What Are SGLT-2 Inhibitors and How Can They Help Your Heart?

This content originally appeared on diaTribe. Republished with permission.

By Mary Barna Bridgeman

SGLT-2 inhibitors can protect your heart! This type of medicine is recommended for people with type 2 diabetes who have heart disease or risk factors related to heart disease. Learn about the use of these medicines, including side effects, their effect on A1C, and their role in supporting heart health

Diabetes is a risk factor for heart disease: people with diabetes are twice as likely to have heart disease or a stroke compared to those without diabetes. Heart disease is often a “silent” condition, meaning that symptoms are not necessarily present until a heart attack or a stroke actually happens. It is important for people with diabetes to realize they may be at risk – click to read more about the link between diabetes and heart disease from Know Diabetes By Heart.

There are many ways to take care of your heart and to reduce the risk of heart disease while living with diabetes. New medicines, including sodium-glucose cotransport 2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists, have been shown to protect the heart and reduce the risk of many specific heart-related outcomes. This article will focus on SGLT-2 medications, and our next article will focus on GLP-1 medications.

Heart diseases

Image source: diaTribe

Click to view and download diaTribe’s helpful infographic on preventing heart disease.

What are SGLT-2 inhibitors?

There are currently four medicines that are categorized as SGLT-2 inhibitors:

These medicines help people with type 2 diabetes manage their glucose levels: they work in the kidneys to lower sugar levels by increasing the amount of sugar that is passed in the urine. SGLT-2s increase time in range and reduce A1C levels while also lowering blood pressure and supporting weight loss. For people with diabetes who have had a heart attack or are at high risk of heart disease, or who have kidney disease or heart failure, these medicines could be considered regardless of A1C level. While SGLT-2 medications are expensive, some assistance programs are available to help with cost – see one of diaTribe’s most popular articles, “How to Get Diabetes Drugs For Free.”

What do you need to know about SGLT-2 inhibitors?

SGLT-2s have a low risk of causing hypoglycemia (low blood sugar levels). Because they increase sugar in the urine, side effects can include urinary tract infections and genital yeast infections in men and women. Dehydration (loss of fluid) and low blood pressure can also occur. Symptoms of dehydration or low blood pressure may include feeling faint, lightheaded, dizzy, or weak, especially upon standing.

Before starting an SGLT-2 inhibitor, here are some things to discuss with your healthcare team if you have type 2 diabetes:

  • How much water to drink each day
  • Ways to prevent dehydration and what to do if you cannot eat or you experience vomiting or diarrhea (these are conditions that may increase your risk of developing dehydration)
  • Any medicines you take to treat high blood pressure

When prescribed for people with type 2 diabetes, SGLT-2s rarely cause diabetic ketoacidosis (DKA), a serious and potentially life-threatening condition. For people with type 1 diabetes, DKA is a well-known risk when SGLT-2s are prescribed. Call your healthcare professional if you have warning signs of DKA: high levels of ketones in your blood or urine, nausea, vomiting, lack of appetite, abdominal pain, difficulty breathing, confusion, unusual fatigue, or sleepiness. When you are sick, vomiting, have diarrhea, or cannot drink enough fluids, you should follow a sick day plan – see Dr. Fran Kaufman’s article on developing your sick day management plan. Your healthcare professional may instruct you to test your urine or blood ketones and stop taking your medication until symptoms go away.

If you have type 1 diabetes or chronic kidney disease, depending on your level of kidney function, these medicines may not be for you. Additionally, SGLT-2s are associated with increased risk of lower limb amputation.

SGLT-2 inhibitors are usually taken as a pill once a day – often in the morning before breakfast – and can be taken with or without food.

What do SGLT-2 inhibitors have to do with heart health?

Results from clinical studies suggest SGLT-2 inhibitors may play an important role in lowering heart disease risks.

Jardiance was the first SGLT-2 inhibitor to show positive effects on heart health in the EMPA-REG OUTCOME trial. In this study, more than 7,020 adults with type 2 diabetes and a history of heart disease were followed. Participants received standard treatment for reducing heart disease risk – including statin medications, blood pressure-lowering drugs, aspirin, and other medicines – and diabetes care, plus treatment with Jardiance. Over a four-year period, results from the study showed that, compared to placebo (a “nothing” pill), Jardiance led to:

  • a 14% reduction in total cardiovascular events (heart attacks, strokes, heart-related deaths)
  • a 38% reduction in risk of heart-related death
  • a 32% reduction in overall death
  • a 35% reduction in hospitalizations from heart failure

Read diaTribe’s article on the results here.

Similarly, the heart protective effects of Invokana have been shown in two clinical studies, CANVAS and CANVAS-R. These two studies enrolled more than 10,140 adults with type 2 diabetes and a high risk of heart disease, randomly assigned to receive either Invokana or placebo treatment. In the CANVAS studies, treatment with Invokana led to the following:

  • a 14% reduction in total cardiovascular events (heart attacks, strokes, heart-related deaths)
  • a 13% reduction in risk of heart-related death
  • a 13% reduction in overall death
  • a 33% reduction in hospitalizations from heart failure

Read diaTribe’s article on the results here.

Farxiga may also reduce heart disease risks. In the DECLARE-TIMI 58 study, more than 17,000 people with type 2 diabetes received Farxiga; 40% of participants had known heart disease and 60% had risk factors for heart disease. Importantly, more than half of the people included in this study did not have existing heart disease. While Farxiga was not found to significantly reduce total cardiovascular events (heart attacks, strokes, heart-related deaths) compared with placebo, its use did lead to a 17% lower rate of heart-related death or hospitalization for heart failure. Read diaTribe’s article about the results here.

More recently, the DAPA-HF study evaluated the use of Farxiga for treating heart failure or death from heart disease in people with or without type 2 diabetes. The study included more than 4,700 people with heart failure; about 42% of those enrolled had type 2 diabetes. Farxiga was shown to reduce heart-related death or worsening heart failure by 26% compared to placebo, both in people with type 2 diabetes or without diabetes. Learn more about these results here.

All of the available SGLT-2 inhibitors have evidence suggesting benefits of this class of medications for people with established heart failure. Click to read diaTribe’s article on SGLT-2 Steglatro and heart health.

Other possible benefits of SGLT-2 inhibitors

InvokanaFarxiga, and Jardiance have also been shown to reduce the progression of kidney disease. Learn more about diabetes and kidney disease here.

SGLT-2s have been studied in people with type 1 diabetes, but are not yet approved for use by the FDA – you can learn about SGLT-2s for people with type 1 diabetes here.

What’s the bottom line?

You can reduce your risk of heart disease and promote heart health while living with diabetes. You and your healthcare team should develop a personalized plan to determine what ways are best for reducing your risk of heart disease. According to the latest evidence and treatment recommendations, SGLT-2 inhibitors may be most useful for people with type 2 diabetes and heart disease or at high risk of heart disease.

