Drink to That: How to Safely Consume Alcohol with Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

We’re already thinking about carbs and calories all the time, and adding alcohol into the mix makes things more complex. ­Experts share their best advice on how to safely drink when living with diabetes.

People who choose to drink alcohol typically do so for a few main reasons: to cope with challenges, to be sociable, or just because they enjoy having a drink. But while alcohol may make some people feel more comfortable, drinking can be especially complicated for people with diabetes. If you’re choosing to drink with friends or loved ones, let’s talk about how you can do so safely with diabetes.

First, alcohol is a drug, and it can be highly addictive. If you don’t drink now, there’s no reason to start. In fact, avoiding alcohol is the healthiest choice for people with or without diabetes. Drinking more than is healthy for the body has been linked to issues in the brain, heart, liver, pancreas, and immune system and is associated with several kinds of cancer, according to the National Institute on Alcohol Abuse and Alcoholism. Drinking is also connected to other health problems, such as unintentional injuries (car accidents, falls, drownings), domestic violence, alcohol use disorders, and fetal alcohol spectrum disorders, per the Centers for Disease Control and Prevention.

So, with all that said, how can you best manage your diabetes if you choose to drink?

What happens in the body when you drink?

Your liver works to create glucose when your blood sugar levels are low, but it also processes any alcohol present in your body, says Sandra Arevalo, a certified diabetes care and education specialist and spokesperson for the Academy of Nutrition and Dietetics. More specifically, “Alcohol gets broken down by your liver. The liver is also in charge of making sugar when your blood sugar levels are low, by converting stored glycogen into glucose, and releasing that glucose into your bloodstream. When you drink, your liver is busy processing the alcohol and has a hard time producing glucose,” she said.

This process “puts people with diabetes at high risk of low blood sugar when they drink,” Arevalo said. “If you are on basal insulin, you may not make enough glucose for the amount of basal insulin you have taken, and you may suffer a hypoglycemic episode.” This applies primarily to people with type 1 diabetes, but people with type 2 diabetes are still at risk for low blood glucose levels when they drink.

What’s in a drink?

That’s a tricky question. What you are drinking and how much of it you choose to drink can make a big difference. Like most things with diabetes, there aren’t simple answers.

According to the CDC, moderate drinking is defined as two drinks or less per day for men, or one drink or less per day for women. The US Dietary Guidelines Advisory Committee recommends one drink or fewer per day for people of any gender. It is illegal for people under 21 to drink alcohol in the United States.

Drinking

Image source: diaTribe

What does the CDC classify as “a drink?” One drink contains 14 grams, or 0.6 ounces, of pure alcohol, which normally equates to 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of hard liquor or spirits such as gin, rum, vodka or whiskey.

What influences your intoxication?

Several factors – including diabetes medications, food, and exercise – can all make things even more complicated, said Carrie S. Swift, a dietician and spokesperson with the Association of Diabetes Care & Education Specialists. “Overall, alcohol intake leads to less predictable blood glucose whether you have type 1 or type 2 diabetes,” she said. But “the impact of alcohol on blood glucose isn’t always the same.”

This can be caused by:

  • Carbohydrate content of drinks: Beer and sweet wines contain a lot of carbohydrates, and can increase your blood sugar level despite the alcohol content. On the other hand, quickly cutting down your intake of these drinks, or quickly making the switch to dry wine or spirits, can carry a high risk of hypoglycemia.
  • Diabetes drugs: Insulin and sulfonylurea medications such as glipizide, glyburide, and glimepiride – all of which help to lower blood glucose levels – “are more likely to cause low blood glucose when alcohol is consumed,” said Swift. Insulin and alcohol work similarly whether you have type 1 or type 2 diabetes. If you take metformin, pay attention to these specific symptoms when you are drinking: weakness, fatigue, slow heart rate, muscle pain, shortness of breath, or dark urine. “Excessive alcohol intake while taking metformin may increase the risk of a rare, but dangerous condition, called lactic acidosis. If you have these symptoms – get medical help right away,” she said. There are no specific or predictable ways that blood glucose levels react when taking other oral diabetes medications or GLP-1 medications, Swift added.
  • Food: “If you drink on an empty stomach, you are more likely to experience hypoglycemia,” said Swift. Yet, eating while drinking “may also increase your blood glucose, especially if you eat more than usual or make less healthy food choices when you drink.”
  • Exercise: If you are physically active either before or after drinking alcohol, it can cause your blood sugars to drop and lead to hypoglycemia.

What and how are you drinking?

If you have diabetes and choose to drink, what should you keep in mind?

