Spring 2013 - Atlantic Health System

B D D I A B E T E S C E N T E R
FOR
C H I L D R E N
A N D A D O L E S C E N T S
Goryeb Children’s Hospital
Morristown Medical Center
100 Madison Ave.
Morristown, NJ 07962
Phone: (973) 971-4340
Fax: (973) 290-7367
The Team
Physicians:
Harold Starkman, MD, Director
Tymara Berry, MD
Barbara Cerame, MD
Daisy Chin, MD
Dr. Frances Guevarra, MD
Lawrence Silverman, MD
Nurses:
Frances Melchionne, EdD, RN, CDE
Clinical Coordinator
Laurie Ebner-Lyon, RN, APN, CDE
Kristin Sabanosh, RN, APN, CDE
Christine Wagner, RN, MS, CDE
Nutritionist:
Connie Shirtz, RD, MS, CDE
Social Worker:
Nicole L Pilek, MSW, LCSW
Administrative Staff:
Donna Parente, Office Manager
Debby Ace, Endocrine Coordinator
Cheryl Baldwin
Ashaki Graham
Sheryl Irons
Joann Millman
Christie Murillo
Medical Assistants:
Martha Ortiz
Pamela Solomon
Pierre the Pancreas * Find him at www.thinklikeapancreas.com
The Glucose Monitor
S P R I N G 2 0 1 3
The Diabetes Foundation, Inc., is a not-for-profit organization dedicated to improving the care and quality of life for
children and adults living day to day with diabetes in the New Jersey/New York Metropolitan area. The
organization focuses it efforts on medical assistance, patient advocacy , public education and camp sponsorships.
Many of our families have been helped by the Diabetes Foundation during times of financial struggle and we are
so thankful to have such a wonderful resource within our community. On April 25, 2013, the Diabetes Foundation
will be honoring one of our own, Dr. Harold Starkman, as Physician of the Year!!
Dr. Starkman!!!

S P R I N G 2 0 1 3
P A G E 2
IT’S A GIRL!
As many of you know already, our Nurse Practitioner Kristin Sabanosh is due to have her second daughter at the
end of June. Many of you have scheduled appointments with her prior to her maternity leave, but are unsure what to do
while she is away. Please check all your supplies and if you feel you will run low over the summer, contact her NOW so
she may call in supplies for you through September. If you are due for an appointment over the summer, please make it
with your physician; the follow up appointment will be with Kristin. If you have Kristin as your nurse and also had Dr.
Guevarra or Dr. Berry as your physician, please contact Kristin or the office and they will assist you in making an
appointment with one of the other nurses while she is on leave. Kristin is also taking care of any camp orders, school orders
for 2013/14, and travel letters that may be needed for the months of June-October 2013. Please email her at
Kristin.Sabanosh@atlantichealth.org if you need these! If you have questions, emergencies, or need logs reviewed over the
summer please do not worry. There is always a nurse in the office available to help while she is out on maternity leave.
Again, if you would like to have a direct contact, email Kristin and she can help you. Thank you for your understanding.
Both children and adults like me who live with type 1 diabetes need to be mathematicians, physicians, personal trainers,
and dietitians all rolled into one. We need to be constantly factoring and adjusting, making frequent finger sticks
to check blood sugars, and giving ourselves multiple daily insulin injections just to stay alive.”
— JDRF International Chairman
 Mary Tyler Moore
This quote truly captures the complexity and intensity required in the caring for diabetes. And the number of kids diagnosed
with Type 1 Diabetes (T1D) grows each year. Here are the latest statistics in the US:
Approximately two million Americans have T1D.
Each year, more than 15,000 children and 15,000 adults—are diagnosed with T1D in the U.S.
Approximately 85 % of people living with T1D are adults, and 15 percent of people living with T1D are children.
Each year at the BD Diabetes Center, we see approximately 80 newly diagnosed children with T1D. Our
goal is to empower each child and family with the knowledge and skills that Mary Tyler Moore described, so
that they can competently manage their diabetes.
Tight blood sugar control after diagnosis has been shown to have great benefit even for years after.
Recent studies describe a “metabolic memory” whereby better blood sugar control early on may minimize
risks for later diabetes-related complications. The mastery of these skills is also important for kids that will
soon be adults. With the older kids we are working hard to ensure a smooth transition from having parents
manage diabetes to independent care. This emphasis on “transition” will come up during visits with the
doctor, nurse practitioner and dietitian during high school. In the US, as many as half of young adults are
lost to regular follow-up with their new adult endocrine team. The BD Center and the Adult Diabetes Center
(or your chosen adult endocrinologist) will be working together for a smooth transition for better continuity
of care. Our team will be supporting you all the way!
T H E G L U C O S E M O N I T O R

