The Latest in GLP-1 Therapy

January 22, 2015

By Kristen Rider, BSN, RN, CDE

GLP-1 agonist medications are a common treatment for the management of Type 2 Diabetes. They work like the hormone GLP-1 (Glucagon-like peptide 1) that the body normally produces to help regulate blood glucose levels. People with Type 2 Diabetes may be deficient in GLP-1, which is why these medications are being used. GLP-1 agonists work to control blood glucose levels by decreasing the amount of glucose that the liver produces, delaying gastric emptying time, and helping the pancreas to produce more insulin when blood glucose levels are high. The first to hit the market was Byetta in 2005. Since then, several others have been launched, some within the past few months. All of the GLP-1 agonist medications are injectable, but each has a different device or mechanism for injection. Dosing varies from twice daily, daily, to once weekly. Some of these medications are FDA approved for use in conjunction with basal insulin, while others were not studied as such. See the comparison chart below for more information on GLP-1 agonists.

Drug Dose Mixing


Pre-injection waiting time


Approved for use with basal insulin


Twice daily



5mcg, 10mcg


Bydureon Kit


Once weekly Yes No

2 mg

Bydureon Pen
Once weekly Yes No 2 mg



Once weekly


Yes 15 min

30mg       50mg




Once weekly



0.75 mg




Once daily

No No 0.6mg


1.8 mg


Package Insert (PI) list

Byetta (exenatide) AZ – Bydureon Pen and Kit (exenatide extended release) AZ – Tanzeum (albiglutide) GSK – Trulicity (dulaglutide) LILLY – Victoza (liraglutide NOVO –

This information is not meant to replace your healthcare Provider’s advice. It is not an endorsement of these products or of the pharmaceutical companies. The Outpatient Diabetes and Nutrition Services Department at St. Anthony’s Medical Center can assist you with questions you may have regarding this change or other questions you have regarding your diabetes self-management. Call us at 314-525-4523 for more information.


Happy New Year – Happy Feet

January 5, 2015

You may have heard that diabetes can lead to foot problems. It can be tempting to ignore your feet, but diabetes can be hard on the feet over time because high blood glucose levels may lead to neuropathy, or nerve damage. Nerve damage can make your feet numb. So you may not feel a small cut or a tight-fitting shoe that can lead to calluses, blisters, or other wounds. Such wounds can get infected and be slow to heal, especially if you have high blood sugar levels and poor blood flow in your feet and legs.

Most people can prevent any serious foot problems and keep feet feeling their best by following these simple steps:

  1. Check your feet every day.

Look for calluses, blisters, scaling (dry skin), cracks in the skin (especially between toes and on your heels), redness, and swelling. If you can’t turn your leg to see the bottom of your foot, try placing a magnifying mirror on the floor and hold your foot above it to check the bottom for trouble spots, or ask someone for help.

Neuropathy can result in both pain and loss of sensation in your feet. When you can’t feel pain, you won’t feel a wound forming (that’s why daily checks are so important!).

  1.  Wash your feet every day and moisturize. Cut nails carefully.

After washing your feet in lukewarm water (not hot!), dry them carefully, especially between the toes. You can avoid dry skin and cracking by using a thick moisturizer on your feet. Rub it in well, but don’t put it between your toes—those dark, moist areas are great hosts for infection.

Cut nails straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toe nails. Have a foot doctor trim your toenails if you cannot see or feel your feet, if you cannot reach your feet, if your toenails are thick or yellowed, or if your nails curve and grow into the skin.

  1. Wear shoes that fit your feet and don’t go barefoot. Don’t forget socks!

Wear comfortable shoes that fit well and protect your feet. Wearing shoes that rub or pinch makes it more likely for a blister or wound to form. Look for a snug but not tight shoe fit, with room to wiggle your toes. For hard-to-fit feet or if you already have foot problems, you may need therapeutic shoes. Ask your doctor about Medicare and other insurance coverage for special shoes. Walking/athletic shoes are good for daily wear. They support your feet and allow them to “breath”. Avoid vinyl or plastic shoes because they do not stretch or breath. Avoid shoes with pointed toes or high heels as they put too much pressure on your toes. And buy shoes at the end of the day when your feet are the largest so that you can find the best fit.