  • Alcoholic drinks can have as much added sugar as some desserts, so think about what kinds of drinks you are having. “It’s best not to choose alcohol mixed with punches or soft drink mixers, such as Pepsi, Sprite, or Coke, daiquiris, margaritas, or sweetened liquors like Kahlua or Bailey’s Irish Cream,” said Swift. Regular beer and sweet wines are also higher in carbohydrates. “These drinks not only add carbohydrate, but excess calories from the added sugars,” she said.
  • If you have a continuous glucose monitor (CGM), use it. While you are drinking, you can see where your glucose is at all times and if it drops quickly. If you don’t have a CGM, “test your blood sugar more often,” said Arevalo. “Mainly if you are not feeling well, you want to know if your sugar is dropping, or if you are getting drunk. Even though both feel equally bad, you will want to know if your sugars are low so you can correct them quickly.”
  • Never drink on an empty stomach. Instead, “Have a good meal before or during drinking,” said Arevalo. But know the carb count of what you are eating and work with your healthcare professional to determine how to take medication for that meal along with the alcohol you are consuming.
  • Exercise and alcohol can make your numbers plummet. “Avoid drinking while dancing or exercising,” said Arevalo. “Physical activity helps to reduce blood sugar levels, and if the liver is not able to keep up with the production of glucose, the risk of hypoglycemia is even higher.”
  • Have your supplies handy, such as a hypoglycemia preparedness kit. Always bring your blood glucose testing kit and enough supplies for you to test frequently. It’s a good idea to have extra test strips, alcohol swabs, lancets, as well as fast-acting forms of glucose, including emergency glucagon in case your blood sugar level doesn’t come up with food or glucose.
  •  If you take basal insulin in the evening, it’s not an easy answer on what to do if you plan to consume alcohol that evening, said Swift. “Depending on what type of diabetes the person has, and other factors, the results of drinking and taking a long-acting insulin before going out, may contribute to a different result,” she said. If you have type 1 and you take your usual amount of long-acting insulin and then you drink alcohol, “It may contribute to delayed hypoglycemia when drinking too much alcohol,” she said. If you have type 2 diabetes and are overweight or have significant insulin resistance, “Taking your usual amount of long-acting insulin may be a good strategy to avoid high blood glucose numbers,” she said. “No matter what your type of diabetes, frequent blood glucose checking will help you take the right action to avoid high or low blood glucose when choosing to drink alcohol.”
  • If you use an insulin pump or a CGM, make sure you check that they are working properly before you leave the house, without any low-power indicators. If you need to fill your pump with insulin or change out either your infusion set or CGM sensor, do it before you begin drinking or get drunk. As Dr. Jeremy Pettus and Dr. Steve Edelman say in this video, “Protect yourself from drunk you as much as you possibly can.”

It’s important for everyone to avoid getting drunk to the point of not being able to protect yourself. For people with diabetes, this includes protecting yourself from hypoglycemia.

Navigating social situations

If you find yourself in situations where people around you are drinking, or your friends like to party, there are ways to fit in without feeling left out:

  • “It’s okay to choose sparkling water with lemon or a diet soda instead of an alcoholic drink in a social setting,” said Swift. “If you do choose to drink alcohol, have a glass of water, or another no-calorie beverage between alcohol-containing drinks.” It’s also okay to hold a drink and not consume it, if that makes you more comfortable.
  • Tell a trusted friend ahead of time where you keep your supplies, such as your blood glucose monitor or CGM reader, how to get glucose tabs or juice if you need it, and, if necessary, how to give emergency glucagon, either by injection or by nasal inhalation, said Arevalo. It’s also good to have a designated non-drinker in your group, who can watch out for everyone’s safety. And be sure the group you are with knows that the signs of a low blood sugar and the signs of being drunk are the same, said Swift: slurred speech, blurry vision, dizziness, confusion, lack of coordination, irritability, and potentially, loss of consciousness.
  • Make sure you’re hanging out with people you want to be with, and consider where drinking fits in to your health goals and your life. “Friends are only friends if they accept you the way you are and help to take care of you,” said Arevalo. “If you feel peer-pressured to drink, let them know that you have to take care of yourself because of your diabetes. Good friends will respond in a positive way, and will understand and help you. If you want to have a good time and don’t want to keep an eye on how much you are drinking, alert your friends about your diabetes. Let them know where you have your supplies, how to use them, and who to call and what to do in case of an emergency.” Remember, never drive if you (or your driver) have been drinking.

Finally, if you’re going to drink, be smart about it. Always start with a blood glucose level that’s at a healthy, in-range level, sip—don’t chug—your alcohol, and avoid drinking to excess. Your body, your brain, and your diabetes will all be easier to manage once you’re done drinking, either for the evening, the event, or for good.

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

So You Got a CGM – Now What?

This content originally appeared on diaTribe. Republished with permission.

By Katie Mahoney, Hanna Gutow, and Diana Isaacs

If you just got a continuous glucose monitoring system, you may be wondering how to use it most effectively and how to understand your glucose data. Read our tips, tricks, and things to consider.

Congratulations – you got a continuous glucose monitor (CGM), an excellent tool to support diabetes management. Hopefully you’re feeling optimistic and excited that you have the opportunity to use this technology.

It’s most likely that you and your healthcare team decided that using a CGM is the optimal way for you to manage your diabetes. Perhaps you were given a prescription for a personal CGM. Or maybe you’re trying CGM as part of Dexcom’s Hello Dexcom program (a free ten-day trial), through Abbott’s MyFreestyle program (a free 14-day trial), or as part of Medtronic’s CGM Discount Access program. You might also be trying professional CGM, which is owned by your healthcare clinic and worn on a short-term basis.

If you haven’t yet been able to get CGM, ask your healthcare team if you can get a trial device or get a prescription. CGM is recommended for anyone with diabetes who takes mealtime insulin. While many people with diabetes currently don’t have access to CGM, we’re hopeful that more and more individuals will be able to use this technology in the future. Regardless of what brings you to using a CGM, we’ve created a three-part guide to help you get started, including tips, tricks, and considerations.

Click to jump down to a section:

Part 1: Before you apply your CGM

Learn the basics.

Before you start using your CGM, it can be helpful to understand its basic features. Continuous glucose monitors (CGM) measure the body’s glucose (or sugar) levels by sensing the glucose present in tissue fluid (also called interstitial fluid). While a blood glucose meter (BGM) provides a measurement of the blood glucose level at a specific moment in time (when you prick your finger), CGMs provide a new glucose level every one to five minutes – depending on the device, that’s 288 to 1,440 times per day. A CGM provides a constant stream of information on glucose levels, trends, and patterns.

