. Existing pumpers will be contacted by

Medtronic and provided with new meters over time, with most receiving a CONTOUR NEXT LINK between

January and March of 2013.

Product features include:

• New high-accuracy CONTOUR® NEXT test strips that deliver exceptional accuracy for close-to-

professional lab results, especially in the low glucose range (<75 mg/dL).

• Fast and easy bolus dosing and continuous glucose monitoring calibration

• Pass-through feature allows for easy downloading to Medtronic’s CareLINK® software, replacing the

CareLINK® USB device

• No Coding™ technology makes testing easy by automatically setting the correct code each time a test

strip is inserted

• Bright, full-color display with large, clear numbers

• Fast 5-second countdown and small 0.6 μL blood sample

• Optional pre- and post-meal markers with audible reminders

• An Illuminated test strip port for testing in the dark

• A rechargeable battery

Since the CONTOUR NEXT LINK meter is now used to upload to CareLink, Medtronic will no longer be shipping

CareLink USBs with new pumps. They will continue to sell CareLink USBs, and customers wishing to use a

CareLink USB to upload their data to CareLink Personal may purchase one on Medtronic’s online store.

Events of Interest

The 2013 JDRF Children's Congress will be held in Washington, DC from July 8 - 10, 2013. This event brings

together at least one delegate from every state to Capitol Hill to explain to members of Congress why we want

a cure for type-1 diabetes. No one knows better the challenges of living every moment of every day with

diabetes than those who live with the disease. This is a wonderful opportunity

to empower any child living with diabetes with the knowledge that they can

make a difference in finding the cure! In past years, the simple act of a child

telling their story has changed the minds of members of Congress.

If you have applied in previous years and were not chosen, please keep applying! There have been many

previous delegates that were selected after applying multiple times. If you are between the ages of 4 and 17,

be sure to apply to represent JDRF at the Children's Congress by 5pm, Thursday, November 1

For more information and to access the application, go to http://www.jdrf.org/index.cfm?page_id=117521.

day in Philly

Athletic diabetics, this is for you! Join Insulindependence on Saturday, November 17 at 11:00am at Drexel’s

downtown location for an afternoon panel discussion on diabetes and exercise with keynote speaker Missy

Foy. Missy is one of two people with diabetes to compete in the US Olympic Marathon Trials (2000). She will

be joined by other amateur athletes living with diabetes and a medical professional to answer your questions.

After the panel join new friends and family at Dave & Buster’s at Penn’s Landing at 5:00pm to socialize at a

networking dinner. This event combines both experiential education with the Philadelphia Marathon/Half-

Marathon on Sunday morning and learning opportunities for people with diabetes and the their

family/friends. For more details, visit http://insulindependence.org/philadelphia-marathon-weekend/

Take control of your diabetes and join others

for a day that will ignite your motivation for

change, offer hope, provide invaluable

education, and change your life!

What makes a TCOYD conference special? Dr.

Steve Edelman, Founder and Director of the

not-for-profit TCOYD was diagnosed with type

1 diabetes at the age of 15 and has lived well

with the disease for over four decades. His

mission is to educate, empower and inspire

people with Type-1 and Type-2 diabetes. Dr. Edelman has never allowed diabetes to define his life. Instead, he

and the TCOYD staff teach other how to live healthy and happy lives with diabetes. www.tcoyd.com

The Diabetes Store Is Open!

The Integrated Diabetes Services store features a variety of useful and hard-to-find over-the-counter products

for making living with diabetes just a little bit better and easier.

The IDS Store includes:

• Books

• Pump Accessories

• Hypoglycemia Treatments

• Sharps Containers

• Skin Wipes

• Lancing Supplies

• Food Scales

• Exercise Videos

• Supply/Travel Cases

• Cooling Pouches

• Ketostix

• Injection Aids

For a complete catalog and to place orders, please visit http://www.integrateddiabetes.com/webstore/

or call 877-735-3648.

