The Biggest News in Diabetes Technology from ATTD 2020 – A Deep Dive on CGM and more!

This content originally appeared on diaTribe. Republished with permission.

By Jimmy McDermott, Eliza Skoler, Divya Gopisetty, Emily Fitts, Frida Velcani, Kelly Close, and Albert Cai

The diaTribe team is on the ground in Madrid, Spain to cover the latest news in diabetes technology from ATTD. Here are our top highlights from the conference so far …!

The 13th annual Advanced Technologies and Treatments in Diabetes (ATTD) conference brought together many great minds in diabetes in Madrid, Spain. With nearly 3,800 attendees from more than 81 countries, ATTD continues to grow dramatically; while it has been since the start in Prague in 2008 one of the most impactful meetings in diabetes, it is now considered one of the top three in the world. Why? It shows the powerful momentum behind diabetes technology in so many respects, from CGM and BGM to automated insulin delivery (AID) to smart pens to new therapies to new learnings in behavioral medicine. Here are some of diaTribe’s key highlights from the conference – we’ve focused on learnings about CGM and the closed loop and will be back with even more after the conference concludes!

Click to jump to a section!

1. Dr. Rich Bergenstal shares tips for understanding CGM data 

2. Data shows use of CGM features is linked to increased time in range

3. Dexcom announces big milestone for G6 in pregnancy, the CE-Mark; available in UK “starting spring 2020”

4. Results show benefits of DIY closed-loop systems: lower A1C and more time in range using Loop

5. WISDM Trial: CGM helps older adults with type 1 diabetes reduce hypoglycemia and improve time in range 

6. Increased FreeStyle Libre scanning frequency is associated with reduced time with both high and low blood sugar

7. MiniMed 670G data shows time in range increases with Auto Mode

8. Tandem’s Control-IQ increases time in range in children

1. Dr. Rich Bergenstal shares tips for understanding CGM data

Dr. Rich Bergenstal from the International Diabetes Center gave tips for interpreting continuous glucose monitor (CGM) data. The audience responded enthusiastically when Dr. Bergenstal explained “FNIR” (Flat, Narrow, In-Range) to describe “ideal” blood sugar: high time in range and flat glucose levels with few ups and downs. To learn more about FNIR, check out our resource page on time in range. Dr. Bergenstal shared a few more catchphrases:

Time in Range

Image source: diaTribe

  • MGLR: More Green, Less Red; refers to the stacked time in range bars (pictured right).
  •  “Thinking fast and slow” – this refers to making “fast”, in-the-moment medication or behavioral changes based on real-time CGM numbers, and “slow” analyses of blood sugar data to understand and act on trends over time. It also recalls the famous prize-winning book from 2011.
  • STAR: Steady, Tight, And in-Range; this is another one we’ve heard lately, and even though it wasn’t in Dr. Bergenstal’s presentation, it’s also very aspirational, just like FNIR!
Screenshot

Image source: diaTribe

2. Data shows use of CGM features is linked to increased time in range

Time in Range

Image source: diaTribe

Dexcom presented real-world data from G6 CGM users showing that people who were most engaged with G6 features (such as alerts, the share-follow platform, and Dexcom Clarity) showed significant improvements in their blood glucose management. These highly-engaged users had the highest time in range and spent 38% less time each day in hypoglycemia (pictured right).

Here are the G6 features that Dexcom highlighted:

  • Alert Settings: Users can set their own target blood glucose range and the G6 will automatically notify them if their glucose levels cross the high or low threshold. This means that users don’t have to constantly self-monitor their blood sugar; 55% of G6 users used this feature to customized their settings.
  • Time in Range

    Image source: diaTribe

    Urgent Low Soon (ULS) alert: This predicts and notifies a user 20 minutes before they cross their low blood glucose threshold. Real-world user data shows that people using ULS spent less time in hypoglycemia (six minutes less below 55 mg/dl and ten minutes less below 70 mg/dl).

  • Dexcom Follow: People with diabetes can share CGM data with their family, friends, and care partners to help monitor glucose levels (with the iPhone app or Android app). This feature was especially helpful among children, whose time in range increased proportionally to the number of people able to view their data.
  • Dexcom Clarity: Weekly reports allow people with diabetes and healthcare professionals to see blood glucose trends and develop insights into their diabetes management (with the iPhone app or Android app). Users can receive encouraging notifications when they achieve their blood glucose goals. The data shows that more understanding of how one’s glucose levels change over time correlates with better outcomes: using weekly Clarity reports led to an increase in time in range by 9%. Additionally, in a study of 26,000 people, those who used Clarity with mobile notifications had 64% time in range, compared to 52% time in range for people who only used the CGM. Learn more about Clarity here!

3. Dexcom announces CE-Mark for G6 in pregnancy; available in UK “starting spring 2020”

Dexcom announced European approval (formally called the “CE Mark”) for its G6 CGM for use during pregnancy for women living with type 1, type 2, or gestational diabetes. This is so exciting! The official “label” is set to launch in spring of 2020. The G6 now joins Abbott’s FreeStyle Libre as approved CGM for pregnant women in Europe – as a reminder, the FreeStyle Libre 2 has alarms (better for pregnancy), and has been approved in Europe for some time. While no CGM is yet approved for pregnant women in the US (though many are using it off-label), the European announcement should help to increase awareness and education around the world. Every pregnant woman in the world with diabetes or pre-diabetes should have CGM in the opinion of many experts (virtually all the ones we know).

