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No, I’m not making it up. Roche Diabetes Care, makers of the ACCU-CHEK® meters and test strips has named August 30-Sept 5 National Infusion Site Awareness Week - and with good reason.

For those who use an insulin pump there are a few things to pay mind to and your infusion site is one of them. 

The infusion site is the area of skin where a pump's needle introduces a little plastic tube under your skin for  insulin delivery. 

Cleaning the skin properly before the needle insertion and rotating your infusion site each time so you don't use the same spot can prevent infection and the build up of scar tissue that can block the flow of insulin.

A 2007 study in the American Diabetes Association journal Diabetes Care reported that some adult patients experience as many as 12 issues of irritation or infection a year because of improper site maintenance.

Infusion site management includes: choosing a location on your body, cleaning and preparing your skin at the site, properly inserting the needle, regularly rotating the insertion site to avoid infection and monitoring insulin flow. It’s recommended people change their infusion site every three days and not use the same site for about two weeks.

Notable irritations due to infusion site problems include: having two unexplained high blood glucose readings in a row, itching, burning, pain, blood or air in your tubing.

Roche launched Infusion Site Week to help diabetes educators increase understanding and education among their patients. Roche has also distributed Infusion Site Awareness Week kits to CDEs across the U.S.

Inside is a DVD, fact sheets and talking points, calendar, buttons, media outreach materials and site tattoos. I know because I got one. If you'd like to request a kit you can do so here.

Actually, I don't use an insulin pump but today I'm wearing the pin and I'm sporting one of the tattoos that came in the box. The tattoos are meant to mark where your infusion site is so you don't use the same spot twice.

Of course I thought about tattooing all my injection sites until I realized there’d be no skin left showing on my body. 

TCOYD, which stands for Taking Control of Your Diabetes, is a non-profit organization that provides one day health fairs all across the country to help people better manage their diabetes. The organization alsobroadcast in-depth discussions with renowned health professionals and patients.

Next month, September 11, if you're anywhere near Rhode Island, you should attend because I'll be there presenting. Of course, it's not the only reason you should come. You'll hear lectures on facets of diabetes care from your feet to your heart, learn and get some exercise, bond with many others and attend interactive workshops where the learning is personal. It's a full day affair of fine tuning your diabetes management provided to you by many respected people in the field. All for only $30. Register here.

Joining you will be top physicians, psychologists, educators, foot specialists, exercise physiologists and there's much to see and do in the exhibition hall including many new devices, products and foods. 

TCOYD was the first diabetes health event I attended way back in the early part of this decade. There I attended, among others, psychologist's Bill Polonsky's workshop where I learned something crucial -- that diabetes is not the leading cause of heart attack, blindness and amputation but poorly-controlled diabetes is. It made a huge difference to me: 30 years of fear slid down my shoulders and the resolve to master my self-care led me to the healthy regimen I have today. 

I also met a lovely gentleman in the exhibition hall who answered all my questions and then guided me to the peer-mentoring programs I deliver today around the country speaking to fellow patients. 

TCOYD is the labor of love of Dr. Steven Edelman who founded it almost 15 years ago. Dr. Edelman was recognized last year with the 'Outstanding Educator' award from the American Diabetes Association.  Edelman himself has lived with type 1 diabetes since the age of 15, and has dedicated his life and work to helping as many people with diabetes as possible to live healthier, happier lives.

My workshop by the way is titled: The ABCs of loving yourself with diabetes and I'm on at 3:30 PM. You'll discover how to live a life with diabetes where you don't just cope with diabetes, but actually flourish. If you come, do let me know. I'll want to say hello. 

I know I've just returned from San Antonio because my body is craving guacamole and the smell of fresh mint in those juicy mojitos! Ah, but that's not what you tuned in for, is it?

The annual diabetes educators conference was a hit with thousands of diabetes educators, nurses, physicians and pharmacists attending the 4 days of lectures, bonding, learning and renewing their credentials, and their spirit. The first evening at the poster event while all were mingling, I asked several CDEs what keeps them going. The answer was always the same, "Making a difference in someone's life," and that feeling was palpable.

The meeting kicked off with President, Deb Fillman's welcome address.  I was extremely happy, and surprised, to hear her talk so emphatically about the need for change. The need for educators and the profession to look outside the box for new ways of working as more will be asked of them. 

Prevention is becoming a big topic in health care and for CDEs. The U.S. Senate's passage of the health care reform bill late last year includes a provision to establish a National Diabetes Prevention Program. This means an expanded role for CDEs in the prevention of diabetes. Although god only knows how they will do more given the thousands of educators for millions of patients.