About Mary

Mary Barna Bridgeman, PharmD, BCPS, BCGP is a Clinical Professor at the Ernest Mario School of Pharmacy at Rutgers University. She practices as an Internal Medicine Clinical Pharmacist at Robert Wood Johnson University Hospital in New Brunswick, New Jersey.

This article is part of a series to help people with diabetes learn how to support heart health, made possible in part by the American Heart Association and American Diabetes Association’s Know Diabetes by Heart initiative.

Source: diabetesdaily.com

Exercise: Getting Started with Type 2 Diabetes

Everyone knows that if you live with type 2 diabetes, exercise will be beneficial not only for your blood sugars, but for your overall health and well-being. The tougher issue is to know where, when, and how to get started. Learn more about the risks, benefits, and factors to consider when starting an exercise regimen while living with type 2 diabetes. Please note: always check with your doctor before beginning any new exercise routine.

Benefits

The benefits of exercise for people with type 2 diabetes are well-known. Exercise helps maintain tighter blood sugar control, lowers the risk for heart disease and other cardiovascular complications, improves blood pressure levels, strengthens muscles and bones, and helps to improve quality of sleep and the body’s ability to handle stress. According to the CDC, adults should aim for at least 150 minutes of moderate-intensity aerobic physical activity (like walking) or 75 minutes of vigorous-intensity physical activity (like jogging or dancing) each week.

Factors to Consider

The best type of exercise is the type that you’ll do regularly, so a main factor to consider is finding something that you like doing. If you dislike the gym, don’t force yourself into a habit of going. If you love the outdoors, craft your fitness routine around hiking or a morning walk. If you love music, maybe take up dancing. The options are endless, so find an activity that you’ll enjoy, and you’re more likely to stick with it!

Recommended Types of Exercise

  • Walking
  • Jogging/Running
  • Hiking
  • Biking
  • Dancing
  • Weight/Strength Training
  • Pilates
  • Yoga
  • Swimming

Additionally, making a fitness activity a habit is the best way to make sure you do it regularly. Pair a walk while sipping your morning coffee each day, or make a date with a friend each Saturday afternoon for a hike in a local park. Opt to bike to work a few times per week, or go to the grocery store on foot, instead of driving. Creating a habit of exercise is the best way to make sure you stick to a new routine.

Make your fitness routine known by sharing your intentions with family and friends, and get them in on it, too. Having people around who support your new lifestyle will ensure that you keep at it, and they’ll benefit from joining in as well. It is also beneficial to have tech help you out. Read up on the 10 best fitness apps for beginners, and prepare to get hooked on being active, tracking your progress, and meeting measurable goals while getting healthier.

Precautions to Take

If you’re new to exercise, it’s important to ease into it. Start with walking, or simply moving more: take the stairs instead of the elevator, or park farther away from the entrance to the grocery store when you do your weekly shopping. Wear a pedometer or fitness watch to track your steps, and aim to get 10,000 each day.

It’s also important to check in with your doctor or care provider before starting any new exercise routine, to make sure you are healthy enough to begin. Also seek their input and advice on what exercise they recommend for you to get started. You will also want to discuss any potential adjustments to any of your diabetes medications before starting a new routine. Additionally, make sure you have quality shoes for walking and exercising, as healthy foot maintenance is vital for people with diabetes.

Lastly, make sure you’re always prepared for your workout with checking your blood sugar before, during, and afterwards to make sure you’re within your target range, and always carry low snacks and plenty of water with you to make sure you’re staying hydrated and protected from hypoglycemia while exercising.

It’s crucial to set realistic goals for your exercise. Are you looking for more peace of mind? To lose weight? To have a healthier HbA1c? Spend more time outside? Really get a clear focus on what you want to accomplish, and aim your exercise routine around that goal. Remember, start small so you don’t get overwhelmed.

Lastly, make sure you have fun. Exercise is about building healthier habits, getting your heart rate pumping, and enjoying yourself while doing something that’s good for you. If you’re not having fun, you’re not doing it right! Make sure to enjoy yourself, and you’ll find that a healthy exercise routine builds dividends over time.

Source: diabetesdaily.com

Diabetes Can Be Controlled But It Is a Constant Struggle!

Philipp was diagnosed with type 2 diabetes right after knee surgery in 2005 and his diagnosis was like a little odyssey. Before jumping into the interview with Philipp, here is what he shared about his diagnosis journey.

mySugr loves to show the many different faces and stories of people with diabetes in the real world. They do their own photoshoots and feature real people living with diabetes instead of using stock photos.

“I was diagnosed with diabetes in 2005, during the evaluation and testing to discover anything that would delay the total left knee replacement surgery.

Nobody mentioned anything about diabetes when I had blood work done the week before surgery.

But upon being admitted hours before my 8am surgery, I was told I was a borderline diabetic. I anxiously asked what does that mean? The technicians at the attending nurse stated that I had a predisposition to having diabetes.

As far as I was concerned, I either had diabetes or I didn’t. I couldn’t grasp the concept of borderline.

After surgery, and in the recovery room when I woke up, I didn’t think anymore about it.

However, once I was delivered to the ward and further tested that evening, I was told that I was now a full-blown person with diabetes. That was a shock, and I began gathering information from the staff. How could I go from borderline diabetes to having diabetes overnight? I wasn’t told what kind of diabetes I had until hours into the second day of my hospital stay. That is when I was diagnosed as type 2.

Upon my third day prior to my release, I was told that I was being prescribed oral diabetes meds and not insulin.

Several weeks later, I was dehydrated and became extremely thirsty and began drinking 32 oz. “slushy” drinks from the 7-11. One every hour.

It became so intense the next day. While my wife was at work, I became so concerned that I drove myself to the VA emergency room. After waiting more than 1 hour I was seen in the ER and after testing my blood sugar level, it was well over 300.

I was blessed for driving to the ER because my vision was super blurry and traffic was almost non-existent. What guided me mostly were the lane dividers that I could hear to guide me, muscle memory for guiding the vehicle and knowing how far away the VA was from our home.

The experiences that are key here are extreme thirst, extreme body temp rise, the extreme need to urinate multiple times in an hour, visual impairment, and potential for bad decision making that can wind up in a very serious situation.

 

1. What was your biggest fears/concerns when you were diagnosed with diabetes?

That it was a mistake. I wasn’t overweight, I exercised regularly and watched what I was eating.

2. What’s the hardest part/biggest struggle for you in living with diabetes day-to-day?

First was the prescription for diabetes medication that the result was not managing my sugar level. Second, not believing this disease couldn’t be eliminated. Third, monitoring my sugar regularly and the levels did not fall below 200.

3. What piece of advice would you give to a person who is newly diagnosed with diabetes?

My advice would be to research as much as possible to get accurate and reliable information regarding diabetes. Do not believe that diabetes can be eliminated. Diabetes can be controlled but it is a constant struggle.

