Diabetic Ketoacidosis (DKA) at 30,000 Feet

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

By PK Hrezo

Twist of Fate?

It’s coincidental, if not oddly poetic, that type 1 diabetes presented itself to my family and me for the first time just two weeks before National Diabetes Awareness Month — a time we won’t soon forget.

Until that night, I thought type 1 diabetes (T1D) was something that kids were born with. I never thought it could be presented at any stage of life. I’d participated in JDRF walks before for friends and charity, so I knew the bare minimum. It had never been suggested to me by medical professionals that T1D was something all parents should keep an eye out for. Perhaps I hadn’t consulted the Parent Handbook regularly enough. But face-to-face with T1D for the first time, it was clear, I was on the brink of full-on parental guilt.

T1D did not run in our family, but that was the first question the ER doctor asked me while my thirteen-year-old daughter Abby was lying on the ER stretcher, nearly comatose, during a severe DKA episode in Halifax, Nova Scotia on October 19th, 2019.

DKA

Image source: Beyond Type 1

I was far from home, away from my husband, family and friends, and I was shell-shocked.

The Backstory

Abby and I had been planning a girl’s weekend to Paris for years, just the two of us, and it was to be the weekend of October 18th. Abby was beyond excited, which now, looking back, is probably what propelled her through the symptoms that we ignored as pre-DKA indicators. But we didn’t know. All we knew was that Abby had been under the weather for about a week – not herself, more tired than usual, and her ear had been bothering her just enough to prompt us to see the family doctor before getting on a plane.

We saw a nurse practitioner who checked Abby’s vitals and said her throat was red, but no ear fluid, and that she’d be okay for travel with some Mucinex. That night, Abby didn’t sleep at all. She woke up and stayed up for most of the night with indigestion. When she looked exhausted the next morning, we chalked it up to a bad night’s sleep.

Once we got to our connection at Chicago O’Hare, Abby seemed to be even more exhausted than before. Looking back, I realize the altitude from the plane ride from Tampa to Chicago had an adverse effect on her already gradual decline into DKA. She was uncomfortable in any position, and very thirsty for sweet, juicy-type drinks. She had an apple juice, a smoothie, a sweet tea with honey – all of these, unbeknownst to me, were contributing to the high sugars that would send her into DKA. I thought I was keeping her hydrated to flush out the virus, but sadly, all I was doing was shoveling more sugars into her bloodstream.

When Abby looked at me during our long layover and said she thought Paris would be a bad idea, I was both glad she’d owned up to it and puzzled by her sudden change. Of course, I wanted to do what was best for her. She mentioned one of our backup destinations — somewhere closer where we could still have our mother-daughter weekend but relax without the hustle and bustle of a busy city. We were already part of the way to another place, so we chose a pleasant B&B in Halifax, where it’d be autumn and beautiful. I made our arrangements and we headed to the next gate.

In Hindsight

If I could redo that day, I wouldn’t have put her on a plane to Canada, but that doesn’t mean I wouldn’t have made a different mistake. I might have booked a room in Chicago, so we could rest and she could sleep it off, which could have been fatal, since I still didn’t know she was in near-DKA.

I called my husband and told him how Abby was behaving, and that we’d changed plans. He was surprised, but agreed she likely just needed rest. That was also about the time doubt squirmed its way into my mind. People were beginning to stare at her. She was stumbling to the bathroom, and she just kept saying she was tired and needed to sleep. I was eager to get out of the airport and settle down somewhere so we could get back to normal. Little did I know, that normal had left us for good.

We pressed on and boarded the aircraft, and after about thirty minutes into the flight, my mommy senses went full-on haywire. What had I done? Something was wrong with Abby — I had no idea what, only that something wasn’t right, and it was too late for us to turn around. Tears welled in my eyes and I stared out the window wondering how I could’ve made such a big mistake.

Completely in the Dark

Abby could hardly hold her cup of ice she’d been munching on. She was dropping everything, and I was getting frustrated, because I’d never seen her that way, and I knew something was happening that she wasn’t telling me. “Talk to me,” I kept saying to her. “I don’t understand what’s going on.”

But Abby didn’t understand what was happening to her either. She complained that her lungs were hurting. Her lungs? I didn’t know if she was exaggerating or if she was having an allergy attack. How did all of those symptoms measure up to exhaustion and a virus? It didn’t make any sense.

Abby got up to use the bathroom again and was gone for quite a while — this is what I now know as T1D’s excessive peeing symptom. I was just about to go check on her, when she returned to our seat and laid over me. Her voice was barely audible when she complained again of her lungs hurting.

“Is there a doctor here?” she asked me in hardly a whisper.

“No,” I told her calmly. “But we’ll find one when we land.”

My nerves spiraled. I was, without a doubt, the worst mom ever. I decided that as soon as we landed, I’d call 911. We were halfway there. I held Abby as she laid over me in the row. And then she began to breathe heavily and rapidly.

I rubbed my hand up and down her arm. The stark difference between my hand temperature and hers was so alarming that I knew I couldn’t put it off any longer.

“Wait here,” I told her, and I beelined for the back of the plane where the two flight attendants stood in the galley.

“Can you see if there is a doctor onboard?” I asked. “I think there’s something wrong with my daughter.”