S P R I N G 2 0 1 3
P A G E 3
STAFF NEWS
We are sad to say farewell to Dr. Tymara Berry, and
Dr. Frances Guevarra this spring. Both are pursuing a
change of career into different areas of the pharmaceutical
industry. They will be greatly missed.
The two doctors joining our staff will be introduced in our
next newsletter.
To make this adjustment happen as smooth as possible, we
will try our best to accommodate your child’s appointments
during this time of transition.
- METER RECALLS
Abbott is recalling its Freestyle InsuLinx blood glucose meters, due to a
malfunction that occurs at extremely high blood glucose levels [1024 mg/dl and
above].This recall does not apply to Freestyle or Freestyle Lite meters. The company
is notifying all registered owners, health care professionals, and pharmacies. Patients who currently use
the InsuLinx can contact the Abbott Diabetes Care Customer Service at 1-866-723-2697 to have a new meter
mailed to you at no charge.
LifeScan is recalling its One Touch Verio IQ blood glucose meters. This does not include the One
Touch Ultra, Ultra 2 , or Ultra Mini meters. At extremely high glucose levels [over 1024 mg/dl], the meter
will turn off instead of displaying the “Extreme High Glucose Above 600mg/dl” message. LifeScan
will replace the meter at no charge Please call LifeScan Customer Service line at 1-800-717-0276. You can
continue to use your Verio meter until your replacement arrives.
T H E G L U C O S E M O N I T O R

S P R I N G 2 0 1 3
P A G E 4
WE are looking for a “new face” for the
Glucose Monitor and we want YOU to design it!! Submit
your entry (entries can be computer-generated or
hand-drawn and must be original) by August 1, 2013.
You can e-mail your design to Nicole at:
nicole.pilek@atlantichealth.org, mail it to:
BD Diabetes Center, Hospital Box 53, 100 Madison Ave,
Morristown, NJ 07962, attn. Nicole Pilek or drop it off
at your next appointment at the center. Not only will
the winning entry be chosen as the new logo for our
Newsletter, there might be a grand prize too…;) All
entries will receive a token of our appreciation and
recognition for your creativity!
ELIZABETH FLAMMER!!
Elizabeth was diagnosed with type 1 diabetes a little less than a year ago. After receiving a stuffed animal
herself from someone with type 1 diabetes, she found that it kept her company in the hospital. In addition, it
made her feel better as she learned about how to manage her new diagnosis. Elizabeth decided she wanted to
Pay It Forward. She reached out to friends, family and neighbors to help her collect stuffed animals to give
to other children with newly diagnosed diabetes. She wants to make sure that they know that things will be ok
and that they are not alone. Elizabeth still has the stuffed animal she received when she was in the hospital
and says that it still brings her great comfort. She hopes to do the same for someone else.
Awesome job, Elizabeth!!
T H E G L U C O S E M O N I T O R