  • Mt. Sinai’s Dr. Carol Levy shared compelling data from the T1D Exchange around CGM in pregnancy. Comparing 2010-2013 to 2016-2018, self-reported CGM use in pregnant women increased from 35% to 65% and average A1C in pregnant women dropped from 6.9% to 6.6%. We bet if time in range data were available, we’d see a big increase.
  • Dr. Levy showed the outcomes of 50 women who used Dexcom CGM during pregnancy. 93% of these women recorded no diabetic ketoacidosis (DKA) or severe hypoglycemia. Typically, about 50% of women with gestational diabetes have a baby with a high birth weight. This percentage was 12% in the group of women using CGM in this trial.
  • As we’ve seen at previous conferences, data supporting CGM during pregnancy is overwhelmingly positive. The CONCEPTT trial examined Medtronic’s Guardian CGM in pregnant women and showed many encouraging results, including:
    • Reduced birth weight of the baby
    • 100 more minutes per day in target glucose range for the pregnant mother
    • 72 fewer minutes per day in hyperglycemia for the pregnant mother

Experts believe that even these encouraging results underestimate the impact of CGM on positive health outcomes for pregnant women and their children. Broadly speaking, pregnancy can cause multiple challenges to diabetes management that CGM can help ease. Pregnant women experience more blood glucose variability with increased insulin resistance and are at a greater risk of hypoglycemia. Learn more here about gestational diabetes.

4. Results show benefits of DIY closed-loop systems: lower A1C and more time in range using Loop

An observational study on Loop, a do-it-yourself (DIY) closed-loop system, found that Loop improved diabetes management significantly. The study followed people using an automated insulin delivery (AID) system, continuous glucose monitor (CGM) readings, and a communications bridge device, called “RileyLink.”

New users (people in the study who had never used this closed-loop system before) showed:

  • An A1C reduction from 6.8% to 6.5% after three months and to 6.4% after six months – and if you think that is not very much, think again!
  • An increase in time in range from 68% to 73%, which is more than one hour per day spent in-range! These time in range benefits occurred in the first month of closed-loop use and were constant throughout the rest of the study.
  • Benefits in A1C and time in range across all age groups.
  • Improvements in user-reported outcomes, including measures of diabetes management distress, sleep quality, and fear of hypoglycemia. Not too many details were shared on this part and we look so forward to learning more!

It is important to note that people in the study were classified as having “well-managed” diabetes at the start of the study, meaning they had relatively low A1Cs (6.8% baseline) and were close to meeting time in range goals, and came from high education levels and socioeconomic status backgrounds. This underscores the need to improve access to closed-loop systems for broader groups of people with diabetes.

Looking ahead, the study will end on March 31, 2020 and all participants will complete a six-month follow-up, so full results will not be available until later this year.

5. WISDM Trial: CGM helps older adults with type 1 diabetes reduce hypoglycemia and improve time in range

The WISDM study examined the impact of continuous glucose monitor (CGM) use in people with type 1 diabetes above the age of 60. Participants used either the Dexcom G5 CGM or standard blood glucose meters (BGM). After six months, the CGM group spent less time in hypoglycemia (with blood glucose below 70 mg/dl) and two more hours per day in-range (70-180 mg/dl), compared to the BGM group. There was also a greater A1C reduction in the CGM group (0.3% decrease compared to no change in the BGM group). Importantly, people using CGM reported significantly fewer severe hypoglycemia events (defined as requiring assistance of another person). These benefits were seen whether people were using insulin pumps or multiple daily injections (MDI).

For the next six months of the study, the individuals using standard blood glucose meters switched over to CGM. New data shows that the people who switched to CGM spent significantly less time in hypoglycemia and more time in range. The CGM-only group maintained the outcomes from the six-month mark, which was also positive to see.

The WISDM study continues to show that CGM is as important, desired, and effective for older adults as it is for younger adults. Indeed, participants who used CGM in this study reported using it 95% of the time. As CGM becomes easier to use and more affordable in the coming years, we look for this valuable technology to be adopted by more people of all ages and backgrounds. That can’t come soon enough!

6. Increased FreeStyle Libre scanning frequency is associated with reduced time with both high and low blood sugar

Dr. Ramzi Ajjan of University of Leeds presented data across many countries and regions showing that more FreeStyle Libre scans each day was associated with reduced time in both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar).

Unlike traditional CGM, FreeStyle Libre does not continuously send real-time glucose data to the reader; instead, the sensor patch must be “scanned” with the reader to get the real-time glucose value, trend arrow, and trend graph. By scanning more frequently, people are viewing their blood sugar data in real-time more often. This allows them to make adjustments to avoid highs and lows, whether by introducing a new habit or working to change a longstanding behavior.

The data shows that as the number of scans per day increased, time spent in hyperglycemia and hypoglycemia decreased. For example, in the UK, the lowest number of scans (about five per day) resulted in 44% time in hyperglycemia, which fell to 24% time in hyperglycemia with the higher number of scans (about 45 per day – obviously on the high end, but you get the idea!). Find more data here.

7. MiniMed 670G data shows time in range increases with Auto Mode

Screenshot

Image source: diaTribe

Medtronic presented data from 7,847 people with diabetes across Europe who used the Auto Mode function of Medtronic’s MiniMed 670G AID system. Among 3,139 670G users, average time in range increased from 62% to 71% before and after using Auto Mode – that’s 2.3 hours more time in-range each day!

