Question Corner: How do I handle the food police?

Dear Question Corner:  I was recently diagnosed with diabetes, and when I go out to eat with family, they ask “should you be eating that?”, or sometimes say, "You can't eat that!". I have been meeting with my Diabetes Educator and am making healthy, well balanced meals based on what I’ve learned.  How do I let my friends and family understand that I know what I’m doing and am bothered by their questions and comments?

-       Questioning New Patient

Dear Questioning New Patient,

Unfortunately, what you describe is a common experience for people living with diabetes.  These questions and comments can come across as judgmental and nagging, and sometimes come at the worst possible time--when you're about to enjoy your food.  Initially you may feel angry, embarrassed, or annoyed.  While this is completely understandable, take a deep breath and recognize that their comments are coming from a place of concern and that they also come from a lack of understanding of what diabetes is and how foods can impact diabetes.  When people comment on what you're eating, you can use this as an opportunity to educate them about diabetes and the role that medication, food, and blood glucose monitoring play in your day to day management.

Of course, it can be exhausting to always have to explain your food choices, so it is also a good idea to set boundaries.  You can tell people that you're happy to answer their questions, but not when you're in the midst of eating and not while you're in a group setting.  Also, let your family members know that questions are fine, but comments about what you should and should not be doing are not helpful.  Find what is most comfortable for you and communicate this to your family.  If you are struggling with taking medications regularly, eating healthy, or other aspects of diabetes care, discuss with your family ways that they can be supportive.  With time and education, you will find that your family can be understanding and supportive in your experience with diabetes.  

This post was written by Camilla Levister, NP, CDE, a Certified Adult Nurse Practitioner and Certified Diabetes Educator who has experience as an insulin pump and continuous glucose monitor trainer.  Ms. Levister is a co-investigator for several research studies in diabetes taking place at the Mount Sinai Diabetes Center.

MSDC welcomes Dr Selassie Ogyaadu

Selassie Ogyaadu, MD, MPH received her MD degree from the University of Ghana Medical School. She then worked in Primary Care and with Sickle Cell Disease for over 6 years. Having an interest in chronic disease epidemiology and a desire to promote health among chronic disease populations, she moved to New York where she obtained a Master’s in Public Health at the Icahn School of Medicine at Mount Sinai. While a student, Dr. Ogyaadu was involved in the ground breaking Type 1 Artificial Pancreas diabetes study with Dr. Carol Levyat the Mount Sinai Diabetes Center (one of only six such centers in the U.S.A.) Dr. Ogyaadu is currently the Clinical Research Coordinator at the Mount SinaiDiabetes Center continuing the important of Artificial Pancreas studies and other notable diabetes research studies.

MSDC Welcomes Ahmad Fakhoury, MS

Ahmad Fakhoury MS, graduated with a Master’s degree in Biotechnology from Columbia University and an undergraduate degree in Biology and Forensic Sciences & Technology from Virginia Commonwealth University. He completed his internship at Columbia’s Irving Cancer Center working on a pre-clinical drug “RUC 4” for treatment of thrombosis. He also worked at Oscar health (for New York State) as a patient care coordinator and gained hands on experience working with patients; he also learned how startup companies function. Ahmad recently joined the Mount Sinai Diabetes Center as a Clinical Research Coordinator where he is assisting with searching for, screening and enrolling research study participants, planning the flow and procedures for various research studies, and reporting all information to his Principal Investigator, Dr. Daniel Donovan. Ahmad is also working Antoinette Bonaccorso CRC, MD, who has made the experience of starting off at a Mount Sinai quite seamless.

An update from the Buettner Lab

The interests and goals of Dr. Christoph Buettner’s laboratory are to study the regulation of metabolism through the central nervous system. Laboratory researchers employ integrated physiology approaches to understand a role of the brain in regulating metabolism throughout the body (orchestrating organ crosstalk such as nutrient flux between adipose tissue and the liver and its relevance in regulating insulin action). It turns out that the brain controls

metabolism and diseases that affect the brain such as Alzheimer’s and other psychiatric diseases, alcohol consumption and stress impair the ability of the brain to control metabolism. In obesity and diabetes, the ability of the brain to process important signals from the periphery such as sensing hormones and nutrients are similarly impaired. The Buettner laboratory tries to understand how the brain achieves this control and how to restore metabolic control by the brain. The group has found that the brain controls inflammation by

controlling lipid metabolism.

A commonly used approach in the Buettner laboratory is to study nutrient partitioning using

metabolic tracers during clamps in rodents that allow the simultaneous assessment of lipid, glucose and amino acid fluxes. These physiological study techniques are complemented by transcriptional, proteomic and metabolomic techniques to arrive at a molecular understanding of how the brain controls nutrient fluxes in peripheral organs such as liver and adipose tissue. The Buettner lab has established that hypothalamic leptin and insulin signaling play important roles in the regulation of adipose tissue lipolysis and lipogenesis. Further, our results obtained to date indicate that hypothalamic insulin and leptin play important roles in regulating hepatic glucose production, VLDL (very low density lipoprotein) secretion, amino acid metabolism and systemic inflammation. In obesity and diabetes, hypothalamic insulin action is impaired, in part through increased endocannabinoid tone in the brain, resulting in dysregulated

nutrient partitioning and a pro-inflammatory state.

