How to Find a Good Mental Health Provider

If you live with any form of diabetes, you’re far more likely to suffer from depression and anxiety. An estimated 40% of people with type 1 diabetes and 35% of people with type 2 diabetes experience significant levels of “diabetes distress,” which can result in negative mental health repercussions, including diabetes burnout.

A mental health provider can be a crucial part of your medical team. Dr. Mark Heyman, the Founder and Director of the Center for Diabetes and Mental Health (CDMH), explains why:

Diabetes is a self-managed condition. This means that it is the person with diabetes, not their doctor, who is responsible for taking care of him or herself on a daily basis. Diabetes involves making frequent, sometimes life or death decisions under sometimes stressful and physically uncomfortable circumstances.

In addition, diabetes management is constant and can feel overwhelming. If you or someone close to you has diabetes, take a minute and think about all of the steps you take in your diabetes management every day. What to eat, how much insulin to take, when (or whether) to exercise, how to interpret a glucose reading, how many carbs to take to treat a low, the list goes on. Decisions, and resulting behaviors (and their consequences) are critical aspects of diabetes management. However, doing everything necessary to manage diabetes can become overwhelming – and feeling overwhelmed is usually no fun.

There are things you can do to help manage the mental distress of diabetes, including finding a good mental health provider that is especially positioned to help people with diabetes. This article will outline how to find the perfect fit!

Consider What You Want in a Mental Health Provider

Think of your mental health provider (or therapist) as someone you’re trying to develop a long-term relationship with. You want to be comfortable sharing all of your thoughts and feelings with this person, and be vulnerable with them as well.

Mental health providers become very close with their clients, so knowing what will make you uncomfortable is very important and crucial to knowing who you want to look for when searching for a provider. Some things you may want to keep in mind:

  • Gender (do you have a preference to work with only men or only women?)
  • Age (you may feel more comfortable working with someone much older or younger than you, or maybe you’d prefer someone closer to your age)
  • Religion (are you looking to connect spiritually with someone? Perhaps your religion is very important to you, or perhaps you’re looking to keep the interactions completely secular)

When you contact a provider’s office or complete an initial questionnaire for therapy, you’ll usually be asked some questions about basic preferences, such as those described above, to help match you with the best therapist.

You may also be able to research a mental health provider’s bio online to learn more about their areas of expertise before scheduling a visit.

Consider the Issues You Want to Address

There are many different types of mental health providers out there, and knowing that specific issues you want to address can help steer you in the right direction. Perhaps you’re suffering from substance abuse, or maybe you have developed anxiety around food. Maybe you and your spouse are struggling with your child’s new diabetes diagnosis, or you’ve noticed depressive symptoms that you want to tackle early. Different providers can help you manage different issues, so be cognizant of that. Some of the different types of specialists include:

  • LCSW – Licensed Clinical Social Worker
  • LMFT – Licensed Marriage and Family Therapist
  • NCC – National Certified Counselor
  • LCDC – Licensed Chemical Dependency Counselor
  • LPC – Licensed Professional Counselor
  • LMHC – Licensed Mental Health Counselor
  • PsyD – Doctor of Psychology
  • Ph.D. – Doctor of Philosophy
  • MD – Doctor of Medicine

But no matter what a provider’s background credentials entail, what matters most is their area of expertise. Reading up on a provider’s background information and bio can help you familiarize yourself with the areas of mental health they deal with, and can help you decide if they would ultimately make the best fit for you and your needs.

Consider Asking for a Consultation

Consider this an interview for the mental health provider you’re considering “hiring.” Some practices will offer a free, 30-minute consultation, so that you can get to know the provider before deciding to come on as a client. Some important questions to ask if you’re able to, are:

  • Are you a licensed provider? (while every state varies, a licensed provider has passed the minimum competency standards for training within your state)
  • What’s your educational background?
  • What is your treatment orientation? (this refers to the school of thought that the therapist draws from in understanding and treating mental health issues)
  • What is your area of expertise? (and if they say “chronic disease” or “diabetes,” that would be excellent!)
  • Do you accept my insurance?
  • What is the cost per session?
  • Are you a prescribing physician? (some providers may be able to prescribe medication for things like obsessive-compulsive disorder, anxiety, and depression)
  • What is your communication style?
  • Do you prefer short or longer-term therapy? (some providers are very short-term goal-oriented, while others prefer developing a relationship over a long period of time)

These questions are not a complete list, but it’s a good start to finding the perfect fit for you and your care.

Seek out Diabetes Experts

It can be very difficult to find the right mental health provider for you and your needs, and that’s especially true when living with a chronic disease like diabetes.

The American Diabetes Association (ADA) recently teamed up with the American Psychological Association (APA) and created a directory of mental health providers specifically equipped to meet the needs of people with diabetes. All providers in this directory are:

  • Currently licensed as a mental health provider
  • A professional member of the ADA (Associate, Medicine & Science, Health Care & Education)
  • Have demonstrated competence in treating the mental health needs of people with diabetes

Currently, the directory has about 60 providers, 40 of which provide pediatric services, and the list is rapidly growing. The tool is simple to use: enter your zip code and whether you’re looking for adult or pediatric services. The directory will then pull up diabetes-trained mental health providers near you. The directory also lets you access what types of insurance a chosen provider accepts, their office location, phone number, and more.

Finding an appropriate mental health provider can be a difficult but worthwhile challenge. Investing your time, money, and energy to improving your mental health as someone living with diabetes is absolutely worth it, and it is crucial that you find a mental health provider that is going to work best for you in getting your needs and goals met. Hopefully these tools will make it a little easier to get there!

Source: diabetesdaily.com

My Type 2 Diabetes Is Forcing Me to Find a New Reason to Live

By Abby Hanna

April 21st, 2021 was when it finally happened. It was around 1:00 am and I was dozing off in bed. With the melatonin in my system and a good day behind me, I had no reason to be up any longer. My nights were usually long and painful due to my anxiety and lively thoughts, but that morning I had a good enough day to let me sleep peacefully. An exceptional day even. I had gotten my blood work from the day before back, and it looked like everything was stellar. My doctor emailed me that afternoon- “Hello Ms. Hanna, your labs look good overall.” I had carelessly overlooked the note she left about my low cholesterol (I’ll just eat more avocado toast or something) and went on with my day proud of how my body was taking care of itself without me ever having to intervene.

And then came that night. That was supposed to be a peaceful night. Me dozing off in bed. Melatonin in my system. And something told me to check my email. I decided why not, noone ever sends anything important at 1:00 am, it’ll be a quick scroll and then right to bed. I noticed another email from my doctor, more blood work results from the other day. I clicked on the message that revealed the results, and it was as if someone had replaced that sleepy pill in my system with Adderall. I’ve never sobered up so fast. I actually had a little bit of research to do from the information that she gave me. What I was looking at wasn’t an email explaining my labs, but the actual labs themselves. With a bit of research and decoding, I had confirmed what I thought was true. A cold chill ran through me as I stared at my labs. I rubbed my eyes to make sure I wasn’t dreaming. No, those labs are correct Abby. You have type 2 diabetes.

It was like finding out that your deepest fears were true. Like looking under the bed and seeing that the boogie man actually was there, or feeling the pain of pinching yourself when you thought that you were dreaming. Or looking behind you and realizing that someone is indeed following you, or getting a test back with a big fat F that you couldn’t afford to fail, or opening your bedroom blinds to reveal a dark figure is watching you, or hearing the sputtering of your car breaking down in the middle of nowhere, or reading your lab results in the middle of the night that say: You. Have. Diabetes. It was the end of my world. My body purged itself of any reason to sleep and immediately filled itself with anxiety and anguish. I did eventually end up going to sleep hours later, after learning every single thing on earth about diabetes.

I actually entered a state of bliss for the next few days. I had found out that my A1c (the number that tracks your blood sugar and how much excess sugar you have in your body) was relatively low when it came to the diabetic range. If your A1c is 6.5 or higher, you have diabetes, and mine was 6.6. I felt great about that, and although I aggressively changed my diet the next couple of days, I held dearly to my truth, which was that I wasn’t that much of a diabetic, only a little diabetic. A diet diabetic, if you will!