The increase in time in range corresponded with a drop in time spent in hypoglycemia and hyperglycemia. These users spent just 1.8% of their time with blood glucose levels under 70 mg/dl, and 0.6% of their time with blood glucose levels under 54 mg/dl. On the hyperglycemia side, users spent 21% of their time with blood glucose levels over 180 mg/dl, and 6% of their time with blood glucose levels over 250 mg/dl. Time in range improvements were seen one month after enabling Auto Mode.

Screenshot

Image source: diaTribe

8. Control-IQ increases time in range in children ages 6-13

Dr. R. Paul Wadwa of the Barbara Davis Center for Diabetes presented highly anticipated results from the DCLP-5 trial of Control-IQ in children ages 6-13 years old. Over 16 weeks, time in range increased from:

  • 53% to 67% in the group using Control-IQ
  • 51% to 55% in the group using a pump and CGM, without Control-IQ.

This means that the children using Control-IQ spent about two and a half more hours each day in their target blood sugar range, compared to the kids using a standard pump and CGM.

Like the adult trial of Control-IQ, most of the increase in time in range occurred at night. At night, the Control-IQ group reached an astounding 80% time in range compared to 54% in the standard pump and CGM group. Overall, time spent above 180 mg/dl was 31% for the Control-IQ group, compared to 43% in the standard pump and CGM group. Time below 70 mg/dl was not changed in either group. There were no cases of diabetic ketoacidosis (DKA) or severe hypoglycemia in the trial.

Dr. Boris Kovatchev from the University of Virginia gave a more detailed comparison of the adult and child Control-IQ trials in the slide below:

Screenshot

Image source: diaTribe

Control-IQ was cleared in December for people ages 14 years and older. Control-IQ is expected to be submitted for approval in children in early 2020.

Thank you so much to the conference organizers Professors Moshe Philip and Tadej Battelino – what an outstanding gathering, and much appreciation for making so many people with diabetes and advocates feel so welcome. You can see so much more on the ATTD Facebook homepage, including the compelling opening ceremony with keynote speaker Dr. Jay Skyler giving a moving talk about technology past and present, as well as a video of talented Spanish musicians and dancers to close out the first night! The live stream was also much appreciated. Thank you so much to technology watcher Albert Cai and his team for their brilliant help in identifying key themes at this memorable conference. We’ll be back with more learnings on therapies, behavior, insulin and more …

Source: diabetesdaily.com

How Do We Afford Our Insulin During an Economic Crisis?

COVID-19 has caused widespread panic across the globe, and that has quickly become apparent given the recent bear stock market, which hasn’t been seen since the Great Recession over a decade ago. You may have seen your IRAs and 401ks plummet in recent weeks because investors are scared.

Some economists are predicting that the United States could even see up to a 30% unemployment rate, as layoffs sore from the mandatory closings of restaurants, bars, gyms, coffee shops, and retail stores across the nation, trying to prevent the spread of COVID-19, the disease that is caused by the novel coronavirus. You may have experienced a recent layoff or reduced hours as a direct result of COVID-19, and if you have, your health insurance may have taken a hit as well (or gone away altogether). So, how can we afford our insulin during an economic crisis? Here is our (hopefully!) helpful advice:

If You’ve Lost Your Job

File for unemployment insurance immediately. Most states require that you’ve lived/worked in the state in which you’re applying for benefits for at least six months to qualify, and you don’t qualify if you quit or were fired from your most recent job. These bi-weekly payments have a cap (depending on your income and the state in which you live), but can definitely help you in the short term until you’re able to find new employment. Congress recently passed the COVID Stimulus Package, which includes expanded unemployment benefits (extending by 13 weeks), and enhances said benefits for four months. The program has also been broadened to include freelancers, furloughed employees and gig workers, such as Uber and Lyft drivers.

Special Enrollment Period

It’s well-known that one must sign-up for health insurance during “open enrollment”, which is a time period, usually once a year, when individuals and employees of companies and organizations may make changes to or buy different health insurance plans. Under the Affordable Care Act, a change in your personal situation, such as getting married, having a child, or losing your health coverage (by way of losing your job) makes you eligible for a Special Enrollment Period, which allows you to enroll in health insurance outside of the typical open enrollment period.

In response to COVID, many Governors are creating SEPs (Special Enrollment Periods) to specifically address people’s concerns over having health insurance and affording their medication during the global pandemic. If you currently do not have health insurance (by choice), but are worried about affording your insulin, or are particularly concerned about contracting COVID19, you may be able to take advantage of a SEP in your state.

See If You Qualify for Medicaid

As of now, 36 states have expanded eligibility for their state Medicaid programs (to 138% FPL), which offer extremely affordable insulin and diabetes care. If you’re a low-wage worker whose employer doesn’t offer health insurance, and you can’t comfortably afford to buy a plan, see if you qualify for Medicaid. Many Governors are looking into expanding Medicaid even further during the national public health emergency.

Cash Relief is Coming

Congress recently passed a $2 trillion Coronavirus Stimulus Package that includes direct cash payments to all American taxpayers. Lawmakers agreed to provide $1200 in a direct (single time) payment to taxpayers making up to $75,000 per year, with $5 less for every $100 per year a person makes all the way up to $99,000. Families will receive an additional $500 per child, in an attempt to create a safety net for people whose jobs and businesses have been negatively affected during this public health turned economic crisis. This bump of cash will help millions of Americans, including people with diabetes, afford their medications easier in the short term while longer-term policy solutions are worked out to help everyone during this crisis.