4. Is there a phrase/statement about diabetes that drives you crazy?

Yes! The statement that diabetes can be eliminated by a regulated diet of certain meds drives me crazy.

5. When you think of the word “freedom” in terms of diabetes, what does that mean to you? What would make you feel more free?

Freedom for me would mean that diabetes can be cured in a certain amount of time.

Source: diabetesdaily.com

How to Increase Your Life Expectancy

If 2020 has taught us anything, it’s that health is everything. There are simple steps everyone can take to increase their life expectancy, and to give individuals the best chance at living a long, healthy life. Incorporate these simple habits into your daily and weekly routines to increase your life expectancy and improve your health now and into the future.

1. Keep Your HbA1c Low, TiR High

If you live with diabetes, one of the healthiest life-extending habits you can adopt is keeping your HbA1c low and time in range (TiR) high. Tightly managing blood sugar levels can help prevent devastating complications such as blindness, amputation, heart disease, kidney failure and premature death.

In addition, since the HbA1c test is simply an average of one’s high blood sugars and low blood sugars, it’s important to keep your blood sugar consistent and stable, with your time in your target range as high as you can get it. Studies have linked more stable blood sugars (and not gigantic swings between highs and lows) to longer life for those with diabetes. Most people aim for an HbA1c lower than 7%, but check with your doctor for your ideal target.

2. Wear Sunscreen

Wearing sunscreen daily is crucial for preventing the deadliest form of skin cancer, melanoma. Even on cloudy days, your skin will absorb 80% of the sun’s rays, and with it, harmful UV radiation. The American Academy of Dermatology recommends using a broad-spectrum sunscreen of at least 30 SPF every time you go outside. Ample use is crucial: On average, people only use about 20-25% of the amount of sunscreen needed for sufficient protection, so make sure to lather up!

3. Move Your Body

It’s no surprise that exercise is healthy for people, especially people living with chronic conditions like diabetes. Exercise is crucial for heart health, to manage blood sugars, increase lung capacity, and build and tone muscles to prevent future injury. All of the short term benefits of exercise add up to a longer, healthier life. Aim for 30 minutes of moderate exercise most days of the week, more if able! A study showed that people who exercise vigorously for only 3 hours a week had cells that were 9 years younger than nonexercisers.

Photo credit: Adobe Stock

4. Spend Time Outside

Nearly 50% of adults have low vitamin D levels, due to our sedentary lifestyle and the fact that most Americans live and work inside most hours of the day. Vitamin D (which can be absorbed right into the skin when people go outside) is important for proper immune system functioning, healthy teeth and bones, managing depression, and may even help prevent both type 1 and type 2 diabetes! Getting outside for just 15 minutes a day is usually enough to maintain adequate vitamin D levels for most people.

5. Spend More Time with Family & Friends

Blue Zone countries, places around the world that have notoriously long, healthy life expectancies, place a lot of emphasis on socializing with family and friends. Having a social circle can help people get through hard times, reduce daily stress, boost resilience and immune response, and act as a literal shoulder to cry on. This is especially important for people with diabetes who can oftentimes feel isolated and alone with their condition. Connecting with others in our struggle can help extend life expectancy: studies show that maintaining a social circle can help people live up to 50% longer, and having just 3 close social ties can decrease your risk of an early death by 200%. 

6. Eat Whole Foods, Mostly Plants

Consuming a diet rich in fruits and vegetables will be full of vitamins, minerals, and antioxidants that can extend life. Even if you don’t go completely vegetarian or vegan, eating more whole, unprocessed foods is beneficial for a healthy life, and to prevent diabetes complications. Many studies over the years have correlated a plant-forward diet to a lower risk of premature death, as well as protective factors against cancer, heart disease, depression, and dementia. People who eat mostly plants tend to have lower body weight, healthier blood pressure levels, and have significantly lower mortality risk. Bon Appetit!

7. Meditate to Manage Stress

Stress has been correlated with shorter life expectancies, and learning to manage it through meditation and yoga can improve and lengthen your life. Successfully managing stress through meditation can improve the quantity and quality of your sleep, boost your immune response, and improve your relationships, all of which add up to a healthier, longer life. Check out some free meditation apps to get you going!

Photo credit: Adobe Stock

8. See Your Doctor Regularly

Regularly seeing your doctor for screens and tests can catch diseases early (such as cancer), and can ensure an appropriate and timely treatment plan if something is detected. Mammograms, colonoscopies, and pap smears are some of the routine tests and screens scientifically proven to decrease mortality from the diseases they screen for. It may not be fun, but it’s proven, effective, and worth it!

9. Reduce Your Sugar Intake

Sugar is the new tobacco. Dr. Aseem Malhotra, a cardiologist from England, shares, “…added sugar is completely unnecessary. Contrary to what the food industry wants you to believe, the body doesn’t require any carbohydrate energy from added sugar.”

There is evidence linking sugar not only to obesity and higher incidence rates of type 2 diabetes, but also to liver disease, heart disease and tooth decay (which can lead to dementia). If you cut out added sugar from your diet, you are also more likely to gravitate to unpackaged, whole foods, which are chock full of vitamins, minerals, antioxidants, and life-extending properties.

10. Get More Sleep

One in three Americans don’t get enough sleep. Lack of sleep has been linked with a plethora of negative outcomes on many body systems, including cardiovascular, endocrine, immune, and nervous systems. Side effects of not getting enough Zs include obesity, heart disease, hypertension, anxiety, depression, alcohol abuse, stroke and increased risk of developing cancer that can all shorten one’s life. Sleep is when the body replenishes cells, is crucial to proper brain functioning, regulates one’s metabolism, and repairs damage done to the body during the day. Adequate sleep promotes healing of all body systems, and getting enough of it can extend your life. Aim for 7-9 hours per night.

These small, easy changes can add up to many more healthy years. Try to incorporate a few of these strategies into your routine today to increase your life expectancy!

Source: diabetesdaily.com

The Rise of Childhood Obesity in the United States

September is National Childhood Obesity Month in the United States, according to the Centers for Disease Control and Prevention. Currently, about 1 in 5 American children (19%) is obese, and the numbers are startlingly and steadily rising. Bringing awareness to this health crisis can help educate parents and caregivers about warning signs for childhood obesity, and how to prevent it for their children and loved ones.

Childhood Obesity is a Major Public Health Concern

It’s important to know that childhood obesity is not about vanity or looks. Childhood obesity is a serious public health issue that has serious and devastating consequences for children and families. Children who are obese have a body mass index (BMI) at or above the 95% percentile (a pediatrician can perform this measurement for you). Children experiencing obesity are at higher risk for other chronic health conditions, including asthma, sleep apnea, hypertension, type 2 diabetes, cardiovascular disease, and even many types of cancers. Additionally, children who are obese are more likely to be bullied in school, and can face mental health issues such as depression, anxiety, and suicidal ideation as they age.