Fillman asked the audience to be more adventurous with change in their personal lives, taking on challenges and reaching for more fulfillment and success, as it will flow into being even better mentors and educators. Fillman also spotlighted the AADE's new online tool, "My AADE Network" which helps members connect wherever they are and create an online community and remote learning.

Rear Admiral and former Assistant Surgeon General, Susan Blumenthal, was the keynote opening speaker. She pressed the sense of urgency upon us that we need to stand up to deal with the obesity epidemic now that's taking a huge toll on America's health and economy.  

The exhibition hall, always interesting to me, didn't get as much traffic as usual and vendors didn't know why except to suggest the short hours precluded many attendees from spending much time there if they were sitting in on continuous lectures. Also, the bookstore made a decision to only carry ADA publications and those of their speakers doing book signings. Other authors needed to show their own book(s) at their own booth, if they had one. 

I presented Saturday morning a behavioral program titled, "Beyond Motivational Interviewing: What Can Happen When You Catch Someone Doing Something Right." There were about 100 attendees excited to be introduced to an entirely new mindset and model for working with diabetes patients: a mindset of "flourishing" with diabetes and a coaching model that enables health professionals to work as facilitators with patients, as appropriate, to:

1.  Explore the context of patients' lives 

2. Play "Strengths Detective" to help patients recall and reconnect with capabilities they've used in the past

3. Collaboratively design mechanisms for sustaining healthy habits, causing positive behavior change faster and more sustainably than when only using the traditional model of "telling patients what to do." 

This is exciting stuff that you'll be hearing more about. I am currently putting the finishing touches on a curriculum to train health professionals on this mindset and model along with my two partners, Boudewijn Bertsch and Eileen Murphy.

A phenomenal play called, 'Close to the Heart' produced by Amylin was one of the conference's highlights. With real actors in tow, it dramatized a patient getting a diagnosis of diabetes and how she deals with it, along with her relationships with her jealous best friend who is struggling with her diabetes, her supportive, yet pre-diabetic husband, and physician. Even I who have had diabetes for 38 years felt anew this woman's confusion and pain. 

After the half hour performance Dr. Steven Edelman of TCOYD, Psychologist Bill Polonsky of BDI, heart surgeon Robert Chilton, Dr. Stephen Brunton and host Davida Kruger, certified nurse practitioner, answered questions in a panel discussion. Kudos to Amylin for going outside the box. It was a smash, and I know Amylin has plans to make short videos of it.

The general session closed with an in-your-face presentation by Dr. Michael Roizen, Chief Wellness Officer at Cleveland Clinic about the cost, both physical and economic, of our obesity and diabetes tsunami. Roizen has been an impressive change-agent spearheading the "Lifestyle 180 Program" at the Cleveland Clinic, which was first piloted with Clinic employees and now available to patients.  

One point Roizen made that still resonates is -- food is an absolute, you can't make a deal with food. What you eat is critical to your body and your health and either will or won't turn on the genes for illness. For instance the sugar in ice cream will change the proteins in your body. That, he says, is a given. You can burn off the calories, but too many unhealthy foods and you're creating inflammation which creates disease. 

Next year's conference is in Las Vegas. I think my husband is already booking the hotel and buying his binoculars to look for Elvis.

In my work to help people better manage their diabetes, I'm doing research on how people create and sustain good management. 

I've written a short survey (13 questions, many multiple choice) that I'd love for you to fill out. It will take you about 15 minutes. Click on this link to go to the survey: https://www.surveymonkey.com/s/riva_research. 

At the end of the survey, just click the "submit" button.

I've never written about what it's like to write for the Huffington Post, until now. Here's the story. Actually, it was a fun question to ponder, and you'll find out more about me than just that single bit of info. 

Amy Tenderich, blogger of the terrifically newsy DiabetesMine.com, posed the question when she asked me to guest post on her blog for today. 

Amy does us all a service posting almost daily about the ongoing news in diabetes. If you haven't taken a look, roam around the site once you've finished my guest post. 

I posted another version of my beef with food - that food is medicine - on The Huffington Post. 

It appears as a lead story today.  

A loyal fan already wrote me,

"What an inspiring article to read first thing in the morning - thank you for your latest Huffington Post piece on healthy eating.  

Great tips in there - and makes me glad I have a fridge full of fresh produce waiting for me at home for tonight's episode of Top Chef (a weakness of mine)."

It also occurs to me maybe I should let you know one of my little secrets for health. 