I knew that when I had a phone call with my doctor she would reassure me that everyone else’s diabetes was bad and that mine was just fine and that with a couple of smoothies, I’d be diabetes-free and back to normal like everyone else. So I waited a couple of days for my appointment. I set up MyFitnessPal. Ate a couple more vegetables, just for kicks, because I knew that when you have diabetes lite like me, you just have to add an order of apples to your McDonald’s meal instead of throwing it out all together.

Monday came around and we finally had the conversation. She told me everything I already knew about diabetes due to my extensive research days before. I told her that my worst habit is eating once a day. She sent a couple of informational videos about living with diabetes and told me that a nutritionist would be calling me soon. And then I posed the question. “So this is like a short-term thing, right? My A1c is pretty low for diabetes, so I just need to get it even lower and then I won’t have diabetes anymore, right?” And then she told me that this diagnosis was forever.

I started sobbing. And I sobbed through the rest of my conversation with her. I sobbed while telling my mom. I sobbed while on my walk. I sobbed in the grocery store while I picked up the “5 best foods to combat high blood sugar”. I sobbed while sitting in the car thinking about how I couldn’t flip this to be something that it’s not. I realized that this was the first thing that I couldn’t run from. I had successfully coped with everything in my life with the help of food. Food was my sidekick, my refuge, my safe space. And with this, I couldn’t run to food. I actually had to do the opposite. I had to run away from food because if I ran to it, it would be the very thing that kills me one day. It made me think about my relationship with myself and my body on a whole new level.

For as long as I can remember, food has been my safety blanket. It was my hobby. I had always loved cooking and wouldn’t mind taking the extra 20 minutes to turn top ramen into fine cuisine, or slow cooking something in the oven to make the taste richer. I loved the crinkly sounds of a takeout order, the squishy packets of soy sauce and ketchup, the red Thank You’s staring at me with gratitude as I opened the bag to reveal what treasure I ordered for that day. I loved the sizzling sound of a raw egg hitting a hot pan. The bubbling boil of a ripe stew slowly melding its flavors over a low fire. Everything about food was special to me, it was an experience, and I unabashedly leaned into it. Eating was my favorite thing to do and I would eat if I felt sad, if I was happy, to celebrate, to commemorate, to combat boredom. Everyone is supposed to eat, obviously, but I wouldn’t shy away from giving myself my favorite foods whenever I wanted them. These tendencies got a lot worse during the pandemic. I was already fighting my depression with cheeseburgers and my anxiety with brownies. The addition of a global catastrophe was scary, but it was no match for pad thai, mac and cheese, and crab rangoon. I felt justified giving myself whatever I wanted whenever I wanted. And why should I feel bad? I hate my life so I’m gonna enjoy my meals because it’s the only thing keeping me from killing myself!

Oops. Did I just say that?

The thought came tumbling to the forefront of my brain as I sat in the car thinking about this new life I would have to live with diabetes. I realized that the only thing keeping me alive was food. Literally. I hated everything else, my depression had taken everything from me but the sweet taste of lemonade or the spicy kick of kimchi. I realized that I hated my body and thus didn’t care what went into it. Growing up with body dysmorphia has made me distance myself from myself as much as physically possible. And mental illness has made me work towards quieting my brain and running from my problems in any way that I can. So, I don’t do my hair, I wear big chunky outfits to hide my body, I let the root of my fears hide in the crevices of my brain, and I revisit my good pal Caviar because it’s the only thing keeping me from ending it all. And now I am forced to take care of my body.

Learning about all the things that can contribute to high blood sugar was probably one of the wildest parts of the diagnosis. Anxiety, bad sleep habits, and stress are three things that I am too familiar with, and three things that also can raise blood sugar. Not eating enough and not getting enough exercise are also three things that can increase your blood sugar, or put it at alarmingly low rates.

Being diabetic means being confronted with my body’s health and well-being for the first time. It doesn’t just mean having more smoothies but it means sleeping at an appropriate time and making sure that I’m not stressing about all the worries of life. It means drinking enough water because my body deserves water, and it means going on a walk because my body deserves to feel the warmth of the sun and the coolness of the wind. This is hard for me. Because I want to sleep all day and I want to stress eat. I want my first time of the day leaving the house to be when I pick up my Ono Hawaiian from the delivery driver. I don’t want to have to think about loving myself and what that really means. But I have to. I have to make the decision to prioritize myself even though indulgence has felt like prioritizing me this whole time. It clearly wasn’t. Because this is where it got me. I don’t know what self-love is and I’m scared to find out, but I know that my security blanket has been ripped from me, and although it’s cold and painful, I hope there is something worth it on the other side.

 

Editor’s note: If you are struggling with mental health issues and diabetes, we urge you to seek professional help. The American Diabetes Association maintains a registry of mental health providers that have specially trained on caring for patients with diabetes.

Source: diabetesdaily.com

Why #insulin4all Advocates Targeted Beyond Type 1

Beyond Type 1, the diabetes nonprofit, found itself in hot water recently after the organization sent a letter stating its apparent opposition to LD673, a proposed bill for an insulin safety net program in Maine. The Maine bill is modeled after Minnesota’s popular Alec Smith Insulin Affordability Act, and guarantees that people with diabetes can access inexpensive insulin in an emergency.

The letter stated that LD673 would “create not only administrative burdens to the Maine government and pharmacies in the state, but also unintended additional out-of-pocket expenses to people living with diabetes.” The organization seemed to argue that its own GetInsulin.org program, a partnership with the major insulin manufacturers, rendered further legislation “duplicative” and unnecessary. 

Some diabetes advocates were outraged at Beyond Type 1’s stance, and accused the nonprofit of favoring the big pharmaceutical companies over people with diabetes.

Late last week, the organization appeared to modify its stance with a new letter, this one explicitly supporting Maine’s new bill. Was it all just a misunderstanding, or did rowdy online activism cause Beyond Type 1 to change its tune?

LD673

Alec Smith, the Minnesota bill’s namesake, died of diabetic ketoacidosis (DKA) in 2017, at the age of 26. At the time, he had recently aged out of his parents’ health insurance plan, and the cost of his insulin had skyrocketed to about $1,300 a month, around half of his total earnings. 

Smith’s mother believes that he died because he could not afford to pay for the insulin that he needed to live. She has become a noted insulin activist, and helped turn his death into a major rallying cry for people protesting the nation’s outrageously high insulin prices.

Minnesota signed the Alec Smith Insulin Affordability Act in April 2020, to widespread acclaim in the diabetes community. 

The new bill in Maine, named An Act To Create the Insulin Safety Net Program, would similarly aim to provide cheap, emergency insulin to those with an urgent need. The emergency insulin would carry a maximum cost of $35 for one month’s supply. The bill also mandates standards for the insulin manufacturers’s otherwise voluntary patient assistance programs (PAPs).

The Letter

In the letter that would cause an uproar, Beyond Type 1 never explicitly stated opposition to the new legislation. Whatever its intentions, however, it’s fair to say that the organization strongly implied its opposition.

The letter argues that state-level legislation such as LD673 is no longer necessary, because nationwide circumstances have changed dramatically since the Alec Smith act was passed in Minnesota:

At the time of its passage, GetInsulin.org did not exist, nor did the urgent need programs offered by the manufacturer. Additional insulin copay, cash pay, and patient assistance programs became available after the Minnesota bill became law that insulin manufacturers’ patient assistance programs (PAPs) are enough to fill the gap in assistance, and that the state statute is not needed. 

While insulin is still disgracefully expensive in most of the US, it is true that there are now more avenues for patients in need than there were only a few years ago. Part of that is due to the success of advocacy efforts, such as the one that coalesced around Alec Smith’s death, that turned insulin affordability into a political hot topic. The Covid-19 pandemic has also shined a spotlight on healthcare inequities, pushing the insulin manufacturers to expand their affordability programs in the last year.

The Beyond Type 1 letter also concentrates heavily on extolling the GetInsulin.org website. GetInsulin.org is essentially a user-friendly portal for the PAPs, aggregating the information from all three major insulin manufacturers in a single space. The website was created in partnership with the big pharmaceutical companies and is at least partly funded by them, facts that raise the suspicions of many people with diabetes, who are often inclined to see Big Pharma as an adversary rather than a partner. 

Are PAPs Really Good Enough?