Team Work

Without hesitation, the flight attendants sprung into action and all the lights on the aircraft came on. While everything was moving in a blur for me, I returned to Abby and a passenger seated behind us, Nick Wasser, popped up as the announcement was made and identified himself as a nurse.

I explained Abby’s symptoms and everything up to that point, and a minute later, two more professionals appeared: Dr. Peter Laureijs and his wife, Beth, also a nurse. The flight attendants had oxygen and medical kits and they moved the passenger from the bulkhead row, so that Abby could be laid there on the floor. The doctor and nurses attended to her with great care, administering oxygen and checking her vitals.

I whispered a prayer and asked God for courage to get through whatever was to come, and that He might save my daughter. I remember very well, the moment when the woman in the adjacent row, Nick’s wife, Johanna, reached her hand over and lay it on mine, with tears in her eyes and said, “If you need anything, I’m right here.” The flight attendants checked on me throughout the remainder of the flight and made sure I was okay. They were in communication with the flight deck, and the pilots opted not to divert, but instead speed up the plane to get us to Halifax sooner, where IWK Health Centre would know how to care for whatever was wrong with Abby.

DKA

Image source: Beyond Type 1

They’d administered an IV by then, and that’s what saved Abby’s life, because unbeknownst to me she was dehydrating by the minute, as her bloodstream was filled with all that sugar that couldn’t be processed.

An ambulance waited on the tarmac when we landed. I could see their flashing lights out the window, and an announcement was made for no one to move until the EMTs had boarded and retrieved Abby. We started moving through the airport and Border Patrol gave me temporary paperwork and told me to call later after we knew what was going on. They wanted to make sure Abby wasn’t contagious, rightfully so, and that we weren’t bringing disease into Canada. At that point, we still had no idea what was happening.

On the ambulance, the EMT said her glucose level was 30 mmol/L (540 mg/DL). That didn’t mean anything to me. I said she’d had a lot of sweet drinks and nothing really to eat, so it was no surprise they were high. I was so naïve to the symptoms of T1D.

Learning the Ropes

The EMTs and ER staff that met us at IWK were all top-notch professionals with such warmth about them, that I never once felt alone, nor judged for my epic mom fail. While Abby was transferred to a bed and hooked up to all kinds of tubes, the ER doctor asked me a ton of questions, one of which was if diabetes was in the family.

“No,” I said informatively.

This is diabetes,” he said. “I can smell the ketones from here.”

“Ketones? What the heck are ketones?”

A word I’d later come to be acquainted with on a much deeper level. T1D had just blindsided me in a T-bone collision. Welcome to your new life. How had I not known? How had the doctor back home not identified it? Did this happen to other kids Abby’s age? Why did it wait so long to show up?

I stepped out and called my husband, and he, too, was in denial at first, insisting she’d probably just had a lot of sugar. Then I mentioned what the doctor said about smelling ketones, and it hit Nate like an anvil.

“Holy cow!” he said. “That’s what I smelled yesterday, remember? I said you need to brush your teeth because your breath smelled, and I thought it was you. I can’t believe I didn’t recognize it!”

Nate is a fire chief in Tarpon Springs and has thirteen years of experience in the EMT/first responder profession, and he has run across T1D patients a number of times.

Abby was admitted to PICU a few hours later where she was tended to by sweet, caring nurses for the next forty-eight hours, and where I would begin googling words and terms I’d never known before, in hopes of learning a lifetime worth of information within a couple of days.

Every time an ICU nurse would come in, I’d fire off questions, one of which being: “Does this type of thing happen very often?” One of the nurses said that in the last three months, they’d had eight cases of pediatric DKA where the parents had no idea that their child was T1D. After ICU, we moved to a room on the children’s ward, where we were introduced to managing T1D on our own. I was trained to use a glucometer and give insulin injections, and how to count carbs.

Making Sense of It All

I posted on Facebook when we finally returned home to Tampa. Sharing the signs of DKA with other parents seemed a priority, in hopes others could learn from my mistake. After my Facebook post went viral, I was contacted by so many other T1D parents and patients who have similar stories. So many of whom were turned away from doctors and ERs who also thought nothing was wrong.

I was an anxious ball of nerves when Abby and I finally received the okay to travel home to Tampa, because I’d be in charge of her insulin doses on my own for the first time. Since I learned dosages and glucose readings in Canadian measurements, I had to retrain my brain to switch over.

DKA

Image source: Beyond Type 1

The IWK nurses stayed in close contact with me throughout our journey home and advised me on what dosage to give after each blood reading. We had a doctor’s appointment the following morning with our new Tampa-based pediatric endocrinologist, and after one delayed flight to Newark, and another delayed flight to Tampa, we muddled through our insulin injections, and were able to get home and begin our new normal.

Together, our family is planning healthier food options with fewer carbs. We are making Abby’s lifestyle change our lifestyle change, we’re all watching our sugar intake. Once at home, I realized how fortunate we were to get help when we needed it, and I realized I didn’t know one of the nurse’s names from the flight. I also wanted to find out the flight crew of UA5596 so I could thank them. I made a Facebook post one morning asking others to help me find them, and I received an overwhelming response.

The post received almost 6K shares from people eager to pass on Abby’s story. The T1D community embraced me in a way I’ll forever be grateful for. Instead of feeling alone with this condition, I feel a part of something so much bigger than a crummy auto-immune disease, and I know a wealth of resources and support are waiting online should I need it.