Causes of Childhood Obesity

Childhood obesity can have many causes, most of which are behavioral in nature, although metabolism and genetics do play a strong role. Lack of physical activity and unhealthy eating patterns are some of the highest risk factors for developing obesity, as is a lack of sleep, and simply not having access to a safe place to exercise or the ability to buy healthy foods (living in a food desert, for example). Many social determinants of health play a role here. Children of lower socioeconomic status are at higher risk of developing obesity than children of higher socioeconomic status, who may have better access to parks and recreation and healthy foods.

Preventing Childhood Obesity at Home

There is a lot that family and friends can do to help to prevent obesity from affecting a child’s life.

  • Tracking a child’s weight and Body Mass Index (BMI) regularly can keep a child on track; if you see rapid weight gain, you can catch it more quickly and reach out to your doctor for a check-up.
  • Focusing meals on fresh fruits and vegetables, and eating foods in their most natural state prevents eating additional additives, preservatives and chemicals that won’t fill a child up, but are loaded with empty calories.
  • Make sure your child is active every day. Aim for 60 minutes of physical activity. This need not be a formal activity, like a soccer game. Walking the dog, helping to clean the house, and even walking around the shopping mall are all great forms of physical activity that gets a child moving and don’t cost any money.
  • Limit screen time. In 2019, the World Health Organization released new guidelines for the recommended amount of screen time by age, for children.
  • Make sure children are drinking water and not soda. About 40% of the calories consumed by 2-18 year olds comes in the form of these empty calories. Swapping soda out for water will save a ton of calories and will ensure that your child is filling up on wholesome, nutrient-dense calories instead.
  • Make sure your child has a healthy HbA1c. Keeping tight control on blood sugars and HbA1c can prevent overtreating lows and overeating, both of which can contribute to weight gain.
  • Eat healthy meals as a family. Children do what you model, not necessarily what you tell them to do. If you act as a role model with healthy meals, they will naturally follow.
  • Make sure your child is getting adequate sleep. When sleep patterns and circadian rhythms are off, children’s hormone levels become out of range, and they are more likely to overeat and not be physically active. They may also fall behind in school and suffer low self-confidence, resulting in overeating as a coping mechanism. Make sure your child is getting good sleep every night of the week.

Community and Societal Support

Preventing obesity may start at home, but it takes a village to raise a healthy child. Communities should provide safe and healthy playgrounds and parks accessible to all children, and local schools should provide free, clean, and safe drinking water and lunchroom cafeterias should provide balanced, healthy meals. Schools should also encourage physical activity, and provide robust physical education classes and electives for children and teens.

Additionally, your child’s health care provider should be conducting regular physical and mental health checks, to make sure your child is on track to enter adolescence and adulthood in a healthy mindset and at a healthy weight, especially if they are living with diabetes, which can make them more prone to disordered eating.

Together, with cooperation from parents, caregivers, schools, communities and engaged pediatricians and care teams, we can work to prevent childhood obesity and set the stage for healthy children and the future (healthy) adults we hope they will become.

Source: diabetesdaily.com

Tackling Carbs with Tech

Many people who live with diabetes avidly avoid eating carbohydrates, as historically speaking, it has been notoriously difficult to cover carbohydrates appropriately with exogenous insulins. But with access to better, faster insulins and the uptick in the use of patient-friendly technology, things are changing, and people’s diets (and their feelings of freedom) have expanded more than ever. Here are the best tech-friendly hacks to tackle the carbohydrate conundrum.

MyNetDiary

This popular app has a searchable database with nearly a million food entries for people to access and look up carbohydrate counts on the go. The company also has a separate Diabetes app that allows users to track blood glucose levels, HbA1c results, and insulin doses, to track their progress over time. If you’re looking to lose weight, MyNetDiary can create a diet plan to meet your needs. You never have to feel restricted when eating meals with family or friends, having all your carbohydrate counting needs right at your fingertips.

Photo credit: GreaterGoods

GreaterGoods Nourish Digital Scale

This food scale is a game changer for those who cook with lots of fresh produce, where carbohydrate counts can vary quite a bit. This scale lets the user view nutrition facts for over 2,000 foods in the scale’s built-in database, and create up to 99 more custom entries. Measure individual ingredients, track full meals, and calculate daily carbohydrate intake much easier with this digital scale.

InPen

This revolutionary device is the only FDA-approved smart pen insulin system that helps prevent users from “stacking” their insulin doses and take the right amount of insulin at the right time. This device works in tandem with a phone app, where users can track insulin on board/active insulin, personalize your doses, sync with continuous glucose monitor (CGM) or glucometer data, and share reports with others. The pen itself is compatible with Humalog, Novolog, and Fiasp, and will even dose in half units. Eating carbohydrates has traditionally been much harder on multiple daily injections, but advancements such as the InPen are making strides to make life much easier for people with diabetes.

Use Alternative Pump Boluses

If you are an insulin pump user, dosing for a high carbohydrate meal can also be difficult, especially if the meal also has a moderate amount of protein and fat (which can delay the absorption of the glucose in the meal). To handle that, try opting for a combination bolus (a.k.a. Combo Bolus or Dual Wave Bolus,  for Animas or Medtronic users, respectively; Omnipod, Tandem t:slim users will use “Extended Bolus”). This is a hybrid delivery mode: a specified portion of the total insulin bolus is delivered upfront, as a normal bolus, while the rest is delivered over a specified period of time as an extended/square wave bolus.

For example, given a 12U dose delivered as a 60/40 combination/square wave bolus over 3 hours: 60% of the total dose (7.2U) will be delivered within seconds of pressing the “deliver” button; the remaining 40% (4.8U) will be delivered equally every few minutes over the next three hours. The result is an initial dose to cover faster-digesting foods, plus an extended amount of insulin action to deal with the slower-digesting foods (which tend to be fattier or have more protein), and to prevent postprandial spikes in blood glucose. Utilizing these settings can be extremely helpful when you’re eating foods like pizza, pasta, Chinese food, Mexican food, or ice cream. Always consult with your diabetes healthcare provider before making any changes to your dosing routine.

Dexcom CLARITY Diabetes Management Software

Photo credit: Dexcom

Dexcom Clarity App

This software can be helpful for patients already using the Dexcom continuous glucose monitoring system, but are wanting to track and change problematic patterns in their blood glucose. This app lets you set target goals for your blood sugars, will track time-in-range, detects patterns of highs and lows and will alert you to them, and will even give the user a predicted HbA1c result. You can also choose to share your data with your health clinic to make changes to your insulin routine or insulin to carbohydrate ratio in real time, and to really find what will work best for you for optimal management.

Living with diabetes is never easy, but thankfully technology has made counting carbohydrates and eating easier than ever before. What apps or tech has helped you to navigate food, eating, and counting carbohydrates? What’s worked best and what hasn’t? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

Going Virtual: The Future of Diabetes Care

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

By Todd Boudreaux

Ashlyn Mills is a physical therapy assistant in an outpatient setting in Florida, working with people with orthopedic and neurological disabilities. She was diagnosed with type 1 diabetes when she was 19 years old. Ashlyn recently started using DreaMed’s telehealth platform to see an endocrinologist, and spoke with Beyond Type 1 about the shift to virtual care.