Patient assistance programs can be valuable and even life-saving resources for people struggling to afford insulin. In some cases, PAPs may even provide more generous support for patients in an emergency than that mandated by the Alec Smith Act and Maine’s proposed law. And because these patient support programs have a reputation for being difficult to access and navigate, there’s no reason to doubt that GetInsulin.org provides a valuable public service.

For insulin affordability advocates, that’s not nearly good enough. The Shot, a weekly digest of insulin affordability news, put the case plainly:

While it’s true that patient assistance programs have become more robust … the programs, like Beyond Type 1’s GetInsulin.org, are voluntarily offered by the companies — often at no cost to them as PAPs are generally tax deductible. The Maine bill, like the Minnesota one that precedes it, locks the companies into providing assistance that patients would otherwise have no guarantee will exist tomorrow.

The PAPs are only reliable as long as the manufacturers don’t dilute them in the future (or disband them entirely). Given that many Americans now feel that insulin is practically a byword for medical exploitation, one can hardly be surprised when people with diabetes regard these programs with suspicion.

The big three – Eli Lilly, Novo Nordisk, and Sanofi – are reliable opponents of government efforts to cap insulin prices. And it would seem that PAPs owe their recent expansion more to the immense public relations pressure that manufacturers have lately had to endure than to any one corporation’s sense of generosity or public service.

Experts do agree that insulin manufacturers do not alone bear the blame for high insulin prices. Manufacturers, pharmacy benefit managers, insurance companies, and pharmacies all benefit from high insulin prices, and our byzantine healthcare market incentivizes all of them to push for price increases. Patients can’t easily vote with their wallets, and are therefore left with little recourse to effect meaningful change.

Insulin affordability continues to be a disaster in the diabetes community. Insulin rationing due to high cost is widespread in the United States, a situation that has probably only gotten worse since the dawn of the pandemic and the economic devastation that has followed. 

The upshot of Beyond Type 1’s argument to the Maine legislative committee was that the PAPs, as accessed through GetInsulin.org, are pretty much good enough. If this wasn’t what the organization intended to communicate with its letter, it made a bad mistake – and on an electric issue.

Online Reaction

Insulin access advocates discovered the letter online, and were outraged. Several accused the organization of corruption and betrayal:

Twitter personality Miss Diabetes illustrated a particularly devastating comic, featuring a caricature of Beyond Type 1 co-founder Nick Jonas:

source: @miss__diabetes

A little context: when Beyond Type 1 was founded in 2015, the organization avowed a principled refusal to accept money from the pharmaceutical industry. Things have changed. Now, according to their website, “Beyond Type 1 partners with pharmaceutical companies, including insulin manufacturers, when the organization finds that doing so furthers mission and impact.” 

This isn’t unusual. Most other prominent diabetes nonprofits also accept Big Pharma money (#insulin4all campaigner T1International is one notable exception). Nevertheless, Beyond Type 1’s position on this issue seemed unusual. The American Diabetes Association, for example, took the opposite stance and penned a letter in support of the bill. 

BT1’s About-Face

Despite the controversy, Beyond Type 1 kept silent for weeks, further disappointing some in the diabetes online community.

In response to a request for comment, a Beyond Type 1 spokesman told Diabetes Daily that the original letter was written not to oppose the legislation but “with the intent of providing information to legislators about existing programs and tools for people with diabetes who are insulin-dependent.” 

Additionally, the spokesman said, “Our team has followed the community response closely, and we know some have interpreted our testimony as one of opposition.”

Soon thereafter, the organization sent a new public letter to Maine’s legislative committee, claiming that it did support LD673, and that it always had:

We’re writing today to clarify and state unambiguously that Beyond Type 1 does support the passage of this legislation. This legislation will help individuals in Maine who may be struggling under urgent or ongoing circumstances to access affordable insulin due to high list prices. Our hope is that people with diabetes who need financial assistance to pay for this life-essential drug may find it through existing programs or potentially those created through Maine’s efforts.

After news of the new letter broke, Hilary Koch, a Maine resident and a Policy Manager for T1International, declared victory on Twitter – but also qualified her celebration with a reminder of how much work needs to be done to achieve universal affordable insulin access.

One can only guess as to the effect that Beyond Type 1’s clarification might have the bill’s chances. Lawmakers may well have already been inclined to support the bill. Just last year, Maine passed more sweeping legislation capping insulin costs for those with state-regulated insurance.

 

Source: diabetesdaily.com

Everything You Always Wanted to Know About Metformin, But Were Afraid to Ask

This content originally appeared on diaTribe. Republished with permission.

By Marcia Kadanoff and Timothy Hay

Starting on metformin? My journey as a type 2 of learning how to deal with side effects, “faux lows,” and learning more about this therapy. 

Editor’s note: this article is in Marcia’s perspective of living with type 2 diabetes, as written by Timothy Hay in January 2019. It was updated in March 2021.

When I was first diagnosed with type 2 diabetes at the age of 58, my doctor immediately put me on metformin, a medication I didn’t know much about.

I soon learned why metformin is considered the first line of defense for people with the condition, as it is safe, effective, and affordable. It’s not linked to weight gain and it puts very little stress on the internal organs. I also read that metformin has side effects for some people.

I expected it to work like insulin in pill form and drop my blood sugar (around 180 mg/dl at the time) right away. But metformin doesn’t work like that. Not at all.

I learned – as millions of people with type 2 diabetes have – that metformin doesn’t immediately lower your blood sugar. It can take four or five days to experience the full benefit, depending on your dosage.

It might not solve all your problems in the blink of an eye. But it is an effective medicine, and its interaction with the body is complex and interesting.

Want more information like this?

What We Know About Metformin

Metformin, which is also sold under the trade names Glucophage, Fortamet, Glumetza, and Riomet, is of the class of drugs called biguanides, which inhibit the production of glucose in the liver.

How does metformin work?

The medicine does not increase insulin levels in the body, but instead lessens the amount of sugar the body produces and absorbs. As it lowers glucose production in the liver, metformin also lowers blood sugar by increasing the body’s sensitivity to insulin. It also decreases the amount of glucose that our bodies absorb from the foods we eat.

What is metformin used for?

Metformin is commonly used to help people with type 2 diabetes manage their blood sugar levels. For most, metformin works to bring down blood sugar gradually when combined with a healthy diet and exercise (I found Adam Brown’s book, Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me to be helpful, particularly in deciding what to eat and not to eat). It’s not so much a quick fix with overnight results as it is an important component of a larger health regimen that keeps the condition manageable.

Is metformin safe?

Metformin is considered a safe, cheap, and effective medication worldwide, and is widely accessible in most countries.

What are the most common side effects of metformin?

Metformin does cause side effects in some people, but many of these are mild, and are associated with taking the medicine for the first time. Nausea and gastric distress such as stomach pain, gas, bloating, and diarrhea are somewhat common among people starting up on metformin.

For some people, taking large doses of metformin right away causes gastric distress, so it’s common for doctors to start small and build the dosage up over time. Many people start with a small metformin dose – 500 milligrams once a day – and build up over a few weeks until the dosage reaches least 1,500 milligrams daily. This means there’s less chance of getting an upset stomach from the medicine, but also means it may take a bit longer to experience the full benefit when getting started on metformin.

I experienced some mild side effects when I started taking metformin, and I found that the symptoms correlated with how many carbs I had in my diet. Once I dropped my carbs to 30-50 grams per day – something that took me weeks to do – any symptoms of gastric upset went away.

Asking your doctor for the extended-release version of metformin can keep these symptoms at bay, and so can tracking your diet.

What is the best time to take metformin?

Standard metformin is taken two or three times per day. Be sure to take it with meals to reduce the stomach and bowel side effects that can occur – most people take metformin with breakfast and dinner.

Extended-release metformin is taken once a day and should be taken at night, with dinner. This can help to treat high glucose levels overnight.

What are less common side effects of metformin?

The medication can cause more serious side effects, though these are rare. The most serious of these is lactic acidosis, a condition caused by buildup of lactic acid in the blood.  This can occur if too much metformin accumulates in the blood due to chronic or acute (e.g. dehydration) kidney problems. Severe acute heart failure, or severe liver problems can also result in a lactate imbalance.

