Review: I Tried the CeQur Simplicity Insulin Patch

The CeQur Simplicity is a mealtime insulin patch.

This new, unique device needs a bit of explanation. It is not an insulin pump. It attaches to the body, and then it does exactly one thing: With a click, it delivers two units of fast-acting insulin.

If you use multiple daily injections (MDI) of fast-acting insulin before meals, the CeQur patch offers enhanced discretion and convenience. This review should help you decide if it’s worth a try.

CeQur (pronounced “secure”) kindly provided me with a sample package for this review. All words and thoughts are my own.

What Is It?

The CeQur Simplicity is a thin, plastic, single-use device that attaches directly to your skin with an adhesive. Just like an insulin pump, it delivers insulin under the skin through a cannula, or tiny tube. After three days, you toss it in the trash and apply a new patch.

You load the patch up with insulin before attaching it to your body. It’s approved for use with Humalog and Novolog U-100 insulins — fast-acting insulin for meals (and blood sugar corrections). This insulin patch does not deliver insulin continuously and cannot be used for basal insulin requirements.

Image courtesy CeQur

This patch has no electronic components at all. It doesn’t have a battery, and it doesn’t sync up with a smartphone or receiver. It has only one function. By clicking two plastic tabs simultaneously, it delivers exactly two units of insulin. You can click it multiple times in a row to deliver four, six, or eight units of insulin, and so on. (The tabs are on opposite sides of the patch, making it incredibly unlikely that they get pressed accidentally.)

You wear the CeQur patch on your belly or abdomen. It’s light and easy to wear, water-resistant, and low profile. It is extremely easy to use discreetly — you can click the two tabs through a shirt or other clothing, allowing you to bolus at a restaurant or meeting without anyone noticing the slightest thing.

Insertion

Getting the patch fully loaded and onto your body does take more than a few steps:

  1. Fill the special syringe with 100 to 200 units of your fast-acting insulin.
  2. Inject that insulin to the patch’s reservoir.
  3. Prime the patch to remove air bubbles and get insulin loaded into the tubing.
  4. Load the patch into a special hard plastic inserter and snap it into position.
  5. Expose the needle and adhesive.
  6. Complete the insertion.
  7. Carefully remove (and dispose of) the needle.

The needle, to tell the truth, appeared menacingly long once it was exposed. But I found the application completely painless, even less painful than inserting a CGM. I didn’t even feel a pinch.

But all these steps do mean that insertion has a learning curve and can’t be accomplished on the run. You can see how it works in this YouTube video.

(I appreciate, by the way, that the CeQur system reuses the inserter, which reduces plastic waste.)

Who Is It For?

Anyone that uses multiple daily mealtime injections to manage their type 1 or type 2 diabetes may benefit from the CeQur.

But you’ll get the most value out of this device if you:

  • Currently use MDI
  • Use a vial and syringe, not insulin pens
  • Use 25-plus units of fast-acting insulin per day
  • Are content with your basal insulin injections
  • Wish you could deliver your mealtime insulin in a faster, easier, and more discreet manner

The CeQur patch might also be an improvement for those with “needlephobia,” dramatically reducing the number of times you need to stick yourself with an exposed needle.

The device is definitely not for everyone. Anyone that already uses an insulin pump has no need for it. If you use insulin pens, as opposed to syringes and vials, the system probably won’t work for you either. And if you use fewer than 25 units of fast-acting insulin per day, it might not make sense for you.

My Take

Once I had the CeQur patch on my body, it worked exactly as it was supposed to.

I really appreciated removing the annoyance of using my syringe and vial every time I ate. I was able to bolus two units effortlessly, whenever I wanted, without reaching for my diabetes supplies or even lifting up my shirt. I can’t tell you how many times I’ve lazily decided not to eat an apple just because I didn’t want to bother measuring and injecting my insulin (and have instead opted for low-carb-but-high-calorie cheese, nuts, or dark chocolate).

I also loved how it reduced the number of diabetes supplies I needed to carry around outside of the house.

CeQur claims that its device leads directly to improvements in A1C and time in range. It didn’t help my control, but I suppose it could be a real advantage for patients who regularly allow the hassle of injection to prevent them from properly bolusing (and prebolusing) for meals. Once the patch is on your body, delivering a bolus is incredibly easy.

The truth is that I wouldn’t wear these patches during my normal everyday life. I have the good luck to be fairly insulin sensitive, and I eat pretty low carb on top of that. I often dose for one, three, or five units at a time, so the count-by-twos dosing reduces my flexibility. More importantly, I almost never use enough rapid insulin to empty a 100-unit reservoir every three days. I would end up throwing quite a lot of insulin in the trash — waste I could never live with, even if I could afford it.

But there are times when I know I’ll need more insulin and appreciate the enhanced discretion. On vacation, for example, I eat more carbs than usual, and I eat out for many meals. And I’m less likely to have tried-and-true carb counts and insulin doses to lean on. It’s a perfect time to use the CeQur. I would love to just click my patch during meals, rather than repeatedly brandishing my syringe at a restaurant.

You can arrange a trial of the CeQur Simplicity insulin patch by first scheduling a telehealth appointment. If you’re interested in getting started for real, talk to your doctor: The CeQur patch requires a prescription to use. The manufacturer reports that its device is covered by many insurance carriers.

Source: diabetesdaily.com

Could There Be a Vaccine for Type 1 Diabetes?

This content originally appeared on diaTribe. Republished with permission.

By Andrew Briskin

In the search for new and innovative ways to treat type 1 diabetes, researchers have looked to develop therapies that protect or improve the body’s ability to produce its own insulin. Learn about the basics of a vaccine currently in development and how it could potentially slow or halt the progression of type 1 diabetes.

For decades, type 1 diabetes treatment has focused on treating the condition, mainly with insulin. In recent years, however, therapies that target the immune system (immunotherapies) have gained more and more traction in their potential to delay or prevent type 1.

You may have heard about a new drug called teplizumab, which has gained much excitement due to its potential to target the immune system and delay a diagnosis of type 1 diabetes for two years or more. A vaccine known as Diamyd, while not as far along in development as teplizumab, also holds promise as a potential immunotherapy for type 1.

As a reminder, type 1 diabetes is a condition where the body’s own immune system attacks and destroys the cells in the pancreas that produce insulin, known as beta cells. This occurs because of something called an auto-antibody. Antibodies are part of your immune system, and their purpose is to identify and neutralize bacteria and viruses. Auto-antibodies, however, mistakenly target one or more of your body’s own proteins, which may damage tissues and organs. One auto-antibody typically found in people with type 1 diabetes targets a type of protein known as GAD-65.

The destruction of the beta cells progresses at different speeds, depending on each individual. However, by the time type 1 diabetes is usually diagnosed, approximately 80% of beta cells have been destroyed. This damage continues until the person becomes completely dependent on insulin injections.

But what if a vaccine could stop this auto-immune destruction before it even occurs? Enter Diamyd Medical, a Swedish biotechnology company taking a unique approach in developing a type 1 vaccine, Diamyd.