A CGM can either be transcutaneous (it goes through your skin) or implanted (it lies under your skin). CGMs require three basic parts:

  1. A sensor that monitors real-time glucose levels under your skin.
  2. A transmitter that sits on top of the sensor and sends glucose information to a smartphone app, reader, or receiver. In transcutaneous systems, the sensor and transmitter are connected as one small on-body device. Some transmitters are disposable with the sensor while others require an additional step to attach. In implanted systems, the transmitter is attached to the skin and can be removed without harming the sensor below the skin.
  3. A smartphone app, reader, or receiver to collect and display your data.

CGMs have a variety of features that differ by brand and model, including the amount of time the CGM needs to “warm up” before glucose readings are available, how long you can wear a CGM sensor before needing to replace it, and alarms that alert you to highs and lows. You can learn more about CGM devices here. For brand-specific resources and information, click here to jump down.

Personal CGM vs. Professional CGM

The CGMs that we just described are called personal CGMs – they are owned by the person with diabetes and used for a long period of time. They are available as real-time CGMs, where the data can be continuously viewed, or as intermittently-scanned CGMs, where information is recorded all of the time, but you need to scan the sensor to view the data.

Another type of CGM is called “professional CGM.” Professional CGMs are given to someone with diabetes for a short session (usually one to two weeks) to better understand that person’s glucose levels. After the wear period, the person will review the data with their healthcare professional. This can provide insights that inform the person’s diabetes treatment, and it can help healthcare professionals recommend therapy and lifestyle recommendations that lead to better glucose management.

Some professional CGMs have a real-time mode, meaning that the user can see their glucose levels while wearing the device. Other professional CGMs have a “blinded” mode. Blinded CGM means that you cannot look at their glucose values on-demand; instead, all of your glucose data is stored and shared with your healthcare professional. This can help your healthcare team identify hypoglycemia (or low blood sugar levels). If you get a blinded professional CGM, your healthcare team will analyze the data and discuss it with you once your wear period is complete.

While long-term, real-time CGM is most effective for day-to-day diabetes management, especially for insulin users, professional CGM can be an important tool for people who are not using personal CGM. Periodic use of CGM can help people learn the effects of food and physical activity on glucose levels, even for those not taking any diabetes medications.

Reflect on your goals, know your targets, and make a plan to respond to highs and lows.

It can be helpful to reflect on your CGM goals, set your glucose targets, make plans for responding to your glucose readings, and decide with whom you want to share your data:

  • Reflect on your CGM goals. Perhaps you want to use CGM to prevent hypoglycemia using its alert system, or to prevent hyperglycemia and increase your Time in Range, or to manage glucose during exercise. Or, maybe you and your healthcare team are going to use professional CGM for two weeks to explore how your lifestyle habits affects your glucose levels. Regardless, the ultimate goal of CGM is to improve your diabetes management.
  • Know your personal glucose targets and make a plan with your healthcare team for how you’ll respond to hyperglycemia and hypoglycemia. Knowing your target glucose range is important for responding to your real-time glucose values. For most people with diabetes the target range is 70-180mg/dl – learn more about Time in Range goals here. Make a plan that incorporates glucose trend arrows from your CGM to help you prevent big spikes out of range. Here are some prompts for you to discuss with your healthcare team:
    • What is my glucose target when I wake up and before meals?
    • What should my glucose level be two hours after a meal? If it is above that value, what actions should I take to bring my glucose levels down?
    • What is my glucose target before bed?
    • What high glucose level should I try to avoid? What should I do if my glucose gets that high?
    • What low glucose level should I try to avoid? What should I do if my glucose gets that low? What should I do if my glucose levels are trending down?

Part 2: Applying your CGM

Connect the CGM to the app and set the system up.

Download the mobile app associated with your CGM system if available. If you’re using a receiver (Dexcom device) or reader (Libre device), make sure it’s charged daily. The CGM should come with instructions for applying the sensor (every seven, ten, or 14 days) and pairing the app, reader, or receiver with your sensor and transmitter. If you have an implanted CGM, it will be applied by a healthcare professional and can last up to 90 days. To jump to brand-specific instructions and tutorials, click here. To learn about CGM adhesives and tips for keeping your CGM on, check out Adam Brown’s suggestions on the topic.

Once your system is set up, your CGM will need to “warm up” before you can see your data. Different models have different warm-up periods, but this will generally take one to two hours, after which your data will be accessible either directly (Dexcom, Guardian, Eversense) or by scanning your sensor (FreeStyle Libre). The warm up period for the implantable Eversense system is 24 hours.

For many people starting to use a CGM, video tutorials can be quite helpful. If you have the opportunity, it’s good to meet with a diabetes care and education specialist or your local pharmacist (if picking up your CGM from a pharmacy). Here are set-up and application tips and tutorials for your CGM:

Part 3: Understanding your CGM data

Once you’re set up with your CGM and the warm up period is complete, you can access your data. There are two types of data you’ll want to pay attention to: real-time data and past data.

Interpret your real-time data.

Depending on the CGM brand you’re using, you can either access your glucose data at any time by looking at an app on your phone, your smart watch, or your receiver. For those using an intermittently-scanned CGM, you can view your glucose levels by scanning your sensor with your smart phone or reader. Looking at your data can feel overwhelming at first, so we recommend focusing on two aspects of your real-time data:

  • First, look at your CGM glucose value. Is it in your target range? If your glucose level is out of range, which steps of your plan should you follow?

If you’re experiencing hypoglycemia in particular, make sure you act right away to increase your glucose levels.

  • Second, look at the trend arrow. Your CGM provides a “trend arrow,” to tell you the direction and speed with which your glucose values are changing. The trend arrow is helpful for understanding what’s going on and how you can respond. For example, if your glucose value is 90 mg/dl and your trend arrow shows that your glucose levels are going down, you may need to take action to prevent hypoglycemia; if your glucose value is 90 mg/dl and your trend arrow shows your glucose levels are increasing, you are likely not going to develop hypoglycemia.