If All Else Fails, Reach Out for Help

If you’re still struggling to afford your medication, you can reach out to your insulin manufacturer for help: Lilly Cares, NovoCare, and Sanofi Patient Connection can help get you free or discounted insulin when you’re in a desperate spot. Currently, insulin manufacturers are not anticipating any supply-chain issues as a result of COVID-19.

Additionally, the diabetes online community (on Facebook, Instagram and Twitter) is an amazing resource of dedicated activists and helpful hands who are always more than willing to help fellow people with diabetes in need. Reach out to your friends and family and let them know you’re struggling. Ask your doctor if they have any samples of insulin you can take from the clinic for free. Let your struggle be known, so people can help you. Do not suffer in silence.

Have you had issues affording your medications and/or insulin during this global pandemic turned economic crisis? What strategies have helped you? Share this post and comment below, we love to hear your stories and suggestions!

Source: diabetesdaily.com

Recipe Roundup: Low-Carb Recipes with Immune-Boosting Ingredients

With all that is going on in the world regarding COVID-19, we are all looking to practice physical distancing to avoid catching this deadly virus. We are all searching for answers and looking for tips on how we can stay healthy. Making sure our immune systems are in tip-top shape is vital in not only avoiding catching the coronavirus but to our long term health as well.

Since we are all stuck at home, this is a perfect time to try a few new recipes. Bond with your family and try making one or all of these delicious concoctions, all containing immune-boosting ingredients. Enjoy great food while getting healthy!

Lemon Meringue Cupcakes

Photo credit: Megan of Mad Creations Hub

Keto Lemon Meringue Cupcakes 

Vitamin C plays an essential role in bodily functions and also is vital to maintaining good health. Vitamin C also increases the production of white blood cells, which help fight infection. Since all citrus fruits contain it, it’s easy to find one you like. This delicious Keto Lemon Meringue Cupcake has easy to follow directions and is sure not to disappoint!

Keto Broccoli Tots

Photo credit: Lindsay of That’s Low Carb

Keto Brocolli Tots

Broccoli is packed with vitamins and minerals. It contains Vitamins A, C, and E, as well as many antioxidants and fiber, making broccoli a great choice for your vegetable. It can be served steamed, roasted, or like in this recipe, turned into a creation that even your children will love!

Easy Lemon Honey Martini 2

Photo credit: Jessica of The Novice Chef

Immune Boosting Quarantini

Being stuck at home can drive you mad… or to drink. What better choice for an adult beverage than something that contains vitamin C and will help you kick back and relax in the evening? Vitamin C has many health benefits, it not only will boost your immune system, but it can also help lower your blood pressure and your risk of heart disease. Cheers!

Blueberry Breakfast Bar Tall

Photo credit: Emily of Resolution Eats

Blueberry Keto Breakfast Bar

Blueberries are an excellent source of nutrients. They are low in calories, but high in fiber and vitamins C and K. This high in antioxidants superfruit may also help to lower blood pressure, reduce heart disease, and improve our brain function and memory. Blueberries are great on their own (freeze for longer shelf life), delicious in smoothies, or can be used in recipes like this one. Enjoy!

Photo credit: Kim of Low Carb Maven

Spinach Salad with Warm Bacon Dressing

While we are stuck at home and less active than we usually are, we are likely all watching what we eat. This simple salad won’t take long to throw together and will give you a healthy dose of folate, vitamin A, vitamin C, fiber, and iron. Dark leafy greens like spinach can be a great source of magnesium, which can help boost your immune system and is also known to improve blood glucose control. A win-win!

While we are stuck home, it is an excellent time to focus on staying healthy. Eating nutritious foods and staying active is our best defense!

Low-Carb Recipes with Immune-Boosting Ingredients

Source: diabetesdaily.com

Homemade Keto Alfredo Sauce Recipe

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

If you’ve never made your own white pasta sauce, you’ll be surprised how easy it is. You can make a simple cream sauce with butter, heavy cream, parmesan cheese, and cream cheese. Those are the four basic ingredients I use to make homemade keto Alfredo sauce.

I like to add a few more ingredients to mine to enhance the flavor. For me, garlic is one of the best seasonings ever so I add in a few freshly minced cloves. I also add in a few shakes of fresh ground black pepper.

There’s very little preparation needed to make homemade sauce. And, it’s much better to make it yourself because commercially prepared ones always contain unnecessary ingredients that up the carbs.

Print

Low-Carb Alfredo Sauce

.wprm-recipe-rating .wprm-rating-star.wprm-rating-star-full svg * { fill: #343434; }

Cook all the ingredients together in a saucepan until smooth. Then serve this easy low-carb cream cheese sauce over zoodles or keto-friendly fettuccine.
Course Side Dish
Cuisine Italian
Keyword alfredo sauce, zucchini
Prep Time 5 minutes
Cook Time 10 minutes
Total Time 15 minutes
Servings 16 people
Calories 321kcal

Ingredients

  • 1/2 cup butter
  • 2 cloves garlic minced
  • 2 ounces cream cheese
  • 1 1/2 cup parmesan cheese shredded
  • 2 cups heavy whipping cream
  • dash ground black pepper

Instructions

  • Melt butter in a medium saucepan over medium heat. Sauté garlic in hot butter until fragrant.
  • Blend in remaining ingredients and simmer for about 10 minutes or until the sauce has thickened.