P A G E 5
Nicole and her beloved
four-legged companion,
Roxxy, love to take walks
and hike when it is nice
outside.
Nicole Pilek has been the
Clinical Social Worker for the
Pediatric Endocrinology
Department for the past six
years. Nicole received her undergraduate
degree in Sociology
with a minor in Spanish from
Fairfield University in
Connecticut and then went on to
attend New York University
where she received her Masters
in Social Work degree. Ever
since graduation, Nicole has
always worked in the healthcare
field and has found her niche
working with children and
families.
Passport ready, Nicole loves to
travel during her personal time.
Ziplining in Costa Rica,
climbing the Eiffel Tower, and
taking a gondola ride in Venice,
are just some of the things she
SWEET TALK with team member Nicole Pilek
has done and places she has been
in the past few years. With a
camera in hand (photography is
one of Nicole’s favorite hobbies;
a few of her favorite shots are
below), Nicole is always looking
to capture the moment.
You can often find Nicole at a
hockey game, cheering the NJ
Devils or rooting for the NY Mets
at CitiField. She got the
opportunity to watch her favorite
football team, the New Orleans
Saints, win on their home turf
when she went to Louisiana in
December last year.
Nicole loves to volunteer. She
has the opportunity to become an
official member of the 2013 MLB
All-Star Team as a volunteer, she
is the captain for her team that
will be participating in the
American Cancer Society’s Relay
For Life event in Hoboken, NJ and
she has helped out at events for
the NJ Special Olympics.
One of Nicole’s favorite sections
at the bookstore is the cookbook
section since she has a passion for
cooking and loves to cook and
entertain for friends and
family...But if you know her well,
it is no secret that she is quite
accident-prone in the kitchen!
Nicole recently started
participating in 5k races and has
crossed the finish line at the Color
Run and Warrior Dash. She is
looking to challenge herself again
this year in the Run for Your
Lives Zombie Adventure Race,
the Special Olympics Tunnel
Challenge and the Electric Run in
Philly.
T H E G L U C O S E M O N I T O R

S P R I N G 2 0 1 3
P A G E 6
THE INSPIRATIONAL TYPE (1): JAMIE BONACCORSO!!!
Dear Dr. Starkman,
I have been a patient under your care for the past 9 years. The Goryeb
Children’s Hospital at Morristown Medical Center has been a supportive and
welcoming environment to me and my family since the first day I was
diagnosed with type 1 diabetes. As I learn to take care of my condition, I
thought it would be nice to raise money for the BD Diabetes Center. Since
I have a love of art, I decided to design fun bracelets for my fundraiser.
The characters on the bracelet were designed to celebrate the differences
among people. I want other children with diabetes to feel comfortable
about our illness, and know the importance of taking care of ourselves in
order to stay healthy. Although we have to take a few extra measures to
stay healthy, we are no different then any other kids. Even though many
kids have this condition, we don’t have to set a life with any limits. My
community offered an abundant amount of support and I am pleased to say
that I raised 860 dollars! I’m donating all of the proceeds to the BD Diabetes
Center because of what they do for children and families every day. I hope
Dr. Starkman graciously accepts
Jamie’s donation check from her
highly successful sale of her
creatively designed bracelets!
with my donation, your staff will continue helping young patients, and keep running
events for people with diabetes. The Goryeb Children’s Hospital has made me realize
that although I have diabetes, it will never get in the way of my dreams. Raising money
was also a way to say THANK YOU to you and your staff for all you have done for me.
Sincerely,
Jamie Bonaccorso
T H E G L U C O S E M O N I T O R

S P R I N G 2 0 1 3
P A G E 7
Guess who is joining the Red Riders and participating in the Tour de Cure this year? …
Dr. Lawrence Silverman!! The Tour de Cure is a series of fundraising cycling events held in 44
states nationwide to benefit the American Diabetes Association. The Red Riders support anyone
living with Type 1 or Type 2 diabetes and their purpose of riding is to showcase the courage it
takes every day to live with diabetes. Why is Dr. Silverman riding?...It is in honor of all his
patients!!
Way to go!!!
DIABETES AND LOCKDOWN AT SCHOOLS
In wake of recent tragedies, school security drills are receiving more attention. NJ
schools are required to hold at least one fire drill/ school security drill each month within
school hours. Since these drills have become more common, we have been receiving
phone calls/emails asking for guidelines on what to provide for times of “lockdown”? At a
minimum all children with diabetes should have a light bag containing the following:
Extra blood glucose meter.
Test strips and lancets for the appropriate meter with alcohol wipes.
Glucose tablets and/or juice boxes as well as complex carbohydrate
snacks.
These supplies will allow a blood sugar check and treatment of a low sugar. If the
child doesn’t know how to check his/her blood sugar, their teachers should be taught. Often
parents write and include a low blood sugar treatment plan to place in the kit. (Helpful Hint)
If multiple meters are not available, it may be easier to have the child have the glucometer
in their school bag at all times, and just the snacks available in the classrooms.
Also, as a reminder, your school nurse should always have diabetes supplies, insulin,
pump supplies, ketone strips and glucagon for day to day use.
Hopefully you will find these guidelines useful in helping plan for your child’s safety at
school.
T H E G L U C O S E M O N I T O R