Beyond Type 1: To start, can you tell me about your diagnosis, and how you originally managed your diabetes?

Ashlyn Mills: I had a strange diagnosis, it was caught a little bit early. I was already being followed by an endocrinologist for some other issues and we started noticing some higher blood sugars on labs. My A1c wasn’t incredibly high so they put me on a Dexcom and started monitoring my blood sugar so they could see what kind of patterns I was experiencing. My fasting blood sugars crept up higher and higher and they went ahead and added basal insulin at that point. I was insulin dependent about three months after my diagnosis.

They diagnosed me with type 1 from the start. They did say that it looked like a latent onset (LADA), but it was pretty clear that it was type 1 from the get go. I was using insulin pens at that time.

Tell me about your treatment since diagnosis.

I live in a rural area in Florida. There’s not an endocrinologist around here. I had been seeing an endocrinologist at the Mayo Clinic in Jacksonville, which is about a two and a half hour drive for me, and that was just because that’s who came recommended by my primary care physician. I was diagnosed at the Mayo Clinic and followed up with endocrinology there for the first two years after my diagnosis. The nurse practitioner that I was seeing there actually left and came to a clinic that was about an hour and a half from my home, and I had a good rapport with her. I went ahead and followed her.

Her and I had come to the understanding that it was difficult for me to see her every three months, so instead I saw her every six months. It became a little bit of an issue for me being able to talk with someone in between if I had issues, which is how I found DreaMed. I could find somebody to bridge the gap between those six months that I’m going without seeing a doctor in person. Now, I’m able to communicate with someone whenever I want to.

How have you been keeping up with your job as a healthcare worker living with T1D during the pandemic?

Florida did a stay at home order back in March. About mid April my employer decided, “We’re going to send everybody who is high-risk home.” I worked from home for about two months and then the numbers started looking better and they sent me back to work. Now, I’m working in the clinic every day and it is nerve wracking. I’m still working but I’m quarantining from my family right now because I was exposed at work.

I go through phases where I feel like I would be fine if I got it but then I have bad blood sugar days and I’m like, “This is it. If I get COVID I’m doomed because my blood sugar was over 200 mg/dL all day today.” Overall, I think I would be okay but I do worry about being hospitalized. I think that’s my biggest fear with the whole entire thing is ending up in the hospital with no family there to be with me. I pray every day that I stay well but I am working and the numbers in our county are rising quickly

How did you find out about DreaMed and what was that process like getting started?

When I was sent home and started doing telehealth with my patients I realized this is easy, there shouldn’t be any reason why I can’t do this.

At the time my endocrinologist’s office was not offering telehealth appointments, even in the midst of COVID-19. I started doing a little bit of research and found DreaMed. I went on the website and signed up for more information. My experience as a provider doing telemedicine is what led me to push to try to find someone that could do the same with me as a patient.

How does DreaMed work?

They asked me what state I lived in and they connected me with an endocrinologist here in Florida, Dr. Kava. I set a telemedicine appointment with her and she spent about an hour with me on that first call. I think you can view it as a replacement service for your current endocrinologist or just an add-on to your current care.

Was it surprising your appointment lasted for an hour?

Dr. Kava would have spent as long as I wanted her to with me. My normal appointments in the clinic, I drive about two hours to be seen for maybe 10 minutes. Most of the time there’s not too much to discuss at those appointments you just make a few changes, but she asked all about my personal life, including my mental health during the pandemic. She really seemed invested in me as a person, too, not just diabetes.

She nitpicked my data because I told her I’m a little bit of a control freak. She said, “If you want tight control I’ll help you.” She spent a long time combing through all of my graphs and figuring out what we could do to get things even tighter than they already were.

Has any diabetes provider before Dr. Kava asked about your mental health?

That’s the first time I recall that happening. When I was first diagnosed I had a diabetes educator talk with me about mental health and diabetes to prepare me for what may be to come with my mental health. They assume if your control is good you’re doing okay with your mental health, but that’s not always the case. I don’t necessarily quit caring for myself when I feel burned out but that doesn’t mean I’m not struggling mentally with it.

It was Dr. Kava spent a good bit of time talking with me about mental health and diabetes and how my mental health was doing with COVID-19 and all of that so I was very impressed with that.

Were there any other specific suggestions that stuck out to you?

Most adult endocrinologists seem stuck in the stone ages a little bit. Dr. Kava looked at my data and she said, “You’re on a closed loop system. The system is going to suspend you if you’re going to go low. If you want to stay below 140 or if you want to stay below 120 I can help you get your settings there.” That was the first time that I had ever had someone be willing to be that aggressive with my care, but I felt like she was totally game for whatever I wanted her to help me do.

Do you think that you’ll continue using DreaMed?

Yeah, ideally I would like something to bridge the gap right now. Although my endocrinologist has started offering telemedicine I’d like somebody that I can talk with through DreaMed and not feel like I’m bothering. When you’re bothering your endocrinologist a lot of times you’ll get an unexpected bill; it would be nice to pay the monthly fee and have somebody at my fingertips whenever I need them. If my endocrinologist quit offering telemedicine I would love for DreaMed to replace my current endocrinologist. As much as I love her it’d be nice to do telemedicine and not have to drive two hours to be seen by someone.

Do you have any advice for someone living with type 1 who doesn’t currently have access to a local endocrinologist?

I just think if anyone’s trying to figure out what to do in the time of pandemic or just tired of driving to see an endocrinologist as frequently as they do, I would suggest looking into DreaMed. They’re currently offering a three-month trial. I have no dog in the fight, I’m not being compensated to say anything about them. You have nothing to lose. They are very honest and I think it’s worth giving a try.

Source: diabetesdaily.com

Making the Most of CGM: Uncover the Magic of Your Ambulatory Glucose Profile

This content originally appeared on diaTribe. Republished with permission.

By Cindy Takigawa and Frida Velcani

What’s an AGP report, and what does it show? Why does my AGP matter? How can I use an AGP report to improve my blood glucose levels and time in range?

Having diabetes is a full-time job: you have to simultaneously monitor your diet, activity, stress, and even sleep. On top of that, you need to calculate and manage the number of carbs you consume in each meal, and keep careful tabs on your blood sugar levels. The Ambulatory Glucose Profile (AGP) report, developed by the International Diabetes Center, is a tool that provides a simplified way to look at data on your blood glucose patterns and trends. It has been recognized as a standard of care for reporting continuous glucose monitor (CGM) data by the American Diabetes Association. In this article, we explain what an AGP report is and how you can use the information to help you navigate your diabetes management.

CGM App

Image source: diaTribe

What is an ambulatory glucose profile report?

