the current newsletter as a .PDF - Joslin Diabetes Center

Newsletter of the
Pediatric, Adolescent, &
Young Adult Section
Volume 7, Issue 4
Fall 2011
The Pediatric Newsletter, along with news of pediatric events, is distributed by e-mail.
To sign up for e-mails, go to: http://www.joslin.org/phs/pediatric_e-mail_signup.html
Making a Difference with Cans and Bottles
When an earthquake of magnitude 7.0 hit Haiti in January
of 2010, images appeared on the news of collapsed
buildings and people with injuries; there was no electricity,
water, or food. For Lilly Branka, now 9 years old and a
patient at Joslin for 6 years, her first concern was how
these people without the basics could manage diabetes. “It
was remarkable, and also unfortunate that she thought this
way,” says her father, Gerard. When Lilly’s mother learned
that Lilly wanted to help children in poor countries get the
supplies they need to manage their diabetes, she called
Joslin. Lilly’s doctor, Dr. Laffel, told her about Life for a
Child, a program through the International Diabetes
Federation that collects donations to supply insulin, blood
glucose monitoring equipment, and education to health
centers in developing countries.
Lilly and her mother, Emily, wrote a letter to their
neighbors asking them to leave bottles and cans outside
their homes so Lilly and her mother could pick them up
and send the money collected from the deposits to Life for
a Child. Word spread, and soon people in nearby towns
were gathering up their cans and bottles to give to Lilly and
Emily. Gerard explained how they got the idea to take
donations of cans and bottles. “A lot of people get asked
for money. We wanted a way to ask people without
Healthy Happy Holidays to All
A Family’s Guide to Holiday Eating
As the fall approaches we once again enter the whirlwind of
the holiday season. From Halloween to the New Year there
are many opportunities to celebrate, and these celebrations
usually include all kinds of delectable delights. Indulge with
a bit of wisdom. We would like to share a few tips to help
keep the holidays healthy as well as happy ones!
Halloween: Tips for Trick or Treating
Trade candy bars for small trinkets (kids aged 3+): key
chains, pencils, stickers, markers, crayons, barrettes,
costume jewelry, action figures, matchbox cars/trucks.
Trade candy for a special, pre-determined treat - a family
outing (walk or hike, bike ride, fall foliage picnic, etc.), a
toy, video, computer game/DVD, CD or music gift card,
money or gift certificate; a new outfit.
imposing on them
too much.” Lilly
also started a coin
drive at her school,
collecting coins
from teachers and
classmates to
donate to the
cause. In total, Lilly
has succeeded in
raising $2,500 for
Life for a Child with the help of family and community
members matching her efforts.
Lilly shared what made her decide to help children with
diabetes in other countries. “I’m very lucky that I have
all the supplies and care I need and my doctors at
Joslin. I want other people to have it too. It’s not easy to
have diabetes in other countries. I’m thankful to the
doctors and nurses who take care of me.” To learn
more about Life for a Child, visit: www.idf.org/
lifeforachild. If you would like help planning a donation
to Joslin, contact Jessica Orndorff,
Jessica.Orndorff@joslin.harvard.edu, 617-309-2534.
-Georgia Feuer, BA
Give out small trinkets (ages 3+) or toys instead of
candy to the children in your neighborhood.
Healthy Holiday Eating Tips
Be Realistic:
You can have treats in moderation and balance
them with healthy choices
Instead of trying to lose weight during the holidays
set a goal of weight maintenance.