While Abby and my weekend had not been the one of culture and mother-daughter bonding we’d hoped for, we found something else equally important. We learned that we are both stronger than we think, and that love and faith will get us through anything. We gained a new respect for life and its fragility, and humanity proved it’s still full of compassion. Since that fateful October night, Abby and I have been invited into a community of fellow T1Ds we never knew existed, and we’re reminded that there is strength in numbers, and that people truly are eager to help when given the chance. We are not alone.

Source: diabetesdaily.com

How to Save More Money in 2020

Everyone is looking to save money, whether it’s to put more money away for your child’s education, to afford expensive diabetes supplies, to take a big trip, or even if you’re trying to buy your first home. Here are our top 10 ways to save money in 2020 (and you won’t even feel the pinch, promise!):

Check Your Automatic Donations

Remember that donation to your favorite diabetes organization or research institute that you made in 2009? Or that rogue political candidate you never heard from again? Double-check to make sure your donations were for a single time sum, and not recurring. A lot of organizations make “recurring” donations the default, and their sticky fingers find their way into your bank account on a monthly basis! Double-check to save yourself some cash.

Buy an Instant Pot

You can save so much money by cooking in bulk, and an instant pot is a game-changer for saving money. Buying rice, beans, potatoes, and vegetables in bulk and then batch-cooking them in an instant pot can save you hundreds of dollars over the years.

public transport

Photo credit: Madeleine Ragsdale (Unsplash)

Take Public Transit to Work

Use public transportation at least half of the week, if possible. Better yet, negotiate to work from home one day a week to save money on gasoline and car maintenance. Alternatively, if you can carpool with a family member or friend, your gas money goes a lot farther!

The Happy Hour Rule

A fun rule to implement in 2020 is to only go out for drinks if there’s a happy hour. Going to a bar for a glass of wine can cost you up to $15 in some cities (for a single glass!), and limiting your imbibing to only happy hours can save you loads, while still having fun.

Try No Coffee Meetings for a Month

The average latte now costs $5, and if you have a daily coffee meeting that’s over $25 per week, and over $1200 per year! Challenge yourself to have a month without coffee meetings, and instead bring your coffee from home to the office. See if you miss the taste, but enjoy how much better your wallet feels!

If Able, Contribute to Your 401k

When you contribute to your 401k, you’re taxed on a smaller salary, and thus your tax burden will be less in the coming year, which could save you hundreds of dollars. Additionally, many employers will match contributions, and if you’re not investing in your employer’s 401k, you could be walking away from free (!) money. According to Investopedia, the ideal amount of contributions is between 15-20% of your earnings.

Ditch Cable

One of the biggest costs in monthly expenses can be the cable bill, and with the countless streaming services available nowadays, it doesn’t make sense to add another $100 a month to your bills. Opt for more wallet-friendly ways to get your TV fix, like Amazon Prime, Netflix, or HBO Go, that are a fraction of the cost of cable.

Be Wary of Fancy Gym Memberships

If you have a resolution to lose weight in the new year, be wary of joining a gym in January. Studies show that 80% of people who have a gym membership don’t go! If you want to lose weight in a sustainable way, focus on diet and natural ways to get exercise, like walking outside or adopting an active commute to work. You don’t need expensive gym memberships to get or stay fit- most of the time, it’s just a waste of money.

Sign Out of Amazon.com

Having a superstore in your pocket (with free, two-day shipping!) is dangerous. Simply deleting the Amazon app, or signing out of your account, will help you curb mindless, spontaneous spending. Instituting a 24-hour waiting period rule before purchasing something is an easy way to determine if you actually need the product you wish to buy.

Make Saving Automatic

Every month, schedule a recurring amount of money to be transferred from your checking account into your savings account for painless savings. Even better, some employers can arrange for a portion of your paycheck to deposit directly into savings, so you never see the money at all. And once you get accustomed to living on less, you’ll find that you don’t even miss the cash that you used to aimlessly spend anyway.

What are some of your favorite money-saving strategies? Share this post and comment below!

Source: diabetesdaily.com

Parenting with Diabetes: I Taught My Two-Year-Old Daughter How to Be My Caretaker

This content originally appeared on diaTribe. Republished with permission.

By Cherise Shockley

diaTribe Community Manager, Cherise Shockley, shares the story of her diabetes diagnosis and how that diagnosis affected her family

I was diagnosed with latent autoimmune diabetes in adults (or LADA, a type of diabetes between type 1 and type 2) in July 2004, at the age of 23. I was a newlywed, my husband, Scott, was deployed, and I had just finished five-and-a-half years in the Army Reserve. I was placed on oral medication (glipizide), and I began to manage this form of diabetes with diet and exercise, knowing that someday I would require regular insulin for the rest of my life.

In March of 2005, Scott returned from deployment, and a month later we found out I was expecting our first child. Nine months into my diabetes diagnosis, I was carrying my first child; I was temporarily placed on Regular and NPH insulins, because I had to stop taking my oral diabetes medication during pregnancy. At the time, I did not have a continuous glucose monitor (CGM) – the first version of the Dexcom STS wasn’t invented until March 2006,  as my colleagues at diaTribe wrote about here.

