November is the American Diabetes Association’s American Diabetes Month, a time to communicate the seriousness of diabetes and the importance of proper control.   You’re probably aware that the National Institutes of Health report that morbid obesity is associated with an increased risk of developing serious disease such as Type 2 diabetes¹.   But sometimes the different types of diabetes can be confusing.  You might also be pre-diabetic and not even know it!  So in the sprit of American Diabetes Month, here is some information we gathered from the ADA to help you sort it out.

What is diabetes?

Diabetes is a disease in which the body does not produce or properly use insulin, a hormone necessary to convert sugar and starches into energy. Its exact cause is unknown, but genetics, obesity, and lack of exercise are all contributing factors².

There are four types of diabetes²:

• Type 1 (insulin dependent)²
  • Results from the body’s inability to produce insulin
  • Type 1 diabetics must take insulin in order to process glucose
  • It accounts for 5% to 10% of all diagnosed cases of diabetes
• Type 2 (non-insulin dependent)³

o   Results from insulin resistance and deficiency

o   It accounts for 90% to 95% of all diabetes cases

o   Many people with type 2 diabetes can control their blood sugar with a healthy diet and exercise program, weight loss, and oral medications

• Gestational
  • Glucose intolerance that affects 4% of all pregnant women²
  • Women with gestational diabetes have a 20% to 50% chance of developing diabetes in the next 5 to 10 years³

• Pre-Diabetes²
  • Occurs when a person’s blood glucose levels are higher than normal but not high enough to be classified as type 2 diabetes
  • 54 million Americans have pre-diabetes

Symptoms of diabetes

Diabetes is often undiagnosed because its symptoms do not seem serious and are easily attributable to other things. They include⁴:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Increased fatigue
• Irritability
• Blurry vision

The impact of diabetes

There are 20.8 million Americans (7% of the population) with diabetes. Of these only 14.6 million have been diagnosed. ³

Among US adults, the incidence of diagnosed diabetes rose 41% from 1997 to 2003. Obesity is a large factor in the increasing diagnosis of obesity.⁵

In 2000, the number of people worldwide with diabetes was 171 million. This number is projected to rise to 366 million by 2030.⁶

The total direct and indirect costs of diabetes in the US in 2002 was $132 billion. Of these the indirect costs (disability, work loss, premature death) totaled $40 billion.³

What can you do?

Appropriate interventions can reduce the risk of type 2 diabetes in people with impaired glucose tolerance. Lifestyle interventions such as diet and exercise have been shown to be at least as effective as pharmacological interventions.⁷This underscores the importance of weight loss as a preventive measure.

Understanding your individual risk factors for obesity and diabetes and what you can do to control or prevent them is crucial to your health.

November is American Diabetes Month. Get screened today. If you already have been diagnosed, work closely with your doctor to identify things you can do to control it, including weight loss. On the LAP-BAND® System website www.lapband.com, you can track your diabetes statistics and medications and see your progress as you lose weight. Register or sign in to My LAP-BAND® Journey to use the trackers.

To find out if you are at risk for diabetes, see your healthcare provider or take the risk test available from the American Diabetes Association, found online at  www.diabetes.org/risk-test.jsp.

REFERENCES: 1. Weight-control Information Network (WIN); an information service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Statistics related to overweight and obesity. October 2006. Available at: http://win.niddk.nih.gov/statistics/index.htm. Accessed August 14, 2007.  2. American Diabetes Association. All about diabetes. Available at:  http://www.diabetes.org/ about-diabetes.jsp. Accessed August 14, 2007.   3. National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistic sheet: general information and national estimates on diabetes in the United States, 2005, Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, 2005.  Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm. Accessed August 14, 2007.  4. American Diabetes Association. Diabetes symptoms. Available at:  http://www.diabetes.org/diabetes-symptoms.jsp. Accessed August 14, 2007.  5. Geiss LS, Pan L, Cadwell B, et al. Changes in incidence of diabetes in U.S. adults, 1997-2003. Am J Prev Med. 2006;30:371-377.   6. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047-1053.  7. Gillies CL, Abrams KR, Lambert P, et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ. 2007.; 334:299.