Notes

Sauce will thicken as it cools and will become very thick if stored in the refrigerator. Simply heat the sauce up for it to be pourable.

Nutrition

Serving: 0.25cup | Calories: 321kcal | Carbohydrates: 2g | Protein: 15g | Fat: 28g | Saturated Fat: 18g | Polyunsaturated Fat: 1g | Monounsaturated Fat: 7g | Cholesterol: 87mg | Sodium: 706mg | Potassium: 65mg | Sugar: 1g | Vitamin A: 950IU | Calcium: 490mg | Iron: 0.4mg


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.

Homemade Keto Alfredo Sauce Recipe

Source: diabetesdaily.com

COVID-19: Ways to Boost Your Immune System

COVID-19, the disease caused by the novel coronavirus, is spreading at breakneck speed across the globe, and people are terrified. Currently, there is no vaccine and no cure (although treatment helps, and in most cases the disease resolves itself within two weeks). The thing that’s scariest about this virus is the term “novel”- this means that it’s completely new, and has never been seen before in humans, so our immune systems cannot adequately fight it off (like we usually can against a cold or sore throat).

While the best ways to prevent getting COVID-19 are handwashing, avoiding sick people, and social distancing, if you contract the virus, there are a number of ways to make sure your immune system is in top shape to help fight it off. Here are our top ways, below:

Manage Your Blood Sugars

Excellent blood sugar management makes people living with diabetes more likely to effectively combat infections of all kinds. “For all my diabetes friends, please invest time to focus on taking the best care you can with your blood sugars. It is the best defense against a COVID-19 infection, without a doubt,” says Dr. Stephen Ponder, the author of Sugar Surfing.

Persistently high blood sugars make us more susceptible to uncontrollable infection, which can lead to severe complications if one contracts COVID-19. Stay extra vigilant by testing frequently, counting carbohydrates, maintaining some semblance of an exercise routine (which can be hard when gyms across the nation are closing to help prevent the spread of the virus), and try to manage stress.

Get Enough Sleep

Sleep is the body’s way to replenish and recharge all the cells in your body (especially brain cells). When one sleeps, the body naturally heals itself. While recommendations vary, most adults should aim for 7-9 hours of sleep per night. This will be crucial to heal the body from normal wear and tear, and to help build up one’s immunity should you come into contact with COVID-19, or even a cold or the seasonal flu.

Don’t Smoke

If you’re a smoker, now is an excellent time to quit. The COVID-19 virus is respiratory, meaning it affects the lungs, and in severe cases causes pneumonia that can be fatal. People most susceptible to severe complications from COVID-19 include older adults (over 60), smokers, and people with chronic health conditions, including diabetes, asthma, and COPD. Smoking is bad for so many reasons, and tanks your immune response, makes you more susceptible to infections, damages your lungs, and increases your risks for severe complications from COVID-19. Check out these resources to help you quit.

Eat the Rainbow

It’s true what your mom said: eat your fruits and vegetables! Fruits and vegetables are full of vitamins, minerals, and healthy fiber that is extremely beneficial to one’s health. Citrus fruits have shown to be particularly beneficial in boosting immunity: grapefruits, oranges, lemons, limes, tomatoes, kiwi, tangerines, clementines. Fun fact: ounce for ounce, red bell peppers contain about twice as much vitamin C as citrus fruits. If in doubt, the more colorful your plate, the better. Getting to the grocery store may be hard right now, but services like Instant Care and Amazon Fresh can deliver fresh produce right to your door, making healthy eating a little easier during this time.

Exercise

Exercise has been proven to boost immunity, and even a little can go a long way. Exercise mobilizes T cells, which are a type of white blood cell that guards against infection. Just make sure not to overdo it (extreme, continuous exercise actually wears the body down and can make you more susceptible to illness). The CDC recommends that most adults get 150 minutes of moderate activity per week, like walking, or 75 minutes of vigorous activity per week like running. And you can break that up into smaller chunks of time, and get creative: running up and down the stairs, gardening, vacuuming, jumping rope, mopping the floors, and walking your dog all count! Currently, only 22.9% of U.S. adults ages 18-64 met the CDC exercise guidelines between 2010-2015.

What strategies do you use to boost your immune system? Share this post and comment below! We love to hear your ideas!

Source: diabetesdaily.com

The FAA Continues to Ground Commercial Pilots with Insulin-Dependent Diabetes

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

By Lala Jackson

On November 7, 2019, the Federal Aviation Administration (FAA) lifted their previous ban on certifying insulin-dependent people with diabetes as commercial pilots. The statement followed a 2015 announcement that the FAA would begin considering certification for insulin-dependent people with diabetes.

Private pilot Chris Hanrahan initially applied for his commercial pilot medical clearance in 2015, when the FAA originally announced they would be considering clearance for insulin-dependent people with diabetes. According to Chris, he has since learned that his original application was used to “acquire data to develop protocols. They were never intending to use our data to admit us, but to develop their guidelines.”

Chris filed his second commercial pilot medical clearance application on December 3rd, 2019 and has been told by the FAA multiple times that he would hear back within three weeks. Now, at the start of March 2020, the FAA has told Chris he will hear back by the end of the month. For Chris and other pilots waiting to hear back, lack of clear expectations and an honored review timeline from the FAA creates confusion and frustration.