My pregnancy was smooth-sailing aside from my diabetes, which took quite a toll on me, but I knew if I did what I could to manage the condition, my little girl would be okay.

Eight months after I gave birth to my daughter, Niya, we said our good-byes to our families and moved from Kansas City, Missouri, to our new duty station in Southern California.

From the time my daughter was one year old, until she was reached two, I was taking oral medication, and my hypoglycemic episodes were few and far between. When I did experience hypoglycemia, I was either at home or at work, and my husband or my coworkers could help me out.

After my daughter turned two, I noticed that my medication was no longer working. With the help of my nurse practitioner, I tried everything in my power to get oral medication to work for me, but it was time to see an endocrinologist.

A few days after my first visit, I met with a nurse practitioner. He told me, “Your beta cells are still present, but we do not want to burn out what little function you have, so I recommend you start taking insulin.” I paused. Although I knew this day was coming, it was like hearing “you have diabetes” all over again.

When we began talking about pump therapy, I asked for something easy to use, knowing that my two-year-old daughter would be my primary caretaker.  I wanted Niya to be able to help me if she needed to.  With my husband working late hours and traveling, we made a decision to teach my daughter how to manage my diabetes. We taught her how to call 9-1-1, how to treat my lows with apple juice, and eventually, how to shut my pump off. In the back of my mind, I wanted her to know how to manage diabetes just in case she received her own diagnosis later in life.

Parenting

Image source: diaTribe

Many parents of children with diabetes share stories of not being able to sleep because they are worried about waking their child up in the middle of the night to check their blood glucose levels. In my family, my daughter was the person I woke up in the middle of the night when I experienced low blood glucose. Before I had a CGM, Niya was the person helping me check my glucose levels and stuffing glucose tabs or candy into my mouth in the middle of the night when my husband was not home.

From the time she was two, my daughter was my primary or secondary caretaker. Scott retired two years ago, so now Niya only helps me out when it’s just the two of us together. If she hears the alarm from my CGM, she asks if I am okay.

I never asked Niya how she felt about her role in helping me manage diabetes; I was nervous to interview my 13-year-old daughter, but I wanted to know how she felt.

Me: How did it feel growing up with a mother with diabetes?

Niya: I was a normal kid. I can eat what I want. I was able to learn how to manage your diabetes and help you when you needed help. I know how to recognize when you are okay.

Me: How old were you when you realized I had diabetes?

Niya: I was four or five. You asked me to film a diabetes video for you.  The hook in the song, “Who has diabetes? Help us stop diabetes,” made me realize that diabetes was a bigger issue. Diabetes was my normal – but the video helped me see that diabetes was also serious.

Me: Was there ever a situation that scared you?

Niya: We recently went to Disney Springs together during Friends for Life. You went really low, and I was scared that you weren’t going to be okay. I didn’t want anything to happen to you when I was with you; I didn’t want to be responsible. Diabetes is a lot of responsibility for a kid, but in some ways, I’m used to it.

Me: That was a scary moment for me, as well. It was the first time in a long time that I was not able to get my blood glucose levels to go up (with glucose tabs or candy). It was important to me to let you shop with your friend while the team at Disney Springs sat with me.

Niya: Thank you for letting me be a kid and not forcing me to live as if I had diabetes. I love you.

Me: Is there anything you would like to say to other children who have parents with diabetes?

Niya: It is sometimes difficult having a parent with diabetes. I now have two parents with diabetes, since my dad has type 2. I want other kids to know that they can navigate it – they will feel extra pressure that other kids don’t feel, but hang in there. When your mother is as special as mine, it’s worth it; diabetes is a big part of my family.

Source: diabetesdaily.com

One Marinade, Three Elegant (and Simple) Meals

This recipe is easy enough for a Wednesday, and elegant enough for company!

Meal planning can be a bore. Sometimes I find that planning on what to eat is as much of a project as what I eat. Here is one simple base marinade that I use with minor adjustments for chicken, pork and fish. This is so easy to make and keep on hand that you get three days of not having to think about what to cook. Each protein changes the flavor enough that you may not realize that it all came from the same formula. Grilling it outside in good weather makes it taste entirely different than roasting it in the oven or pan searing it. I have the recipes for chicken, salmon, and pork on my website. This is the base recipe. It is enough for 2 chicken breasts, 2 salmon fillets, or a 2 pound pork roast or 4 pork chops.*The trick is to use the best balsamic vinegar you can afford.

Enjoy, Be healthy, be Decadent!

Balsamic Marinade

Total carbohydrates: less than 9 grams in the entire recipe

  • 3 tbsp Ariston or any syrupy balsamic vinegar
  • 3 tbsp olive oil
  • 1 tsp dijon mustard
  • Juice and zest of ½ lemon
  • 2 tsp Herbs de Provence
  • 1 medium shallot minced
  • 2 garlic gloves, grated or minced
  • Salt and pepper to taste*For pork, I eliminate the lemon juice and zest

I just combine this in a jar and shake it up before brushing or spooning over the protein

On chicken:
On the grill, at medium low setting for 15-17 minutes per side.
In the oven, at 350 degrees for 45-50 minutes, turning once.
In a sauté pan, at medium setting for 15-17 minutes.