Trend arrows can help with premeal insulin dosing, before and after exercise, before bed, and to understand where your glucose will be trending in the next 30 minutes. Trend arrows are particularly beneficial when used with insulin on board (short-acting insulin that was recently taken for food or to correct a high glucose level and is still working in the body). For example, if your trend arrows are going down and you have insulin on board from an insulin dose given two hours previously, your risk of hypoglycemia is even greater.

For those not using insulin, trend arrows can help understand how different foods and activities affect glucose levels. For example, if a person sees that the arrow is rising rapidly after a certain meal or snack, they can go for a walk to try to bring it down. It may also signal that next time you should consider a smaller portion size or try to add protein or fat to prevent glucose levels from rising as quickly.

Each CGM has a slightly different interpretation of the arrows, but here’s a general idea of what the trend arrows can tell you.

data

Image source: diaTribe

We recommend working with your healthcare team to decide how often to check your glucose levels. Many people benefit from checking glucose when waking up, before meals, before physical activity, and at bedtime. Some people benefit from checking one to two hours after meals. A person should also check their CGM any time they feel symptoms of high or low glucose. CGM alarms are especially helpful for monitoring glucose levels as they change – more on this below.

Interpret your past data.

Once you’ve used your CGM for a few days, you can see your recent daily trends and the amount of time you’re spending in the target range (70-180 mg/dl). This is also called retrospective data. It is beneficial to review your glucose data regularly to understand how your lifestyle – like the food you eat, your exercise habits, your stress levels, and medications you use – affects your glucose levels. Look at your glucose levels over the past two weeks, one month, and three months; talk with your healthcare team about trends that you are noticing and how they might be addressed. Learn about the many factors that affect glucose here.

During diabetes care appointments, your healthcare team can view this data in an Ambulatory Glucose Profile (AGP) report and use it to talk with you about how your diabetes management is going and any potential adjustments to your care plan. This should be a collaborative discussion between you and your healthcare team about how your diabetes data compares to your management goals and what changes could be made.

Each CGM system offers a standardized one-page report, called an ambulatory glucose profile (AGP). The AGP includes three important components:

  1. CGM key metrics
  2. 24-hour profile
  3. Daily glucose patterns

Although there are many ways to view your glucose data, the AGP report often has all of the information that you need. We’ll explain the three main pieces below. To learn more, read our in-depth piece on understanding your AGP report: “Making the Most of CGM: Uncover the Magic of Your Ambulatory Glucose Profile.”

CGM key metrics

More green, less red.

The time in range bar shows the percentage of time you spend in five glycemic ranges:

  • data

    Image source: diaTribe

    Time in Range: glucose levels between 70-180 mg/dl

  • Time Below Range: glucose levels below 70 mg/dl
  • Time in severe hypoglycemia: glucose levels below 54 mg/dl
  • Time Above Range: glucose levels above 180 mg/dl
  • Time in severe hyperglycemia: glucose levels above 250 mg/dl

Your goal is to grow the green bar and shrink the red bars – in other words, increase Time in Range and decrease time Below Range and time in severe hypoglycemia. See more on Time in Range goals and standard targets.

24-hour profile, also known as Ambulatory Glucose Profile (AGP).

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How do you figure out how to change your diabetes management to increase your Time in Range and decrease your Time Below and Above Range? That’s where the 24-hour profile is helpful, which shows your daily glucose trends across the full 24-hour day.

  • Understanding what the 24-hour profile shows: The black line represents your median glucose level throughout the day based on data from a set period of your CGM use (e.g., the last two weeks). The blue shaded areas help show how much your glucose levels vary at different points in the day.
  • Using the data: Compare different times of day to see what might be influencing your glucose numbers. For example, while the person shown above has glucose readings that vary greatly at 3pm (indicated by a very wide shaded area), their 8am glucose numbers are much more consistent (the shaded area at 8am is narrower), despite being higher. This person also regularly sees a spike in sensor glucose readings at around 9am. What’s causing that increase? Maybe it’s a higher carbohydrate breakfast choice, forgetting to bolus, not bolusing early enough, or not accounting for all the carbs in breakfast. Reflecting on what is causing a spike or valley can help you make behavior changes to reduce fluctuations and increase your Time in Range.
  • chart

    Image source: diaTribe

    The goal: The overall goal is to keep your glucose levels in your target range without big spikes or valleys, sometimes called “flat, narrow, in range” (FNIR). In the AGP above, the green box represents the user’s target sensor glucose range (70-180 mg/dl). While the user stays in range overnight and in the afternoon, they tend to see spikes in the morning and evening. With the goal of FNIR in mind, you can look at your long-term data and ask, what’s making it possible for me to stay in range? What is making my glucose spike or fall?

  • The good news is the goal for most people is to spend 70% or more Time in Range. However, increasing your Time in Range by even 5% (an extra hour per day in range!) can be helpful. You don’t have to reach perfection to improve clinical outcomes.

Daily glucose profiles.

With your trend data, you also can see your daily 24-hour glucose profiles from the last two weeks. The figures show the target range (70-180 mg/dl) in gray, spikes above 180 mg/dl (hyperglycemia) in yellow, and valleys below 70 mg/dl (hypoglycemia) in red. Viewing the data day by day can help you evaluate how specific factors and behaviors impacted your glucose values on a certain day.

data

Image source: diaTribe

To make the most out of your daily glucose profiles, it can be helpful to log your daily food and exercise to compare with your glucose profile and see which behaviors help you stay in range and which ones tend to make you go out of range.