I not only have a medicine cabinet in my bathroom, but I also have one in my kitchen. 

It doesn't have a mirror on it, although to be frank that would be a great incentive to eat healthy, wouldn't it?. But it does have these big shiny silvery doors. 

I'm sure having a medicine cabinet in my kitchen is not particular to New York City. You probably have one too.

And just to show you I'm a woman of my word that food is medicine, I've put up a picture of what you'll find in my kitchen medicine cabinet most days. 

Come to think of it there's probably more medicine in my kitchen medicine cabinet than in my bathroom medicine cabinet. 

I like to think that's a good thing.

Every summer in Orlando, Florida, Children With Diabetes, an online community for families with diabetes, runs an amazing conference for families called "Friends for Life." It's just winding up today.

Children with diabetes come and play and make new friends (for life). Parents attend lectures to learn more about: managing diabetes, helping their children manage their diabetes, managing the emotions of having a child with diabetes and to bond with other families. There's also access to a mini-vacation with Minnie and Mickie over at Disneyworld.

Every year since 2007 I've attended at least one diabetes conference. Friends for Life was the first diabetes conference I ever attended. It felt instinctive--at 54 I still was, and always will be, a child with diabetes. 

Since 2007, I have wanted to make my book, "The ABC's Of Loving Yourself With Diabetes" available to families at Friends for Life. This year, Dex4 (manufacturer of glucose products) gave me the opportunity to donate 150 books and distribute them in their welcome gift bags that they handed out to new families attending the conference. 

I sincerely thank Dex4. I also hope as families leave the conference this year, buoyed with new learning, memories and friendships, that when they need a booster shot of strength again, they'll dip into my book and find their way there. When you live with diabetes from a place of courage, confidence, forgiveness, patience, joy and pride, as my book guides you to, this ride utterly changes for the better. 

Dex4 is working, through both education and products, to help one always be prepared to correct a low blood sugar. I work with Dex4 upon occasion as a patient-expert advisor.

There's a list of top diabetes blogs out by Masters In Public Health. The site's creators, Mary and Paul Hench, say their list represents excellence in content and research, and blogs are listed in no particular order. 

The list is neatly categorized into "Personal Blogs Of Diabetics," where you'll find DiabetesStories, "Diabetes Social Networks," "Diabetes News and Updates" and "Blogs From Moms of Diabetics." 

Each blog has a line or two describing it making it easier for you to chose where to dip in. The Hench's created their site after spending months researching masters in public health programs and unable to find a reliable database of usable information. So, you guessed it, they created one. 

Take a look at the blog list and see what value might be there for you. The Hench's would be pleased.

Leave it to Manny Hernandez, founder of tudiabetes and estudiabetes, to come up with a Facebook game to help people with diabetes improve their eating and fitness habits. And the gem is, while you’re learning and doing, your ‘friends’ are helping you through it!

The game is called HealthSeeker™ and was launched June 14^th with Joslin Diabetes Center collaborating on content and the sponsorship of Boehringer Ingelheim. Already, there are more than one thousand players.

How it works is you enlist your Facebook ‘friends’ to be your support circle and ravers as you take action steps that help you meet your healthy lifestyle goals. You’ll track your progress and you can share your game results via Facebook status updates and send them out to your Twitter followers.

As Manny, who has been living with diabetes since 2002 says, "I cannot overstate what a source of support, information and inspiration social networking tools like this can be for someone living with a chronic condition like diabetes."

HealthSeeker™ provides simple action step suggestions and rewards your success through achievement badges and experience points you earn, kudos your friends can send you and comments they can leave on your Fridge door. (Your game Fridge door, that is!)

While your computer is home base, getting away from your computer is where the action happens - in the supermarket, in your kitchen, on the basketball court, in the pool. Then you come back and share your results.

The game is set up so that you choose “Missions” (healthy actions) as in the lingo of the old TV show, Mission Impossible – “Your mission if you choose to accept it….” 

These missions are the stepladder to achieving your goals. As you complete your mission, you move up in the game and get access to more and more detailed action steps where you will need to sharpen your healthy living-chops. For example, if a mission on Level 1 suggests you eat a certain kind of food once a week, later on you will have to do it twice or three times per week - and that’s the beginning of building new habits.

Manny has made going after health fun to give us all a helping hand to improve our diabetes management, and our life. Further, the fun of playing the game with hundreds of others, scoring yourself, seeing yourself gain more points and sharing your results, may be just the motivation you need to now get in the game. 

So get online and then get out on the field! There’s nothing holding you back now but you.