“Think Like A Pancreas” Goes Platinum!

The 2nd edtion of Gary Scheiner’s Think Like a Pancreas: A Practical Guide to

Managing Diabetes With Insulin is selling like low-carb hotcakes! Since its

release, Think Like A Pancreas #2 has sold more than 10,000 copies worldwide.

Reviews on prominent websites and blogs have been overwhelmingly positive

and supportive. And for good reason: the updated edition of the highly-

acclaimed original now includes detailed sections on continuous glucose

monitoring, new medical options for insulin users, smart pump therapy, web-

based support and management resources, and pregnancy & type-1 diabetes.

To order a copy (or two or ten) personally autographed by the author, call

Integrated Diabetes Services or visit the Diabetes Store at the IDS website.

October/November Special:

Need a workout but don’t feel like getting up off your comfy sofa or armchair?

Now you can do both! “Chair Dancing” videos lead home users through a full

cardiovascular workout while seated. Upbeat instructors and music make these

videos a great choice for people of all ages – particularly those with hip, leg or foot

problems. Three different VHS videos are available so that you can add variety to

your armchair workouts:

� Original Chair Dancing

� Chair Dancing Around the World

� Chair Dancing Through the Decades

Normal Price: $30.00

Special Price for October & November 2012: $15 each To order, call IDS or visit the Diabetes Store online.

Sample a CGM

Use of Continuous Glucose Monitors is growing steadily as the systems become more accurate & user-friendly,

and insurance coverage expands. Still, many people are hesitant to purchase a system outright without

knowing if it’s really worth all the effort. If you’re interested in trying

a CGM (and learning some things that can improve your control),

Integrated Diabetes Services offers a CGM Trial Service. This service

is available just about anywhere since

we can ship the necessary equipment to

you and talk you through the sensor

attachment process via phone or video chat (skype). Select either a two-week

Dexcom Seven-Plus trial, or a one-week Medtronic sensor-augmented pump trial

(you must have a Medtronic 522, 722 or Revel pump). The trial service includes a

detailed analysis of your sensor data as well as specific recommendations for

fine-tuning your glucose control. The cost for the service is $269, including all necessary equipment, initial

training and data analysis. Details can be found at http://www.integrateddiabetes.com/cg_trialserv.shtml.

Call 1-877-735-3648 to schedule.

For mail-order diabetes supplies (test strips, pump supplies, sensors, prescriptions and more), we are proud to

recommend Byram Healthcare. Byram works with most public and private insurance plans, provides a very

wide selection of diabetes self-management products, and offers excellent customer support. Visit

www.byramhealthcare.com or call 877-902-9726. When calling, give the referral number 126735.:

? ? ? Trivia Question ? ? ?

Which is considered a Low-GI (Glycemic Index) food?

a) Corn bread muffin

b) Sourdough bread

c) Flour tortilla

Find the answer at the Type-1 University (www.type1university.com) website homepage.

Diabetes Bites is published monthly by Integrated Diabetes Services LLC and is distributed to more than 6000

individuals who either have or treat diabetes. For advertising opportunities, please contact

gary@integrateddiabetes.com or call (877) 735-3648.

Diabetes management consulting in-person or remotely via phone and the internet. Please visit

www.integrateddiabetes.com for details.

Gary Scheiner MS, CDE Owner/Clinical Director

Jennifer Smith, RD, LD, CDE

Debbie Liebman, RN - Office Adminstrator (aka “the office mom”)

Karen Bellopede, Receptionist

Debbie Conley, Accounts Receivable

333 E. Lancaster Ave., Suite 204

Wynnewood, PA 19096

(610) 642-6055

Toll-free: (877) 735-3648

Fax: (610) 642-8046

www.integrateddiabetes.com

The web-based school of higher learning for insulin users. Live and pre-recorded courses on a variety of

topics.

www.type1university.com