The FAA has extensive guidelines around medical certifications for a variety of disease states that have the potential to impact the safety of flights. With insulin-dependent diabetes, the FAA has expressed concern about the “risk of subtle or sudden incapacitation due to hypoglycemia.” Because of this, they have created an extensive set of steps for pilots with diabetes to receive medical clearance.

For those seeking medical clearance to fly commercially a continuous glucose monitor (CGM) is required, as well as a significant amount of documentation including:

  • a minimum of 6 months (or 12 months, depending on which guideline document is being referenced) of CGM data that shows percentages of time in range
  • additional blood glucose check by fingerstick data
  • a detailed Excel spreadsheet that notes glucose levels during past flights and any actions taken to correct levels
  • reports on episodes of blood sugar <70 mg/dL or higher than 250 mg/dL for the past year
  • HbA1c data from the past year
  • eye and cardiac evaluations
  • a detailed diabetes and medical history
  • and comprehensive lab work including thyroid and B12 levels

Additional reports for recertification are required every three months. Despite the extensive application data required, the FAA reports they’ve received ten applications from insulin-dependent pilots since their statement in November. However, none have yet been approved. The FAA says they’re working on reviewing applications within 90 days on a case by case basis.

“They keep changing the time frame,” Chris told the Beyond Type 1 team. “There’s no explanation or logic at to why they’re doing this. They’ve told me they’ve had my stuff looked at by their endocrinology team and they told me everything is fine, they’re just waiting on signatures.”

For Chris and pilots like him who have followed every guideline to apply, a clear decision from the FAA is what they deserve.

Source: diabetesdaily.com

Proposed Rule Would Increase Out-of-Pocket Costs for Medications

This content originally appeared on diaTribe. Republished with permission.

By Karena Yan

Under the rule, people in the United States using prescription discount coupons would have to spend more money in order to meet their deductibles

In January, the Department of Health and Human Services (HHS) announced a proposed rule that would no longer require health plans to count prescription discount coupons, also called copay assistance, toward deductibles and out-of-pocket maximums. This change, which would take effect in 2021, would make it more difficult for people to meet their deductible (the yearly amount you pay before insurance kicks in) and thus increase how much they pay yearly for their medications. Many people – especially those with chronic conditions such as diabetes – rely on copay assistance to afford needed medications, meaning this proposed rule would result in major financial and access barriers for millions of people.

Typically, discount coupons reduce the out-of-pocket cost of a medication, and the original (higher) price is counted toward an individual’s deductible. For example, if the cost of a medication is $100, a copay card can bring down the amount you pay to $5, with the remainder paid by the drug’s manufacturer. Under traditional policy, the full cost of the drug – $100 – would be counted toward your deductible, even though you’ve only paid $5 of your own money.

However, under the proposed rule, insurers would be allowed to exclude any coupons or other forms of copay assistance from a person’s out-of-pocket limit. In other words, from the example above, only the $5 you paid would count toward your deductible. This would be a win for insurers and a loss for patients, as the practice, also known as copay accumulator adjustment programs, effectively increases the amount of money people pay out-of-pocket for their medications. This creates significant financial access barriers and also undermines people’s ability to take their medication as prescribed.

Among other negative consequences, such increased prescription costs will exacerbate the insulin affordability crisis, which is already causing thousands of people to ration or skip doses of insulin. In turn, unreliable adherence to life-saving drugs like insulin can lead to many costly complications and ER visits.

The diaTribe Foundation wrote a letter to advocate against this part of the proposed rule and urged HHS to place people’s health, survival, and well-being first by ensuring that discount coupons are counted toward annual deductibles. Several other organizations have written letters opposing HHS’s proposed rule, including The American Autoimmune Related Diseases Association and the Aimed Alliance, which, along with individuals, have generated over 1,000 public comments submitted in response.

To learn more about copay cards and other forms of prescription savings, please see the articles below:

Source: diabetesdaily.com

To the Doctor Who Told Me I Couldn’t Have Type 1 Diabetes

Dear Dr. N,

I walked into your office, hopefully optimistic. I was having stomach issues for quite some time and was lackadaisical about it, and it worsened. I checked out a local “mom” Facebook group to find some gastroenterologist recommendations. Your name was mentioned a few times, and your office was less than a mile from my house. I also was hoping to see a woman, so I was thrilled find see this local recommendation and made the appointment.

You came in with a smile, looked me in the eye, and shook my hand, as it was our first time meeting. I immediately felt calm and confident that I picked a good name out of the virtual hat. Until you asked me about the forms, I had just filled out. “I see here you have type 1 diabetes?” you asked. I recited my usual response that yes, I did, for only six years, diagnosed at age 37 and with no family history.

This was the moment that I lost all faith in you as a doctor and as an educated civilian. You looked up at me and started to explain, “Type 1 is diagnosed at birth.” Umm, no, it’s not. And what really felt like a kick in the gut was when you started to lecture me on the two different types of diabetes, explaining condescendingly, that since I was diagnosed as an adult, I have type 2.

It took everything I had not to walk out. After all, I needed the appointment. I needed your expertise. I understand your schooling isn’t in endocrinology, but the lack of pretty basic knowledge was quite concerning.