An AGP report is a standardized, single-page report that includes glucose statistics like time in range, a summary glucose profile, and daily glucose graphs. It converts blood glucose readings from a CGM device into a detailed picture, allowing you to quickly visualize the time you spend above and below your target range. The report is based on at least seven days of CGM data, with 14 days of data (or more) considered ideal. Currently, many CGMs include a version of the AGP report in their devices and reporting software.

An AGP report that summarizes data provided by self-monitoring of blood glucose (SMBG) is currently being developed. This article focuses on CGM AGP reports.

Why does my ambulatory glucose profile matter?

The AGP report is the same no matter what device you use – it allows your healthcare team to assess blood glucose levels and trends in a standard way for everyone they see. Below you’ll find sample AGP reports from Abbott, Dexcom, and Senseonics.

The AGP report shows patterns in a user-friendly way so that people with diabetes can easily identify the times of day when glucose levels are consistently low, high, or fluctuating. The general goal for people with diabetes is to have their glucose levels stay within the target range of 70 to 180 mg/dL for at least 70% of the day, spending less than 4% of their time in hypoglycemia (under 70 mg/dL). The information from an AGP report can help you have a discussion with your healthcare team about goals for your diabetes management and ways you can achieve them. The data offered by this report can help make your care far more precise and effective.

What exactly does your AGP show?

The standard AGP (designed by the International Diabetes Center and shown above) will show your data like this:

  • Glucose Statistics and Targets: This section displays metrics including average glucose, glucose variability, and Glucose Management Indicator (GMI), which can be thought of as your predicted A1C. It also includes the dates and number of days in the report, as well as the percent of time that the CGM was used to collect data. While time in range goals can be individualized, the expert-defined goals for various groups of people with diabetes can be found in this section. You can read more about time in range targets here.
  • Time in Ranges: This color-coded bar chart helps you visualize the percentage of time spent above and below your target range.
  • Ambulatory Glucose Profile: This graph combines all of your glucose readings over time to display your trends across a 24-hour period. At the end of this article you can find examples of what this will look like for your specific CGM.
    • Black line: the median of all the readings. Half of your glucose values are above the middle black line and half are below.
    • Green lines: this is your target glucose range.
    • Dark blue area: 50% of glucose values lie in this area.
    • Light blue area: 90% of glucose values lie in this area. This percentage may differ between AGP reports. The International Diabetes Center report includes 90% of glucose values, while the Eversense report shows 80% of glucose values.
    • Dotted blue lines: 5% of the highest and lowest glucose values are above and below this line, respectively.
  • Daily Glucose Profiles: Each box shows your glucose pattern from a single day.
    • Yellow area: instances of high glucose (hyperglycemia).
    • Red area: instances of low glucose (hypoglycemia).

How can I interpret an ambulatory glucose profile report?

An AGP report combines several days of blood glucose readings into one snapshot. Once you have identified daily patterns, you can work with your healthcare team to adjust your medications and insulin dosing to spend more time in range. You may also discuss timing of food or physical activity, what you are eating, or ways to reduce stress. Here are some steps you can take to understand your data:

1.     Look at your time in range. The goal is to shift the numbers into the 70 – 180 mg/dl target range while having fewer lows and extreme highs. Each AGP report includes a bar chart of your time in range; one way to see this goal in action is to aim for more “green” and less “red” on the bar chart.

2.    Keep track of the usual times you wake up, go to sleep, eat meals and snacks, and are physically active. Food, activity, medication doses, and dozens of other factors can affect your blood glucose levels. Recording these activities and their timing will help you understand your AGP report and the patterns you see.

3.    Identify times when your glucose levels are lowest and highest, and look for times of more variability. Speak with your healthcare professional about what factors may be causing highs, lows, and variability in your AGP and how you can reduce them. The wider the shaded blue areas on your report, the more variability there is in your glucose levels.

4.    If you can, compare your current and past AGP reports, and create an action plan with your healthcare team. What strategies did you use previously to make changes? Identify a few steps to improve your glucose patterns moving forward.

To learn more about how people with diabetes and healthcare professionals can use AGP, click here. For more resources on time in range, check out diaTribe’s comprehensive library here.

Abbott AGP

CGM App

Image source: diaTribe

Dexcom AGP

Dexcom

Image source: diaTribe

Eversense AGP

AGP

Image source: diaTribe

Source: diabetesdaily.com

How Telemedicine Improves Diabetes Care

How Telemedicine Improves Diabetes Care

By Heather Nelson

Rapid advances in telehealth have provided doctors a level of convenience (1) that lends itself to well-rounded patient care. In this article, we will highlight some benefits of telemedicine relating to diabetes management.

Rise of Diabetes Distance Care

Telemedicine is the use of technology in delivering medical care to patients from a distance (2). Once considered necessary for rural or underserved communities, telemedicine has transformed over the past 50 years into a vibrant, integrated service utilized by hospitals and physicians around the globe (3).

Diabetes telemedicine has combined the wonders of technology and the necessity of recurring specialty care to enable providers to be more proactive. One effect of telemedicine on the management of diabetes is that providers are able to help their patients see improved HbA1c levels (4).

As always, in the grand scheme of diabetes therapy solutions, the measuring stick has always been the almighty HbA1c. As technology improves, doctors are seeing the added benefits of reading telehealth data from sensors to measure Time-In-Range as well (TIR) (5).With both of these in mind, a new treatment option can succeed or fail based on the ability to improve HbA1c ranges consistently or provide greater time in optimal blood glucose range. This seems to be no struggle for telemedicine.

The benefits of telemedicine in diabetes distance care are so promising that the CDC (Centers for Disease Control and Prevention) ran a 2-year study in rural Alabama and Georgia (6). The outcome showed decreased hemoglobin A1c as well as average reduced travel time of over 78 minutes per visit. Based on their findings, the CDC declared that “diabetes care delivered via telemedicine was safe and was associated with time savings, cost savings, high appointment adherence rates, and high patient satisfaction.”

Additionally, another study found lower HbA1c levels as well as improved blood pressure and cholesterol levels after just one year of telemedicine (7).

These studies might seem great on paper, but you might be asking yourself…

“How can telemedicine help me manage my diabetes?”

Well, I’m so glad you asked. Welcome to “Telediabetes”!

We all know that diabetes is a chronic disease that requires regular and constant monitoring. Some providers wish to see their patients bi-annually, while others request quarterly or even monthly check-ups. The practical challenges of regular office visits can sometimes prove challenging, and in the gap of in-office care and at-home management, the person with diabetes flounders. This gap is precisely where telemedicine shines.