MDOC-03528-01 05/09

Who do you tell about your LAP-BAND® System surgery and when? There is no right or wrong. It depends on when you feel comfortable enough to share the news with friends, family and even acquaintances.

Be Prepared for Anything
Don’t be surprised that the general public is far more knowledgeable and accepting of bariatric surgery thanks to increased education and media coverage of celebrities who discuss their surgeries openly. But don’t be surprised as well that your weight losses can change your relationship with others. Explain your decision and ask for their support as you progress along your weight loss journey. Minimize contact with those who give you a hard time or encourage you to make poor food choices or skip your exercise routine.

www.lapband.com

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There are many foods you can enjoy after full recovery.  Don’t feel deprived. Your goal should be to eat a healthy nutritious diet, especially since you are eating much smaller amounts.

Your food choices should be as nutritious as possible, high in protein, vitamins and minerals as well as low in fat and sugar. Consuming junk foods and high-calorie liquids will slow down or stop your weight loss. Use the food tracker found on www.lapband.com to see if you are meeting your nutrition goals. Always check with your doctor about your nutrition plan.

Here are a few “super foods” that will help you meet your weight loss goals without feeling deprived.

Low-fat cottage cheese.
It packs protein and calcium. Top with a bit of fresh fruit (such as blueberries or strawberries) or mix with sugar-free Jell-O for a touch of sweet. For an easy lunch, combine cottage cheese with tuna.

Tofu.
You can add it to smoothies, soups, and stir fry; scramble it like eggs; and even bake this high-power protein. While tofu tastes bland by itself, it readily absorbs the flavors of ingredients with which it’s prepared.

Beans.
Beans are high in fiber and protein—two keys to feeling satisfied. You can top fat-free or vegetarian refried beans with a bit of low-fat cheese.

Canned tuna (packed in spring water) and canned chicken.
Drain and add some light mayo to these excellent lunch choices and you’ve got a tasty protein powerhouse that makes a great topper for a slice of tomato or whole-grain crackers.

Flavored water.
Everyone needs to stay well hydrated for good health, but LAP-BAND® System patients need to take special care to drink plenty of water and other low- to no-calorie beverages.  Dehydration causes nausea and vomiting, which can make bands slip. For flavor, try Crystal Light or non-carbonated, no-sugar-added flavored waters. Sugar-free protein waters are another option.

Seafood.
If you’re looking for a high-quality protein source that’s low in fat and calories but high in vital nutrients, look no further than the seafood section of your supermarket. Seafood is a good source of the B complex vitamins.. It’s also an excellent source of minerals and an important source of calcium. And it serves up omega-3 fatty acids too. Flaky fish choices (salmon, tuna, and tilapia) are better than shrimp, scallops or calamari.

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When you doctor gives you the go-ahead to start a fitness routine, how do you create good habits to help you clock at least 30 minutes of moderate physical activity?  Try these tips to get you started.

Be an early bird. Working out first thing in the morning is the easiest for most people. Start with 15 to 20 minutes of an activity such as walking, elliptical, stationary bike, or swimming. Then gradually increase the time as you begin to feel motivated to do more. Get up just 20 minutes earlier and you can start your day by crossing “work out” off your to-do list.

Break it up. If several short walks fit better into your day than one long one do it that way. Take a good pair of walking shoes to work and go for a walk at lunchtime.

Zero in on your time zappers. Look at your schedule and see where you could really find time. Sneak in a workout routine, such as squats, lunges, and abs, while watching your favorite TV show. Have a stationary bike or treadmill? Put it in front of your TV so you can burn calories and catch your favorite shows at the same time.