Moreover, to have someone, let alone a medical professional, tell you that the disease that you battle day in and day out, is in fact, not the disease you have, takes poor bedside manner to an entirely new level. The sleepless nights, the bruises on my body, the low that put me in the back of an ambulance must have been a figment of my imagination. I quickly started to defend my disease and defend the fact that yes, I DO have type 1 diabetes, and I have been on insulin since the day I was diagnosed.

You looked like you barely believed me as you confidently smirked and went on to jot down your notes. You confirmed my age at diagnosis and went on to say, “What took them so long?” This is when I really should have walked out the door. Instead, I was furious and blurted out, “If I had it for much longer, I would HAVE BEEN DEAD.” Clearly, you have zero understanding of this condition.

After I reluctantly went on with the examination, the outcome was that you recommended a colonoscopy because you didn’t like “me or my family’s history.”  As you started to lay out the details of the preparation and what to expect, you told me to stop all insulin the day before. What? Stop all insulin? You couldn’t have said that. But you did. And I responded with, “Do you mean fast-acting insulin because if I stopped taking all of my insulin, I will likely show up tomorrow in DKA (diabetes ketoacidosis).” This is when I knew I was definitely not returning.

I was angry. I was disappointed. I felt helpless. I was not going to let a doctor who had zero knowledge of my disease, try to convince me that I didn’t have type 1 and almost put me into DKA perform my colonoscopy. I canceled my appointment the next day and decided not to give them a reason why. But three weeks later, it is still making my blood boil.

Please educate yourself. Please listen to your patients. Please do not give out dangerous misinformation. Please, I beg of you.

Source: diabetesdaily.com

Managing the Emotional Toll of Diabetes and COVID-19

The world as we know it has changed due to COVID-19, the illness caused by the novel coronavirus. The number of businesses closing, people being quarantined (mandatorily or voluntarily), laws changing to contain the spread of the disease in the United States, cities invoking curfews and travel bans, and people dying is changing by the hour. If it suddenly feels as though you traveled through time and landed in the zombie apocalypse, you’re not alone.

Add to that the layered anxiety and worry that comes with having diabetes in the time of an unmitigated infectious disease (of global pandemic proportions) disaster, and it can become too much to manage. It can be a complicated mix of concern for the world, the risk to yourself, and how you feel about the risk to loved ones in an environment of uncertainties and unknown unknowns. Here are our top ways to manage the stress:

Know the Facts

Having diabetes doesn’t necessarily put you at any higher risk for getting COVID-19, but you can be susceptible to more severe complications if you acquire the disease. Do not panic. Do not get sucked down into the rabbit hole of myths and conspiracy theories. Learn the facts from reputable sources only. Following advice from The World Health Organization and the CDC are two good places to start. You may have increased anxiety around diabetes and coronavirus (that’s expected and warranted), but unnecessary stress doesn’t help, either.

Disconnect

Most of us are working from home these days, and while that’s an excellent way to help contain the spread of disease and protect people with preexisting conditions like diabetes, it’s also keeping many people glued to their screens for most of the day, and that means, glued to the news. Get away from your computer screen, the news, Twitter, and the chaos of Facebook for some time each day (walks outside are excellent, now that the spring weather is upon us!). Set limits on how much you watch the news (it’s crucial to stay informed, it’s not so crucial to watch CNN for 7 hours straight). Or better yet, limit screen time to evenings only.

Infographic by The World Health Organization

Be Prepared, Not Panicked

There’s only so much you can do, but make sure you do it! Practice proper social distancing, hand washing techniques, stay home if you’re sick, and avoid crowded places, sick people, and high traffic areas (airports, etc.).

If you can, stock up on two weeks’ worth of food, toiletries, and medication, and make arrangements to work from home, if able. It’s understandable that most people cannot afford to stock up on fresh food and medication. More affordable, shelf-stable food items that can go a long way include canned goods and frozen vegetables, and dried beans and rice. That being said, there’s no need to necessarily hoard grocery items, as grocery stores do not have any supply-chain issues and hoarding for yourself may cause deprivation for others (although, of course, make sure you have more than enough supplies to treat low blood sugar at home). Additionally, check out our advice for obtaining additional diabetes supplies without breaking your budget during this crisis.

If your job requires in-person time (if you work in the service industry, are a healthcare worker, provide city services such as garbage collection or sanitation, or your boss simply won’t budge on a work from home arrangement), try and maintain 6 feet distance between you and others, ask for latex gloves if you work in a grocery store or are a mail carrier and touch lots of objects (be sure you know the proper way to use them!), and avoid standing near sick people. Also, wash your hands thoroughly and often. If you can find it, hand sanitizer also is extremely helpful when on the job if running water and soap aren’t readily available. COVID-19 is caused by a novel Coronavirus, meaning it’s never been seen before, and the epidemiological characteristics of the spread of the disease are still being uncovered. It’s best to use extreme caution. It’s recently been revealed that it *may* be airborne, although studies are conflicting.

After you’ve adequately prepared, don’t continue to panic. Falling to hysteria won’t help anyone, but being prepared can give you peace of mind if you’re forced to be at home for a while.

How to Protect Others from Getting Sick - Coronavirus 2

Infographic by The World Health Organization

Move Your Body

Exercise is one of the main ways to decrease stress, and just because many cities are closing down their gyms, doesn’t mean you can’t move your body. Aim for a moderate activity for at least 30 minutes every single day. Warming weather can mean outdoor runs or walks, bike rides or hikes, and YouTube is an excellent resource for yoga and meditation classes and various cardio routines. Check out this article for even more ideas! You may not be able to control a lot right now, but moving your body is one concrete thing you can do to feel better.