Check inside your shoes before wearing them. Make sure the lining is smooth and there are no objects inside. If you keep your shoes in the garage or outside, look to make sure no spiders or other critters have taken refuge in the warmth of your shoes!

Wear clean, dry socks and change them daily. Avoid tight elastic bands (they reduce circulation). Don’t wear thick or bulky socks as they can fit poorly and irritate the skin.

  1. Protect your feet from hot and cold and don’t go barefoot!

Never walk barefoot! Wear shoes at the beach or on hot pavement. Don’t put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it. If your feet get cold at night, wear socks. Be sure to wear proper foot wear in the winter months to prevent frost bite and don’t let your feet get wet in snow or rain.

  1. Show your feet to your health care provider at every office visit.

Ask your doctor to look at your feet at every visit. Take your shoes and socks off once you are in the exam room. Your health care provider should perform a complete foot exam at least annually – more often if you have foot problems. This exam should include checking the sense of feeling and pulses. Call your doctor right away if a cut, blister, or bruise on your foot does not begin to heal after a few days.

  1.  Keep the blood flowing to your feet.

Poor circulation means you won’t get enough blood flow to heal wounds, so it will take longer to get well. Some signs of poor circulation include weak pulses in your feet or legs, shiny and hairless skin, and discolored skin.

Put your feet up when you are sitting. Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to help blood flow in your feet and legs. Don’t cross your legs for long periods of time.

Don’t smoke. Smoking restricts blood flow in your feet.

  1. Try to hit your blood glucose targets

High blood glucose levels can lead to slow-healing foot wounds and slow the body’s ability to fight infection. High sugar in the blood acts like a food source for the bacteria in infections, making them become more powerful and spread more quickly!

  1. Get help for open wounds

Don’t risk your health! Get treatment for foot wounds as soon as possible. Visit your physician or a podiatrist, a doctor specializing in foot care, if you have an open cut, blister, or sore on your foot that isn’t healing. Do not try to treat yourself with over-the-counter antibiotic ointments.


If you take care of your feet every day, you can lower your chances of losing a toe, foot or leg. Begin taking care of your feet today!





Balancing Holiday Festivities and Diabetes

December 24, 2014

Merry Christmas from the Outpatient Diabetes and Nutrition staff at St. Anthony’s Medical Center. With the Christmas and New Year holidays comes plenty of feasting and merriment. Enjoying the season is important, but if you or a family member have diabetes, it’s also very important to maintain a healthy routine for managing the condition.

Having diabetes doesn’t mean missing out on the festivities. What it does mean is balancing holiday indulgence with healthy diet and exercise choices. The American Diabetes Association has some helpful guidelines to help you keep your diabetes managed well this holiday season and into the New Year:

  • Enjoy holiday foods, but don’t overdo it. Instead, spend more time with your family members sharing stories, playing games or heading out to the park for a pickup game of football or basketball. Make the celebration about the people you’re with instead of food.
  • Bring something to share. If you count carbohydrates to balance out your medication, offer to bring a dish you like to the celebration. Look up the nutrition information beforehand so you know how many carbohydrates are in a serving.
  • Plan to get out. After everyone has enjoyed the meal and the dishes are washed, invite everyone out for a walk around the neighborhood to enjoy the Christmas lights.
  • Monitor what you drink. Many holiday cocktails use high-sugar mixers like regular soda and juices. The calories in these drinks can add up quickly. Look for ways you can incorporate sugar-free options to avoid letting your blood glucose levels go out of control. It’s also important to avoid drinking on an empty stomach in order to prevent low blood glucose. If you opt to imbibe, keep in mind that the Association recommends one drink or less per day for women and two drinks or fewer per day for men.

Enjoy this holiday season with your friends and family without losing control of your diabetes management. Sit down around the table to enjoy a delicious orange and walnut salad or spiced sweet potato casserole with these healthy guidelines in mind, and then take a short walk after dinner.

Wishing you the best of health in 2015.