Way to go Manny!

Vancouver-based social game development group, Ayogo Games, Inc. developed the game code.

The first of hopefully an annual event was held this past June 6 & 7– the "Food for your Whole Life Health Symposium" – spearheaded by Dr. Oz. It was a two-day free event held at the Grand Hyatt Hotel in New York City to explore how food and lifestyle choices affect overall health. And, to better arm dietitians to help patients make better food choices.

I happened to miss the first day that was open to the general public and drew 1,000 people, but attended the second day exclusively for health professionals, largely dietitians and some diabetes educators, and media. 

I find it interesting with all the constant information coming at us these days on health and healthy eating that people just aren't indulging in it. So I asked the same questions of everyone I met while meandering between lectures and standing on the long line into the ladies room: “Why, with all the information out there on healthy eating, are people fatter than ever?” “Why are half the people with type 2 diabetes not managing their diabetes very well?” “What has to change so that people change their behavior?”

I heard the same reply from everyone—there is too much information out there and it has become too confusing. Some of it is contradictory, and none of it is laid out for people to act on easily.

In a private interview I conducted (yes, I’m still getting used to this Huffington Post blogger status) with a key speaker at the symposium, Dr. David Katz - a Yale University researcher and authority on nutrition, weight management, and the prevention of chronic disease and a leader in integrative medicine and patient-centered care - he confirmed these observations. He also pointed to the media’s collusion. With an endless need for "new" news and a ravenous appetite to titillate us, the media barrages us with an endless supply of findings that has left the general public reeling with confusion. The result:  heightened stress and not knowing what to do. The other result: people do nothing. 

Katz has been working along with several others on a nutritional ranking system called "NuVal™" that's being piloted by Kroger, a chain grocery. Kroger is piloting it in 23 stores in Lexington, KY. It's anticipated they will roll NuVal out to their additional 2500 stores in 31 states.

NuVal ranks foods from 1 to 100 as a guiding system on nutrition to help consumers make healthier choices among a category of food. For instance, you'll know the healthiest crackers among all the available crackers in the supermarket.

Right now NuVal is in 600 stores with another 400 stores rolling it out later this year.  Katz believes if people begin to choose the most nutritious foods in most categories, these small shifts can make a significant health difference. Katz also shared with me that his wife, a PhD, returned to their house one day with five loaves of supermarket bread and said basically - You pick the healthiest one!  

Katz also said regarding diabetes that many doctors tell their patients in very vague terms what to do, like “Lose some weight” and “Get some exercise.” These directives fall right off patients’ shoulders as soon as they walk out of their doctor's door. He also said most doctors think diabetes patients are “non-compliant” because they have no willpower, but Katz made it abundantly clear that it is not a matter of willpower, but the enormous lack of translating all this information into easy-to-understand, actionable steps.

The day I attended the symposium, the speakers elucidated us on the upcoming changing dietary guidelines, likely out in November, and took us through a healthy eating map from childhood through old age. The message, throughout however seemed pretty consistent: eat mostly fruits and veggies, whole grains, lean protein and healthy fats.

Dr. Michael Roizen, Chief Wellness Officer at the Cleveland Clinic with numerous other impressive titles behind his name, and Oz’s writing partner, closed the event outlining Cleveland Clinics' progressive "Lifestyle 180 Program" that they first test-piloted on employees of the Clinic with remarkable results and a cost-savings to the Clinic well worth the investment.

For patients, the program encompasses a six week immersion program that is geared to change the four factors 75% responsible for chronic illness: smoking, food choices and portion sizes, physical inactivity and stress.

Very briefly, the program includes overhauling one's cultural climate, largely your kitchen ridding it of toxic foods, having participants experience “I can do it” aha moments, muscle memory of right eating and exercise and a buddy system. One of the bottom line messages was - while our genes are our inheritance, our lifestyle determines whether they get turned on or not.

For those with diabetes who have gone through the program, Roizen said 60% were able to discontinue one or more of their medications for blood sugar, cholesterol or hypertension (high blood pressure) within six months.

Most of the people I met at the event thought it was of value and, for me, it only points to the urgency with which we are all recognizing we must turn this ship around that is so badly headed in the wrong direction.   

The principal sponsor of the event was the California Walnut Commission. Affiliated sponsors numbered 7, including Healthcorps and the Wild Blueberry Association of North America.  

I did manage to sample the delicious wild blueberries which I was told are available in my favorite grocery, Trader Joe, as well as other chain groceries. I also got to grab a few packets of 1 oz servings of walnuts - that’s about 7 whole walnuts. Unfortunately, I also managed to forget the bag I stowed them in, leaving it under my conference table. 