Create Structure

With school closings and changing work routines, nothing feels normal right now and that can cause a lot of anxiety. Try to create some sort of structured routine (small changes can make a big difference!). Wake up at your normal time, even if you don’t have a commute right now. Make your bed every morning. Shower. Put on pants (yes, some people need a reminder to change out of their PJs when working from home!). If you usually have Tuesday night pasta night, have your Tuesday night pasta night. Sticking to a routine is especially important if you have children at home and they’re not in school currently, but a routine is healthy for everyone.

Check in on Your People

Gathering in crowds is not recommended right now, per CDC guidelines, but that doesn’t mean you shouldn’t check in on your friends and family. Skype, FaceTime, or even good old-fashioned texts and phone calls are excellent ways to stay in touch with everyone. We’re all in this together, and reminding people that they aren’t alone is crucial right now for mental health and sanity.

Supporting loved ones amid covid-19 pandemic

Infographic by The World Health Organization

Do Something Tangible

When you take away social gathering, date nights out, going to the movies, playing mini-golf, going bowling, and your kids’ weekly ballet class, everything suddenly feels…digital. Do something tangible: clean out the garage you’ve been meaning to clean out for the past 2 years, go through your clothes for Goodwill donations, repaint and rearrange a room, learn how to knit, dig around in your garden, pull out the dusty Scrabble and Scattergories games from the basement and have a game night, master your grandma’s cornbread recipe–anything that is physical will benefit you tremendously, and help peel you away from the constant stream of anxiety-provoking news.

Eat Healthy

The whole world being on pause right now might have given you license to stress-eat ice cream every night last week, or pour one too many glasses of wine over the weekend, but keeping a healthy eating routine will fuel your body and make you feel better over the long run. What feels good in the moment isn’t always the best thing for us over the long haul, and making sure we’re drinking enough water, eating plenty of vegetables, and getting good sources of protein will sustain us much better than ice cream ever could (sorry to say!).

Allow Yourself Some Grace

The world isn’t operating at 100% right now, and so it’s okay that you aren’t, either. You haven’t been able to concentrate on your work emails at all? Haven’t had the motivation to cook an elaborate meal? Not feeling optimistic about the future? Give yourself some grace, and allow yourself to slow down and feel this moment. This is a global pandemic, and (hopefully only) a once-in-a-lifetime event. Things are not normal, and it’s unreasonable to expect yourself to pretend like everything’s okay. It’s okay to not be okay right now.

Know This Is Only Temporary

Everything is in extremes right now, and it’s foreign to many of us. Maybe you’ve had to cancel travel plans, maybe you’ve had to return home from a study abroad program early, or you’re missing out on a Broadway play. Maybe you’ve even postponed your wedding. These are not normal times, and things won’t always be like this. Eventually, you will be able to go to the movies again, go to concerts with large crowds and not worry, get dinners, go bowling and grab happy hour without a care, and when you do, you can toast to happiness and good health, and getting through this horrific time, together.

How are you coping emotionally during this difficult and complicated time in the world? Share this article to help a friend, and comment your thoughts below; we would love to hear them!

Source: diabetesdaily.com

Cauliflower Spanish Rice

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.

By Robyn Perez

If you’re like me, the taste of cauliflower can be overwhelming, and sometimes you want to not care about the extra carbs in rice! But, after much trial and error, I’ve finally accomplished a cauliflower rice dish that hardly tastes like cauli. Husband-approved!

cauliflower spanish rice

Print

Cauliflower Spanish Rice

.wprm-recipe-rating .wprm-rating-star.wprm-rating-star-full svg * { fill: #343434; }

A delicious complement to your favorite Mexican dish or the perfect base for a burrito bowl, this variation of Spanish rice is packed with nutrients and is naturally low-carb.
Course Main Course
Cuisine Spanish
Keyword Cauliflower, Low-Carb
Servings 3 servings
Calories 67kcal

Ingredients

  • 1/3 red onion diced
  • 4-6 cherry tomatoes diced
  • 1 package cauliflower rice I use the Earthy Choice kind from Costco; 8.5 oz bags
  • 1/2 can El Pato hot tomato sauce key ingredient, 7.75 oz can
  • 2 tsp avocado oil or olive oil
  • cilantro optional
  • Cotija cheese optional
  • canned green chilies optional

Instructions

  • Sauté and season the red onion with salt and pepper in olive or avocado oil until translucent.
  • Add in the bag of cauliflower rice.
  • Add in the half can of El Pato.
  • Cover and simmer for about four minutes.
  • Open that baby up, throw in those diced tomatoes and stir and cook for an additional three to four minutes.

Notes

You can throw in some cilantro and green chilis for extra flavor and top with Cotija cheese for an almost authentic Spanish style rice.

For a delicious burrito bowl, you can add cooked chicken chunks, roasted veggies, and guacamole.

Nutrition

Calories: 67kcal | Carbohydrates: 8g | Protein: 1.5g | Fat: 3g | Fiber: 2g | Sugar: 4.5g


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.

Cauliflower Spanish Rice Recipe

Source: diabetesdaily.com

1 2 3 27

Search

+