Combine social outings with activity. Need a girls’ night out? Forget the movies or the coffeehouse—look for something more active. Try bowling, skating, even window-shopping at the mall.
Turn anything into a workout.  Any activity that moves the body continuously is going to get you one step closer to a healthier body and lifestyle. Your body won’t know the difference between playing tag with your kids or your dog in the park and jogging on a treadmill at the gym. Also try trading more sedentary chores with your spouse for more active ones (for example, washing dishes or folding laundry for gardening or cleaning floors).

www.lapband.com

MDOC-03528-01 05/09

Read up on the surgery, attend orientation meetings, accompany your loved one to appointments, and in general, offer your unconditional love and understanding as your loved one progresses along his or her journey. Remember that an important part of living with the LAP-BAND® System is making healthy and satisfying diet choices and finding fun and effective exercise options. So let your loved one choose the restaurant when you dine out together. Offer to go on walks with him or her. Find simple yet meaningful ways to give encouragement. Encourage them to sign up for My LAP-BAND® Journey at www.lapband.com where they can try out nutrition, fitness and lifestyle support tools as well as many special offers.

MDOC-03528-01 05/09

Slow eating is the key to mealtime success after LAP-BAND® System surgery. Here are some tricks to help you slow down at the table.

1. Shrink your place setting.
Set your place with a salad plate or small bowl and child-size utensils. When your utensils are small, you’ll get properly sized small mouthfuls even if you inadvertently go on autopilot while you’re eating.

2. Don’t cut off more than you can chew.
Aim for the size of a pencil eraser or a pea.

3. Make 30 your lucky number.
Food needs to be well chopped up by your teeth. Plan to chew each bite 25 to 30 times—until food is the consistency of mashed potatoes or baby food.

4. Push the pause button.
Plan to put your fork down for at least one to three minutes between bites. Some LAP-BAND® System surgery centers recommend breaks as long as five minutes. This allows you to notice any feelings of fullness in your pouch and to gauge whether you’re still hungry so you don’t overeat.

5. Time your breaks.
For the perfect pause without watching the clock, use an egg timer. Or if you have a board game with a sand timer, such as Boggle or Scattergories, use the timer from your game. Check first to see how long the timer takes. You may have to turn it back over to get enough time between bites.

6. Wear a “mindful eating” bracelet.
Wear a comfortable rubber band (one that’s not too tight) on the wrist of the hand you eat with, as a reminder to slow down. You could also choose a special bangle bracelet or any other wrist-circling item (from a bit of colorful yarn to a piece of fine jewelry) to remind you about your new eating habits. www.lapband.com

MDOC-03528-01 05/09

You don’t want to get caught up with the numbers on the scale and waiting for them to go down. If you are following your post-band instructions, moving more, and eating properly, you should feel good about yourself regardless of what the scale says.

Here are some healthy weigh-in habits.

Don’t overdo it by weighing yourself several times a day. Your weight fluctuates normally throughout the day.

After surgery, many people don’t lose weight at all until their band is properly adjusted. Then the weight loss tends to be slow and steady – one to three pounds per week in the first year. In the second year it varies from person to person, so keep regular visits with your doctor for proper adjustments to keep your weight-loss on track. Use the appointment tracker tool at http://www.lapband.com to record your appointments and adjustments.

MDOC-03528-01 05/09

Now that you are losing weight after your LAP-BAND® System surgery, it’s time to give your mind a healthy makeover too.

Here are some healthier ways to look at food:

It’s fuel for your body.
View food as nutrition. Eating is necessary, like breathing. It fuels the things that you do (exercising, working, playing, etc.), and it provides essential nutrients for every cell in your body. Protein from lean meats repairs muscles after exercise, and calcium in dairy foods builds strong bones.

It’s only a small part of your life.
Most people get fat because they are hungry all the time and never get full. The LAP-BAND® System addresses both these issues. Having your appetite dimmed can help you spend less time thinking about food. If your small meals aren’t satisfying you or you’re always “looking for food,” it may be time to see your surgeon for a LAP-BAND® System adjustment.