Metformin can also increase the risk of hypoglycemia (low blood sugar), particularly for those who take insulin and drugs which increase insulin secretion (such as sulfonylureas), but also when combined with excessive alcohol intake. Even though I’m not on insulin, I started on continuous glucose monitoring (CGM) to be able to keep a closer eye on my blood sugar levels. Of course, regular checking with a blood glucose meter is also helpful in preventing low blood sugar episodes.

Because long-term use of metformin can block absorption of vitamin B12, causing anemia, sometimes people need to supplement vitamin B12 through their diet as well.

For most people who take metformin, side effects are mild and relatively short in duration.

Metformin

Image source: diaTribe

The “Faux Low”

There is another common side effect often experienced by people taking metformin for the first time. It’s something called a “faux low.”

A faux low happens when you drop your blood sugars to a “normal” range after running consistently high (i.e. above 180 mg/dl), whether by starting on a therapy like metformin or going on a low-carb diet, or both! Your body responds to this change as if it’s in real hypoglycemia (below 70 mg/dl).

Although every person with diabetes has a different blood-sugar threshold and different symptoms, people often feel irritable, tired, shaky, and dizzy when their blood sugar is 70 mg/dl or lower. When I experienced faux lows, I felt similarly dizzy, lightheaded, nauseous, and extremely hungry.

Tool

Image source: diaTribe

If you experience symptoms like these and have confirmed with a glucose meter the low you are feeling is indeed false (i.e. your meter says you’re at 96 mg/dl), keep taking your metformin as directed. Don’t start carb-loading (eating carb-rich foods like orange juice to bring sugars back up).

If I’m indeed having a faux low and not a real one, I found that drinking water and taking a high-sodium, non-carbohydrate snack (nuts are great for this, especially macadamia nuts which are high in fat) nips the symptoms in the bud, allowing me to move on with my life.

Note that especially for type 2 folks out there on metformin and insulin or sulfonylureas, hypoglycemia is a real risk. If you’re feeling low, check your blood sugar – there will be times when you do need to treat hypoglycemia with glucose tablets or orange juice or the like.

Metformin interactions: what should I avoid while taking metformin?

When taken at the same time, some drugs may interfere with metformin. Make sure your healthcare team is aware of any medications that you take before you start on metformin, especially certain types of diuretics and antibiotics. Remember, insulin and insulin releasing medications can increase your risk of hypoglycemia, so it is particularly important to carefully monitor your glucose levels.

You should also avoid drinking excessive amounts of alcohol while taking metformin – aim for no more than one glass per day for women, and two per day for men. Alcohol can contribute to lactic acidosis.

Does metformin cause cancer?

In 2019 the FDA investigated whether some forms of metformin contain high levels of a carcinogenic (cancer-causing) chemical called N-nitrosodimethylamine (NDMA). In 2020, the FDA recommended the recall of several versions of extended-release metformin, and more than a dozen companies have since voluntarily recalled certain lots of the medication. While low levels of NDMA are commonly found in foods and drinking water, high levels of the substance are toxic and can cause cancer.

You can check to see if your metformin has been recalled here. For people taking extended-release metformin, the FDA recommends that you continue to take your medication until you talk to your healthcare professional.

Other Possible Metformin Benefits

Most people with type 2 diabetes tolerate metformin well and are glad it’s available in generic form, which keeps the price low. The medication is so effective as a first-line therapy the American Diabetes Association includes it in its diabetes Standards of Care.

But metformin could have additional uses and benefits outside of treating type 2 diabetes.

Researchers are currently studying whether the medicine can help in the fight against cancer, neurodegenerative conditions, vision problems like macular degeneration, and even aging. It will be a while, however, before uses other than blood-glucose lowering are proven to be effective.

At the same time, metformin is also used in the treatment of gestational diabetes and polycystic ovary syndrome.

The American Diabetes Association has said more doctors should be prescribing metformin to treat prediabetes (a state of higher-than-normal blood glucose levels that doesn’t meet the diagnostic criteria for diabetes), especially for people under the age of 60, although the FDA has yet to bless metformin’s use for the condition.

Can metformin cause weight loss?

The FDA has also not officially approved metformin as an aid in losing weight. Many people with type 2 diabetes have lost weight after taking the drug, as researchers are still torn over exactly how metformin affects the weight. Some believe it decreases appetite, while others say it affects the way the body stores and uses fat.

Scientists are also examining metformin’s potential to protect against heart disease in people with type 2 diabetes – some older data supports this. While robust heart outcome trials with metformin are yet to be conducted, more attention is being paid to this research area.

Metformin and type 1 diabetes

It will be an exciting development if metformin is helpful in the treatment of cancer or neurodegenerative conditions like Huntington’s. But what if it is found to help people managing type 1 diabetes?

Metformin is not currently approved by US or European regulatory agencies for use in type 1s, but people have been known to take the medication anyway, and many doctors prescribe it if someone with type 1 diabetes is overweight. There are actually several reasons metformin is an attractive option for many type 1s. One, metformin has been found to help reduce glucose production in the liver, which is a problem in type 1 diabetes. Two, people often form resistance to the insulin they take, and metformin can help improve insulin sensitivity.

And, metformin may support weight loss and protection against heart disease. A study published in the Lancet following type 1 participants for three years found that compared to placebo, participants taking metformin lost weight. Particularly because insulin often causes weight gain, healthcare providers prescribe metformin “off-label” (not for intended use approved by regulatory agencies) to their type 1 patients. While the study didn’t find that metformin definitively protects against heart disease, based on observed trends in the data, the authors concluded that it may have a role in heart disease risk management.

The Bottom Line?

Metformin

Image source: diaTribe

If you are a person with type 2 diabetes, there are plenty of benefits to taking metformin for its original, intended purpose.

Its side effects are minimal for most people. It’s affordable and covered by Medicare and most insurance plans. Speaking for myself: metformin doesn’t have to cure aging or cancer to be immensely valuable. It helps me process insulin and go on with my life. For me, that’s enough.

About Marcia Kadanoff

Marcia Kadanoff is an advisor to The diaTribe Foundation. She was diagnosed with type 2 diabetes in June 2017 at the age of 50-something, and both her parents and grandparents died of diabetes-related complications. With the help of diaTribe and Adam Brown’s book, Bright Spot & Landmines, Marcia discovered that type 2 diabetes can be put into remission with lifestyle changes. Over the next 7 months, Marcia worked to reverse her diabetes through a LCHF (low-carb, healthy fat) way of eating and regular exercise. Along the way, she lost 45 lbs (!) and found that she no longer suffered from sleep apnea and fibromyalgia. Marcia has maintained her weight loss for a year and had a 4.9% A1C at her last checkup. She wants other people with type 2 to know that they too can put their diabetes into remission.

Source: diabetesdaily.com

Survey Reveals the Heavy Burden of the Pandemic on People with Diabetes

The COVID-19 pandemic has now been ongoing for over a year, and even with the light finally visible at the end of the tunnel, it is undoubtable that it will have lasting effects, for years to come.

Late in 2020, we partnered with the American Diabetes Association (ADA) to conduct a survey-based analysis to assess the effects of the COVID-19 pandemic on Americans living with diabetes.

Approximately 2,600 responses were collected from the Thrivable online patient panel. People from all 50 states shared their experiences during the pandemic, describing the impacts on access to healthcare, food, outlook on receiving a COVID-19 vaccine, and more.

Key Findings: Reduced Health Care and Food Access

  • About 4 of 10 Americans with diabetes delayed seeking routine medical care, with more than 50% stating the fear of COVID-19 exposure was the primary reason.
  • About 1 in 5 Americans with diabetes have foregone or delayed getting an insulin pump or continuous glucose monitor (CGM).
  • More than 1 in 4 stated their access to healthy food was reduced, with about 1 in 5 relying on food assistance programs.
  • Almost half who receive assistance report that the food they receive negatively affects their diabetes management.
  • About 1 in 5 people who receive nutritional assistance report not having enough food to eat.

Moreover, about 1 in 5 Americans with diabetes have reported having to choose between buying food vs. affording their diabetes supplies.

The effects of the COVID-19 pandemic are widespread and span across multiple facets of people’s lives. For people with diabetes, many of whom are already struggling to afford their healthcare expenses, the financial effects of the pandemic may be particularly grim.

Perspectives on the COVID-19 Vaccine

When asked about their comfort level of receiving a COVID-19 vaccine as soon as it is made available to them, people with diabetes reported being more likely to want to receive it right away as compared to data collected from the general population.