Welcome from the Chief!

It gives me great pleasure to present you with the first issue of the Mount Sinai Diabetes Center Newsletter. The mission of the Mount Sinai Diabetes Center is to provide the highest quality care to our patients, to improve the outcomes of patients with diabetes, to be at the forefront of cutting edge research in diabetes, to train future leaders and innovators in the field of diabetes and to serve our community through outreach programs and patient advocacy. As you will see in this newsletter, we are achieving success on all fronts. Our clinical program continues to grow and the number of patients we serve is increasing every year. Our recent research breakthroughs in areas such as beta cell regeneration, brain control of metabolism, and an artificial pancreas are leading the way to improving care and hopefully finding cures for diabetes, both type 1 and type 2. We have providers that provide outreach to our community with education, free seminars, and we continue to advocate for more government programs to stem the diabetes epidemic, such as our recently published op-ed advocating for a sugar tax. I hope you enjoy learning about our activities as you read this newsletter. We welcome any comments, suggestions, or questions.

Yaron Tomer, MD, FACP, FACE

Lillian and Henry M. Stratton Professor of Molecular Medicine

Chief, Division of Endocrinology, Diabetes and Bone Disease

Icahn School of Medicine at Mount Sinai

---

Research Highlights from the Diabetes Obesity and Metabolism Institute (DOMI)

• Dr.Andrew Stewart, MD, the Irene and Dr. Arthur M. Fishberg Professor of Medicine and Director of Mount Sinai’s Diabetes, Obesity and Metabolism Institute led a team of scientists who discovered a novel mechanism that regulates the replication of insulin-producing beta cells in the pancreas. Their findings provide novel working models describing the control of cell cycle progression in the human beta cell. These discoveries offer new insights into possible therapeutic approaches to stimulate the regeneration of pancreatic beta cells in patients with type 1 and type 2 diabetes. To find out more about this discovery, click here.

• In a study published in Cell Metabolism, Christoph Buettner, MD, PhD, Associate Professor of Medicine, and Neuroscience and colleagues recently  reported that that impairment in insulin action in the brain may be one of the earliest defects that occurs in obese patients who eventually develop diabetes. To find out more about this discovery, click here.

• In a study published in the Journal of Autoimmunity, Dr. Yaron Tomer (Chief of the Division of Endocrinology, Diabetes and Bone Disease) and colleagues recently reported that epigenetic changes, which are changes in the way genes work when they are not mutated, play a key role in the development of type 1 diabetes. To find out more about this discovery, click here.

Diabetes Clinical Research Corner Update

Mount Sinai is dedicated to diabetes research.  Below are research studies that are currently underway, recruiting, or completed.  If you are interested in becoming a research volunteer reach out to Camilla Levister, NP at 212-241-5177 or our research coordinator at 212 241-9089:

• PERL (Prevention of Early Renal Loss in Diabetes): This is an exciting and landmark National Institutes of Health-sponsored study to explore if a pill that has commonly been used for other conditions can prevent the progression of kidney damage caused by type 1 diabetes.  .   Recruitment ends October 31^st.You can learn more by going to www.perl-study.org

• Artificial Pancreas Program:  If you are interested in participating in future Artificial Pancreas Studies, contact Camilla Levister, NP at 212-241-5177.

• TrialNet, Pathway to Prevention:  This is a study jointly funded by ADA, JDRF, NIDDK and others, being conducted at 18 Clinical Centers in 8 countries and studies those at increased risk for type 1 diabetes.  If you are 1-45 years old and the 1^st degree relative of a person with type 1 diabetes, you may be eligible to participate.  Second degree relatives (cousins, uncles, nieces, nephews, half siblings, or grandparents) of someone with type 1 diabetes between the ages of 1 and 20 years old may also be eligible.  This study is currently recruiting.  Contact our research coordinator for further information at 212 241-9089.

• Victoza (liraglutide) use in type 1 diabetes:  This study explored the efficacy of liraglutide in patients with type 1 diabetes in improving glycemic control, reducing total daily insulin requirements, and body weight loss.  This study is currently completed and we look forward to hearing about the results when the data from all sites is fully analyzed. 

• Faster acting insulin aspart (FIAsp):  This study is currently completed.  FIAsp is a new and faster formation of insulin aspart, a type of rapid acting insulin.  This trial explored the efficacy of FIAsp in diabetes management as measured by hemoglobin A1c and finger stick glucose values after meals.  We look forward to the results of data analysis for this multisite study. 

• Sotogaflozin use in type 1 diabetes: This is a study assessing the benefits of an SGLT 1/SGLT 2 inhibitor as adjunctive therapy in the management of type 1 diabetes; this study will likely be opening mid September 2015. 

Additional studies will soon be starting for type 1 and type 2 diabetes.  Please call 212 241-5177 or 212 241-9089 if you would like to additional information regarding current or  upcoming studies.