Because GAD-65 is found in the beta cells of the pancreas, auto-antibodies against GAD-65 recognize the protein and damage the beta cells. “What we want to do is re-program the immune system, specifically how it reacts to GAD-65. It’s like a reverse, or therapeutic, vaccine,” said Ulf Hannelius, CEO of Diamyd Medical. “The objective is to change the pro-inflammatory, autoimmune reaction to GAD-65, and to skew that to an anti-inflammatory reaction.”

How it works

Researchers at Diamyd are currently taking the approach of injecting a small amount of the GAD-65 protein into a lymph node several times during the study. (Lymph nodes are small, bean-shaped structures throughout the body that contain some of the body’s immune cells.)

The hope is that these immune cells will travel to the pancreas, encounter a beta cell with GAD-65, and instead of destroying the beta cells, work to reduce the attack and preserve them.

Where we are today

Over the past two decades, several obstacles have emerged, including a trial that failed to demonstrate the vaccine’s effectiveness that was suspended in 2011. Since that time, however, the company has made several changes. According to Hannelius, the company has changed the way that the vaccine is administered (directly into the lymph nodes instead of under the skin), and is now recruiting participants from a slightly broader age range (12-29 years) than before.

“We haven’t made any actual change to the drug or formulation, but we now administer the vaccine directly to the lymph nodes, the site where the immune reaction happens, with a much smaller dose,” said Hannelius. “Even with the smaller dose, we are now seeing a much stronger immune response compared to when we injected [just under the skin].”

Additionally, the company now screens for the presence of a particular gene associated with a high risk for type 1 diabetes. According to Hannelius, this gene is found in up to 40% of people with type 1, with this sub-group showing a particularly positive response in clinical trials.

In the past two years, data has been promising. In 2021, the company published results from its phase 2b trial, DIAGNODE-2. This study, which included 109 study participants ages 12-24, showed that the vaccine improved glucose management, as measured by Time in Range, in recently diagnosed study participants throughout the 15-months of the study, compared to the placebo group.

Diamyd and LADA

On July 7, Diamyd announced results from a 14-person safety study with promising results in people diagnosed with latent autoimmune diabetes in adults (or LADA). LADA, like type 1, is a form of autoimmune diabetes, but the attack on beta cells takes longer, with the diagnosis usually occurring in adults. The complete study results will be presented at the European Association for the Study of Diabetes (EASD) 2022 annual conference in Stockholm, Sweden in September, which diaTribe will be attending on-site.

Upcoming Diamyd Clinical Trial

Diamyd is now starting a new phase III trial called DIAGNODE-3. On May 19, Diamyd announced that the trial enrolled its first participant. The trial is currently enrolling at 20 clinics across several European countries including Sweden, Spain, Germany, the Netherlands, Poland, and Czechia. Researchers hope to include 330 participants in total.

While the trial has been on a partial clinical hold in the U.S. since October 2021, Hannelius mentioned that the company is working hard to address the FDA’s concerns. He hopes that the FDA will be able to lift the clinical hold in time for Diamyd to offer the trial to US clinics and patients.

In general, Diamyd represents another effort to find an immunotherapy that could potentially delay or prevent type 1 diabetes, and prevent complications in the future. Researchers continue to work towards new and innovative ways to treat type 1 diabetes, and the Diamyd vaccine might eventually become a treatment option that, unlike insulin, combats the immune response that leads to type 1 diabetes.

To find out more about the DIAGNODE-3 trial, participating European locations, and eligibility, read the clinical trial page or contact clinicaltrials@diamyd.com for more information.

To find out more about immunotherapies for type 1 diabetes, read these articles:

Source: diabetesdaily.com

Study: Higher Insulin Doses May Increase Cancer Risks in Type 1 Diabetes

A new analysis has suggested that people with type 1 diabetes that use larger amounts of insulin have an increased risk of cancer.

The news arrived in the form of a research letter published by JAMA Oncology, written by Wenjun Zhong, PhD, a statistician with pharmaceutical giant Merck, and Yuanjie Mao, MD, PhD, a professor of endocrinology at Ohio University.

Zhong and Mao were working with an old and important data set: the Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Interventions and Complications (EDIC) study. These two trials were the first to definitively link intensive glucose control with reduced risk of diabetic complications, changing mainstream diabetes treatment as we know it. The DCCT and EDIC remain the best looks we’ve ever had at long-term outcomes in type 1 diabetes, and continue to yield fresh insights.

Study participants were stratified into low, medium, and insulin high insulin use categories:

  • Low use: <0.5 units per kilogram per day (38.5 units per day for an average American woman weighing 170 pounds)
  • Medium use: Between 0.5 and 0.8 units/kg per day
  • High use: >0.8 units/kg per day (61.6 units per day for an average American woman)

Those in the high use category were nearly 50% more likely to develop cancer than those in the low use category, with the medium use category nearly as high.

It is unclear from the analysis if the increased use of insulin itself causes cancer, or if the increased use of insulin is simply a consequence of other health problems that might be associated with cancer development. High levels of endogenous insulin have been linked with cancer in people without diabetes, as has insulin resistance, two conditions so related that it is difficult to tease them apart.

It took decades for the increased risk of cancer to reveal itself among the participans in the DCCT and EDIC trials. Most of the cases of cancer identified in the new analysis were diagnosed in the third decade of follow-up, 20 years or more after the trials began. The average patient was 50 years old at the time of their first cancer diagnosis.

Other factors, including glucose control and obesity, did not have a correlation with cancer incidence.

What does it mean for real people with type 1 diabetes? Dr. Mao interpreted the results:

Our results implied that clinicians might need to balance the potential cancer risk when treating patients with type 1 diabetes on a high daily insulin dose or that improving insulin sensitivity may be preferred than simply increasing the insulin dose.

It seems unlikely that doctors will recommend that patients intentionally take less insulin to reduce the risk of cancer, given the overwhelmingly negative effect of chronic hyperglycemia. Optimal glycemic control remains paramount for people living with type 1 diabetes.

But it is possible to reduce insulin requirements the right way: by improving your insulin sensitivity. Insulin sensitivity is a blend of both modifiable and unmodifiable factors (like age and family history). According to the CDC, the two biggest modifiable factors are excess weight and physical activity. Working out regularly and losing weight should reduce the amount of insulin you need to stay comfortably in your blood sugar range. There are other smaller factors too, including sleep quality and nutrition. Check out our article: “How to Become More Insulin Sensitive.”

Exercise and diet can also reduce short-term insulin requirements. A lower-carbohydrate diet, especially one that avoids sugar and simple starches, can reduce insulin requirements as quickly as your next meal. And many people with diabetes find that cardiovascular exercise, even at a light intensity, is a better way of correcting some blood sugar highs.

While the news gives us another reason to consider prioritizing insulin sensitivity, you should speak to your doctor before making any dramatic diet or lifestyle shifts. A rapid drop in insulin requirements carries with it a risk of hypoglycemia, and it may be necessary to quickly change your dosage of insulin and other glucose-lowering medications.