Alison, Cathy, Darla, Denise, Diane, Kim, Kristen, Sue



Source: Milwaukee Journal Sentinel and the  American Diabetes Association


Clean – Separate – Cook – Chill: Basic Food Safety Steps

December 10, 2014

by Alison Brinker, RD, LD

The holidays are a great time to review food safety guidelines. A person with diabetes is at higher risk for foodborne illnesses. With diabetes, your immune system may not readily recognize harmful bacteria or other pathogens. This delay in the body’s natural response to foreign invasion places a person with diabetes at increased risk for infection. If a person with diabetes contracts a foodborne illness they are more likely to have a lengthier illness and require hospitalization compared to a person without diabetes. During the holidays many people are preparing food for friends and family. Making sure it is prepared safely is a must to prevent anyone from getting a foodborne illness.ID-10026109

Four basic steps to food safety:

  • Clean
  • Separate
  • Cook
  • Chill

Clean: Wash hands and surfaces often. Bacteria can spread throughout the kitchen and get onto cutting boards, utensils, counter tops, and food. Wash hands in warm soapy water for at least 20 seconds before and after handling food and after using the bathroom, changing diapers or handling pets. Wash cutting boards, dishes, utensils, and counter tops with hot soapy water between the preparation of raw meat, poultry, and seafood products and preparation of any other food that will not be cooked. You can also sanitize cutting boards and counter tops by rinsing them in a solution made of one tablespoon of unscented liquid chlorine bleach per gallon of water. Plastic cutting boards may be run through the wash cycle in your automatic dishwasher. Wash produce by rinsing under warm tap water, including those with skins and rinds that are not eaten. Clean the lids of canned goods too before opening.

Separate: Don’t cross-contaminate. Cross-contamination occurs when bacteria are spread from one food product to another such as with raw meat, poultry, seafood, and eggs. Always keep these foods and their juices away from ready-to-eat foods such as salad. Never place cooked food on a plate that previously held raw meat without first washing the plate with hot soapy water. Don’t use marinades used on raw foods unless you bring them to a boil first. Consider having two cutting boards; one designated for raw meat, poultry and seafood and the other for ready to eat foods such as bread, fruits, raw vegetables and cooked meat.

Cook: Cook all meats to the recommended temperature. Use a food thermometer to measure the internal temperature in several places to make sure that the meat, poultry, seafood or egg product is cooked to the correct temperature to prevent foodborne illness.

Looking for Something to do with those Turkey Leftovers?

November 28, 2014

Thanksgiving Leftovers

by Alison Brinker, RD, LD

What to do, what to do with all that leftover turkey? Below is a great recipe for using the turkey you just couldn’t finish on Thanksgiving Day. This will make a great lunch or light dinner. The avocado provides a good source of healthy, unsaturated fat, after a holiday that is usually full of unhealthy saturated fat from butter, gravy and cream sauces.

Turkey and Avocado Wraps

Serving size: 1 wrap, recipe makes 4 servings

½ avocado

3 tablespoons plain, fat free yogurt

¼ teaspoon chili powder

2 cups chopped lettuce

2 small tomatoes, finely diced

2 tablespoons fat-free Italian dressing

4 10-inch whole grain flour tortillas

12 ounces sliced, leftover turkey

1 cucumber, thinly sliced

  1. In a small bowl, mash the avocado with a fork. Add yogurt and chili powder to avocado and mix well.
  2. In a medium bowl, toss lettuce and tomato with Italian dressing.
  3. Spread 1-1/2 tablespoons of avocado mixture on one tortilla. Add 3 ounces of turkey, ¼ of the lettuce and tomato mixture, and ¼ of the sliced cucumber.
  4. Create a wrap by folding in the left and right side of the tortilla until the edges are about 1 inch apart and then roll from the top down. Repeat this process for remaining 3 tortillas.

Nutrition Information:

Total carbohydrate, 45 grams, 3 ounces meat, 2 fat choices

Source: Healthy Calendar Diabetic Cooking, a full year of delicious menus and easy recipes



Happy Healthy Thanksgiving!

November 19, 2014

by Alison Brinker, RD, LD

Thanksgiving is all about being with loved ones and of course EATING!