Less than half as many people with diabetes stated that they would never want to get the vaccine as compared to data on the general population (10% vs. 21%, respectively).

It is perhaps not surprising that people with diabetes feel more strongly about receiving a COVID-19 vaccine than the general population. Currently, the Centers for Disease Control and Prevention (CDC) state that people with type 2 diabetes  “are at increased risk  of severe illness” from COVID-19, while people with type 1 diabetesmight be at an increased risk for severe illness.”

Other Insights: Barriers to Clinical Trials Participation

In addition to exploring the financial burden of the pandemic and assessing readiness to receive a COVID-19 vaccine, we also gathered information regarding previous participation or willingness to participate in a clinical trial. As per the recent press release,

“People with diabetes have participated infrequently in clinical drug trials in the past (only 11% report having done so), but the majority – 60% – say they are likely or very likely to participate in such a study in the future. Yet nearly a quarter of those who responded to the survey said they didn’t know how to participate in a drug trial if they wanted to do so.”

Check out the full press release from the ADA as well as the more data below:

New Data Alert: COVID-19 Brings Crisis of Access for Millions Living with Diabetes

Effects of the COVID-19 Pandemic on People with Diabetes

Methodology and Panel Demographics

These figures are based on Thrivable’s survey of more than 2,500 people with diabetes nationally, between December 7th and December 14th, 2020

  • A multiple-choice survey was distributed online to people with diabetes (U.S. residents) who signed up for the Thrivable Insights panel.
  • Participants were not compensated for their responses.
  • Data was analyzed using Qualtrics and Excel.
  • Details on panel breakdown include:
    • N = 2,595
    • o 47% with type 1 diabetes, 53% type 2
    • o 69% female, 31% male
    • o All 50 U.S. states are represented

Source: diabetesdaily.com

How Race and Ethnicity Affect Diabetes Prevalence, Management, and Complications

This content originally appeared on diaTribe. Republished with permission.

By Julia Kenney, Matthew Garza, and Eliza Skoler

Black, Indigenous, Hispanic, and Asian individuals, and people of all non-white racial and ethnic groups are more likely to have diabetes and diabetes-related health complications than their white peers. Here’s how social determinants of health lead to differences in diabetes care and outcomes, creating racial, ethnic, and economic health disparities in the United States.

According to the 2020 National Diabetes Statistics Report published by the Centers for Disease Control (CDC), diabetes affects over 34 million people in the United States – that’s more than one in ten people. However, diabetes does not affect all communities equally. As with many conditions – such as heart disease, chronic lung disease, and chronic kidney disease – a person’s race, ethnicity, and socioeconomic status influences both their risk for developing diabetes and their access to diabetes management resources. The health disparities that exist among the many races in the US are not attributable to genetics or biology alone, but also to socioeconomic factors and social determinants of health that disadvantage people of color.

Though genetics and biology do play important roles in diabetes prevalence and complication rates, this article will focus on the societal factors that affect the lives of people living with diabetes – such as access to healthy food, healthcare, employment, and other socioeconomic factors. We aim to specifically explore the racial health disparities that disadvantage communities of color. We will also highlight some of the factors underlying the concerning patterns in diabetes prevalence, management, and complications, and share ways to promote health and access to care for people with diabetes, regardless of race and ethnicity.

Defining Key Terms

  • Race & Ethnicity – Race is a socially constructed way to group individuals based on skin color and physical features. There is no specific set of genes that defines a race. Ethnicity is also socially constructed, and it categorizes people based on a shared sense of group membership (like language, culture, history, or geography).
  • Socioeconomic status – Socioeconomic status is a measure of a person’s economic and social standing. This term is often used interchangeably with social or economic class.
  • Health disparities – Health disparities are differences in health outcomes among various populations or communities. They are closely linked to social, economic, and environmental disadvantages that affect groups that have systematically experienced greater obstacles to health (due to factors including race, gender, age, sexual orientation, and economic status.)
  • Health equity – Health equity is the goal that every person, regardless of their background or circumstance, is able to live a healthy life with full access to quality healthcare and other health resources. Achievement of health equity requires valuing every person equally and addressing avoidable inequalities with focused, societal efforts to eliminate injustices and health disparities.
  • Social determinants of health – These are factors that influence a person’s health but fall outside the scope of a healthcare professional’s influence. They are the conditions in which people are born, grow, live, work, and age. For example, social determinants of health can include a person’s race, gender, socioeconomic status, education, and where they live and work; these factors are often longstanding and have multi-generational effects. Social determinants of health are one of the major causes of health inequities – the unfair and avoidable differences in health status.
  • Systemic racism – Also called institutional or structural racism, it is defined by systems and structures (such as medicine or the healthcare system) that have procedures or processes that disadvantage people of color.

Systemic racism lies at the center of this article. As we discuss racial health disparities and their underlying causes, keep in mind that these factors are a result of the long-standing structures that affect the lived experiences of people of color – they are not attributed to the personal decisions of individuals.

A Look at Racial Health Disparities in Diabetes

What do health disparities actually look like in the US? The data show concerning patterns: Black, Indigenous, Hispanic, and Asian populations are more heavily affected by diabetes than their non-Hispanic, white counterparts, in diagnoses, management challenges, and diabetes-related complications.

The CDC’s diabetes statistics report showed alarming differences among races in the estimated percentage of adults with diabetes (both diagnosed and undiagnosed) in the US from 2013 to 2016:

  • Black, non-Hispanic: 16.4%
  • Asian, non-Hispanic: 14.9%
  • Hispanic: 14.7%
  • White, non-Hispanic: 11.9%

While these differences in rates are stark, the evidence shows that diabetes prevalence is not dependent on race from a genetic or physiological standpoint alone. For example, in this study from 2007, when researchers accounted for socioeconomic factors, the differences in rates of type 2 diabetes between racial groups were reduced. This supports the idea that socioeconomic factors that disadvantage people of color are a significant cause for these health disparities.

In a 2017 study published in the Journal of Racial and Ethnic Health Disparities, a team of researchers from Meharry Medical College and Vanderbilt University found that there were differences in the quality of diabetes care between racial and ethnic groups. Using the 2013 Medical Expenditure Panel Survey (MEPS) data, they looked at adherence to five ADA-recommended services over one year that indicate quality of diabetes care. Compared to white individuals, Hispanic, Black, and Asian individuals received fewer diabetes management checks, including A1C tests, eye exams, foot exams, blood cholesterol tests, and flu vaccines. Even in adjusted models which controlled for factors like insurance coverage, poverty, and education, some of the disparities remained. Most notably, Hispanic, Black, and Asian individuals were still less likely to receive the two recommended annual A1C checks. The researchers showed that this difference in quality of care occurred partly because populations of color had less access to health insurance and diabetes management education, compared to white populations.

Trends in care translate to trends in diabetes outcomes – including complications and death rates. A study from 2014 looked into racial and ethnic differences in diabetes complications and mortality. Black, Indigenous, and Hispanic individuals had higher rates of retinopathyend-stage kidney disease, and amputations than non-Hispanic white individuals. Furthermore, these groups were more likely to die from diabetes than non-Hispanic white Americans:

  • Indigenous populations were 3 times more likely to die from diabetes
  • Non-Hispanic Black Americans were 2.3 times more likely to die from diabetes
  • Hispanic Americans were 1.5 times more likely to die from diabetes

Just as with the risk of diabetes, people of color are not genetically predisposed to diabetes-related complications due to race alone. A combination of social and environmental factors plays into a person’s ability to successfully manage their diabetes.

How Genetics and Biology Are Involved

Racial and ethnic categories are not as closely associated with genetics and biology as some people think. In fact, categories such as white, Black, Asian, and Hispanic are defined more by society than by any set of specific genes. However, to fully address the factors that affect diabetes prevalence and outcomes, we must understand the role of genetics and biology. Studies have shown that there are biological differences among races that correspond to how a person metabolizes (or utilizes) glucose, their insulin sensitivity, and how fat is distributed in the body – however, a person’s family history of diabetes is more telling of their genetic risk for that condition than the color of their skin. The research on how genetics, biology, and race all intersect and interact to influence diabetes is complex; there is still much to determine.