Takeaways

For people with type 1 diabetes, high daily insulin usage may be associated with increased long-term risk of cancer.

The change in absolute risk is not massive, and it shouldn’t be any reason for panic. However, it is yet another reminder of the value in reducing insulin requirements through diet, exercise, and other healthy lifestyle habits. When your body is more insulin sensitive, it’s easier to keep your blood sugar in range, and there may be long-term benefits, to boot.

Source: diabetesdaily.com

Sugar-Free Coconut Cream Pie

This content originally appeared on Sugar-Free Mom. Republished with permission.

All coconut lovers will enjoy this delicious keto coconut cream pie with homemade pie crust and rich creamy coconut flavor in your first bite!

If you’re on a keto diet or low carb diet, traditional coconut cream pie is much too high in carbs to be enjoyed while losing weight or trying to get into ketosis. Our recipe today for sugar-free coconut cream pie has just 3 net carbs per slice!

Using egg yolks as opposed to whole egg with egg whites is how to make this coconut pie the creamiest keto dessert recipe you’ve ever had!

Print

Sugar-Free Keto Coconut Cream Pie

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Course Dessert
Cuisine American
Servings 12 slices
Calories 280kcal

Ingredients

  • 1 pre-made coconut flour pie crust
  • 13.5 ounces canned coconut milk
  • ½ cup Better Than Sugar Confectioners
  • ¼ teaspoon salt
  • 1 teaspoon coconut extract
  • 4 large egg yolks
  • 2 teaspoons gelatin
  • 4 ounces cream cheese
  • 1 cup heavy cream
  • ½ teaspoon coconut stevia or to taste
  • 1 cup unsweetened shredded coconut divided in half OPTIONAL

Instructions

  • In a large saucepan, over medium low heat, add the coconut milk, sweetener, salt, and extract. Stir to combine. Do not boil.
  • Whisk the eggs in a small bowl. Temper the eggs by adding a small amount of the coconut mixture into the eggs a little at a time. Do this 3 times then stir in all the eggs into the sauce pan on the stove. Bring to a simmer. Sprinkle the gelatin over the coconut milk and whisk until dissolved. Continue to stir until mixture thickens and internal temperature is 175 degrees F. Remove from the heat. Allow coconut mixture to cool about 1 hour.
  • Add the cream cheese to the stand mixer with the paddle attachment and blend until smooth. If you are using the optional shredded coconut, add it to a dry skillet and cook on low heat, stirring constantly, until browned. Once cream cheese is smooth, pour in half the toasted coconut and blend through. Save remaining for topping.
  • Add the cooled coconut mixture to the cream cheese in the stand mixer. Blend until well combined and smooth. Taste and adjust sweetener. Pour in 1 cup heavy cream and liquid stevia, switch to the whisk attachment and whisk on medium speed for about 10 minutes to slightly thicken. Taste and adjust sweetener. Pour the batter into the pie crust.
  • If using optional shredded coconut, sprinkle remaining shredded coconut over the pie and refrigerate 6 hours or overnight. Optional topping: When you are ready to serve, use a whipped cream canister to decorate crust of pie.

Notes

Net Carbs 3g (optional shredded coconut not included)
If you use optional shredded coconut, total carbs will be 8 instead of 6 and fiber will be 4, making net carbs 4 grams.

Nutrition

Serving: 1slice | Calories: 280kcal | Carbohydrates: 6g | Protein: 5g | Fat: 26g | Saturated Fat: 17g | Polyunsaturated Fat: 1g | Monounsaturated Fat: 2g | Cholesterol: 103mg | Sodium: 185mg | Potassium: 110mg | Fiber: 3g | Sugar: 1g | Vitamin A: 209IU | Vitamin C: 1mg | Calcium: 22mg | Iron: 1mg


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

Source: diabetesdaily.com

Explaining the Research: What Will It Take To Cure Diabetes?

This content originally appeared on Beyond Type 1. Republished with permission.

By Julia Sclafani

People with type 1 diabetes have heard that a cure is five or 10 years away for many years. This moving target and lack of clarity into what’s happening behind the scenes has left many people in our community feeling frustrated.

The scientific understanding of type 1 diabetes (T1D) has progressed by leaps and bounds in recent decades, turning what once seemed impossible because it has never been done—curing an autoimmune disease—into a possibility. The next steps include turning accumulated knowledge into actionable solutions. And potential solutions are being tested in people right now.

JDRF is the leading global organization funding T1D research. While a large part of their work is in accelerating better treatments for and potentially slowing or preventing the onset of T1D, the majority of their research focus and research dollars) is on potential cures for T1D, with a goal of ending the disease entirely. JDRF Chief Scientific Officer Sanjoy Dutta explains the current state of research on diabetes cures and how we’ve gotten here.

Here are a few significant developments in what we understand about T1D from the last 30 years:

  • It’s not just a childhood-onset disease (the former name of ‘juvenile diabetes’ is a misnomer); half of newly diagnosed individuals are adults.
  • If you have an immediate family member with T1D, you have a 15x higher chance of developing it. However, 85% of people who are newly diagnosed have no known family history of T1D.
  • T1D is more prevalent in certain ethnic groups.
  • There are more than 50 genes known to have some impact on T1D.

Diabetes Is Complex

There’s no single known cause for T1D, and that leaves many questions open as to how to best treat, cure or even prevent it.

Dutta explained that researchers are looking at non-genetic factors that may contribute to T1D, like environmental triggers, viruses and even gut microbiota.

It’s hard to study these factors since T1D isn’t typically diagnosed until a person’s body has stopped or significantly reduced producing insulin, even though the disease starts long before insulin production stops.

“This often makes type 1 diabetes a very challenging disease to study,” Dutta said. “It is asymptomatic and precipitates in an individual without much forewarning.”

Screening for T1D is available and can identify the early stages of T1D before it becomes symptomatic. However, childhood screening is not yet standard clinical practice.

Early detection and monitoring would help researchers study the disease’s progression before a person is showing the warning signs of T1D.

Expanding Our Understanding of T1D and Cures

Despite this, scientific understanding of T1D has advanced significantly. This shift in understanding diabetes has changed how the scientific community approaches T1D research.

This understanding has “led us to focus on different pathways of curing the disease. That’s why we often refer to them as cures because we don’t think it will be a one size fits all.”

Some researchers even suggest that what is referred to as T1D may be several different diseases with similar and overlapping symptoms, Dutta said. Just as we used to think T1D only developed in children, our current understanding of diabetes may also continue to evolve.

“No two individuals with type 1 diabetes are the same—sometimes even two siblings present very, very differently with type 1 diabetes,” Dutta said. “This heterogeneity of type 1 diabetes has made it very difficult to attack it with one therapy that’s going to work for everyone.”

Two Major Areas of Focus in Diabetes Research

One of the exciting areas of cures research JDRF supports is cell replacement therapy, like the treatments being developed by ViaCyte and Vertex Pharmaceuticals that are currently in clinical trials.

“Instead of trying to solve the immune problem in the body and regrow the beta cells in the body, we make the cells outside the body and try to implant them into the body.”