Remember the plate method of portion control when building your Thanksgiving plate.   Make ½ your plate non-starchy vegetables such as carrots, green beans, Brussels sprouts or broccoli. Make a ¼ of your plate starch, such as sweet potatoes, rice or stuffing. If more than one is available take a little of each to help keep your blood glucose from going too high. The other ¼ of your plate should be lean turkey. White meat is lower in fat making it a healthier choice. Always remove the skin from poultry to help cut fat intake as well. Add a small amount of gravy, or an even better choice could be a small amount of a fruit based relish. Now you have a plate that will help keep your glucose in target range.

Be sure to take a look at all the foods available before making your selections. This way you will use your carb choices wisely and for the foods you know you will enjoy the most.

Eat slowly and enjoy your food. When we eat too fast sometimes we will take a second helping before our brain has time to tell us we are full.

Choose calorie-free drinks such as water, tea, or diet soda. Save your carbohydrates for the foods you enjoy.

Have dessert! Take a small portion and eat slowly to enjoy the taste.

Don’t skip meals earlier in the day. Skipping meals may cause you to feel so hungry that you make poor choices or over eat. When carb counting, saving carbs is not recommended. It is still important to keep carb intake consistent throughout the day to keep blood glucose in target range.

Exercise is a great way to help lower blood glucose. Encourage family and friends to join you on a walk after your meal to help lower glucose levels. Exercising a few days before and after Thanksgiving will also help manage those extra calories eaten during the holiday.

Holidays are definitely a challenge! If you eat too much on Thanksgiving don’t beat yourself up. Make a plan to get back on track!

For more tips on Surviving the Holidays, join the Diabetes Education staff on Thursday, November 20th at 1:00 p.m. in the Conference Room at the Hyland Education & Training Center.  This support program is free and open to the public.  For more information visit:

Veterans Day

November 10, 2014

by Susan Klick, MSN, RN, CNL

Veterans Day honors the duty, sacrifice, Veterans Day and service of America’s nearly 25 million veterans.   It is a celebration to honor America’s veterans for their patriotism,  love of country, and willingness to serve and sacrifice for the common good.

A brief history lesson:   In 1919, President Wilson proclaimed November 11 as the first commemoration of Armistice Day.  Although World War I officially ended when the Treaty of Versailles was signed, the fighting had actually stopped seven months earlier when an armistice, or temporary cessation of hostilities, between the Allied nations and Germany went into effect on the eleventh hour of the eleventh day of the eleventh month – November 11, 1918.  An Act (52 Stat. 351; 5 U.S. Code, Sec. 87a) approved in May, 1938 made the 11th of November a legal holiday to be dedicated to the cause of world peace.  This act was later amended and on June 1, 1954, November 11th became Veterans Day, a day to honor American veterans.

Here are a few of the many activities going on in our area honoring Veterans.  Get out and say thank you to our Veterans!  It doesn’t have to be Veterans Day to say thank you to the brave men and women who have fought and who are fighting for our country.  But on November 11th, each and every one of us need to make a special effort to do so.

Saint Louis Science Center Salutes Military Veterans

Date:  Tue, 11/11/2014                           Time:  9:30am – 1:00pm

On Nov 11, the Saint Louis Science will honor all who have served in the US Armed Forces with a patriotic display of US flags, World War II soldier re-enactors, military vehicles and a special tribute. All Veterans get FREE admission to D-Day film.


National Park Service Fee Free DayDate:  Tue, 11/11/2014  Time:  9:00am – 6:00pm                  Location:  The Gateway Arch

The National Park Service honors America’s veterans with free entrance to all parks for all visitors on special days throughout the year. This fee is included in the Arch tram and movie tickets, so enjoy a $3 discount on these dates!

Activity:National Park Service Fee Free Day


Visit Jefferson Barracks Park

Jefferson Barracks Park is approximately 425 acres. Jefferson Barracks served as a gathering point for troops and supplies bound for service in the Mexican War, Civil War, various Indian conflicts, Spanish-American War, Philippine War, and World Wars I and II. Jefferson Barracks also served as the first Army Air Corps basic training site. Robert E. Lee, Jefferson Davis, Zachary Taylor, Ulysses S. Grant, Philip Sheridan, Stephen W. Kearny and William T. Sherman were a few of the famous Americans to serve at Jefferson Barracks.



U.S. Department of Veterans Affairs



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