A helpful tool when reviewing your data with your healthcare team is called DATAA. Which stands for:

  • Data – look at your diabetes data together
  • Assess Safety – Look for and try to solve Time Below Range (hypoglycemia) first
  • Time in Range – Discuss what’s working and how to replicate that by looking for the times of day or the days of the week when Time in Range was the highest
  • Areas to Improve – Note when you spent more Time Above Range (hyperglycemia) and discuss ways to reduce this
  • Action Plan – Develop an action plan together

Other Tips, Tricks, and Considerations

1. Exercise & your CGM

To learn about how to use your CGM before, during, and after exercise, check out our article “Exercise Well with Your CGM – Recommendations, Glucose Trends, and Strategies.”

An important note about exercising with a CGM: There can be a difference between CGM glucose measurements and BGM glucose measurements due to what we call a “lag.” Changes in glucose levels in interstitial fluid are not seen as quickly as they are in the blood. At rest, the interstitial glucose lags about five minutes behind the blood glucose; in situations when glucose changes rapidly, such as during exercise, lag time can increase up to 24 minutes. This means that your CGM readings aren’t always going to be accurate during exercise. This lag can also occur outside of exercise, any time your glucose levels are rising or falling quickly.

2. How to make CGM alarms your friend

Adam Brown has written about how it can be helpful to think about your CGM as a partner in your diabetes management, rather than a nag that points out when you’re not in range. Alarms can be useful tools. By alerting you to current or predicted highs and lows, as well as rate of change, you can increase your Time in Range and see your 24-hour glucose profile become flatter, narrower, and more in range. You can personalize your CGM alarm settings to your preferred thresholds or turn them off completely (though some devices won’t let you turn off an urgent low alarm at 55 mg/dl). It’s helpful to work with your diabetes care team to determine your individualized alarm settings.

3. Sharing data with friends, family, and care-partners

The ability to share your real-time glucose data with your care-partners and loved ones is a huge plus of using CGM – your support network can help you track your glucose levels and keep them in range. At the same time, sharing your data with others makes some people nervous and self-conscious. Decide who you want to share your data with and talk with that person about boundaries and how you want to communicate about your data. For more on how to approach these conversations, check out Kerri Sparling’s “To Share or Not to Share: My Approach to Diabetes Data,” and “How to Coach Your Care-Partner on CGM Data.”

4. How to talk to your healthcare team about your CGM

Now that you’re using a CGM, talking with your healthcare team about your CGM data should become a key part of every visit.

Ahead of the visit: To help visits go smoothly, many healthcare professionals will ask you to upload your CGM data before you come into the office (or before your telehealth appointment) so they can review the data and be prepared to talk with you. Learn about uploading your data here. Note: some CGM systems upload automatically once connected to the clinic’s data portal. It’s also helpful to look over your data – like your AGP report – and come up with questions to ask your healthcare professional ahead of the visit. You may have questions about parts of your daily glucose profile that you don’t understand, areas where you’re having a hard time staying in range, or just general questions to help you navigate your data.

During the visit: To make sure that you and your healthcare professional are on the same page, it can be helpful to take a few minutes at the beginning of your appointment to explain your interpretation of your data in your own words. This may be a good time to start a conversation on any questions you may have prepared ahead of your visit. It is also important to take time with your care team to develop an action plan based on your CGM data with a few straightforward priorities for you to focus on before your next visit.

Brand-Specific Resources

While any CGM can help improve your diabetes management, there are some differences between the currently available systems that you may want to consider or talk about with your healthcare team – see our chart comparing different CGMs here. Specifically, we recommend asking your healthcare professional about how alarms may be able to alert you to times of hyperglycemia or hypoglycemia, what it means if you have to calibrate your CGM, and how to use your CGM with smart insulin pens, mobile apps, or even insulin pumps in an automated insulin delivery (AID) system.

To reach out to CGM companies for product support, contact their customer service departments:

  • Abbott: +1-855-632-8658
  • Dexcom: +1-888-738-3646
  • Medtronic: +1-800-646-4633
  • Senseonics: +1-844-736-7348

This article is part of a series on Time in Range.

The diaTribe Foundation, in concert with the Time in Range Coalition, is committed to helping people with diabetes and their caregivers understand Time in Range to maximize patients’ health. Learn more about the Time in Range Coalition here.

Source: diabetesdaily.com

How to Advocate for Yourself: Making Employer-Sponsored Health Plans Work for Your Diabetes Care

This content originally appeared on diaTribe. Republished with permission.

By Julia Kenney

The therapies, devices, and care that people with diabetes need can be expensive without adequate insurance coverage. For those with employer-sponsored health insurance, there are steps you can take to improve your insurance options and advocate for yourself.

Over 45 percent of Americans have diabetes or prediabetes and roughly half of US adults receive health insurance through their employer. Unfortunately, not all employer-sponsored health plans meet the needs of people with diabetes. According to a study of 65,000 people with type 1 diabetes on employer-sponsored health insurance, the average annual out-of-pocket cost of diabetes care was $2,500. Eight percent of study participants had annual costs well over $5,000. Since diabetes is most prevalent in low- and middle-income households, these costs, in addition to paying for premiums and non-diabetes healthcare, are unaffordable for many people.

If your health insurance does not cover a component of your diabetes healthcare, or if your diabetes care is covered but still unaffordable, you can work with your employer to get better coverage. Here is an overview of the different types of health insurance, who to go to for help, and how to advocate for better diabetes health coverage.

What are the different types of health insurance?