Beta cell replacement therapy aims to replace the cells that have stopped producing insulin in people with T1D. While this therapy does not restart the body’s ability to produce insulin using its own cells, it does allow insulin to be produced in the body using the transplanted cells. This is referred to as a functional cure.

Research on stem cell-derived cell replacement therapy has come a long way in the last 20 years.

“We know how to make the beta cells outside the body and we can make them in billions of quantities for many people with type 1 diabetes… islet transplantation and pancreas transplantation from donor cadavers have taught us that we can cure the disease through transplantation.”

Cell replacement therapy currently requires immunosuppression (drugs that keep the body’s immune system from attacking the transplanted cells) but research is ongoing to develop cell replacement therapies that work without the need for immunosuppression.

Another area of focus for JDRF is on the underlying pathology of T1D—meaning learning how to identify and address its causes. This could mean halting, slowing or reversing the causes of T1D.

“It’s a dual-pronged approach—to reset the immune balance and regrow beta cells,” Dutta said.

These treatments are called disease-modifying therapies. One drug, teplizumab, has been shown to delay the onset of type 1 diabetes for people who have the autoantibody markers of the disease. It is currently under FDA review.

Clinical Trials Take a Long Time

Numerous beta cell replacement therapies have reached the clinical trial phase. But trials for these treatments take a long time.

“It takes six to 12 months of treating an individual with a drug to see a small change in beta cell production. That is if the drug works.

“There are many diseases where you can do a clinical trial and you can get a readout in 30 days’ time, in 60 days’ time. You can move faster and also have many horses in the race,” Dutta said.

Clinical trials for experimental T1D treatments don’t work like that. This long—and sometimes frustrating—process is the subject of the newly debuted documentary, “The Human Trial.

Money Fuels Research

On average, it takes 15 years and $1.5 to $3 billion to develop a drug and make it available to consumers—and that’s for a “normal drug,” Dutta pointed out.

“Research may feel incremental because research is slow in drug development.”

About 85 to 99% of experimental treatments fail, meaning less than one out of ten ideas is going to be effective.

“And so these will take time, will take significant resources, will require lots of clinical trials, lots of human participation there. These are the challenges of drug development.”

JDRF has established an innovative venture philanthropy fund, the T1D Fund, aimed at accelerating T1D research, with a major focus on T1D cures. The goal is to accelerate diabetes research and scientific breakthroughs.

Looking Toward the Future of Cures Research

Dutta acknowledges the lack of breakthroughs may feel frustrating.

“Are people with diabetes where they would like to be? Absolutely not. They want to be off their devices. They want to be off carb counting. They want to be insulin-free. And we’re not there yet.”

Taking a long view, Dutta keeps perspective on where advancements have been made and where things are headed.

Diabetes care and diabetes technology are advancing rapidly. Automated insulin delivery systems and continuous glucose monitoring have changed daily life for many people with T1D, though more people need access. Hyperglycemia and rates of diabetes-related complications have gone down, Dutta points out.

People now are becoming pilots, swimmers, athletes, truck drivers and other things that they were not able to even dream of 10, 15 years. ago. So, that gives me hope,” Dutta said.

Dutta is confident scientific understanding of diabetes will continue to accelerate and that there is reason to be hopeful for new advances and breakthroughs in the science and treatment of T1D.

“It will feel incremental, but we just need to turn the corner once—and I think…the floodgates will open because then we will prove to ourselves that we can do it.”

Source: diabetesdaily.com

The Role of Exercise in Improving Gestational Diabetes Outcomes

This content originally appeared here. Republished with permission.

By Adeline Jasinski

Gestational diabetes affects as many as 1 in 10 pregnancies in the US and can have negative consequences for both the parent and the baby. Proper exercise may help you prevent or manage your gestational diabetes.

According to the Centers for Disease Control and Prevention (CDC), gestational diabetes affects between 2% and 10% of pregnancies. It’s a common diagnosis, but just because it’s common does not mean that it’s not scary. If you were recently diagnosed with gestational diabetes, you may have questions about why you developed it, how you can manage it, and how it will affect you and your baby.

What is gestational diabetes?

During pregnancy, the placenta releases hormones to support the pregnancy. In some people, these hormones make the body’s cells temporarily resistant to insulin, leading to gestational diabetes. In this way, pregnancy causes gestational diabetes, meaning that those who develop it did not have any type of diabetes before becoming pregnant.

Normally, insulin helps most cells of the body open to let glucose in. When the cells become resistant to insulin such as during pregnancy and the pancreas cannot supply enough insulin, too much sugar stays in the bloodstream, resulting in high blood glucose levels. But who is most at risk for developing gestational diabetes?

Risk factors for developing gestational diabetes

Certain factors can put you at higher risk for developing gestational diabetes. You are more likely to develop gestational diabetes if you:

  • Have obesity or excess weight
  • Do not get the proper nutrition
  • Are deficient in micronutrients such as Vitamin D, A, iron, zinc, folate, and iodine
  • Are at advanced maternal age
  • Have a family history of type 2 diabetes

Some of these factors, such as your age and family history, are out of your control. But you can always work on your diet and exercise habits. By taking steps to maintain a healthy weight, exercise, and get the right nutrition, you can reduce your risk of gestational diabetes. In doing so, you reduce your own risk of future illness as well as the risk for your future children.

It can be easier to talk about maintaining a healthy weight and eating right than to do it. If eating healthy foods and exercising are not habits for you, you might not know where to start. You will find some actionable tips below, but you should also talk to your healthcare provider before starting a new exercise program or making major changes to your diet.

Gestational diabetes puts you and your child at risk

For many people, gestational diabetes goes away after delivery. However, it can affect your future health and the health of your baby. That is why it is so important to prevent gestational diabetes from developing .

If you do develop this condition, it is critical that you carefully manage it during the pregnancy and take action after pregnancy to try to avoid future health problems.

Women who develop gestational diabetes have a high risk of developing type 2 diabetes and cardiovascular disease later in life. Gestational diabetes can also have a long-term impact on the baby’s health, too. Children whose parents had gestational diabetes are more likely to have obesity or excess weight. They are also more likely to have poor metabolic health, including greater insulin resistance, impaired glucose tolerance, type 2 diabetes, and low insulin secretion.

However, if you currently have gestational diabetes, do not feel discouraged. New research shows that changes in maternal behavior can positively impact children’s health. Children of parents with obesity who received treatment for gestational diabetes had better childhood BMI outcomes than children of those who declined treatment for gestational diabetes.

Treatment of Gestational diabetes

Lifestyle behavior change (including exercise and a prescribed diet) is an essential component of management of gestational diabetes and may suffice for many women. Insulin should be added if needed to achieve glycemic targets. Insulin is the preferred medication for treating high blood sugars in gestational diabetes mellitus.

Can exercise help manage or even prevent gestational diabetes?

Physical activity reduces blood glucose levels. Exercise causes muscle cells to increases glucose consumption. It also makes muscle cells more sensitive to insulin, which means they continue to take up glucose after exercise. Through these two mechanisms, exercise can help you manage your glucose levels.