Obviously, I need to eat more berries and walnuts to improve my aging memory!

Wow, I am late to this discussion, but felt it worthwhile to join because it appears the debate continues...

Last month Diabetes Health published "What People with Type 1 Diabetes can Learn from Type 2s" by Clay Wirestone  It set off a firestorm of comments, mostly from type 1s, about how dare you tell us we can learn something from those lazy, fat type 2s!

David Spero, blogger over at Diabetes Self Management then wrote this post, "Type 1s Vs. Type 2s?" calling for type 1s and type 2s to come together for the sake of our health and that both sides are not fully aware of what the other side lives with. Interestingly, the comments posted on Spero’s site were almost unanimously empathetic.

It seems to me, Wirestone’s biggest goof was his argument (that t1s can learn from t2s) and his tone. If he’d approached the topic from the point of view that t1s and t2s share some commonalities and we can each learn something from each other, the war may have never ensued. But it is a fascinating study in how we all emotionally hold diabetes.

You should go read the stories and comments to both stories. In reading all the comments to Wirestone’s post, I found Allison Blass nailed it for me:

"The problem with this article isn't so much that it's saying people with type 1 can learn something from type 2, but assuming that people with type 1 aren't already learning these lessons for themselves. Plenty of PWDs with type 1 exercise regularly, take their medication faithfully, and make small changes to get healthy. These aren't genius concepts divined by the type 2 community. 

I will say that the amount of misinformation and misconceptions about type 2 diabetes in the comments are disgusting. Type 2 diabetes is not CAUSED by obesity - it's a contributing factor. Type 2 is not cured through diet and exercise - it is managed, just like insulin. Type 2 diabetes does not have the same flexibility as type 1 - blood sugars have to be dropped through extra exercise or changes in diet, not just a simple bolus. People with type 2 diabetes can go years without being diagnosed, which means that many people with type 2 are diagnosed at the same time they find out they have complications.

Type 2 diabetes is a bitch, same as type 1 diabetes. And yes, they are different. But we both have to do things that are different, we both have a health issues and learning tactics and strategies for handling certain situations could help. 

In any event, if you don't like people spreading misconceptions about your disease, you should probably be damn sure you're not spreading misinformation about someone else's. It's not nice." 

-Allison Blass www.lemonade-life.com

And then, as I said, even tho I came late to the game, I felt compelled to add my own 2 cents worth and so I posted this today on Spero’s blog:

"As a type 1 for 38 years I understand the cry of type 1s that no one understands how hard and intense it is to live with this disease, and that we are grouped under the same umbrella of those lazy, fat type 2s who did it to themselves.

Yes, many type 2s engaged in poor health habits that may have led to their diagnosis, but not all. One in five are slim actually. For some the genetic component is so strong they would have gotten it regardless of their actions. And there must certainly be type 2s who are annoyed with the bad press their own brothers and sisters bring them.

But one diabetes being worse than the other? It's all a matter of perspective. I wrote a book recently, "50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It"  and the myth I always quote is, "Type 2 diabetes is not as serious as type 1."

It is one of my favorites, because the emotion runs so high and because the answer seems so obvious, but is not. Both are extremely serious because they can both lead to the same devastating complications. While type 1s will never get off their insulin, and endure more intense management, type 2s are asked to undertake preventive behavior, which anyone can tell you, is a bitch.

Since most type 2s are diagnosed years after they have the illness, many already have complications by time they're diagnosed. And while most type 1s will live with their illness longer than type 2s, many will also live more healthfully with it because they developed healthy habits earlier and they see more directly the positive result of healthy habits.

When “What People with Type 1 Diabetes Can Learn from Type 2s,” appeared on Diabetes Health what incensed most readers was the cavalier notion that type 1s aren't doing good enough, so obviously we could learn a thing or two from type 2s. That reeks of presumption and offends.

We all have something of value to share from our experiences, and it's up to us as individuals how we manage our diabetes. And, how we choose to see it - some see themselves as victims and only see hardship, others see diabetes as a welcome wake-up call and get healthier, and others see diabetes as a signal that life is precious and go about making the most of it.

Since no one can argue with your experience, it's foolish to throw rocks at someone else's. And while personally, I would vote to change the names of type 1 and type 2 diabetes to better reflect the differences and educate the general public about the differences, when it comes to helping each other out, let's not overlook that living with any chronic disease we share many similarities."

What's your take on this?