For salmon:
On the grill, at medium-low setting for 8-10 minutes per inch.
In the oven at 400 degrees for 7-10 minutes per inch.

For pork roast:
10 minutes at 400 degrees then reduce heat and cook for 40-45 minutes at 350 degrees.

For pork chops:
On the grill at medium low setting for 15-17 minutes per side.
In a sauté pan at medium setting for 17-20 minutes.

Source: diabetesdaily.com

No-Noodle Keto Lasagna with Spinach and Meat

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

Most people assume that lasagna is off-limits for low carb diets. After all, it’s made with layers of pasta noodles.

But when you think about it, the rest of the ingredients in lasagna are pretty low-carb. Cheese is the star of the dish, and many lasagnas use meat as well. Add in a low-carb marinara, and you’re well on your way.

So really, the only thing left is to replace the noodles.

You can easily make a pastaless lasagna recipe by simply taking out the noodles. In fact, this is exactly what I do for my keto Instant Pot recipe. The result is super tasty, but also very messy. It’s the kind of dish you eat out of a bowl, not on a plate.

There’s nothing wrong with that, but it is a bit different than traditional lasagna. In my opinion, to make an authentic style pasta-free lasagna, you just need to make it in layers.

Substitute for Lasagna Noodles on a Keto Diet

There are a few great options to replace the pasta layer when you’re making a low-carb lasagna.

One tried and true method is using a vegetable layer. You could try spaghetti squash, cabbage, eggplant, or even strips of zucchini noodles to replace the pasta layer. But vegetables add extra carbs.

Another option is to use thin slices of deli meat. In Maria Emmerich’s cookbook, Quick and Easy Ketogenic Cooking, she has a fantastic recipe for skillet lasagna that uses thin roasted chicken breast to create the layers. You could also try pepperoni or salami for even more flavor.

Replace Pasta with Meat

When I was creating this recipe, I decided I wanted to try something a bit different. I wanted a dish that was super satisfying and full of great flavor that didn’t rely on veggies.

So, I decided to replace the pasta layer with meatza!

If you’re not familiar with meatza, it’s just a term for a low-carb pizza crust made out of meat. It holds up really well to sauces and melted cheese, so it’s great for Italian cooking. I also use it in my spinach tomato meatza pizza recipe.

The meatza noodle layer adds a ton of flavor and really takes this keto no-noodle lasagna to the next level. And it’s quite easy to make!

No-Noodle Keto Lasagna with Spinach and Meat

A low-carb lasagna for meat lovers. Rather than try to sneak in a vegetable for the pasta layer, meat is used instead for this no-noodle keto friendly casserole.

Meatza Ingredients:

  • 2 pounds ground lean beef
  • 1 egg yolk (beaten)
  • ½ cup parmesan
  • 1 teaspoon garlic powder
  • 1 teaspoon onion powder
  • 2 teaspoon ground sage
  • 1 teaspoon ground oregano
  • 1 teaspoon dried thyme
  • ½ – 1 teaspoon cayenne pepper powder (can be omitted if desired)
  • salt and ground black pepper (to taste)

Lasagna Ingredients:

  • 2 – 2 ½ cups marinara sauce
  • 10 ounces spinach
  • 2 egg yolks (beaten)
  • 1 cup ricotta
  • 2 cups mozzarella cheese (freshly grated )
  • ½ cup parmesan
  • ¼ teaspoon onion powder
  • ¼ teaspoon garlic powder
  • ⅛ teaspoon ground black pepper
  • 1 tablespoon olive oil
  • fresh parsley ( for garnishing)

Making the meat slices

  1. In a small container, mix onion powder, garlic powder, sage, oregano, thyme and cayenne powder (if using). Reserve ½ teaspoon for marinara sauce.
  2. Place ground beef in a large platter or large bowl and mix in seasoning. Sprinkle parmesan and beaten egg yolk. Mix well.
  3. Line two 9×13 baking pans with parchment paper. Transfer seasoned ground beef and flatten with a spatula or back of a spoon.
  4. In a preheated oven of 450°F, bake ground beef for 7 to 12 minutes or just until browned. Drain oil and slice to fit lasagna container.

Preparing the lasagna

  1. In a bowl with marinara sauce, add parmesan, reserved mixed seasoning (from meatza ingredient and mix well. Set aside.

  2. In another bowl with beaten egg, fold in ricotta. Set aside.
  3. In a skillet, heat olive oil and spinach until wilted. Season spinach with onion powder, garlic powder and black pepper.
  4. Assemble lasagna. Pour 2 to 3 tablespoon marinara sauce to an 8×8 baking pan. Top with meatza slices, spread more marinara sauce. Add all sautéed spinach and spread ricotta mixture on top. Cover with half of mozzarella cheese. Repeat with remaining ingredients, with mozzarella at the top most part.
  5. In a preheated oven of 400°F, bake for 15 minutes or until cheese is melted and slightly golden.

Recipe can be split between two loaf pans to eat one now and save one in the freezer for later. The frozen unbaked casserole can be baked right from the freezer or thawed first to shorten baking time. Just bake at 350°F until heated throughout, about 15 minutes thawed and 20 minutes frozen.