You will have expenses no matter what health insurance you have, but some plans can be more affordable for diabetes care. These are the expenses you will typically encounter with your health insurance plan:

  • Premium – Similar to paying rent, a premium is a fixed amount that you pay every month to keep your health insurance active. It’s common for employers to pay about half of your monthly premium, and sometimes more. In 2019, people with employer-sponsored insurance paid an annual average of $1,242 for health insurance premiums.
  • Deductible – The deductible is the amount you pay out-of-pocket before your insurance provider covers expenses. For example, if you have a $1,000 deductible, your insurance coverage will not kick in until you’ve paid $1,000 in healthcare expenses for that year.
  • Copays – Copays are a fixed amount that you pay for a health service or medication, and your insurance provider covers the rest of the cost. Copays are a helpful way to pay for diabetes care because they are fixed, predictable costs that people can plan for.
  • Coinsurance – Unlike fixed-price copays, coinsurance costs are a percentage of the total price of a health service or medication. These expenses are less predictable because medication prices can fluctuate.

There are three main types of health insurance – health maintenance organizations (HMO), preferred provider organizations (PPO), and high deductible health plans (HDHP). Here is an overview of the different types of health plans and what they might cost:

  • HMO – Health maintenance organizations have high premiums and low deductibles. An HMO plan covers healthcare within a network of hospitals and healthcare professionals. Your providers must be in-network in order to get your diabetes care covered. If your diabetes care professionals are in-network, this is often the most cost-effective healthcare option for people with diabetes.
  • PPO – Preferred provider organizations also have high premiums and low deductibles than HDHPs. PPOs are more flexible than HMOs because you are able to see providers out-of-network and you can see specialists without a referral. Because of this, PPOs typically have higher premiums and out-of-pocket costs than HMO plans.
  • HDHP – High deductible health plans typically have low monthly premiums and high deductibles. In 2020, the IRS defined a HDHP as any plan with a deductible of at least $1,400 for an individual and $2,800 for a family. If you have a high deductible health plan, you can open a health savings account where you set aside money to pay for medical expenses tax-free. These health plans are good for people who don’t anticipate needing regular healthcare; paying for diabetes care can be difficult with this type of plan because you will have high out-of-pocket costs upfront before you meet your deductible.
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Keeping these different types of health insurance and related expenses in mind, here are some things people with diabetes should think about when reviewing an employer-sponsored health plan:

  • What are my diabetes-related costs? Make a list of your diabetes healthcare costs including medications, devices, supplies, healthcare visits, and lab tests.
  • What are the health insurance costs? Look at the premium, deductible, and whatever cost sharing method (copay or coinsurance) is used for the health plan.
  • Are my medications and devices covered? Refer to your health plan’s Summary of Benefits and Coverage to see what is included in your insurance coverage. If a therapy or device is not covered, you may have to switch to one that is or submit a request to get it covered. Getting a new medication or device covered under your health plan can be a challenging and time-consuming process.
  • Is insulin covered pre-deductible? Some health plans cover insulin before you reach your deductible because it is considered preventive medicine. This can make insulin considerably more affordable, especially for people on high deductible health plans.
  • Are my healthcare professionals in-network? Accessing in-network healthcare is more affordable than out-of-network care. You should choose a health plan where your current providers are in-network or one that has good in-network options.
  • Can I access a flexible spending account (FSA) or health savings account (HSA) to save money? FSAs and HSAs are used to put aside money that is not taxed to help pay for medical expenses. HSAs are paired with high deductible health plans. FSAs can be used for any kind of health insurance and all FSA funds must be used in the same calendar year. Learn more about FSAs and HSAs here.

If I have a problem with my insurance, who do I go to for help?

Your employer’s human resources (HR) department should be able to address many of your insurance-related questions, since it likely helped select the health plan(s) available to you. Your HR department is your first resource for health insurance questions. If you need help selecting an insurance plan, want to see if your diabetes care is covered, need to file a claim, or are having trouble navigating your plan and understanding the costs, the HR department will support you.

For further questions, your HR department can refer you to a representative with the health insurance company or to a third-party administrator. A third-party administrator will help you understand your health plan, file health insurance claims, and navigate the appeals process if your insurance company denies coverage for a diabetes treatment. You can also apply for an exception to get treatments, medications, and devices covered if recommended by your doctor. A third-party administrator will guide you through these steps for getting important diabetes treatments covered.

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How can I make my employer-sponsored health coverage better for people with diabetes?

People with diabetes typically require expensive medications, devices, and regular visits with healthcare professionals to stay healthy. Robust employer-sponsored health insurance plans should make these expenses affordable and predictable. If you are trying to make permanent changes to your employer-sponsored health plan, your HR department can help you advocate for future health plans that better support diabetes needs. Employers have the power to make changes to their health coverage options every year. Here are some changes you can advocate for:

  • Add insulin and other diabetes care to the preventive medicine list.

In 2019, the IRS ruled that expenses for chronic disease management can be covered before you meet your deductible under a high deductible health plan. HMOs and PPOs also have preventive medicine lists. Diabetes care such as insulin, A1C testing, blood glucose meters, and eye screening – which are all considered preventive medicine – can be added to the preventive medicine list to reduce the copay or coinsurance costs for diabetes care. This saves employees money instead of paying full price before meeting their deductible.

  • Request to get a medication or device covered under your health plan.

If a device or medication you currently use (or want to try) is not covered under your health plan, you can ask for coverage in next year’s health plan. Diabetes devices, such as continuous glucose monitors (CGM) and insulin pumps, can help people with diabetes manage their glucose levels and increase their Time in Range, but are expensive without insurance coverage. Employers can typically negotiate to cover essential diabetes care, so request coverage for your medications and devices. Your diabetes treatment should be determined by your healthcare professional, not by what’s included in your health plan.

  • Share discounts and rebates with employees.

While list prices for diabetes medications may be high, your employer’s pharmacy benefit manager (PBM) can negotiate discounts and rebates on drug prices on behalf of the insurance plan and employer. The list price minus the negotiated discounts is called the net price. Sometimes PBMs and employers will keep the money saved; however, employers can pass discounts on to their employees to lower their out-of-pocket costs.