Plan Ahead:
Try not to arrive
hungry/thirsty at a
party; eat a light but
filling snack (yogurt,
fresh fruit, raw
veggies with
hummus, cheese
Continued on p.5…

PAGE 2
Pediatric, Adolescent, &
Young Adult Section Team
Endocrinologists
Lori Laffel, MD, MPH
Chief of Pediatrics
Joan Mansfield, MD
Assoc. Clinical Director of Pediatrics
Cielo Alleyn, MD
Angelina Bernier, MD
Allison Cohen, MD
Michelle Katz, MD, MPH
Sanjeev Mehta, MD, MPH
Alyne Ricker, MD
Clinical and Research Fellows
Josh Borus, MD
Elvira Isganaitis, MD, MPH
Nurse Educators
Cindy Pasquarello, BSN, RN, CDE
Nurse Manager
Ashley Atkins, RN, MSN, CPNP
Liz Foster, BSN, RN, CDE
Deb Holtorf, MSN, MPH, PNP, BC-ADM
Joyce Keady, MSN, RN, CPNP
Kerry Milaszewski, BSN, RN, CDE
Lisa Rasbach, MSN, RN, CPNP
Lisa Schmidt, BSN, RN, CDE
Melissa Williams, RN, MSN, PNP
Administrative Staff
Louise Crescenzi
Manager of Pediatric Operations
Georgia Feuer, BA
Stephanie Holloway
Medical Assistants/Phlebotomist
Stephanie Ellis
Yosaris Rodriquez
Child Life Specialists
Micaela Francis, CCLS
Jennifer Griffin, MS, CCLS
Dietitians
Laurie Higgins, MS, RD, LDN, CDE
Heidi Quinn, MS, RD, LDN
Behavioral and Mental Health
Debbie Butler, MSW, LICSW, CDE
Jessica Markowitz, PhD
Research Staff
Lisa Volkening, MA, CCRP
Assoc. Director, Pediatric Research
Margie Lawlor, MS, CDE
Leah Bellman, BA
Kaitlin Gaffney, BS
Emily Fisher, MA
Marcy Hudson, MA
Christina Kelley, BA
Maureen Malloy, BS
Suzanne Mickey, BA
Roxanne Phillips, BS
Camille Ratliff, BA
Tina Roth, BA
Brittany Ryan, BA
Insulin Pump… Is it for you?
Classes held 3:30pm-5:00pm on
the third Wednesday
of every month
For more info, call 617-732-2603
NEWSLETTER OF THE PEDIATRIC, ADOLESCENT, & YOUNG ADULT SECTION
Meet the Newest Members
of the Joslin Pediatrics Team
Leah Bellman, BA – Research Assistant
Leah recently graduated from The George Washington
University in Washington, DC. While a student, she
worked as a Research Assistant at Children’s National
Medical Center in HIV Services. Her interest in the
psychological effects of living with a chronic illness led her
to the Joslin. She likes to read, go to the beach, hang out
with friends, try new restaurants, and keep up-to-date with
celebrity news.
Jennifer Griffin, MS, CCLS – Child Life Specialist
Jen attended Emmanuel College in Boston, MA for
Undergraduate studies, then got her masters degree in
Child Life and Family Centered Care at Wheelock
College in Boston. She completed internships at the
Floating Hospital for Children at Tufts Medical Center
and also at Signature Healthcare Brockton Hospital in
Brockton, MA. Before Joslin, Jen worked at Franciscan
Hospital for Children in a residential school for children
and adolescents diagnosed with autism spectrum
disorders and various other behavioral issues. She enjoys working with pediatric
patients and their families, helping them learn and cope with a diagnosis, medical
procedures and hospitalization using play.
Christina Kelley, BA – Research Assistant
Christina grew up in Needham and graduated from Harvard
University in May of this year. She enjoys working with
children and families and especially loves the culture and
atmosphere of Joslin Pediatrics. Her research interests
include pediatric health and the intersection of neuroscience
and health -- while in school she worked in the Cognitive
Neuroscience lab at Children’s Hospital. In her free time,
Christina loves playing Ultimate Frisbee.
Camille Ratliff, BA - Research Assistant
After graduating from Duke University, Cami embarked on
eight months of international endocrinology and diabetes
rotations to study the social dynamics of diabetes. One traineeship
was in Romania, the other in Turkey. A varsity
athlete in college (fencing) who loves to cook, she became
interested in studying diabetes because of the involvement
of exercise and diet as well as genetics, health disparities,
emerging clinical technology and patient-centered care.
Cami speaks 5 languages in addition to English– Spanish, German, Turkish, Haitian
Creole and Romanian. She is excited to be a part of the Joslin team and learn more
about diabetes in pediatric and adolescent populations.
Monica Diaz, a medical
VISITORS TO JOSLIN student from SUNY
Downstate, was at Joslin
from June to August studying BMI in pediatric patients with type 1
diabetes. Jeannie Berg, a Certified Diabetes Educator, came from
South Africa to Joslin to learn about diabetes management in the
United States.

VOLUME 7, ISSUE 4
PAGE 3
Upcoming Events
Caring for Children with Diabetes: repeated 3 times -
Mon. 10/3, Tues. 11/15 6:30pm-8:30pm, Sat. 12/3 9am-11am at Joslin
An introduction to diabetes and how it is managed in children
Topics covered: impact of insulin, food, and activity on management,
ways to provide best care for youth, etc.
Suitable for grandparents, daycare personnel, nannies,
friends & family, any interested party
Cost: $30 per person, light meal included
Contact: Georgia Feuer, georgia.feuer@joslin.harvard.edu;
617-309-4530; www.joslin.org/phs/caregivers_classes.html
Registration form available on website.