As discussed, genetics alone do not explain diabetes-related health disparities among the races. Furthermore, we cannot reduce the large health disparities by focusing solely on biological factors, which are largely predetermined; we must instead focus on the socioeconomic factors and social determinants of health that exacerbate racial disparities, which are in large part founded in longstanding systemic racism. Below we describe some of the many elements of systemic racism that affect a person’s ability to manage their diabetes and receive quality diabetes healthcare.

Main Causes of Racial Health Disparities in Diabetes Prevalence

The factors we discuss here are influenced by systemic racism that is built into the social, economic, and political fabric of the United States. The systemic racism that people of color experience results in things like lower wages, fewer academic and professional opportunities, and reduced community resources. With this in mind, factors like income, unemployment, health insurance, and food and exercise environments are not entirely personal choices, but can be explained by a number of external causes.

Income 

In the US, there are major racial differences in wealth. A 2018 Kaiser study offered this breakdown of people living below the federal poverty level:

  • 1 in 4 Indigenous people
  • 1 in 5 Black people
  • 1 in 5 Hispanic people
  • 1 in 10 white people

Further statistics on income and poverty levels can be found in the US Census Bureau’s 2019 report, which confirms the racial disparities in poverty rates. People living with incomes below the federal poverty level in 2018 were earning only $12,000 a year (or $25,000 for a family of four). These families – and many above the federal poverty level – often can’t afford the nutritious food, safe exercise opportunities, and healthcare needed to prevent and manage diabetes.

Unemployment and Health Insurance

People of color in America are also more likely to be unemployed. According to the US Bureau of Labor Statistics, the rates of unemployment in 2019, broken down by race, were:

  • 6.6% of Indigenous people
  • 6.1% of Black people
  • 3.9% of Latino and/or Hispanic people
  • 3.1% of white people

These unemployment rates and racial disparities have been further exacerbated by the COVID-19 pandemic, which dramatically increased unemployment rates in the US. Though unemployment is closely tied to income, it can also influence a person’s access to health insurance, since many people receive health insurance from an employer.

Stat

Image source: diaTribe

The high cost of healthcare means those who are uninsured or underinsured often do not get the care they need, including preventive healthcare (such as annual check-ups and prediabetes screenings) and instead must rely on inconsistent care. Unfortunately, Black, Indigenous, and Hispanic people are less likely to be insured in America. According to a Kaiser study of non-elderly individuals in the US, these were the rates of uninsured people in 2018:

  • 21.8% of Indigenous people (identified as American Indian or Alaskan Native
  • 19% of Hispanic people
  • 11.5% of Black people
  • 7.5% of white people

Food and Exercise

A healthy diet and regular exercise are known to reduce the risk and improve the outcomes of type 2 diabetes. However, Black, Hispanic, and Indigenous communities in the US have less access to healthy foods and experience higher rates of food insecurity than white communities. According to the USDA, more than 35 million people lived in food insecure households in the US in 2019, including:

  • 25% of Indigenous people
  • 19.1% of non-Hispanic, Black households
  • 15.6% of Hispanic households
  • 7.9% of non-Hispanic, white households

Food insecurity is most common among low-income communities, which are disproportionately occupied by people of color. Moreover, food deserts (where there is little to no access to healthy foods) and food swamps (full of unhealthy fast-food options) are located primarily in minority neighborhoods. These communities are often faced with local food options that put them at an increased risk for diabetes: more small grocery stores with limited choices, fast food restaurants, and liquor stores, and fewer supermarkets with fresh fruit and vegetable options, bakeries, and natural and whole foods.

In addition to less access to healthy and affordable food, people of color often also have less time, money, and overall access to venues for exercise. This article from the New York Times about the racially exclusive culture around jogging is an eye-opening example of the barriers to exercise that many Black people face. Even at a time when some of the world’s most elite runners are African or Black, Black runners and joggers (in America, especially) often engage in protective measures such as running only during the daytime, steering clear of certain neighborhoods, or wearing Ivy League sweatshirts to deflect any suspicions that could lead to racist attacks.

Main Causes of Racial Health Disparities in Diabetes-Related Health Complications

Barriers to healthcare (such as a lack of health insurance or insufficient income) continue after a person is diagnosed with diabetes. Without ongoing, regular diabetes care, people face higher rates of health complications. Here are some of the barriers:

  • The high cost of insulin has made the life-saving drug inaccessible to many people, including people of color who have higher rates of unemployment and little or no health insurance. An American Action Forum report showed that insulin costs a person an average of $6,000 per year and found that one in four people with diabetes report rationing their insulin because they cannot afford the cost of their full prescribed dose.
  • Despite major advances in diabetes technology that make diabetes management easier, including wider use of CGM and insulin pumps, disparities exist in who has access to these tools. Black individuals are less likely to use an insulin pump or CGM than their white counterparts – which may be due to failure of the healthcare professional to write a prescription for technology, insufficient information about diabetes technology, an inability to afford these devices, or subtle racism on the part of the established medical system.
  • Even for people who have insurance, the costs of diabetes care and a diabetes-friendly nutrition plan can be challenging for people with low incomes.

Social and racial barriers widen diabetes health disparities. There is a history of prejudice against people of color in our healthcare system: Black, Indigenous, and Hispanic individuals can have the same income, insurance, and medical condition as white people yet still receive lower quality care due to systemic racism. In 2018, fewer than 12% of practicing physicians in the United States were Black, Hispanic, or Indigenous individuals. This means that there are fewer healthcare professionals who can earn trust and identify with communities of color. For more information on racism in healthcare, check out Unequal Treatment.

The Importance of Addressing Health Inequity in Communities of Color

It is clear that the disparities in diabetes prevalence, care, and management can be explained in part by of a number of social determinants of health, many of which are influenced by systemic racism. Every person with diabetes faces health barriers. But for many, the color of their skin can make successful diabetes management even more difficult and sometimes impossible. Every person with diabetes should have access to diabetes care, medication, and technology, and to living a healthy life with diabetes.

What Can We, as a Society, Do to Reduce These Disparities?

It will take extensive, collaborative, and creative work to address these disparities. We can begin by educating ourselves and others. Some good first steps include learning about the challenges faced by people of color with diabetes, about the people working to address these issues already, and about the ways to get involved. Check out some of our other articles on these subjects:

At diaTribe, we want to acknowledge the people and the organizations at the local, state, and national levels who are already doing the work needed to effectively tackle the health inequalities that lead to higher rates of diabetes and less favorable outcomes among people of color. In addition to those whose jobs focus on addressing health disparities, there are other ways for people to be involved in promoting health equity. Here are some ideas to consider:

No matter what skills or resources you may have, determine how your expertise might be of benefit – particularly if you are in the health field where you can address systemic racism and health disparities. The more we learn about how the social determinants of health and racism in healthcare contribute to a person’s risk for diabetes and influence their diabetes management, the better prepared we’ll be to knock down barriers to quality care.

We acknowledge that every person should have the resources to manage their diabetes and, in the case of type 2 diabetes, to prevent it. All people, and especially people in positions of privilege, have a responsibility to help break down barriers to equal care for underserved communities. As people with diabetes and their allies, we have to do the work – and build upon the work already being done – to address racial health disparities and create more equitable and inclusive healthcare for people of color – in fact, for all of us.

Source: diabetesdaily.com

New Therapy to Treat Type 1 Diabetes Rolls Out Clinical Trial

Type 1 diabetes is an autoimmune condition whereby the person’s own immune system attacks the pancreatic cells that produce insulin. Insulin signals for glucose uptake into cells, a carefully regulated and important process, that when disrupted, can lead to an array of health complications, and without treatment, results in death. Many advances in the care of type 1 diabetes have been made in the last century; however, there is no cure for the condition, and patients rely on frequent blood glucose monitoring and insulin injection or infusion therapy to survive.

We have been closely following the work of Dr. Bart Roep and his colleagues at the City of Hope over the last several years. We first spoke to him at the 79th American Diabetes Association (ADA) Scientific Sessions in 2019.

“Dr. Roep has dedicated his professional life to trying to cure type 1 diabetes. Over an almost 30-year career, he has earned numerous prestigious awards and is perhaps most well-known for his work discovering how T-cells recognize specific antigens on beta cells in the context of type 1 diabetes pathogenesis. Currently, he is Chan Soon-Shiong Shapiro Distinguished Chair in Diabetes and the founding chair of the Department of Diabetes Immunology within City of Hope’s Diabetes & Metabolism Research Institute. Dr. Roep is also the director of the Wanek Family Project for Type 1 Diabetes.”