  • Use copayments for cost sharing instead of unpredictable coinsurance.

Coinsurance costs are unpredictable because they fluctuate as a drug’s net price changes. You can advocate for your employer to choose health plans that use copayments for healthcare cost sharing, instead of coinsurance.

More resources for accessing diabetes healthcare with your employer-sponsored health plan:

Feel free to share this article with your employer or your HR department. All people with diabetes deserve access to affordable, high-quality care. To learn more about health insurance and affording diabetes treatment, visit diaTribe.org/access.

Diabetes Series

Image source: iStock Photo

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

Source: diabetesdaily.com

High Blood Sugar at Night: What to Do

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler

Why do your blood sugar levels increase at night, and what you can do to prevent this? Learn strategies for managing high blood sugar levels overnight and in the morning, including healthy bedtime snacks.

For National Sleep Awareness week, we are focusing on how to regulate overnight blood glucose (sugar) levels. With the many factors that can affect your glucose levels, nighttime can be a challenge. Some people with diabetes experience high overnight levels while others fear or experience a glucose drop during sleep. Trying to keep glucose levels stable overnight will help you get more sleep and feel better – and a good night’s sleep will aid your diabetes management the next day. While this article focuses on overnight highs, you can learn more about preparing for and preventing hypoglycemia (low blood sugar) here.

Here are some tips and strategies for how people living with diabetes can get better sleep at night and avoid high blood sugar levels.

Click to jump down:
Symptoms of High Blood Sugar at Night
Is It Safe to Sleep with High Blood Sugar?
Why Does Blood Sugar Go Up at Night? 
What is the Dawn Phenomenon?
How to Stabilize Your Blood Sugar Overnight
Great Bedtime Snacks for People Living with Diabetes
What Should Your Blood Sugar be When You Wake Up?
How to Lower Morning Blood Sugar

Symptoms of High Blood Sugar at Night

If your blood sugar is high at night you may experience symptoms of hyperglycemia. Hyperglycemia, or “high glucose,” is not defined by one specific glucose level. While many people with diabetes aim to keep blood sugar levels below 180 mg/dl during the day, some people aim for the lower range of 120 or 140 mg/dl at night, when they are not eating.

At night, symptoms of hyperglycemia include:

  • Poor sleep
  • Waking up often to urinate or to drink water
  • Headache
  • Dry mouth
  • Nausea

Other symptoms of hyperglycemia that you may experience during the day or night include:

  • Frequent and excessive urination
  • Extreme thirst
  • Blurry vision
  • Confusion
  • Weakness
  • Shortness of breath

Is It Safe to Sleep with High Blood Sugar?

Glucose levels that are occasionally a little high at night generally don’t pose serious, immediate health concerns. Most people with diabetes cannot avoid some high glucose levels. However, frequent or long-term highs – particularly extremely high levels (above 250 mg/dl) – can be dangerous. It is important for people with diabetes to reduce high blood sugar as much as possible for two key reasons:

  1. Frequent hyperglycemia can lead to major health complications caused by damage to blood vessels and nerves, which can affect your eyes, heart, kidneys, and other organs. This occurs when glucose levels are too high over a long period of time.
  2. Very high glucose levels can be a sign of diabetic ketoacidosis (DKA, or high levels of ketones in your blood indicating that there is not enough insulin in your body). This occurs mainly in people with type 1 diabetes and can be life-threatening. For more information on DKA, read “Ketosis vs. Ketoacidosis: What’s the Difference.”

Why Does Blood Sugar Go Up at Night?

There are many factors that can cause your blood sugar to increase at night. For example: what food you ate during the day, how much and when you exercised, whether you ate snacks before bed, the timing of your insulin doses, and your stress level. You can experience different patterns of high blood sugar at night. You may start with high glucose when you go to bed, start the night in range but go high several hours later, or spend most of the night in range until the hours just before you wake up. By identifying your body’s patterns, you can figure out what is causing your high blood sugar and how to address it.

Common causes of a glucose increase at night include:

  • Eating too close to bedtime: whether you’re snacking or eating a late dinner, a post-meal glucose spike can lead to high glucose levels overnight. In particular, high-fat, high-carb meals (like pizza or pasta with creamy sauces) might delay glucose absorption causing an extended period of high blood sugar levels.
  • If you have type 2 diabetes, a treatment plan that doesn’t adequately address your nighttime insulin resistance or missed doses of your glucose lowering medication can cause high glucose levels at night (and often also during the day).
  • Over-correcting a low glucose level before bed. If you need to bring your glucose level back into range before you sleep, take just enough glucose to stabilize your blood sugar. Quantity-limited treatments (like glucose tablets or small candies) that will raise your glucose levels by a specific amount can be very helpful – learn more here.
  • If you take insulin, your insulin levels may be inadequate during the night. Depending on your dose and timing of basal insulin, the insulin may not last in your body until the morning. Learn about different types of insulininsulin pumps, and automated insulin delivery (AID) systems, all of which can be helpful for staying in your target glucose range overnight.
  • Taking less insulin before bedtime due to fear of low blood sugar overnight.

What is the Dawn Phenomenon?

Another reason for high nighttime blood sugar levels is the “dawn phenomenon.” The dawn phenomenon occurs early in the morning when the body naturally signals your liver to produce glucose, giving your body the energy it needs to wake up.

The hormonal changes associated with the dawn phenomenon happen to people with or without diabetes, though those without diabetes do not experience hyperglycemia. If you take insulin, you may need to try a new basal insulin or adjust the timing and amount of your basal dose (with injected insulin) or your nighttime basal rates (with an insulin pump) to cover an early morning rise.