It’s not a source of guilt.
Eating when you’re physically hungry is necessary, so it shouldn’t make you feel any shame. Physical hunger builds gradually, and it happens naturally when you’ve gone a few hours without food. Make smart choices about what you select to eat when you are hungry, and feel good about what you’ve chosen. If emotions frequently lead you to want to overeat or make less-healthy choices, therapy, exercise, meditation, and getting enough sleep may help quiet cravings. Register for My LAP-BAND® Journey  and the complete the food tracker daily to look for unhealthy eating patterns. You can learn more at www.lapband.com

It’s a good excuse to unwind.
In our busy world, it can be tough to take time to focus on the present moment.  But it’s important that you eat without distraction. Trying to talk or watch TV while eating can lead you to eat too fast, consume too much, or chew too little, causing unpleasant results. To practice mindful eating, focus on the food in front of you. Reflect on the fact that you are about to nurture your body. Then pay attention to each bite: its texture, its aroma, how it feels in your mouth, how it tastes, and how enjoyable it is. For 20 to 30 minutes, enjoy your meal. Then move on to other things.

Still having trouble?
Check out the LAP-BAND® Therapeutic Lifestyle Change Program,  developed by the medical experts at Lindora®  for LAP-BAND® System patients. It’s a free, personalized 10-week program in a “virtual clinic” setting with 24/7 access. Learn more here. http://www.lapband.com/life_after_surgery/supporting_a_loved_one/partners/lindora/

MDOC-03528-01 05/09

It might be easier for you to add more activity to your life if you partner up with someone. On those days when you don’t feel like exercising, you will be more likely to do so if you’ve made plans to work out with someone. Here are some ways to find a partner and make your workout more fun.

Your weight-loss-surgery center might have a support group where you can find potential workout partners at a fitness level close to yours. Your family and friends might be willing to do something active with you if you ask. If you have a dog, spend more time walking your pet. If you don’t have a dog of your own, offer to help a neighbor or friend by his or her dog.

www.lapband.com

MDOC-03528-01 05/09

Adding more exercise to you daily routine is an important part of your LAP-BAND® System journey. As you gradually increase your level of activity, you will be helping yourself to reach and maintain your weight-loss goals.

Here are a few ways to ease into your program and feel more comfortable and less self-conscious.

Dress for success.
Look for lightweight, breathable materials that will wick moisture away from your body. Steer clear of heavy cottons, which will just add bulk and make you more self-conscious as they soak up sweat and keep it close to your body. To reduce chafing, wear tight, formfitting garments under your main clothes. If you experience slightly raw or sensitive spots, dab on a petroleum jelly product to minimize discomfort.

Talk to your Doctor:
Discuss starting an exercise program with your doctor before starting.

Take it slow.
Start by exercising at a low-to-moderate pace instead of all-out. Intense sessions head straight for your glucose, or sugar, stores. And while this is essentially a good thing, it’s often counterproductive for many LAP-BAND® System patients: Lowered blood sugar may cause you to feel famished and crave carbs, possibly leading you to poor food choices.

Start with simple walking.
Your body weight by itself is a tool—you don’t need a lot of fancy equipment starting out. Start by walking 10 to 15 minutes a day, working up to at least 30 minutes three times a week by month three. You can track your time and see your progress with the Activity Tracker located in My LAP-BAND® Journey

Add in strength training.
Look for a personal trainer who has experience working with overweight clients and can set you up with strength and flexibility exercises you can do privately at home. At this point, you can purchase resistance bands (pick styles with handles for a better grip) or light free weights. Tip for any strength-training exercise: You should be able to do about two or three sets of 12 to 20 repetitions, with the last two reps becoming difficult. That will help you pick the right resistance or weight.

Find a friendly center.
At-home workouts are a good option. But some people may benefit from a group experience. At a fitness center, you get equipment, and you may also make great connections that help the time go by quickly. Women-only gyms can offer a comfortable, supportive environment. At any center, take a tour at the time you would be coming for a regular workout. Look around at the people to get a sense of whether you would feel comfortable exercising alongside them. Make sure the staff is educated and has experience working with bariatric clients.

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