Friday, February 09, 2007

Know Your Numbers, Control Your Diabetes!

I first met Amy Tenderich online when she began her now-celebrated diabetes blog, Diabetes Mine. Amy's blog has blossomed since then to the most widely read diabetes blog online. She's landed herself an online column at dLife, and now she has a wonderful new book, co-authored with Dr. Richard Jackson from the world-renowned Joslin Diabetes Center. I'm so thrilled to host Amy on the blog today!


Amy Tenderich

Dr. Richard Jackson

AMY TENDERICH, a professional journalist with an MA in communication studies, was diagnosed with type 1 diabetes in May 2003. Almost instantly, she began to tell it like it is on her own diabetes blog (, for which she recently received the LillyforLife Achievement Award™ for diabetes journalism. Amy now also brings her unique observations on the challenges of living with diabetes to dLife in a monthly column, and does double-duty as a full-time mom. She and her family live just south of San Francisco, California.

DR. RICHARD JACKSON is Medical Director of the Joslin Diabetes Center's DOIT (Diabetes Outpatient Intensive Treatment) Program. Dr. Jackson is a well-known endocrinologist and Harvard Medical School Professor.


Know Your Numbers, Outlive Your Diabetes helps you chart and understand the 5 most important values (your personal “Essential Health Factors”) for living a long and healthy life with diabetes (EITHER Type 1 or Type 2). That makes them pretty darn important! They are:

· Hemoglobin A1c—a measure of the average amount of glucose in your blood over the last several months

· Blood Pressure—a quick, painless armband test to determine the force of blood flow through your body

· Lipid Profile—a group of blood tests measuring your cholesterol and triglycerides (another type of fat), which is used to determine your risk of heart attack or stroke

· Microalbumin—a urine test that is an early indicator of kidney damage

· Eye Exam—a yearly exam that consists of dilating your pupil, allowing the doctor to see the back of your eye

Now, be honest. If you have diabetes, or are newly diagnosed, when was the last time you had these tests? Do you know the result numbers? Do you know what they mean? One thing you can be sure of: If everyone tracked and acted on these values regularly, [their lives] would look a lot rosier today.


"Cons? There are no cons. It's the perfect diabetes reference handbook... This book is a terrific resource for diabetes management." Deb Manzela, York Times

“Even those without diabetes will wish they had it just so they can use this book. Know Your Numbers, Outlive Your Diabetes is written by two great authors espousing a positive and practical approach to better health. This book allows even the mathematically inept to understand their lab values and what area of their health is most important to work on. Targets for the five critical areas: A1c, blood pressure, lipids, microalbumin, and the eye exam, how to achieve them, and what order is most important to work on are presented.”

— John Walsh, PA, CDE, and Ruth Roberts, MA, authors of Pumping Insulin and Using Insulin

"Diabetes often makes people feel frightened and overwhelmed, but a good understanding of modern management and the goals of treatment are now having major positive impact on quality of life and health outcomes. In the end, the informed patient makes this happen. Richard Jackson and Amy Tenderich have really hit the bull’s eye by focusing on the key things that help people gain control over their diabetes. I expect that many people will find this sensible, easy-to-read new book enormously helpful."

-- Dr. Gordon Weir, former editor of Diabetes, former Medical Director of the Joslin Clinic, and chaired professor at Harvard University.


1. Please tell the story of how this book came to be.

Dr. Jackson and I were introduced by a mutual friend at the American Diabetes Association’s annual conference a few years ago. We both had a strong sense that a clear-cut patient guidebook for good health with diabetes was sorely missing. We started chatting, and right away it became clear that we both wanted to fill that gap with an upbeat, no-nonsense book. We’re both very happy with the result.

2. Who can benefit from this book? Why?

Know Your Numbers is invaluable for any adult diagnosed with diabetes or pre-diabetes. It’s the first-ever, hands-on guide to proactively preventing “diabetes-related complications,“ meaning the long-term damage the disease can cause (rather than preventing diabetes itself).

Amazingly, the "therapeutic goals" for diabetes patients are well-publicized, but nobody gives most patients much idea how to achieve them. Until now, no useful, practical guide existed to help people with diabetes get a handle on their own health.

3. Please explain a little about each of the five tests in the book. Why are they important?

The five tests are:

· Hemoglobin A1c – a measure of the average amount of glucose in your blood over the last several months

· Blood Pressure – a quick, painless armband test to determine the force of blood flow through your body

· Lipid Profile – a group of blood tests including cholesterol and triglycerides (another type of fat) used to determine your risk of heart attack or stroke

· Microalbumin – a urine test that is the best early indicator of kidney damage

· Eye Exam – a yearly exam that consists of dilating your pupil, allowing the doctor to see the back of your eye

These 5 simple medical tests are the best and ONLY measures currently available that indicate each person’s own individual diabetes health risks. Yet despite being widely accessible and easy to administer, fewer than 42% of adults with diabetes have either had these tests, or understand what the results mean, according to an April 2006 report by USA Today.