If exercise helps manage blood glucose levels, it makes sense that exercise might also help prevent gestational diabetes. Several researchers have asked this question and found that physical activity can do just that.

One recent analysis looked at over 40 studies that followed more than 16,000 women to see which methods work best for preventing gestational diabetes. This analysis found that regular physical activity and a dietary intervention were beneficial in preventing gestational diabetes, although it did not specify which type of activity is best.

Another study went further and examined whether resistance exercise effectively mitigates symptoms of gestational diabetes. In resistance exercise, large muscle groups contract to overcome an external resistance, such as weights.

This study followed 99 women with gestational diabetes. These women were provided online education tools as well as personal dietary guidance from nutritionists and nurses. Half the women received only dietary training while the other half also completed a six-week resistance training program.

The women who went through the resistance training program performed moderate resistance activities three times a week under the supervision of a nutritionist, sports medicine expert, and the researcher. The women improved their gestational diabetes outcomes according to several measures:

  • Lower fasting blood glucose levels
  • Lower postprandial blood glucose levels (post-meal levels)
  • Lower rates of insulin use
  • Reduced blood pressure
  • Reduced weight gain during pregnancy

How to incorporate resistance training into your routine

Incorporating physical activity into your routine can help you control your blood glucose levels and prevent or manage gestational diabetes. April Semon, Public Health Nutritionist with the New York State Department of Health, said, “Moderate physical activity is important for pregnant women but especially for women who have gestational diabetes. Moderate physical exercise can help insulin work better in the body and improve blood glucose levels.”

Semon added that any activity will help, but resistance training is a good option for those with gestational diabetes and for pregnant people in general. She described that in the second and third trimesters of pregnancy, people experience a forward shift in their center of gravity because of the growing fetus, which can make aerobic activity challenging. Resistance training is stable, which may make it easier and more comfortable. Even people on bedrest can perform resistance activities.

Your routine should target your major muscle groups, although you can spread the work out over multiple days. For example, you might target the upper body on one day, and the lower body on another. Here are some suggested resistance exercises (with descriptions) to do during pregnancy:

  • Chest and shoulders: chest press and lateral raise
  • Back: seated row
  • Arms: dumbbell row and triceps kickback
  • Legs: dumbbell squat, cable back kick, and standing calf raise
  • Core: plank, bird dog, and side bridge

When working out, avoid motions that flex at the hips or waist as well as overhead lifting, as these can place too much stress on the lower back.

As always, listen to your body and rest when you need to. Consider working with a personal trainer who specializes in pregnancy if you need more guidance.

Incorporating exercise, especially resistance training, into your routine could help prevent or manage your gestational diabetes. To learn more about gestational diabetes and exercise, you can read these articles:

Source: diabetesdaily.com

Keto vs. Mediterranean: Should We Be Eating More Fruit, Legumes, and Whole Grains?

The American Journal of Clinical Nutrition has published the results of a new trial pitting the keto diet against a lower-carb Mediterranean diet for individuals with type 2 diabetes and prediabetes.

Each diet restricted carbs, but the Mediterranean diet included generous amounts of fruit, legumes, and whole grains. Which diet had a more powerful effect on health, including blood sugar control and cardiovascular risk factors? Read on …

The Design

Although the trial was not especially large, with just 33 participants, it had a very clever design. Volunteers were asked to eat either a well-formulated keto diet or a lower-carb Mediterranean diet designed to share three key similarities. Each diet:

  • Restricted added sugars
  • Restricted refined grains
  • Emphasized nonstarchy vegetables

These three guidelines — each of which is endorsed by practically every nutrition authority out there — ensured that the two diets shared a nutritious foundation. Just as important, the substantial overlap between the two diets allowed the researchers to isolate the nutrition factors that they really wanted to study.

That brings us to the three key differences between the two diets. The keto diet eliminated the following three foods, and the Mediterranean diet emphasized them:

  • Most fruits (The keto diet allowed limited amounts of berries.)
  • Legumes
  • Whole, intact grains

The image below summarizes these differences (“WFKD” stands for “well-formulated ketogenic diet,” and “Med-Plus” is the lower-carb Mediterranean diet).

The American Journal of Clinical Nutrition, https://doi.org/10.1093/ajcn/nqac154

These three differences were the real focus of the study. Restrictions against fruit, legumes, and whole grains arguably represent the most significant ways that keto and very low-carb diets violate nutrition orthodoxy — and help explain why diabetes authorities have appeared nervous about recommending them.

The primary question as, the study itself puts it, was:

Do people with an impaired glucose metabolism experience greater metabolic benefits or harms when restricting legumes, fruits, and whole, intact grains in addition to avoiding added sugars and refined grains?

Fruits, legumes, and whole grains are widely hailed as some of the healthiest ingredients you can put in your body, but low-carb advocates try to avoid or eliminate them because they are high-carb. Some argue that even the healthiest carbohydrates, those from minimally processed whole foods with plenty of fiber and protein, will still stress the metabolism, especially for those of us with diabetes.

The keto diet in this study, which followed the influential guidelines set forth by two of the diet’s most prominent advocates, aimed to limit carbs to 20 to 50 grams per day.

It’s important to reiterate that the Mediterranean diet used in this experiment may not match the Mediterranean diet you’re imagining. Because they were avoiding refined grains, study participants ate very little pasta or bread. The researchers clarified this by calling their diet “Mediterranean-plus.” It was essentially a lower-carb Mediterranean diet. The primary sources of protein and fats were seafood and olive oil.

Study participants, all of whom had prediabetes or type 2 diabetes, were randomly assigned to try one diet for 12 weeks, and then to switch and try the other diet for an additional 12 weeks. They were told to eat their fill — which means that any weight loss was incidental, a natural consequence of the diet and not the result of any specific attempt to lose weight.

The Reality

There’s the design of a study, and then there’s the reality of it. You can tell volunteers that they’re not able to eat sugar for 24 weeks, but unless you have them under lock and key they’re bound to slip up. For some of the study period, volunteers were provided with carefully measured meals. But for the majority of it, they did their own shopping. During those sessions, unsurprisingly, they just about doubled their intake of added sugar and refined grains (although they remained far below their established baseline).

Arguably, this makes the findings of the study even more useful. In the real world, most people are going to cheat a little bit. A study that examines perfect adherence to an extreme diet may be of limited relevance to the average person who doesn’t want to say goodbye to cookies and pizza for the rest of their lives.

Before the study began, our participants averaged 746 calories per day from carbohydrates, much of it coming from a much larger amount of added sugar and starch. On the keto diet, participants took in about 250 calories per day from carbohydrates, and about 16 grams of fiber. On the Mediterranean diet, participants took in an average of 556 calories per day from carbohydrates, and 24 grams of fiber.

It seems like the minor straying didn’t matter much. During every part of the experiment, volunteers ate a lot fewer calories, 250 to 300 fewer than they were accustomed to eating. This total did not vary between diets, nor did it change when participants switched from premade meals to self-catered. Remember, the diners were allowed to eat as much as they wanted within diet restrictions, so this suggests that both diets drove effortless calorie cutting.