Teddy Bear Clinic at ADA
Diabetes Walk
Saturday October 22nd, 11am-
1pm at Boston Common
Joslin is holding a Teddy Bear
Clinic at the 2011 Boston Step-
Out Walk to Stop Diabetes. Visit
www.stepout.diabetes.org to learn
more about the walk.
Annual Halloween Party: Saturday
October 29th, 10am-noon at Joslin
Crafts, pumpkin bowling, magic tricks, a
haunted house, and more
Come in costume!
Contact: Micaela Francis
micaela.francis@joslin.harvard.edu;
617-309-4528
Pump Education Program
for School Nurses:
Saturday, November 5th at Joslin
One-day program focuses on diabetes management
using insulin pumps
Contact: Georgia Feuer,
georgia.feuer@joslin.harvard.edu;
617-309-4530
www.joslin.org/insulin_pump_education_fo
r_school_nurses.html
6.25 Contact Hours. Individual price: $125.
Groups of 3+: $95. Includes breakfast and
lunch. Registration form available on website.
Past Events
On July 13, 2011, Pediatrics held their
annual Summer Magic Event. With
about 75 people in attendance, families
were able to enjoy a picnic-style dinner,
games, crafts, and balloon animals.
The magician had a lot of fun jokes,
clever tricks, and lots of audience involvement.
We couldn’t stop laughing!
This summer Pediatrics was able to bring about 40 families on the annual
Tours of Fenway Park. Families learned how Fenway has become
one of the most historic ballparks in America and they also enjoyed meeting
other families living with diabetes. Many of the patients felt the best
thing about their tour was the view while sitting in the Green Monster
seats. This has always been a favorite event and interest keeps growing
each year.

PAGE 4
NEWSLETTER OF THE PEDIATRIC, ADOLESCENT, & YOUNG ADULT SECTION
Research Opportunities at Joslin
T1D Exchange
Description: The Type 1 Diabetes (T1D) Exchange is
a nationwide registry collecting information about children
and adults with type 1 diabetes. The purpose of
the registry is to gather information about people with
type 1 diabetes to help better understand the natural
course of type 1 diabetes and the effectiveness of current
treatments. Participation in the registry involves
completion of a questionnaire about medical and family
history including diabetes diagnosis and treatment
and laboratory test results. Annual updates of information
are also part of the registry.
Recruiting: At the Joslin, individuals being followed in
the Pediatric, Adolescent and Young Adult Section
may be eligible to participate in this registry.
Contact: Camille Ratliff at (617) 309-4477 or
camille.ratliff@joslin.harvard.edu
RESEARCH UPDATE
Several members of the Pediatrics staff attended
the 2011 ADA Scientific Sessions in
San Diego, CA, where they presented results
of research accomplished here at Joslin. The
well-attended oral and poster presentations described
the range of family and social supports that promote
better blood glucose control. These include having
regular contact with a case manager who educates and
supports the young person with diabetes (M. Katz);
having a “Medical Home”, i.e. care that is accessible,
family-centered, continuous, compassionate, and culturally
effective (M. Katz); and parent goal-setting for
A1c and blood glucose levels (M. Boot et al). The presentations
also addressed the impact of diabetes on
families with a survey to measure the burden of diabetes
care (J.Markowitz); and looked at the impact of
starting an insulin pump on disordered eating patterns
(J. Markowitz). Another presentation reviewed changing
patterns of prescribing medications to treat type 2
diabetes (S. Mehta). One of the many interesting sessions
at the four-day meeting included a progress report
on the Artificial Pancreas, where closed-loop systems
using insulin pumps and glucose sensors respond
to high or low blood glucose levels by increasing or
decreasing insulin delivery respectively. There are
many ongoing studies around the globe designing and
evaluating versions of an “artificial pancreas.” There
was also a major session on transitions in care from
pediatric to adult diabetes specialists, organized and
chaired by Joslin’s Dr. Lori Laffel.
-Alyne Ricker, MD
CGM Improve Diabetes Study
Description: The purpose of this
study is to find out how to make it
easier for children and teens with
type 1 diabetes to use continuous
glucose monitors (CGM) over a long
period of time. The study involves 12
visits over a 24-month period with additional phone contacts
between visits. The extra three visits occur during the first
six months of the study: the rest of the visits will occur at
routine clinic visits. Families randomized to the intervention
group will receive a family based behavioral intervention providing
support and education regarding use of the CGM.
Families in the usual care group will receive this information
at the end of the study. Youth in both groups will wear a
CGM device throughout the study. Families will be asked to
complete surveys at various intervals over the course of the
study and labwork will be collected for the youth in the study.