Without measuring and controlling these key factors, a great number of people in this country are headed straight down the path towards diabetic complications, including blindness, kidney failure, cardiovascular disease, and limb amputation. This doesn’t have to be the case!

4. What is the biggest obstacle people with diabetes face in attempting to get healthy? How do you recommend they deal with this obstacle?

Actually two: setting priorities and finding motivation.

First, so many people start off with the wrong ideas about diabetes, and they’re quickly overwhelmed. They think they have to do everything at once (overhaul their diet, lose 20 pounds, start a rigorous exercise program, tighten their glucose control, etc, etc.). But doing all that at once is just too difficult. And guess what? It doesn’t even make sense from a health standpoint. Only by knowing what your real health risks are can you take the right actions – ONE or TWO things at a time – to improve or maintain your health.

Secondly, it’s incredibly hard to get and stay motivated, since managing diabetes can be so difficult and frustrating. Many people fall into the trap of thinking, "I feel fine now, so I must be fine" (but diabetes does its damage over the long-term). Or they believe, "I'm doomed anyway, so it doesn't matter what I do" (not true! You can make a significant on your own health and your future).

To find your own motivation, we encourage people to think about what matters most in their life: career, family, hobbies or whatever makes them tick. Whatever it is, you have to be making healthful food and exercise choices and taking your medications not because your doctor said so, or even due to your family’s pestering, but because YOU (the person with diabetes) care about your own health and believe that your actions matter.

5. A very large task like managing one's diabetes health is easier taken in small steps. What are the first and most vital steps a reader can take?

That’s the whole point of our book: taking a step-by-step, positive approach to controlling your own health. Our message is that you don’t have to – and shouldn’t – try to tackle everything at once.

The most important first step to outliving diabetes is finding out where you where you stand with this disease. (By outliving, we mean preventing the long-term complications of diabetes, and finding a way to manage your diabetes every day without going crazy, and without letting it rule your life.) And the best and only way to find out where you stand is by having these 5 tests conducted regularly, obtaining the results, and understanding what the results mean. Then you can use our book to create a do-able action plan to offset on your most critical health risks.

6. As parents, we struggle with how much independence to give our kids vs. micromanaging every moment, test, etc. At some point, our kids will need to flourish on their own. What advice would you give to us parents about getting our kids responsible for their own health without scaring them? How can this book benefit us and them?

As you know, I’m a mother of three myself, and I think if it were my children, I’d want to send them off into the world with the clearest possible strategy for living well with diabetes and avoiding diabetic complications. That means in addition to checking their blood glucose before meals and fine-tuning insulin doses, they need to keep an eye on the “big picture” by monitoring these 5 key health risks regularly.

I hear so many stories of kids that did well under their parents’ care, but then went into serious “neglect mode” for a whole chunk of years during college and young adulthood. As a parent, I would try to drum into their heads that they need to know their A1C, blood pressure, lipid, microalbumin, and eye exam scores at all times, and know what to do about it if something is out of range. Even if complications start to set in, all of the damage is treatable or in many cases reversible if it’s caught early.

7. What’s been the most helpful thing for you personally in dealing with your diabetes every day?

I’d have to say becoming involved with the diabetes community -- because nothing is more helpful than finding others who are living a parallel diabetes life.

I’ve met so many amazing people through my blog (, who have helped me feel connected and also helped me come to terms with the “forever” of this disease.

To me, getting connected in this way is essential because:

· Having diabetes does not get easier over time…

· New treatments can be hard to get/ hard to adapt to…

· Quirky things happen; often you want to know if other people with diabetes have experienced (not just the doctor’s opinion)

8. Any plans to write more books?

I sure hope so. Nothing concrete just yet.

9. My author friends will want to know how the co-authoring process worked for you. Any tips for working with another party?

You need to like each other! Have a good rapport. Be able to laugh it off when things don’t always go as planned. Have clear-cut roles: Who’s the organizer? i.e. the one who’s keeping track of what’s finished and what still needs revising and what’s on your schedule next? Who’s writing what chapter? At what point does the “buck stop” on niggling with each other’s contributions? If you aren’t clear about these things at the outset, co-authoring could be very messy and unpleasant.

Luckily, Dr. Jackson and I really enjoy each other. He was the content expert/medical authority, and I was the writer/project manager. He even inserted little idiosyncrasies and jokes for me in lots of early drafts. It was my job to catch them. That sure made editing more fun.

Thank you so much, Amy! While I normally link to Amazon, B&N, and indy booksellers (and the book is, of course, available there if you wish), Amy and Dr. Jackson have a special option for you. If you order the book using this link, you will receive 5 free Extend Bars.