1. 10 th Biennial Conference Management of Diabetes in Youth Keystone, July 12-16, 2008 Barbara Davis Center for Childhood Diabetes

2. Goals Learn to serve better children and youth suffering from diabetes Meet colleagues, enjoy the mountains, have fun

3. Tradition Professor Peter Chase, MD BDC Clinical Director 1980-2000 Keystone Conference Program Director 1990-2006 CDF 1977- present

4. Sponsors Platinum: Abbott Diabetes Care Novo Nordisk Gold: LifeScan; Roche Diagnostics; Smith Medical Silver: Medtronic Diabetes, Pfizer, Sanofi-Aventis Brass: Agamatrix; ADA; Animas Corp; BD Medical/DC; Cumberland Hospital; Eli Lilly & Co; Insulet Corp; Nipro Diabetes Systems

5. Organizers Marijane Engel (CDF) Linda Schneider (CDF) Ariel Quigley (CDF) Volunteers (Guild) Carissa Figal (BDC) Ian Smith (BDC) - slides

6. Barbara Davis Center for Childhood Diabetes www.BarbaraDavisCenter.org 1980-2005 Since 2005 Pediatric Clinic: 3,500 T1D & T2D patients Young Adult Clinic: 1,800 T1D patients Eye Clinic, Laboratories

7. Tours of the BDC Thursday 8-3 30 min- 1 hour Contact Carissa Figal to sign up

8. Diabetes in Youth in the U.S. 170,000 patients younger than 20 y 1,500,000 patients with type 1 diabetes all ages Number of new patients annually has tripled in the past 20 years

9. T1D incidence is rising 3-5% per year Due to environmental cause(s) Incidence /100,000/ yr in children aged 0-14

12. Technology

13. Where are We Today? Average A1c by Age, 2005-06 *11-18 yrs; ^the original 14 centers, unchanged compared to 1998 Age Intensive RxHvidoere N=1,295^ Sweden (80% of the nation) Los Angeles N=1664 BDC Denver N=3910 DCCT N=195 EDIC N=175 <6 7.58.07.8 6-12 7.97.88.2 13-188.18.48.6*^8.48.4*8.6 >18 7.17.9 8.0 7.8

14. T1D patients diagnosed in childhood live longer NishmuraR, et al. Diabetes Care 2001 Duration of diabetes (yrs) 0.5 0.6 0.7 0.8 0.9 1 05101520253035 1975- 1970- 1965- Duration of diabetes (yrs) 0.5 0.6 0.7 0.8 0.9 1 05101520253035 1970-74 1965-69 1975-79

15. Incidence of microvascular complications is declining Hovind P, et al. Diabetes Care 2003 1961-65 1966-70 1971-75 1976-80 Diabetic nephropathyProliferative diabetic retinopathy 1965-69 1970-74 1975- 79 1980-84 30 20 10 40

16. Poor control of hypertension and dyslipidemia in young adult patients with T1D Hypertension Dyslipidemia Maahs D, Diabetes Care 2005 Wadwa P, Diabetes Care 2005

17. CME Credits Nurses must sign in daily Nurses must sign in daily All others need to sign in only once All others need to sign in only once The sheets are at the Conference Registration desk The sheets are at the Conference Registration desk The American Dietetic Association may award additional credits. The American Dietetic Association may award additional credits.

18. Evaluation sheets Sheets included with your materials Sheets included with your materials Please turn in on the last day at the Conference Registration desk Please turn in on the last day at the Conference Registration desk Your feedback and suggestions for the future are important! Your feedback and suggestions for the future are important!

19. Books “Understanding Insulin Pumps & CGMs” by Peter Chase included in your backpack Additional copies as well as the “Pink Panther” books available for sale at the Registration desk

20. Dinner tonight Here, Longs Peak room, 5:45-6:45 Speaker: Dr. Robert Slover (BDC) Topic: “Closing the loop with insulin pumps and glucose sensors” Sponsored by: LifeScan, Medtronic Diabetes & Novo Nordisk Followed by “Meet with Counterparts”, here 6:45-8:00

21. Altitude sickness Headache Poor appetite, nausea, vomiting Fatigue or weakness Dizziness or light-headedness Insomnia Pins and needles Shortness of breath on exertion Persistent rapid pulse General malaise, drowsiness Swelling of hands, feet & face) Above 8000 ft - 20-30% of visitors from low altitude affected Keystone 9300 ft (2800 m) - 72% of the oxygen at sea level Mountains 12000-14000 ft (3650-4300 m) – 60-65% of the oxygen Symptoms last usually 1-2 days only, if severe – seek help !

22. Prevent altitude sickness Stay at low elevation Do not exercise hard Drink more water (avoid carbonated drinks) Eat more carbs, less fat and less salt Reduce alcohol and caffeine intake Feeling worse? - seek help smoking, emphysema, asthma, anemia, diabetes, high blood pressure UV, lightning, cold, dehydration