Net carbs: 2 g per serving

No-Noodle Keto Lasagna with Spinach and Meat Recipe

Source: diabetesdaily.com

Este Haim on Burnout + Bolusing for Pizza

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

By Todd Boudreaux

Este Haim is the bassist of the pop group Haim, which she formed with her sisters Alana and Danielle in 2007. Este has also been living with type 1 diabetes for nearly 20 years. Last week, Haim announced the release of their new track “Hallelujah,” stating the song is for “anyone struggling with chronic illness.” Beyond Type 1 caught up with Este to ask about the genesis of the track, her life on the road with T1D, and how she faces diabetes burnout with the help of her support system.

A Rough Transition

Freshman year of high school is perhaps the biggest transition in any teenager’s life. For Este Haim, that transition was made all the more difficult by her diagnosis with type 1 diabetes at age 14. Este recalls how difficult it was to fit in given all that she was going through.

“Yeah, it wasn’t a great way to start my first week of high school… I was basically a social pariah for a very long time. You know, I was just the diabetic kid in school that passes out and no one knows why and the diabetic girl that smelled like orange juice all the time.”

Although some of her classmates made life difficult in high school, there are two people Este has always been able to depend on — her sisters Alana and Danielle.

“Not only are they my sisters, I’m also in business with them, so we spend so much time together. We’re on the road together 24 hours a day for weeks on end. So they’ve seen every version of me. They’ve seen me in a good place with diabetes, and in a sh*tty place with diabetes,” Este says.

“I’m lucky that I have Danielle and Alana to be my support and when I am having a bad day, a bad week, a bad month, they’re always the first people to be like, ‘Dude we got you. Whatever you need. We’re going to get through this. Let’s get you a healthy meal. Let’s not have pizza after the show tonight. Let’s go get you something good so that you don’t wake up and your blood sugar is 350.”

Real Talk

“Pizza is such a blessing but it’s also such a curse” — Este’s description of pizza is all too real for anyone who has lived with diabetes.

“After a show, I get so hungry and the only thing that’s available to me is pizza. And we all know that pizza does weird sh*t to blood sugar. It’s this unexplained thing — bread I can bolus for, tomato sauce I can bolus for, cheese I can bolus for, but for some reason when they’re all together it’s this magical thing that I can never get right. It’s insane, what is that? It’s like my favorite food. And of course, it’s the one thing that I really can never get right. It’s hard being on the road and craving food and realizing the only things that are open late are either diners that don’t really have a lot of like salad-y options, or pizza.”

Este’s sisters fully grasp the exhaustion that comes with living with diabetes and have become an amazing support system for her. Their holistic view serves to remind Este that she is more than her diagnosis.

“My sisters have this incredible attitude of, ‘If you’re going to have a bad day, have a bad day, and just live your goddamn life. Tomorrow’s a new day, you get back on the wagon, get back on taking better care of yourself, let’s make some healthier choices. Let’s take a walk around the venue for a little bit, let’s get some exercise.’ And that also takes energy on their part. So I’m thankful that I have them on the road and it’s definitely an integral part of diabetes, is having that support. I’m really lucky.”

Life on the Road

Haim

Image source: Beyond Type 1

Keeping track of blood sugars on a consistent schedule is extremely difficult, and the ups and downs of life on the road can wreak havoc on the ability to maintain glycemic control, of which Este is all too aware.

“It’s being in a different time zone and not being able to sleep and then the stress of that and the cortisol in my blood making my blood sugar rise for no reason. Often, I won’t even know that I’m stressed out, and then I’ll see on my Dexcom that the arrow just goes straight up.”

Having a continuous glucose monitor (CGM) has been a game-changer for Este, not just because it allows her sisters to follow her glucose levels remotely, but also because of what it means to others living with T1D.

“I think awareness is so important and that’s why I wear my Dexcom on my arm now because I have a way of showing people that I am a type 1 diabetic… before I didn’t really have that.”

Diabetes Burnout

Este doesn’t mince words when it comes to the importance of mental health awareness for people living with type 1 diabetes. She is candid about the very real struggles that anyone living with a chronic illness endures over the course of their life.

“I think something that I struggled with, something a lot of people with diabetes struggle with, is perfection. We were taught to look at high blood sugars as a failure. I think that leads to diabetes burnout because you’re constantly trying to be perfect. Mentally, there’s only so much of that you can take without feeling like a failure… And I think that’s been the majority of the reason that I burn out. I’m just like ‘F*ck it, fine, whatever.’”

Haim recently released a new song titled ‘Hallelujah’ and Este posted that her verse in the song was inspired by her struggles living with T1D, specifically calling out the phenomenon of diabetes burnout in her post.

“It’s a lot easier sometimes to just ignore it and not deal with it, but we all know it always catches up with you… I feel like I’ve gone through diabetes burnout — for long periods of time — at least 10 different times in the past 20 years of being a diabetic, and like it’s tough, man. It’s tough to maintain that as a type 1 with chronic illness because there isn’t necessarily a promise that there’s a light at the end of the tunnel, and I said it in my post, it’s like a 24-hour job you can’t clock out of, that you don’t get paid for. Maintaining that mental toughness I think is exhausting for a lot of people.”

Haim

Image source: Beyond Type 1

Looking to the Future

At the end of the day, it all comes back to the support we receive from the people around us. As our discussion wrapped, Este told Beyond Type 1 how important it is to remind those that support us just how appreciated they are.