The Results

Glucose Control

Both diets significantly improved glucose control, just about equally. Study participants improved their A1C and their fasting blood glucose.

Continuous glucose monitor (CGM) measurements suggested that the keto diet lowered blood sugar more effectively than the Mediterranean diet. And a variety of sensitivity analyses attempting to control for the effects of medication use, COVID-19 lockdowns, and other factors suggested that the keto diet may have conferred statistically significant glycemic improvements over the Mediterranean diet.

The bottom line? Both diets had big blood sugar benefits, but the keto diet may have narrowly outperformed the Mediterranean diet.

Cholesterol

The cholesterol results were somewhat mixed.

Both diets increased HDL, so-called “good cholesterol,” and both diets decreased triglycerides; each change represents a major metabolic improvement. The keto diet fared somewhat better here. It conferred a larger decrease in triglycerides, and, according to some sensitivity analyses, may also have had a better impact on HDL levels.

But there was one big difference between the two diets: They had opposite effects on LDL (“bad”) cholesterol. The Mediterranean significantly reduced LDL cholesterol levels, but the keto diet significantly increased them.

Much study has linked high LDL cholesterol with bad cardiovascular outcomes, including early death from heart attack and stroke, which has made it a primary target of diabetes medical interventions. But many prominent low-carb advocates dispute the connection between LDL and cardiovascular disease, especially for those on a ketogenic diet.

Weight

Despite not actively attempting to shed weight, participants lost a good deal of weight on both diets. Those on the keto diet lost a bit more.

After phase 1, volunteers eating keto lost a very impressive average of 6.9 kilograms (kg) (about 15 pounds). Those eating the Mediterranean diet lost a still-notable 4.9 kg.

Nutrients

The Mediterranean diet was more nutritionally replete. Participants in the Med-Plus phase consumed more folate, vitamin C, and magnesium than those in the keto phase, although it’s not clear if these deficiencies rise to a concerning level. The Mediterranean diet also included about 50 percent more fiber.

Satisfaction

Volunteers appeared to enjoy each diet equally. There was no significant difference between the two diets in quality of life measures or in adherence rates.

There was one subtle point in favor of the Mediterranean diet. Weeks after the formal completion of the study, researchers followed up with the volunteers. During this time they were free to eat whatever the heck they wanted to. It turned out that they seemed to stick closer to the Mediterranean eating pattern than the keto one, suggesting that they preferred the Med-Plus approach and that it may be more sustainable.

Takeaways

The most important takeaway is the fact that both diets had excellent results. All study participants lost weight without having to count calories, and enjoyed improvements in blood sugar, HDL cholesterol, and triglycerides.

That’s not a shock. By now it is a solid expert consensus that we should be eating less sugar and simple starches, and more nonstarchy vegetables. It would have been surprising if these two diets didn’t result in metabolic improvements for patients with diabetes.

So, how about those legumes, fruits, and whole grains? It appears that including those more-healthful carbohydrates in the diet of a person with prediabetes or diabetes may possibly result in slightly less weight loss, slightly higher blood sugar, and lesser improvements in HDL and triglycerides. But avoiding those three ingredients for the high-fat ketogenic diet comes with one potentially major downside: an increase in LDL cholesterol.

The authors of the paper conclude that in the context of an otherwise low-carb diet, the benefits of fruit, legumes, and whole grains outweigh the downsides. They reason that the modest improvements in glycemic control and weight conferred by the keto diet are not significant enough to overcome the rise in LDL, the lack of fiber, and the “greater potential for nutrient deficiencies.” So if you’ve chosen a low-carb diet to prioritize glycemic control, the answer may be yes: Maybe you should swap some of those low-carb ingredients for some healthful minimally processed carbohydrates.

But there’s little doubt that low-carb advocates would dispute the conclusion. The study was not a true test of a hardcore ketogenic diet, which may confer even greater metabolic benefits, and the meaning of rising LDL cholesterol remains controversial.

Either way, this study isn’t enough to definitively recommend one diet over the other. The authors aver that “patients should be supported in choosing a dietary pattern that fits their needs and preferences.” The American Diabetes Association has endorsed both low-carb and Mediterranean diets as viable eating patterns for people with type 2 diabetes.

Warnings

Carbohydrate restriction can cause a rapid drop in blood glucose levels; diabetes patients that take medication with known risks of hypoglycemia, such as insulin or sulfonylureas, should be prepared to quickly or proactively change their dosage. This should be done in consultation with a doctor.

None of the participants in this study was using insulin or other powerful glucose-lowering drugs, such as GLP-1 receptor agonists. The results of this study are therefore not necessarily generalizable to patients that require insulin before every meal, including those with type 1 diabetes.

Source: diabetesdaily.com

10 Things I Learned Working With an Online Registered Dietitian

Recently, I’ve had several difficult months managing my blood sugar. I was continuously having nighttime highs and couldn’t seem to pinpoint why. I’d also have days where my glucose remained above 200 mg/dL without even eating a morsel of food. Ten pounds have slowly crept back up on the scale. I started to feel very frustrated and hopeless about my current overall health, body image, and possible complications all this could cause down the road.

I reached out to my endocrinologist who tried to get creative and offered me some new solutions to try. We tried switching my long-lasting insulin and she suggested trying a 50/50 mix before bed to cut the spike from my late night protein intake. But nothing seemed to work and burnout set in. I needed to find the motivation to tackle this nighttime issue along with getting serious about making changes to lose weight. I knew I couldn’t do it alone, so I reached out to a friend for guidance. He happens to be an expert.

Ben Tzeel is a registered dietitian and the founder of Your Diabetes Insider. He has been coaching people with diabetes for over six years and I often see him post on his Instagram (@manoftzeel) boasting of his clients’ successes. Whether it was losing weight, putting on some muscle, or simply looking to fine tune their diabetes management, these people were succeeding! I was intrigued. I contacted Ben, who graciously offered to help me out. All opinions in this article are my own.

Here are some of the things I quickly learned about diabetes and the value of online coaching:

1- Use an app and track!

The weight had been creeping back on and I needed to get serious. Ben recommended an app that counts calories and macronutrients. It is fascinating to see how quickly calories and macros add up! Documenting everything you eat will, at the very least, make you more mindful of your intake. And if you’re looking to lose weight, it might be the best way to make sure you stay at a calorie deficit. The macronutrient breakdowns also help you correctly bolus, if you need insulin for meals. This has helped my numbers tremendously after meals: even if you aren’t sure of your actual insulin-to-carb ratio, this still is better than a guess!

2- Stay accountable

Whether it is just using an app religiously or having an accountability partner, make sure you keep your head in the game. Thankfully, Ben checks in often; otherwise, I may have used the excuse “oh it’s summer!” and slowly lost motivation. This is one of the biggest benefits of online coaching, to me. Ben kept me accountable, and he stayed positive despite any setbacks. Positive change doesn’t happen overnight, so it’s important to have a little extra motivation while your behaviors slowly improve. Check in, stay connected, and know you have people cheering you on!