4 Reasons Why Real-time Feedback No Longer Requires Face-Time Appointments

  • Is the driving distance to your endocrinologist office making those quarterly visits hard to squeeze into your lunch hour? Transmit your health records and let telemedicine connect you for guidance in basal rates adjustments or dosing tweaks with less time off work.
  • Is prohibitive weather keeping you from talking with your mental health practitioner about diabetes challenges? Log into a portal and send a message detailing your snow-day concerns straight away. They can respond via email or video conference to provide real-time support and encouragement.
  • Are school absences piling-up making it hard for your child to miss another half-day for their monthly appointment? Simply log-in, upload the latest chart data you’ve been keeping, and let their doctor analyze the trends and suggest small changes. These tweaks can make a big impact in keeping them at optimal health while keeping them in school and learning (8).
  • Have travel challenges made your food dosing questionable? Send a message to your certified diabetic educator (CDE) and let them guide you to healthier solutions and safer swagging.

Whatever reason you have to miss out on those essential office visits, telemedicine doesn’t judge. Telemedicine understands.

With Great Tech, Comes Great Responsibility

The rapid advances of tracking devices and sensors mean we can readily gather reliable glucose data in a fairly simple manner. But that’s not the full picture your healthcare team will need. We all know that taming the diabetes monster requires a multi-faceted approach. The rise of newer and better diabetes management technology has perfectly poised the diabetic community to benefit from telemedicine and all it has to offer including lifestyle modifications, mental health checks, and more. But we must have solid data to reap those benefits.

The best way to take advantage of all the rewards of telemedicine is to provide good and useful data. The more data you can afford, in a succinct and readable format, the better distance care your provider can give. Utilizing technology means you should be able to provide food records, insulin doses, basal and bolus rates (for our pump-loving friends) as well as activity, health events, and other biometrics like Ketones, HbA1c readings, weight and body measurements.

Beyond the tracking of data itself, presentation also matters. Clearly you can’t courier-pigeon over a stack of origami-worthy paper logs and in this day and age, you shouldn’t have to. Organize your logs into a format that is easily accessible for your healthcare provider. If they need CSV, Excel sheets, or PDFs, provide what they can read.

How mySugr PDF Reports Makes Data Sharing Easy

If you are reading this and genuinely shocked to learn that you need to log things like insulin dosing and food intake, allow us to usher you out from under your rock and into the age of technology by introducing the reporting feature in the mySugr app! Indeed we believe you are the captain of your pancreas. As such, the ability to harness all your well-tracked data into usable information for you and your doctor is a key focus of our app. Using the reports feature you can quickly:

  • View your own data at a glance, anytime, to see trends.
  • Select your own time period to see only the data you wish to discuss. No more information overload or sifting through months of records needlessly.
  • Send preferred data to your doctor via email for quick communication about necessary formula changes. Even select from one of our three output formats for optimal communication.
  • Stay in constant communication and more!

Using the data in these reports, you can truly be the master of your own fate. The reports are meant to empower you as you discuss your treatment decisions with your provider, making the conversation more constructive and putting you back in the driver’s seat of your care.


And for our US friends in the diabetic online community (DOC), we still have our fabulous bundle! mySugr has over 2 million registered users to-date and a 4.6+ rating on the App Store and Google Play. The mySugr Coaching service is second-to-none and utilizing our monthly subscription gets you:

  • Blood glucose meter
  • Lancing device (with a box of refills…so that’ll last you basically forever, amiright)
  • Unlimited test strips (new shipments arrive before you even run out!)
  • The mySugr Pro App (that includes the ability to estimate the HbA1c!)
  • Diabetes coaching (with a pretty top-notch team)
  • Free shipping

And all the tech-support a person could need!

Indeed, we believe telemedicine is here to stay (9) and with good reason!

People living with diabetes can find more freedom and a better quality of life with the rising accessibility of a healthcare team armed and ready to interpret and predetermine the many responses to all the data we track.

As always, mySugr stands on the edge of change ready to help usher in this new age with open arms and glucometers for all Rise up mighty warriors and embrace the freedom of “telediabetes”!


(1) Wicklund E. Leveraging Primary Care Telehealth for Convenience and Quality. https://mhealthintelligence.com/features/leveraging-primary-care-telehealth-for-convenience-and-quality(2) White LA, Krousel-Wood MA, Mather F. Technology meets healthcare: distance learning and telehealth. Jan. 2001. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116779/

(3) eVisit: The Ultimate Telemedicine Guide | What Is Telemedicine? 2018. https://evisit.com/resources/what-is-telemedicine/

(4) Hompesch M, Kalcher K, Debong F, Morrow L. Significant improvement of blood sugar control in a high risk population of type 1 diabetes using a mobile health app – A retrospective observational study. Poster presentation at ATTD 2017, Paris, France.

(5) Beck R, Bergenstal R, Riddlesworth T, Kollman C, Li Z, Brown A, Close K. Validation of Time in Range as an Outcome Measure for Diabetes Clinical Trials. March 2019.

(6) Xu T, Pujara S, Sutton S, Rhee M. Telemedicine in the Management of Type 1 Diabetes. 2018. http://dx.doi.org/10.5888/pcd15.170168

(7) Steven Shea, MD, Ruth S. Weinstock, MD, PhD, Justin Starren, MD, PhD, Jeanne Teresi, EdD, PhD, Walter Palmas, MD, Lesley Field, RN, MSN, Philip Morin, MS, Robin Goland, MD, Roberto E. Izquierdo, MD, L. Thomas Wolff, MD, Mohammed Ashraf, BA, Charlyn Hilliman, MPA, Stephanie Silver, MPH, Suzanne Meyer, RN, Douglas Holmes, PhD, Eva Petkova, PhD, Linnea Capps, MD, Rafael A. Lantigua, MD, PhD, for the IDEATel Consortium. A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus. Jan-Feb. 2006. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380195/

(8) Please note that all mySugr products have a minimum age limit of 16 years for the mySugr Logbook and 18 years for the mySugr Bolus Calculator (for more details please read mySugr’s General Terms & Conditions).

(9) Klonoff David C., M.D. Using Telemedicine to Improve Outcomes in Diabetes—An Emerging Technology. July 2009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769943/

Source: diabetesdaily.com

Diabetes and Reality TV, with Marcus Lacour from Say I Do

By Alexi Melvin

Netflix’s “Say I Do” is a reality show about surprise dream weddings, but its first episode showcased something we don’t often see in reality TV – type 1 diabetes (T1D). In the episode, Marcus LaCour was given the chance to surprise his wife Tiffany with a magnificent wedding do-over.

Alongside planning and logistics, Marcus also spoke candidly about his life with type 1 diabetes, spurred by a conversation around how wedding catering decisions needed to take into account the food choices he makes to help manage his blood sugar levels. We caught up with Marcus to chat about his experience on the show, how he handled presenting his type 1 diabetes to the world, and where he and his family are now.

Did you ever imagine that you’d be on a TV show on Netflix?

I definitely didn’t expect it. It’s one of those things where you’re like, you know what? If it happens great, if it doesn’t, it’s great too. I don’t think it dawned on me really until we started shooting. Once we started filming, I was like, “Oh, this is it. This is legit.”

When you were talking about your T1D on the show, it came across so well. Is that something you discussed beforehand with the producers? Did you preface anything or was it organic?