“The thing that I want to impart to people is to tell our loved ones that support us — that we do appreciate them — and to thank them for being supportive because I don’t know what I would do without my sisters, my parents, my best friends and my boyfriend for that matter… I think it’s really important to find the people that truly love and support you. I know it sounds trite and cliché, but all we can do is look to the future and try and live our best lives and have fun doing it. Enjoy every day as much as you possibly can, and don’t let diabetes get in the way of you doing and achieving everything that you want to do. Truly, that’s all we really can do.”

Source: diabetesdaily.com

Onederland: Poems About a Childhood with Type 1 Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler and Kelly Close

Jamie Kurtzig, a high school student living with type 1 diabetes, just published a book of 100 poems that she has written over the last ten years

Onederland: My Childhood with Type 1 Diabetes is a book of 100 poems recently published by a 15-year-old diabetes advocate, Jamie Kurtzig. The book takes readers through Jamie’s childhood, touching on themes of growing up, navigating challenges, and finding hope. We attended the book launch yesterday and were so impressed by Jamie’s discussions about diabetes. We asked her if she could give one piece of advice to families that reflected the sentiments of her own family, and she answered eloquently with a single word “Hope.” She continued, “Never lose hope.”

Jamie was diagnosed with type 1 diabetes when she was one year old and has been writing poems since the age of five. Her book is now available from Book PassageBarnes & Noble, and Amazon. We sat down with Jamie to learn about her poems and her vision for this book.

Jamie: I’ve always liked writing poetry; I wrote my first poem when I was five, and it’s actually included in the book. Writing poetry helps me express myself and make sense of things and think about things, so it’s been a really fun process. I’m excited that Onederland is now published.

What did you learn about yourself during this process?

Jamie: Diabetes has really influenced who I am, and it has also given me a passion for finding a cure, something I want to do for the rest of my life. I realized this while writing my book.

What do you most want people to know about Onederland?

BookJamie: All of the proceeds are going to diabetes non-profits – including The diaTribe Foundation – to help find a cure, one of my main goals. I would love to experience just one day where I do not need to check my finger or bolus for a meal or have glucose tabs for low blood sugar. I’m so lucky to live in the Bay Area and have access to tools to help me manage diabetes; we need to find a cure not only for people like me, but for people everywhere.

How did you go from the poems you’ve written over the last ten years to this incredible, finished book?

Jamie: I had these poems but didn’t know what to do to get them on paper, so I talked with Book Passage, an awesome local bookstore. They introduced me to great mentors, who helped me create a story arc — my story — so that the book evolves along with my life. I start with an intro of me (“Where I’m From”), and then move into some of the challenges in my life and how I’m dealing with them and working with them, and then into more hope. I also wanted to include an index so people could see how old I was when I wrote each poem.

What was the hardest part of publishing a book?

Jamie: Getting all the details right! I had to order three proofs before I caught all the mistakes.

Who are your favorite poets?

Jamie: Mary Oliver – I have a giant quote of hers on my wall. And also Emily Dickinson.

How did your family respond to your choice to publish a book of poetry?

Jamie: My mom has been so supportive of me. In everything I do she always supports me and helps me get things done – which is awesome because sometimes it’s hard for me to get from ideas into… a book!

We asked Sara Kurtzig, Jamie’s mom, to tell us a bit more.

How do you feel about Jamie’s book of poems?

Sara: So, so proud. She’s so graceful to me, and I so appreciate her way and her spirit, and I think it comes through in her book. I had never read her book until she asked me to read her proof. I read the whole thing on the airplane and I was in tears. She had to do a lot of work to make this happen. She had to figure it out. She picked the paper, she picked the font, she picked the title. It’s a lot of thinking. I feel that she did not cut corners and took the time to do all of it. And I am so proud. She did this all in her own way. And she is donating every penny to various diabetes non-profits. We can get a lot of places with that power.

Find Onederland: My Childhood with Type 1 Diabetes at Book PassageBarnes & Noble, and Amazon.

Jamie was a Junior Summer Associate in 2019, working with college students and recent college grads at The diaTribe Foundation and Close Concerns. She is also now a writer for diaTribe – read about her experience with Loop and her advocacy work at the 2019 JDRF Children’s Congress.

Source: diabetesdaily.com

Traveling with Type 1 Diabetes: Valencia, Spain

Dr. Jody Stanislaw has had type 1 diabetes (T1D) for almost 40 years and is on an inspiring adventure of living in a new country every month until September 202. She is on a mission to inspire T1Ds everywhere that living a healthy and adventurous life with T1D is 100% possible.

This month she is living in Valencia, Spain. Check out this video of a gorgeous city square and learn why paella, a classic Valencia dish, should be eaten at lunchtime.

Source: diabetesdaily.com

Shaved Brussel Sprout Salad

This content originally appeared on ForGoodMeasure. Republished with permission.

I disliked Brussel sprouts as a child. Mind you, I loved cabbage to the point I begged my mother to make sauerkraut almost weekly. That said, I felt validated in my sprout-loathing as the edible buds topped the most-disliked vegetable list nearly every year. Nothing changed until I married my husband, who happened to adore the little cabbages. I experimented with roasting, glazing, but this recipe is my favorite. It shines for hours on a buffet, works layered in a sandwich, but I think it’s best paired with a savory roasted entree.