S P R I N G 2 0 1 3
P A G E 8
THE INSPIRATIONAL TYPE (1): CHLOE COHEN!!!
My name is Chloe Cohen, I am 12 years old and I was
diagnosed with Type 1 diabetes when I was ten years old.
When I was in the hospital anxiously sitting in my hospital
bed, worried about all the “what ifs” of being diabetic, I
wished I had fun activities to do to keep me relaxed and
happy. I know it can be a little overwhelming when you are
first diagnosed with diabetes.
That is why I came up with the idea to give newly
diagnosed children small bags of fun games and activities to
keep them busy while they are at the Goryeb Children’s
Hospital. Each bag is specifically created for each age group
and gender. My hope is that the games inside the bags will
keep the patients occupied and thinking positively. I have also
enclosed a personalized note from me to new patients
encouraging them and just letting them know that I am
thinking of them!
Chloe pauses for a pic with the wonderful bags she
has put together for newly diagnosed patients.
T H E G L U C O S E M O N I T O R

S P R I N G 2 0 1 3
P A G E 9
Checking Blood Sugars at Bedtime
It is just as important to check blood sugars at bedtime, as it is before
meals. By not checking your bedtime blood sugar, you are potentially risking an
overnight low, or more commonly, losing one-third of your day (your sleeping
hours) with a high blood sugar.
You always want to avoid an overnight low blood sugar while you are
sleeping. The general rule is, if your blood sugar is less than 100 at bedtime, eat a
10-15g carbohydrate snack without insulin. As in all aspects of diabetes
management, the “target” bedtime number is individualized. Make sure you
know the target bedtime number for you or your child.
If your bedtime blood sugar number is high, and your basal or Lantus dose
is correct, you will most likely wake up with a high blood sugar reading without a
bedtime correction. The role of the basal rate or Lantus insulin dose is to keep
your blood sugar steady. If you go to sleep at 200, you will wake up around 200,
without a correction. If your bedtime number is high, the only way to improve
your overnight and wake-up number is with correction.
PUMP NEWS!!!
Omni Pod has begun production of a new smaller pod. It is 34% smaller but continues to have a 200 unit
reservoir. This pump will now calculate insulin on board using both meal and correction
boluses. Existing Omni Pod pumpers will be upgraded to the new pump with their next supply
order. We will be evaluating this new pump and pod as our current patients receive it.
New Pump! Tandem Diabetes Care has introduced the first pump with a touch screen and rechargeable
battery. It is called the t:slim and was launched in August, 2012. It has a 300 unit reservoir and can use
any standard infusion set. The BD Pediatric Diabetes Center has recently placed one patient on the pump
to assess its use in our pediatric population.
T H E G L U C O S E M O N I T O R