The immune system coordinates defenses against pathogens (like viruses and bacteria) via intricate cross-talk between different immune cells in the body. It is also able to recognize the host (self-tolerance) and under normal circumstances, should not attempt to destroy the person’s own cells (with the exception of special circumstances, like cancerous cells, for instance).

Photo by iStock

For the treatment of autoimmune conditions, like type 1 diabetes, much research is ongoing in an effort to “re-write” some of the “programming” and cellular cross-talk thought to be responsible for autoimmune attack. The “inverse vaccine” for the treatment of type 1 diabetes attempts to do just that in the following process:

  1. Immune cells are taken from patients and “re-educated” in the test tube to improve self- tolerance
  2. These cells are injected back into the patient, in hopes that they will not longer drive autoimmune attack, but rather “educate” the immune system to tolerate the person’s own beta cells

Last year, we reported that the initial safety and tolerability studies appeared promising.

Now, additional clinical trials are poised to begin:

“The vaccine is made using one’s own immune cells (dendritic cells) and a beta cell protein. The vaccine may teach the immune system to stop attacking the beta cells, which may help the beta cells recover and make enough insulin to control blood sugar levels. The vaccine may also help reduce future type 1 diabetes related complications.”

It is a very exciting time for type 1 diabetes as we move from just treating the symptoms to actually trying to stop the disease,” Roep remarked in a recent press release.

What are your thoughts on this research? Would you participate in the trial?

Source: diabetesdaily.com

New Target A1C Recommended for Youth with Type 1 Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Matthew Garza and Lydia Davis

The American Diabetes Association has lowered the A1C target for children to less than 7.0%, aiming to improve long-term health outcomes without increasing hypoglycemic events.

The American Diabetes Association (ADA) recently issued a new recommendation on A1C targets for children: youth with type 1 diabetes should aim for an A1C below 7.0%, rather than the previously recommended target of 7.5%. The ADA also emphasized that although this is a target for the general population of children with type 1 diabetes, it is important that each child’s A1C goal be personalized, taking into account hypoglycemia awareness, baseline A1C, and other health issues.

In 2018, the American Diabetes Association (ADA) reiterated its long-held recommendation that children with type 1 diabetes should aim to have an A1C of less than 7.5%. This target was designed to help prevent severe hypoglycemia (low blood sugar) in children. The ADA has revised that position in light of a recent review paper, which showed that elevated blood glucose levels can lead to significant complications during child development, including abnormal brain development, an increase in heart problems, retinopathy, and neuropathy. The review also showed that newer diabetes therapies and technology have resulted in a lower risk for severe hypoglycemia.

However, for certain groups of at-risk children, this new recommendation may not apply, and it may be safer to target an A1C of 7.5% or higher. Children with low hypoglycemia awareness, those who cannot alert others to symptoms of hypoglycemia, those without access to helpful diabetes technology (such as continuous glucose monitoring), and those who cannot test their blood glucose levels regularly should continue to aim for an A1C of less than 7.5%. Children with a history of severe hypoglycemia should aim for an A1C of less than 8.0%.

In contrast, children who are not at risk for hypoglycemia (for example during the often-experienced “honeymoon” period) should aim for an A1C as low as 6.5%.

The lower A1C goal of 7.0% will hopefully lead to a reduction in diabetes complications during childhood and throughout the lives of people with type 1 diabetes, without increasing their risk of severe hypoglycemia while they are young.

Source: diabetesdaily.com

COVID-19 Vaccine for People with Diabetes: What’s Going On?

The COVID-19 vaccine is here, and like most things dealing with the pandemic, the rollout of both the Pfizer-BioNtech and the Moderna vaccines has been a nightmare. The Trump administration’s Centers for Disease Control and Prevention (CDC) Advisory Committee for Immunization Practices (ACIP) released loose guidelines for states to follow in determining how to disseminate the vaccine but has largely left most of the decisions up to the states. Most people don’t yet know when they’ll receive the vaccine, and on the whole, most states are still in phase 1a, disseminating shots to frontline healthcare workers and those living in long-term care facilities.

In their initial recommendations, people with type 1 diabetes would receive the vaccine further down on the priority list, along with healthy individuals under 65 years old. People with type 2 diabetes are classified as, “at increased risk for severe COVID-19–associated illness”, and are thus to be given priority access in phase 1c, along with people who suffer from other conditions, such as cancer, heart failure, sickle cell disease, chronic obstructive pulmonary disease (COPD), and smoking. Type 1 diabetes is classified as, “might be at increased risk for severe COVID-19-associated illness”, to be given access in phase 2, with other conditions such as being overweight (BMI >25), and suffering from neurologic conditions.

This would put people with type 1 diabetes in the general population rollout, months after not only people with type 2 diabetes have gotten their shots, but behind many other chronic conditions, too. This is a harsh slap in the face for a community that could face so many negative consequences should they contract the virus (not to mention people with diabetes make up 40% of all COVID-19 deaths).

But recent data has come out that people with type 1 diabetes suffer from mortality from COVID-19 at similar rates as people with type 2 diabetes, and a study conducted by Vanderbilt University said people with either type 1 or type 2 diabetes who have COVID-19 have three to four times higher risk of severe complications and hospitalization as compared to people without diabetes.

Several more studies show that having type 1 diabetes is potentially even more dangerous if you contract COVID-19  than having type 2: A Lancet Diabetes & Endocrinology study published last year looked at medical records from the National Health Service in England to conclude that the risk of dying from Covid-19 was almost three times higher for people with type 1 diabetes and almost twice as high for type 2 than for those without diabetes.

In Scotland, another Lancet study said being admitted to an ICU or dying was more than twice as likely for type 1 diabetes patients and nearly 1.5 times more likely for type 2 diabetes patients than for people without diabetes.

People with type 1 diabetes have been told that they live with a disability the entire time they’ve lived with this incurable illness. We’ve sat on the sidelines while going low, been discriminated against in the school and workplace, shut out from certain industries and employers, and know the unique and awful feeling of our skin tightening from a hyperglycemic event after our pump failed for the umpteenth time in our sleep. We require special accommodations, a militant watch on our medication, exercise, insulin, and food intake, and are never offered a break, a day off, or even a hint of affordable insulin.

We live in the unique situation of a dual-reality: having a chronic condition, yet feeling its invisibility every day. We’re never quite “sick enough”; we never “look” diabetic; sometimes, we feel like we don’t even “deserve” the meager accommodations that we get (always pre-board flights, because you’re allowed to!). We live every day with the knowledge that our life expectancy is likely shorter, our days are harder, and especially during this pandemic, many of us have lived in fear of a serious complication should we contract COVID-19 and the bleak consequences we could face. Many of us have stayed home, shut-in, and waited this out, while watching some of our able-bodied peers continue to ignore public health protocols and guidelines.

The end result of the CDC’s recommendations burns and is tangible: states, including Iowa, Illinois, and Virginia, are prioritizing dissemination of the vaccination to people living with type 2 diabetes before people living with type 1 diabetes. Simply put: we’ve been told to stay in, shut up, and wait it out for the vaccine, due to our fragile health condition, and now that the vaccine is here, our disability is yet again being ignored.

Yes, type 2 diabetes is being prioritized and that is right, good, and important, but type 1 diabetes needs to be prioritized, too. They’re not mutually exclusive. Currently, the United Kingdom is not differentiating between type 1 and type 2 diabetes; they are prioritizing people who have either type. Other countries are following suit.

On Tuesday, the Trump administration reversed course, adopting part of president-elect Joe Biden’s distribution plan, advising states to prioritize everyone over the age of 65 and any person with a chronic condition to get the vaccine as soon as possible; states have yet to officially adopt these plans on a wide scale.

Recently, several letters were sent from various diabetes advocacy organizations to the CDC urging them to reconsider their guidelines. Organizations such as T1International, Mutual Aid Diabetes, The American Diabetes Association, JDRF, Beyond Type 1, Children with Diabetes, The diaTribe Foundation, DiabetesSisters, and T1D Exchange have lent their voices to make the needs of the 1.6 million people living with type 1 diabetes in America known.