Recruiting: Children and teens, ages 8-17 years, who have
had type 1 diabetes for at least 1 year and who are receiving
care at Joslin and their parents or legal guardians
Contact: Emily Fisher at 617-309-4644 or
emily.fisher@joslin.harvard.edu
The Tolerance Study
Can Glucose Monitoring
Improve
CGMi Study
Description: This study is trying to help us better understand
what causes type 1 diabetes to help find new ways to prevent
or reverse the disease. The study is being done with
researchers at Harvard Medical School and is funded by the
Juvenile Diabetes Research Foundation. The study visit
includes the completion of questionnaires and a blood draw.
Recruiting: Individuals, ages 18 years and older, both with
and without type 1 diabetes
Contact: Roxanne Phillips at 617-309-2481 or
roxanne.phillips@joslin.harvard.edu
Type 1 Diabetes Risk Assessment
The Natural History Study — TrialNet
Description: This study aims to identify youth and adults at
risk for type 1 diabetes by testing for diabetes-related antibodies
in relatives of people with type 1 diabetes. It involves
a single blood test. People who test positive will be eligible
for further testing and may be eligible to participate in prevention
trials.
Recruiting: Parents, children, & siblings, ages 1-45, and
cousins, grandchildren, nieces, & nephews, ages 1-20, of
people with type 1 diabetes
Contact: Hui Zhang at 617-309-4739 or
hui.zhang@joslin.harvard.edu

VOLUME 7, ISSUE 4 PAGE 5
Recipe: Cheesy Pizza Poppers Nutrition Facts:
Ingredients:
Per serving (1/4th of
1/3 cup low fat ricotta
recipe, 3 poppers)
1/2 cup light shredded mozzarella 136 calories
1 1/2 tsp tomato paste
3.6 g fat
1/2 tsp dried minced onion
5.6 g protein
12 small wonton wrappers
16.25 g carb
12 sprays of butter spray
1 tbsp grated parmesan cheese
Dipping sauce:
1/8 tsp garlic powder; 1/2 cup canned crushed
tomatoes; 1/8 tsp Italian seasoning
Directions:
Preheat oven to 375 degrees; spray baking sheet with non-stick
spray and set aside. In medium bowl, combine ricotta, mozzarella,
tomato paste and minced onion. Mix thoroughly and set
aside. Lay wrappers on a clean, dry surface. Spoon filling into
the center of each wrapper, fold over to make a triangle. Gently
pinch the edges to seal. Place each popper on the baking sheet.
Spray with butter spray and sprinkle with parmesan cheese and
garlic powder. Bake in the oven until golden brown, about 10
minutes, flipping after 5 minutes. Combine crushed tomatoes
with Italian seasoning in a microwave safe bowl. Stir well. heat
for 1 minute. Serve with poppers for dipping.
“Healthy Holiday Eating” continued from p.1
stick, 1/4 cup of nuts, or ½ sandwich) and a glass of water to
stay well hydrated before you leave for the holiday party.
Avoid Overeating:
Stay at least an arm’s length away from the food
table before and after eating to prevent nibbling
Choose small portions of your favorite foods and eat slowly;
savor the flavor!
Wait a few minutes before going for seconds. It takes 15
minutes for the signal to go from belly to brain to say, “hey
wait, I’m pretty full!”
Keep track of nibbling - put a small portion of crackers or chips
or pretzels on a plate and walk away from the bowl
If planning on dessert, take less starches at the main meal – fill
your plate with salad and vegetables
Food Choices:
Try to choose more vegetables, fruits and whole grains
Limit fried foods
Have dessert-but keep it small; and remember it’s nice to
share! You can always split a dessert with your friends or
family
Physical Activity
Remember to move! -Start a family tradition:
Take a walk between dinner and dessert
Have a game of flag football
Break out the croquet set
Toss a ball around
Enjoy holiday decorations by foot after a meal
-Heidi Quinn, MS, RD, LDN and
-Laurie Higgins, MS, RD, LDN, CDE
Check out these resources for
optimizing care at school:
1. diabetes.org/schooldiscrimination
Provides links for the following information:
Legal protections for your child
Training resources
Special school-related considerations and challenges
2. diabetes.org/assets/pdfs/schools/dmmp-form.pdf
Sample Diabetes Medical Management Plans
(DMMP). DMMP is a plan created by the child’s
health care team, which outlines the specific needs
of your child’s care while at school.
3. diabetes.org/504plan
Sample of 504 plan, which is a written plan that
makes sure that the child with diabetes has all the
same opportunities and education available as children
without diabetes to prevent discrimination.