S P R I N G 2 0 1 3
P A G E 10
THE INSPIRATIONAL TYPE (1): MARK BOTTGE!!!
BREAKING BARRIERS
What is determination? Determination, to me, means to keep going no matter what's in your
way. Determination really means firmness of purpose.
Imagine waking up and having a big bowl of cereal and then going to school. Well all that
changed for me. I'm an eleven year old boy with diabetes and celiac. Every day it's a struggle to keep
my diabetes managed.
I am a very active kid and I love to run and play soccer. With diabetes when you play a sport it
affects your blood sugar. When I first started playing soccer I was really good. Then when I got my
diabetes I wasn't playing as hard as I used to. Now I have to try even harder with my diabetes.
In school I'm not the smartest kid but I try my best. But with my problems, I occasionally have
to leave in the middle of class to test my blood, and sometimes my blood sugar is low and I miss the
whole class. This can be really hard to manage because of all the makeup work I owe.
During lunch I'm not allowed to eat the same food as my friends because of my celiac disease. I
have to eat gluten and wheat free foods. This is hard for me because I can't eat all the good foods like
cake, pizza, cookies and a bunch of other foods. When I go to parties I have to bring my own foods,
and if my blood sugar is low I have to sit and watch my friends run around and have fun while I sit
there and wait until my blood sugar comes back up.
Even though I have all these medical problems I never stop. Even though I have these problems
I play for my school soccer team, my travel soccer team, baseball, and basketball. I am determined to
conquer these diseases and nothing will ever stop me. One day I will overcome this!
Mark entered this essay into the 2013 BREAKING BARRIERS
nationwide scholastic contest to show that even though there are
challenges to taking care of diabetes and celiac disease, using
positive attitude and perseverance can break through these
barriers. Hope he wins!!
T H E G L U C O S E M O N I T O R

WOW! WOW! WOW!! Leonieke proves that nothing can stop you from pursuing
your passion; not age, not diagnosis...nothing!!! We are so proud of you!!!
T H E G L U C O S E M O N I T O R

P A G E 12
Both of these recipes
are courtesy of
“Dishing it up
Disney Style –
A Cookbook for
Families with Type 1
Diabetes”
Tigger’s Tip:
Peeling carrots is
something
Tiggers...and kids…
do best!!
Hercules’ Tip:
The protein in this
breakfast is just what
every hero-in-training
needs! Parents should
take charge when using
the oven, but the
younger set can still
scoop out the sour
cream and even try
separating the eggs.
Tigger’s Tortellini Vegetable Soup
Ingredients:
2 tablespoons olive oil
1 medium onion, chopped
1 small zucchini, diced
1 medium carrot, peeled and diced
5 ½ cups chicken stock
1 teaspoon dried basil (more if fresh)
1 bay leaf
½ cup canned crushed tomatoes
½ teaspoon salt
9 ounces fresh or frozen tortellini (cheese or meat filled)
2-3 tablespoons chopped fresh parsley
Black pepper, to taste
Instructions:
Heat the olive oil in a medium soup pot or large saucepan. Add the onion, zucchini, and carrot. Saute over moderate
heat for 8 to 10 minutes, stirring often, until the onion is soft and translucent.
2. Add the stock, basil, bay leaf, tomatoes, and salt to the pot. Increase the heat and bring the mixture to a low boil. Add
the tortellini and bring the soup back to a low boil. Cook it for 2 minutes, then reduce the heat and let it simmer for 5
to 6 minutes longer. Gently stir in the parsley and pepper during the last minute or so.
Nutritional Info: Serving: 1 ½ cups, Calories: 177, Total Fat: 7 grams, Total Carbohydrate: 15 grams, Fiber: 2 grams,
Protein: 13 grams
Hercules’s Oven Eggs with Ham
Ingredients:
1 medium onion, finely chopped (about 1 ½ cups)
1 teaspoon butter
1 teaspoon olive oil
4 medium leaves Swiss chard, stems removed and leaves finely chopped (about 1 Cup)
6 whole eggs
6 egg whites
1 cup light sour cream
1/3 cup chopped fresh Italian parsley
1 ½ cups cooked, diced ham (about 7 ounces)
2 ½ cups grated reduced-fat Swiss or sharp cheddar
Instructions:
1. In a medium-size skillet, sauté the onion in the butter and olive oil until soft and translucent, about 5 minutes. Add the
chard and cook until just wilted, about 1 minute. Let cool.
2. In a bowl, beat together the eggs and egg whites. Stir in the sour cream, parsley, ham, chard mixture, and 2 cups of the
cheese.
3. Pour the mixture into a greased 9X13-inch glass baking dish. Cover it with plastic wrap and refrigerate overnight, or
bake it (uncovered) immediately.
4. Heat the oven to 375F. If the casserole was refrigerated overnight, let it sit for 15 minutes at room temperature. Bake
until it has set, about 35 to 40 minutes.
5. Sprinkle the casserole with the remaining cheese and bake until the cheese melts, about 3 minutes.
Nutritional Info: Serving: 1/12 piece, Calories: 150, Total Fat: 7 grams, Total Carbohydrate: 4 grams, Fiber: 0 grams,
Protein: 16 grams, Gluten-free
T H E G L U C O S E M O N I T O R