The bottom line is that we need to curb the tide of this pandemic. Almost 400,000 Americans are dead, with a holiday-related surge in cases, hospitalizations, and death on the way. We need to get shots into as many arms as quickly as possible and stop telling some of our most vulnerable populations that, yet again, they aren’t sick enough to qualify, and that they can wait. We can’t.

Source: diabetesdaily.com

How Sweet It Is: All About Artificial Sweeteners and Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

What are artificial sweeteners, can people with diabetes consume them, and why are they controversial? Here we share advice and break down the types of sugar substitutes that are currently available

You may feel like you’re not sure how artificial sweeteners affect health or relate to diabetes – that’s fair, because there’s a lot of uncertainty on the subject. More than a dozen different kinds of artificial sweeteners are available. These products – also known as low calorie sweeteners, nutritive or non-nutritive sweeteners, or sugar substitutes – help make food and drinks sweet, without the calories found in sugar or the glucose spikes.

So, what are artificial sweeteners? How do they work? How do they affect people with diabetes? And ultimately, are artificial sweeteners good for you?

In short, artificial sweeteners can be much sweeter than sugar itself, so a little goes a long way. This can help reduce how many calories you consume from an artificial sweetener. Additionally, artificial sweeteners are typically not absorbed by the body the way sugar is, so they pass through you without as much concern for weight gain or blood sugar fluctuations.

In this article we’ll discuss what makes one artificial sweetener different from another, their side effects, whether they are safe or unsafe, and how to decide if an artificial sweetener is right for you.

“In our world of diabetes, [these products] make healthy eating more flexible, and they do not take away from one’s daily carbohydrate allotment,” said Toby Smithson, a registered dietician nutritionist and certified diabetes care and education specialist, and the founder of DiabetesEveryday.com. Smithson presented a seminar, “The Sweet Truth about Low Calorie Sweeteners,” at the virtual 2020 conference of the Association of Diabetes Care & Education Specialists (ADCES). Smithson has lived with diabetes for more than four decades and has watched artificial sweetener options grow. She is also a consultant for Splenda, a type of artificial sweetener.

A Bad Reputation

Despite how much they can help with blood glucose management, misperceptions about artificial sweeteners live on. For one thing, while artificial sweeteners themselves have few carbohydrates or calories, the foods they are in likely have some calories and carbs from other ingredients. “Claims like ‘sugar-free,’ ‘reduced sugar’ or ‘no sugar added’ are not necessarily carbohydrate-free or lower in carbohydrate content than the original version of the food. For this reason, we recommend that you read the nutrition facts label to understand how many carbs and calories you are eating,” states the American Diabetes Association’s website. “Using sugar substitutes doesn’t make an unhealthy choice healthy. It just means it’s less unhealthy.”

The Academy of Nutrition and Dietetics, the American Heart Association and the American Diabetes Association have all issued statements indicating that people can use artificial sweeteners cautiously when eaten as part of a healthy diet guided by current federal nutrition recommendations. In her presentation, Smithson said, “The expert consensus on low calorie sweeteners found low calorie sweeteners to be safe, they reduced sugar and energy intake, and had no adverse effects on sweet preference, appetite, or glucose control. Artificial sweeteners may improve diabetes management, but there hasn’t been enough data on gut health and artificial sweeteners to comment on that aspect.”

Still, negative perceptions linger. “Studies on certain sweeteners have revealed questions about their safety which have not been adequately answered,” said Dr. Robert Lustig, author of the upcoming book Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine“Two examples are aspartame and saccharin, which have been associated with cancer in animals. But these have not been proven in humans. Nonetheless, these doubts persist in the public’s mind.” Lustig argues that we don’t know enough about how sweeteners affect humans to determine whether they are fully healthy for our bodies.

One woman with diabetes came to see Smithson for nutritional guidance and explained that she drank sugary – not artificially sweetened – soda regularly. “She thought it was safer to do,” said Smithson. “To help her understand this, I explained how a regular soda would affect her blood sugar. We suggest drinking regular soda to help spike a blood glucose level within 13 minutes, as a treatment for hypoglycemia. It really got the point across to my patient.”

Today’s Sugar Substitute Options

Why would someone with diabetes think a Coca-Cola would be a better choice than a Diet Coke? With many different products on the market and varying news and studies about nutrition, it can be hard for the public to keep up with changing trends. Similarly, different artificial sweeteners have specific aftertastes, some more obvious than others.

“Some people will use eight teaspoons of sugar in a cup of coffee, and for them it would be hard to transition to an artificial sweetener immediately,” said Sandra J. Arevalo, a dietician, certified diabetes care and education specialist, and National Spokesperson for the Academy of Nutrition and Dietetics. She has counseled people with diabetes over the past 25 years. “I tell them to start reducing the amount of sugar, instead of switching immediately. To reduce the amount of sugar helps change the taste buds, which makes it easier to adapt” to using a smaller amount of an artificial sweetener.

What are the sweeteners available, and what do we know about them? This chart shows common artificial sweeteners that people use at home. All of them are low-calorie, low-carb sweeteners.

Sweetner

Image source: diaTribe

Some artificial sweeteners are mainly used in processed foods. If you’re checking for sweeteners on a food’s nutrition label look for the types listed above, as well as neotame and advantame – two more sweeteners that are thousands of times sweeter than sugar.

Overall, experts recommend using the smallest amount of any sweetener possible. “These sweeteners are safe on a single-dose basis; none of them will make you keel over and die,” said Lustig. “But the question is, what about multiple doses? It’s like tobacco smoke. One cigarette won’t kill you, and not even a pack of cigarettes in one day will kill you. But a cigarette a day for 20 years just might.”

Arevalo agrees.

“Just keep it to the minimum,” she said. “Enjoy it, but be careful of the amount.”

Are some sweeteners healthier?

Some people may be sensitive to certain artificial sweeteners, and Arevalo said plant-based sweeteners may cause fewer side effects such as stomach discomfort.

  • Stevia: Stevia sweeteners are plant-based and newer, and they cost more than sweeteners that have been on the market longer, notes Arevalo.
  • Monk fruit: “Monk fruit is gaining popularity due to consumer demand for ‘natural foods’ because it originates from the pulp of the fruit,” said Smithson.

Sugar alcohol sweeteners occur naturally in foods and are absorbed by the body more slowly than sucrose. They may be not calorie-free or carb-free, said Smithson. Typically used as a food additive for sugar free candies, cookies, mints and gum, sugar alcohols don’t cause cavities or a rapid jump in blood glucose levels, but they can cause diarrhea, stomach cramps, gas and bloating in some people, especially if you eat a lot of them. Swerve is a sugar alcohol sweetener that is popular among people eating very low carb diets – it has no calories and no effect on blood glucose, Smithson said.

So, which artificial sweetener is best?

Lustig noted that 2017 research published in the Canadian Medical Association Journal found that some studies suggest a possible link between using artificial sweeteners and weight gain and higher risk of obesity, high blood pressure, metabolic syndrome, type 2 diabetes (the studies included people with and without diabetes) and heart disease. However, more research is needed for definitive results.

Lustig’s bottom line is the less sweetness, the better. “Everyone needs to de-sweeten their lives, especially people with diabetes,” he said.

But many people love sweets. With any sweetener, both Smithson and Arevalo recommended that people conduct their own taste test to determine which product they like best, as some sweeteners have a bitter aftertaste. “Everyone’s taste buds are different and everyone’s feelings are different,” Smithson said. “Taste goes a long way and taste matters.”

About Cheryl

Cheryl Alkon is a seasoned writer and the author of the book Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby. The book has been called “Hands down, the best book on type 1 diabetes and pregnancy, covering all the major issues that women with type 1 face. It provides excellent tips and secrets for achieving the best management” by Gary Scheiner, the author of Think Like A Pancreas. Since 2010, the book has helped countless women around the world conceive, grow and deliver healthy babies while also dealing with diabetes.

Cheryl covers diabetes and other health and medical topics for various print and online clients. She lives in Massachusetts with her family and holds an undergraduate degree from Brandeis University and a graduate degree from the Columbia University Graduate School of Journalism.

She has lived with type 1 diabetes for more than four decades, since being diagnosed in 1977 at age seven.

Source: diabetesdaily.com

1 2 3 5

Search

+