3- Rotate your sites

One of the first things Ben did was ask for access to my Dexcom reports. He clearly saw that some days I would just remain high all day without rhyme or reason. The first question he asked was if I rotated my insulin injection sites.

Why is rotating important? If you don’t, fat and scar tissue can build up, which creates insulin absorption issues. I got so comfortable using my hips and buttocks for shots over the past 9 years of living with diabetes. He suggested I try my stomach, the thought of which used to make me cringe, but I did it, and it helped a lot!

4- Stop eating so late at night

This has been a problem for me as far back as I can remember. I guess emotional and mindless snacking turned into a terrible habit. Ben noticed that my overnight spikes were usually occurring three to five hours after the last time I ate. Eating late at night, even if you’re choosing healthy snacks packed with protein, can wreak havoc on your blood sugars. Protein and fat cause a delayed blood sugar spike which, coupled with dawn phenomenon, meant I was fighting an uphill battle. And what’s worse: the spike would happen while I was sleeping so I was rarely able to correct it. Cutting myself off from snacking, even a few hours earlier, removes a very unpredictable variable and has allowed me to see improved numbers overnight!

5- Plan ahead and meal prep

Getting focused and organized is key to success when it comes to healthier eating. If you are able to set aside a few hours once a week to prepare meals, you are more likely to eat at home, stick to your portion sizes, and avoid takeout splurges. You also are sure to save a couple bucks by doing so!

6- Practice Introspection

When Ben pinpointed my problematic late-night snacking, I explained that this was a hard habit to break. Instead of giving me unrealistic options like chewing gum or taking up sewing, he asked me point blank, “How can you make changes to reinforce new habits?”  I was stumped. I had never actually looked inward and tried to come up with a tangible solution that could help me take steps in the right direction. I took a moment and answered, “I’m not quite sure.” Hours later, I sat with his question and thought of some ideas that could work. Save one sweet thing to look forward to after dinner! Stop buying the things I know I am a sucker for! The ideas came from within, which felt very empowering.

7- Celebrate victories!

If you are spending time trying to improve your diabetes management or lose unwanted weight, you should be proud! It isn’t easy juggling everyday life, plus the demands of diabetes. If you do something you are proud of, celebrate! Tell a friend, buy that new dress, or get pampered! You deserve it!

8- You can have carbs! 

Both Ben and I have explored different ways of eating during our diabetes journeys. At one point, we were both ultra low-carb, but we each found it to be unsustainable. Now, we both are mindful of our carbs but aren’t scared of them either. Carbohydrates are tricky, but learning how to correctly dose for them can make life with diabetes a lot less stressful.

9- Blood sugar trends are key to troubleshooting

One of the hardest things about diabetes is knowing how to make adjustments to keep your blood sugar control tighter. Low or high blood sugar measurements can be caused by about a million different factors. Ben made making adjustments based on my blood sugar trends so easy! I was able to understand where the highs and lows were coming from, how to make adjustments to my food, activity, and insulin (along with my care team), and really tighten my control in a short period of time. Now, I’m much more confident in my dosing at each meal!

10- Consider online coaching

I was a little reluctant to work with an online coach, because I wasn’t sure what kind of time and attention I would get. I didn’t need to worry. Ben quickly got me up to speed, made everything easy to understand, and started troubleshooting my issues right away. Ben has both personal and professional expertise with diabetes. Working together was a priceless experience that I highly recommend for anyone looking to improve their diabetes and/or weight management. In the meantime, you can follow Ben on Instagram for daily tips and tricks “injected” with some humor, which we could all use.

 

My experience is ongoing and I am still learning a lot. I am continuing to work on staying consistent with tracking on my nutrition app, hitting my macros, limiting nighttime snacking, and being accountable to both Ben and myself! Thanks Coach!

You can learn more about Ben and his team of diabetes dietitians here. 

 

Source: diabetesdaily.com

The Best Keto Bread You Can Buy

This content originally appeared on Low Carb Yum. Republished with permission.

By Lisa MarcAurele

When you are craving bread on the keto diet, these are a few of the best options of keto bread to buy. They will keep you within your macros and allow you to still enjoy some of your favorite meals!

It’s no secret that one of the most difficult things about the keto diet is giving up your favorite types of food. Totally denying yourself might work, but it could also backfire.

Stop staring longingly at that cinnamon raisin bread and bagels and enjoy them again! All you have to do is make sure that your favorite keto cinnamon raisin bread is made with a net carb count that keeps you within your macros.

The really good news is that there are keto bread brands at your favorite grocery store. I’ll share some of the best keto bread to buy so that you don’t have to bake a loaf every time you want some hamburger buns.

If you love to bake, then I’ll also include some of my favorite easy keto bread recipes at the end of this post too.

Benefits of Buying Keto Bread

I love to cook and bake, and many of my favorite types of keto bread are homemade. But sometimes, you just don’t have time to bake something. In these instances, buying keto bread can be a huge time (and keto diet) saver.

Buying keto breads is also a fantastic way to make food for everyone without them knowing you are serving them something that is low in carbs. Keto hot dog buns, for example, look and taste just like regular bread!

Another benefit is that you don’t have to slice it yourself. This might seem like a tiny thing to some people, but when you eat bread at lunch to make sandwiches, it’s a huge time saver.

Difference between Keto Bread and Gluten-Free Bread

Did you know that some keto bread is gluten-free, but not all gluten-free bread is keto? That might sound confusing, so let’s break this down a bit.

In order to qualify as gluten-free, a food product cannot contain gluten – which is a protein found in wheat, barley, and rye. A lot of bread that contains wheat gluten is also high in carbs since wheat flour, barley flour, and rye flour all contain a lot of carbs.

The problem is that most gluten-free products just use other high-carb flour, like oat fiber, oat flour, potato flour, rice flour, or corn starch. All of these types of flour contain too many carbs to fit into a keto lifestyle.

Keto bread will be made with things like organic chia four, golden flaxseed meal, almond flour, or coconut flour. If a keto bread isn’t gluten-free, it’s typically made with vital wheat gluten which has just 4 grams of carbohydrates per quarter cup.

The most important thing to remember is to just look at the nutrition label. No matter what it claims on the front of the package, you should always count your macros and make sure the bread you buy has low enough carbs.

Tips

  • Avoid anything with added sugar. If you read the ingredients information and it lists sugar added, avoid it.
  • Eat nutritious bread. Products with a good amount of fiber may improve your gut health.
  • Get sliced bread. This way, you can make a sandwich and pack it in your lunch.
  • Read nutrition labels. Buy types of bread that are high in protein, high in fiber, and low in carbs.

The Best Keto Bread to Buy

Now that you know a little more about keto-friendly bread and how to tell it apart from gluten-free bread, let’s take a closer look at some popular keto bread brands.

All of these products have a net carb count that will help you stay within the macros of a low-carb diet.