Let’s get ready for...SUMMER!!
SWIMMING WITH DIABETES
*NEVER SWIM ALONE*
TELL THE LIFEGUARD YOU HAVE DIABETES!
WEAR YOUR ID BRACELET IN THE WATER!
WEAR SHOWER SHOES AROUND THE POOL AREA!
HAVE TREATMENT FOR LOW BLOOD SUGARS!
REMOVE PUMP IF NOT WATER RESISTENT.
MONITOR BLOOD SUGAR REGULARLY!
GET OUT OF THE WATER IF FEELING TIRED, WEAK, DIZZY, ETC.
Always swim with a buddy, so that if something happens, someone can go for help.
Tell the lifeguard you have diabetes so that if you have a low blood sugar, they are aware of how to help you or will call for assistance.
Wearing an ID bracelet at all times helps emergency personal determine how to treat you in case of an emergency.
Wearing water shoes around the pool and locker room will reduce the chances of bruising or cutting one’s feet, or of picking up athlete’s foot.
People with diabetes should examine their feet after leaving the pool to check for cuts, bruises, abrasions.
Bring along glucose tabs, juice, and snacks in case your blood sugar drops. Keep a glucose meter and glucose tabs or snacks poolside. Get out of the
water to treat.
If you wear a pump, consult your health care provider before beginning a swimming program. Not all pumps are water proof, and you will need to
follow your Endocrinologist’s guidelines for how long the pump can safely be disconnected.
The tired feeling brought on by exercising can feel like hypoglycemia, so it’s very important to monitor blood sugar at regular intervals. It’s very
important to remove yourself from the water and measure blood sugar if experiencing hypoglycemic symptoms. If you are having a hypoglycemic
episode, treat immediately and make sure blood sugar is stable before returning in the water.
Scenes from our 2013
SPRING SPLASH SOCIAL
with our little fishes!!
T H E G L U C O S E M O N I T O R

S P R I N G 2013
P A G E 14
The maginative Site:
The section to inject your creativity!!
Wanna share your artistic talent with others? Submit your drawings, paintings, photography or poems to Nicole via E-mail: nicole.pilek@atlantichealth.org
Mail: BD Diabetes Center, Morristown Medical Center, Hospital Box 53, Morristown, NJ 07962, Attn: Nicole Pilek or just drop it off at your next appointment.
Let the creative person inside you out!!
T H E G L U C O S E M O N I T O R

BD Diabetes Center for Children and
Adolescents
Goryeb Children’s Hospital at
Morristown Medical Center
Hospital Box 53
100 Madison Ave
Morristown, NJ 07962
Office Phone #: 973.971.4340
Fax #: 973.290.7367
Easier Prescription Refills!
There is a fast, and easy way to get your prescriptions
refilled and it’s free!! Our office participates in
Relay Health, a web-based secure service for
requesting prescription refills. We strongly
encourage patients to use Relay Health for efficient
and timely renewals. Please contact your diabetes
nurse educator for more information on how to signup.
Remember – After hours and weekends,
on-call physicians do not have access to your
child’s chart and cannot authorize
prescription refills.
A Pharmacist can dispense 3 days of diabetes related
supplies without a prescription; this may be an
out-of-pocket expense. It’s always best to request
your prescriptions at your scheduled diabetes
appointments, or by using Relay Health.
Think...
T H E G L U C O S E M O N I T O R

We will not be having a
diabetes family picnic this
summer.
However…
We will be having a diabetes
family celebration in the fall
around Halloween.
Details coming the end of
summer… :)
T H E G L U C O S E M O N I T O R