4. diabetes.org/safeatschool
Information about ADA’s Safe at School Campaign,
which is designed to ensure that children with diabetes
will be medically safe at school and be offered
the same opportunities as children without diabetes
5. diabetes.org/zip
For finding your local ADA office.
6. http://ndep.nih.gov/publications/
PublicationDetail.aspx?PubId=97#main
The National Diabetes Education Program’s Helping
the Student with Diabetes Succeed: A Guide for
School Personnel.
7. There are more resources on the Joslin website:
http://blog.joslin.org/2011/08/back-to-school-withdiabetes-the-basics/
;
http://www.joslin.org/info/
school_lunch_and_diabetes_meal_planning.html
-Ashley Atkins, RN, MSN, CPNP
Get Connected
The Joslin discussion boards are moderated by
Joslin staff and offer a safe place to ask questions
about diabetes and to interact with other parents or
teens living with diabetes.
Teens boards: http://forums.joslin.org/
JoslinDiscussionBoards/41.aspx
Parent boards: http://forums.joslin.org/
JoslinDiscussionBoards/42.aspx
Joslin Blog: http://blog.joslin.org/
If you would like to find a support group in your
area, you can check your local American Diabetes
Association chapter (contact: Anna Floreen,
afloreen@diabetes.org) or your local Juvenile
Diabetes Research Foundation chapter (contact:
Lauren Shields, lshields@jdrf.org).
If you are a college student living with diabetes, you
may want to join the College Diabetes Network at
www.collegediabetesnetwork.org/ to connect with
other students living with diabetes.

PAGE 6 NEWSLETTER NEWSLETTER OF THE OF PEDIATRIC, THE PEDIATRIC, ADOLESCENT, ADOLESCENT, & YOUNG & YOUNG ADULT SECTION
Connor and Evan Murphy, both patients
Donation Spotlight
of Joslin, donated an assortment of
games and crafts to the playroom. The playroom has made their experience at
Joslin a positive and memorable one. Mom stated that, “It always puts a smile on
their faces to go and hang out” and that, “It makes it much easier on us as
parents during appointments.” The boys wanted to do something special for
the playroom because they always have fun there.
Share your achievements on
The Pediatric Star
Board!
Bring in articles or pictures
Pediatrics was fortunate to receive a generous donation of
books entitled The Jester Has Lost His Jingle, by David Saltzman,
from The Jester and Pharley Phund. It is a story that helps
children realize that even when they are feeling upset or frustrated
with a chronic illness, laughing is an important coping
tool. Please see one of the Child Life Specialists, Micaela or
Jen, if you would like one of these books.
from your shining moments
to share with the Joslin community.
Recent stars include:
SCHOOL
DIABETES
SNACKS
METER
Word Search: School Time
FRIENDS
INSULIN
RECESS
TESTING
HOMEWORK
TEACHER
K F R S N A C K S E S
R B S D N E I R F A S
H E C U S T L O V N R
O O H E N E R W S F G
E E O D I A B E T E S
M I O T L C H M T A R
E E L H U H C O E E A
G N I T S E T H C R M
M T H R N R S E T E B
I N N S I R S C E K E
S O E H G S D N E S S
Joslin Patients Participate in the JDRF’s Child’s
Congress in Washington D.C.
Several Joslin patients were picked to attend the JDRF’s
Children’s Congress located in Washington D.C. this
summer. Jackson Savage, Jonathon and Jordan Beals,
Caroline Jacobs, Ellen Shaheen, Abigail Lore, and Emilie
Gordon set out to advocate for themselves and their fellow
friends with Type 1 Diabetes. The three day event
allowed children from all over the country to speak to the
representatives of the United States Congress about
what it is like to live with Type 1 Diabetes, the risk of
complications, and the ongoing need to fund research to
find a cure.
-Micaela Francis, CCLS
Ellen Shaheen and her mom
Caroline Jacobs
Jackson, Jordan,
Jon, & a friend with
Senator Scott Brown
Questions, comments, or suggestions?
E-mail Georgia at georgia.feuer@joslin.harvard.edu
Ashley Atkins, RN,MSN,CPNP
Debbie Butler, MSW,LICSW,CDE
Georgia Feuer, BA
Alyne Ricker, MD — Medical Advisor
Micaela Francis, CCLS
Laurie Higgins, MS, RD, LDN, CDE
Heidi Quinn, MS, RD, LDN
One Joslin Place, Boston, MA 02215
Pediatric, Adolescent and Young Adult Section; (617) 732-2603