Great Low Carb Bread Company

If you are a bread-lover, the Great Low Carb Bread Company is your one-stop shop. They make tasty and fluffy sandwich bread, hot dog buns, hamburger buns, bagels, and even pasta.

The sandwich bread comes pre-sliced, and there are a ton of fun flavors. Try the pumpernickel – it has a rich flavor that tastes just like regular bread.

ThinSlim Bread

Known for making bread with zero net carbs, ThinSlim bread is available at several local markets. Even though it is made with wheat protein isolate, it is a low-carb bread because it has just as much fiber as it does carbs. The fiber comes from the oat fiber and chicory root.

Keto Bread At ALDI

Yes, you can buy keto bread at ALDI (and Amazon). You might be surprised at how inexpensive it is! (In fact, there are a lot of low-carb options at ALDI!).

L’oven Fresh Keto Friendly Bread is both high in protein and in fiber. In fact, one serving has an impressive 9 grams of fiber.

LC Foods Bread

The LC Foods online Low Carb Market offers freshly baked bread rolls and loaves that ship right to your door. They have a wide variety, including delicious keto cinnamon bread.

The hotdog and hamburger rolls are perfect for summer cookouts. The sub rolls and sliced loaf breads make great sandwiches.

Cauliflower Sandwich Thins

How about a low-carb bread that is made without wheat gluten or flour? These cauliflower sandwich thins from Outer Aisle are made with cauliflower, eggs, parmesan cheese, and nutritional yeast.

They are perfect for sandwiches or wraps and taste delicious when you bake them as a personal pizza.

Egg Life

Egg Life wraps are made with eggs, not flour. They come in a bunch of different flavors – my favorite is the everything bagel wraps. They are made with literally egg whites, hemp seeds, and a bunch of spices.

You can easily find them on Amazon or at Giant, Safeway, or even ALDI.

Crepini

If you love crepes, then you will really enjoy all the different varieties of Crepini wraps. From sweet crepes with cinnamon to grande egg wraps with cauliflower, you will find one that works for the meal you want to eat.

Kiss My Keto Bread Golden Wheat

People on the keto diet love that Kiss My Keto makes bread that tastes just like a regular loaf. It’s the perfect sandwich bread to use for a turkey and cheese sandwich.

Solo Carb Bread

Whole grain lovers, this bread is for you! Solo Carb (so low carb, get it?) makes a fantastic harvest wheat bread that will impress even the biggest keto skeptic. They also make fantastic Artisan rye, and amazing dinner rolls too.

FAQs

Here are some questions people frequently ask about buying keto bread.

What is keto bread made of?

This depends on which brand of keto bread you buy. Most are made with almond flour, coconut flour, and some kind of high-fiber seeds like flaxseed meal.

How long does keto bread last?

Most types of keto bread will last just as long as regular bread. Keep it sealed completely to prevent it from going stale.

Is Ezekiel bread keto?

I do not consider Ezekiel bread to be keto-friendly. It is really high in fiber, but there are still 15 grams of carbs in each slice. Yikes!

How much bread can I eat on the keto diet?

When you are on a keto diet, you have to track your personal macros. You can eat as many slices of low-carb bread as you want, as long as you only consume the maximum number of carbs you are allowed.

If you enjoyed learning about buying keto bread, then here are some more low-carb bread you can make at home.

Source: diabetesdaily.com

Guide: How to Find LGBTQ-Affirming Healthcare

This content originally appeared on Beyond Type 1. Republished with permission.

By Julia Sclafani

Everyone should have access to affirming, supportive doctors and healthcare professionals. Unfortunately, knowledgeable, gender-affirming and LGBTQ-friendly medical care isn’t always easy to find.

If you’ve faced stigma or bias or have just felt misunderstood by healthcare providers, you’re not alone. Evidence shows LGBTQ+ people are less likely to visit their doctor despite the fact they have specific health needs and risks–including diabetes.

According to one study, up to 39% of transgender people face harassment when seeking routine healthcare. Beyond harassment, many patients find themselves contending with “trans broken arm syndrome”—where healthcare providers assume, consciously or unconsciously, that any medical issue must be directly related to a transgender patient’s gender identity.

If your provider is making you feel uncomfortable or if you’ve been avoiding going to the doctor because you don’t trust them to give you the care you deserve, you don’t have to settle. There are better options out there—and it’s becoming increasingly easier to find them thanks to growing resources.

Take Advantage of Telehealth

Telehealth has been around for a while, nonetheless, the COVID-19 pandemic accelerated the number of doctors and types of services that are now routinely available.

While not all medical evaluations or routine check-ups can be done virtually, many can.

Telehealth can make it easier for YOU to get the healthcare you need. Meeting with your HCP virtually can eliminate commuting, time spent waiting, childcare needs, missing too much work, and other obstacles that come with getting to a physical location. It can also help settle some nerves you might have about discussing gender identity in person.

In fact, having easier access to your healthcare team via telehealth could also help you reach your A1c and overall management goals, as research suggests.

If you have a reliable and secure internet connection and privacy, you can make the most of many types of doctor’s visits from wherever you are.

Luckily, telehealth is becoming more commonly used in diabetes management and endocrinology.

Finding Gender-Affirming Care

OutCare offers a nationwide directory of “healthcare providers who identify as culturally competent in the care of the LGBTQ+ community” in the United States.

This can be a great place to start, and you might connect with a primary care provider or endocrinologist who truly understands and respects you.

If local providers aren’t available to you or you don’t feel comfortable making changes to your diabetes management team, look for providers who can support you and your health in other ways.

Consider specialty telehealth practices that cater to the LGBTQ+ community. These practices tend to focus on sexual health and gender-affirming care, though some, like FOLX Health, offer virtual primary care. QueerDoc and Plume Health are examples of telehealth practices focused on sexual health and gender affirmation.

It is worth noting that many specialty telehealth practices don’t accept insurance and operate on membership or fee-per-service basis, though sliding scale pricing can be an option.

These resources can help you expand your healthcare team so it includes providers you feel truly comfortable with. Being able to openly discuss aspects of your health and life is a must for a person with diabetes—because nearly every part of life can impact your blood sugars. And of course, because you deserve to feel fully seen and supported regardless of your gender identity.

Online Support and Resources

Peer support and online communities are great tools for connecting with others who can relate to your experience.

OutCare offers free online classes and sessions—everything from yoga and mindfulness to virtual support groups.

Other online support communities serving LGBTQ individuals include:

  • Spart*a: An advocacy organization for trans and gender-diverse active-duty and veteran service members.
  • Trans and Gestating Support Group: A bimonthly, doula-led support group that meets via Zoom.
  • Trevor Space: An online community connecting LGBTQ young people (ages 13-24) all across the world.
  • Asperger/Autism Network: An advocacy organization that offers online support groups and other live event resources for LGBTQ+ people with autism.
  • Beyond Type 1 and Beyond Type 2: Online communities to connect with people with diabetes.

There’s still such a long way to go when it comes to helping people within the LGBTQ+ community get the support and care you need. You deserve a healthcare team that respects you and acknowledges your full identity. Don’t give up!

Source: diabetesdaily.com