Shaved Brussel Sprout Salad

This naturally low-carb and gluten-free salad is a quick recipe for those craving for some greens to complement an entree.

  • 2 cups Brussel sprouts (shredded)
  • 1 teaspoon sea salt
  • 2 tablespoons stone-ground mustard
  • 2 tablespoons Meyer lemon juice
  • 2 tablespoons olive oil
  • 1 teaspoon garlic
  • ½ cup flat-leaf parsley (chopped)
  • ½ cup salted almonds (roasted, chopped)
  • 1 cup avocado (sliced)
  1. Wash and process brussel sprouts.
  2. Toss with sea salt and rest 15 minutes.
  3. Combine mustard, lemon juice, olive oil and garlic.
  4. Toss brussel sprouts and parsley in dressing, until well-covered.
  5. Top with almonds and avocado.

3g net carbs

Shaved Brussel Sprout Salad Recipe

Source: diabetesdaily.com

Prior Authorization: Getting Diabetes Supplies and Medications Covered by Insurance

This content originally appeared on diaTribe. Republished with permission.

By Divya Gopisetty

What is a prior authorization? Read on to learn more about why diabetes supplies or medications might require a prior authorization and how to go through the process

It can be frustrating to learn that you need a prior authorization when you already have a prescription. Insurance plans sometimes require a prior authorization to cover a diabetes supply, device, or medication, even if your doctor prescribed it to you.

Read on to learn about what a prior authorization is, and how you can make the submission process as smooth as possible.

In this article:

Click to jump to a specific section!

What is a prior authorization?

My pharmacist told me I need a prior authorization. What happens next?

How can I check if I need a prior authorization?

How long do prior authorizations last?

What happens if the prior authorization is denied?

What is a prior authorization?

A prior authorization, also known as a pre-authorization or pre-certification, means that your healthcare provider or device company has to get specific approval from your health insurance company (so that it will pay for it).  The requirements for prior authorization differ between and within insurance plans.

If you need a prior authorization, the pharmacist cannot process your prescription until your healthcare professional has contacted the insurance company. Similarly, a device company may not ship your diabetes device to you until it has prior authorization from the insurance company.

A prior authorization is designed to make sure certain prescription drugs or devices are used correctly and only when medically necessary. Before your insurance plan will cover a certain device or drug, you must show that you meet a set of criteria.

Prior authorizations are most often handled by your healthcare professional’s office, but sometimes are handled by the device company itself (e.g., for CGM).

If you want to see what a prior authorization request form looks like, check out this one for OptumRx.

My pharmacist told me I need a prior authorization. What happens next? 

  1. If your insurance company requires (and has not received prior authorization), your pharmacy will contact your healthcare professional.
  2. The healthcare professional will contact your insurance company and submit a formal authorization request.
  3. Your insurance plan may have you fill out and sign some forms.
  4. Your insurance plan will contact the pharmacy once it has approved or denied the request.

During this process, be sure to communicate with both your healthcare provider and your insurance company to see if they need any additional information. Prior authorizations usually take about a week to process – after that, check with your pharmacy to see if the request was approved. If the request was approved, you should be able to pick up your prescription from the pharmacy.

If it wasn’t approved, your pharmacy should be able to tell you why, and then you can decide to request an appeal.

As someone living with diabetes, you are your best advocate. Be prepared to track down the paperwork to make sure you receive the requested device or medication.

How can I check if I need a prior authorization?

Check your health plan’s policy and formulary (you can normally access these on the insurance company’s website) to see if any of your treatments require a prior authorization. Or, you can call the member services number found on the back of your insurance ID card to speak with someone directly.

How long do prior authorizations last?

Most approved prior authorizations last for a set period of time (usually one year). Once it expires, you’ll have to go through the prior authorization process again.

What happens if the prior authorization is denied?

  • You can request an appeal (which is often successful!)
  • You can pay the full cost for the medication or healthcare supply, without insurance coverage.

Want to learn more?

Check out this easy-to-read resource created by DiabetesSisters on prior authorizations, step therapy, and appeals.

What’s Worked for Other People with Diabetes? Hear from Them!

  • I was denied my first CGM in 2008 by a Blue plan and fought and won by knowing how to Google my payer’s medical policy and prove that I met coverage criteria. It helped that I was given the HCP line phone number by a nurse sympathetic to my cause, but I ended the call with an authorization code. – Melissa
  • My strategy has always been persistence pays (eventually the insurance company will give in, although they may have peculiarities to navigate. The doctor’s office is really key and many have specialists who only deal with insurance company issues [mine does]). I’ve been covered by 4 insurance companies over the past decade while at the same employer if that tells you anything about the evolving insurance market. My experience with Anthem was a hassle but predictable, United Healthcare was easiest to navigate, Aetna was straightforward but a pain and had some weird rules (Why does a precertification inexplicably expire at the end of a calendar year? My chronic illness did not expire at the end of the year.). – Scott
  • Do you have experiences with prior authorizations? Let us know!
diaTribe Series

Image source: diaTribe

This article is part of a series on access that was made possible by support from AstraZeneca. The diaTribe Foundation retains strict editorial independence for all content. 

Source: diabetesdaily.com

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