It was organic. We literally were just sitting and talking about it. The subject of food came up and early on I told them, “Hey, I’m a type 1 diabetic.” We were just having a conversation of, “Hey, how’s this, how’s that? How did that happen? How were you diagnosed?” Literally, just conversation flowed from there. In my honest opinion, it was one of the most genuine conversations I’ve had with anyone about my condition, just because it was in a room and in the area where there was an open space where I could tell them everything I needed to tell them about the condition.

You touched on how much your wife did for you when you had a situation where you lost your healthcare – the rationing of food and things like that. Did that also include rationing of insulin? Were you having issues with getting supplies?

I was. I was getting samples from my doctor’s office at one point. You know when you’re trying to ration insulin or trying to pick the insulin you can afford, it’s not as effective as what you’re used to. I was getting the regular 70/30 mix insulin pens. I kept bottoming out throughout random times of the day. I was used to taking NovoLog but [at one point, my doctor] didn’t have any NovoLog samples. So I was literally just getting whatever he had.

When [my doctor] did get the NovoLog pens, I was using those thinking, okay, he should have some more samples. Well, there was a time where he didn’t, and that time for about a month maybe, we’ll say three weeks, I was rationing my insulin, because I’m trying to make sure that if I do go high, I have enough to cover the high. If I go low, just [having food] to eat, but more importantly, what you need on a daily basis [to keep your levels stable].

One day, the doc called and said they didn’t have any samples. I was down in my last 10 units. So for about an extra two and a half, almost three weeks, I was rationing 10 units of insulin.

When did that situation start getting better for you?

I ended up getting a loan from my boss because at the time I started a new position and he was like, “I don’t want to see you suffer.” At the time, NovoLog Flex Pens were $250 for the pack. So he gave me a check for $250 and said, “Hey, go get your meds.” So that was how I got through that. Then somehow, by some sort of miracle, after that pack ended, my doctor, all of a sudden, got samples again.

What is your management routine like now?

It’s the Omnipod right now. I’ve got better insurance that covers the pods altogether. It’s still an adjustment for me though, because I’m used to not having a PDM. Before, [when] I was on the injections, it was, wake up, take your long term, and then just carry the Humalog pen on me at all times. Then with the pump, [if] we’re going to work out, I forget to suspend my insulin flow. Or if the site doesn’t take, having to double check and make sure blood sugars aren’t really high. So it’s a couple of different things, but it’s not bad. It’s still an adjustment though.

Do you feel you prefer the MDI or do you feel the pump ultimately is going to be better?

I’m already seeing changes in my numbers, just from average standpoint. On the shots, the lowest my A1C was, or I could get it, with 6.9, 6.8, but now I’m seeing, that even though there are days where I may be high because the pod didn’t take, or I may run low, those days are few and far between, so I’m running normal on a lot more of a regular basis.

Do you use a Continuous Glucose Monitor (CGM)?

I don’t. It looks we have to go four months without a CGM and track those numbers before insurance will approve it.

In terms of your diet, on the show, you talked about how you’re conscious of what foods are going to spike your blood sugar. Is there a specific diet you to stick to? Are there certain foods you prefer or are you getting more flexible with it because of the pump?

I am still a very conscious eater. I prefer to eat clean. Everything has to have a balance. Now I know with the pump, you have that freedom to literally eat whatever you want. But for me, when I was diagnosed, I didn’t have that option. So, it was literally sticking to that diet, sticking to that regimen. Everything has to have a fresh fruit or fresh vegetable, [there] has to be a starch. There has to be a grain and there has to be a protein. That’s the only way that I know.

I came across a comment online that said, “Well, diabetics can eat whatever they want.” It’s very true. But for me, I don’t want to run that risk. I think I’ve always done something whenever I got a new insulin, when I got my Humalog, I wanted to make sure it worked. So I got a peanut butter Twix, took it to cover it, just to see what it would do. When I got my pump, I had a chocolate chip cookie just to make sure it was working. It would work, but overall, my diet is consistent. I prefer to eat clean. It’s just because I know these things aren’t going to have a whole lot of impact on my blood sugar.

I saw on Instagram that your daughter’s been learning more about your T1D management. How’s that going?

It’s going well honestly. Before, when I was taking my shot, it was just, “Hey, Daddy’s got to take his insulin,” or, “Daddy’s got to check his blood sugar.” So she’d always been curious about it. Then one day I had to change my pod. “Are you changing your pod, Daddy?” “Yeah, Daddy’s changing his pod. you want to watch?” “Yeah, I want to watch.” So she came in and got hands on. I always want to make her aware just in case something happens. If my blood sugar goes low and I’m unresponsive, or if I’m too low and I can’t get up to get anything, I want to make sure she’s aware to say, “Oh, Daddy’s not feeling well. Daddy he needs something to eat.” Or, “Something’s going on. Let me tell Mommy.” I always want to make sure she’s aware of what my condition is, not to scare her, but to the point where she can be reactive.

Who did you have as a support system when you were first diagnosed?

My mom was my biggest supporter. I didn’t keep it from my friends, but I felt they wouldn’t be able to understand. They were used to me just being able to get up and do whatever. If we wanted to play football, it was get up and do it without having to worry about anything. They knew I had type 1 diabetes, but they didn’t know the entire scope of what it meant to take care of that condition. So it was my mom. Then over time, my friends started to get a little bit more of an understanding of it. So my friends would ask, “Hey, what’s your blood sugar like? Are you OK?” Or if I was going to the gym to work out with some of my buddies, “Hey, don’t forget your meter.” Or I’d always bring my meter with me and I’d have to check in the middle of work out, see either I’m high or low, or just to figure out where I was at. They would always ask, so they held me accountable in that regard.

Have you been getting a lot of people in the type 1 community reaching out on Instagram or social media?

I’ve gotten that. It’s always refreshing because [they’re] like, “Thank you for representing and letting the world know about your condition.” Well, it’s a part of me. I’d be foolish to hide it, like, “I don’t have a condition.”

Had you been involved in the type 1 community at all before appearing on Say I Do?

Not necessarily. I’ve always wanted to though. I’ve been at this for almost 20 years, it’ll be 20 years in November. When I first got diagnosed, there weren’t a lot of support groups. There weren’t very many places for me to go where I could vent or even if I had high blood sugars or even lows, how to combat that and deal with those. But now times have changed. I would love to be able to get out and talk to people about what our condition is and how to manage it effectively.

What’s next for you and your family?

Honestly, I am not sure. I work for a Children’s Hospital down here, so I recruit for them and it’s just more or less just going with everything at this point, just laying back and enjoying the ride while we have it.

Do you think you’re going to seek out more TV opportunities?

To be honest, I don’t know. This is all new. It’s all new to both of us. If more opportunities come, then yeah. Absolutely. But it really just depends on what comes down the pipes. I think the ultimate goal would be just for us to just enjoy this and see where it takes us.

Source: diabetesdaily.com

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