How to Stabilize Your Blood Sugar Overnight

The most important thing you can do to stabilize your blood sugar is monitor your glucose levels at bedtime, during the night, and when you wake up to look for patterns. This will help you determine what’s going on in your body and how you can fix it. While there are many strategies people use to stabilize blood sugar at night, every person is different – you’ll have to look for trends in your body, experiment with ways to lower glucose levels over a period of time, and learn what works best for your body.

  • Check your blood sugar (or CGM) before bed. If it’s already high, your blood sugar levels may remain high throughout the night. To address this, you’ll want to start by adjusting when you eat your evening meal and what it consists of, and how much mealtime insulin you take to cover it.
    • Avoid eating lots of food close to bedtime. For diaTribe writer Adam Brown, the key to staying in range overnight is low-carb, early dinners, with no snacking after dinner.
    • Consider eating less food at night and taking more basal insulin to cover your evening meal.
  • Check your blood sugar (or CGM) during the night, between midnight and 3am. If you were in range before bed but have high glucose levels between midnight and 3am, you may need to adjust your basal insulin dosage and timing. If you are low during that time, you may experience a rebound high blood sugar later on – this is usually associated with overcorrecting the low.
    • Talk with your healthcare team about the optimal nighttime insulin regimen for you. You may need to adjust your insulin to avoid both early low blood sugar and later high blood sugar.
    • If you take basal insulin, see if you’re able to get an insulin pump or an automated insulin delivery (AID) system. AID systems will automatically adjust your basal insulin doses throughout the night to help keep your glucose levels stable.
    • For some people, a small snack before bed (with a small dose of insulin, if appropriate) can help stabilize glucose levels throughout the night and avoid an early morning high. Keep reading for a list of healthy bedtime snacks.
  • Check your blood sugar (or CGM) when you wake up. If you were in range before bed and between midnight and 3am, but have high blood sugar in the morning, you may be experiencing the dawn phenomenon or running out of insulin (or other medication).
    • If you take insulin, you may need to delay the timing of your basal dose to as close to bedtime as possible. Or, you may increase your basal rates with an insulin pump from around 3am on.
    • If you have type 2 diabetes, talk with your healthcare professional about your glucose-lowering medications to make sure that your treatment plan addresses overnight hyperglycemia.

It’s possible to experience a combination of these events – you may have high blood sugar levels at various points throughout the night. If you have a continuous glucose monitor (CGM, you’ll be able to better track your glucose levels throughout the night. You can use your CGM data to relate your behaviors to patterns in your nighttime glucose levels. Does the timing of physical activity affect your glucose levels overnight? What about food choices throughout the day, in terms of type, quantity, or timing of food? If you don’t have a CGM, the more frequently you can take a blood sugar readings the better. Learn how to get the most of your fingerstick blood sugar data here. It’s important to share your nighttime glucose observations with your healthcare team so that you can find the best ways to stabilize your blood sugar over the entire night.

For more advice on stabilizing nighttime glucose levels, read Adam Brown’s “The Overnight Blood Sugar Conundrum.”

Great Bedtime Snacks for People Living with Diabetes

For some people, a healthy bedtime snack helps to prevent glucose swings during the night. By eating a small snack that is full of protein and healthy fats (and low in carbohydrates), your body may be better able to avoid an overnight high – but if you take insulin, be sure to cover the carbohydrates in your snack even if it only requires a small dose of insulin.

Here are some snack ideas:

  • Plain nuts or seeds – try eating a small handful
  • Raw vegetables, such as carrots, celery, cucumbers, or tomatoes, with a small amount of hummus or peanut butter
  • Plain yogurt, and you can add berries or cinnamon (read about choosing a healthy yogurt here)
  • Chia seed pudding

Remember, a bedtime snack is only helpful for some people. To see if it works for you, you’ll have to carefully monitor your glucose before bed, during the night, and when you wake up.

What Should Your Blood Sugar Be When You Wake Up?

The goal of diabetes management is to keep your blood sugar levels as stable as possible. This means that when you wake up, you want your glucose to be in range and to stay in range throughout the day.

For many people with diabetes, the overall target glucose range is between 70 mg/dL to 180 mg/dL (3.9 to 10.0 mmol/L). To start the day strong, the American Diabetes Association recommends that you aim to wake up with glucose levels between 80 to 130 mg/dL. Talk with your healthcare team about your glucose targets.

How to Lower Morning Blood Sugar

Whether a morning high is caused by the dawn phenomenon or something else, here are a few things you can try to lower your blood sugar levels:

  • Physical activity when you wake up can help bring your glucose level down. Even going for a walk can be helpful.
    • To learn about exercise guidelines and glucose management strategies, click here.
    • Read Adam Brown’s take on walking – the most underrated diabetes exercise strategy.
  • Eating a light breakfast can help keep a morning high from increasing even more. Taking your mealtime insulin will help lower your blood sugar.
    • Adam Brown suggests eating a breakfast that is low in carbs, and notes that sometimes mealtime insulin has to be adjusted in the morning. One of his favorite breakfasts is chia pudding, since it has little impact on glucose levels; see what else he eats for breakfast here.
    • Catherine Newman has six popular, low-carb, delicious recipes in “The Morning Meal.”
  • Intermittent fasting and time-restricted feeding approaches to meal timing can also help people keep morning blood sugar levels in range. Read Justine Szafran’s “Intermittent Fasting: Stabilizing My Morning Blood Sugars” to learn more.
  • For additional ways to navigate mornings, read seven strategies from Adam Brown in “A Home Run Breakfast with Diabetes.”

Source: diabetesdaily.com

What if a Pump Could Deliver Both Insulin and Glucagon?

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

By Lala Jackson

Diabetes technology like insulin pumps and continuous glucose monitors (CGMs) have created less burdensome care routines for people living with diabetes who are able to get them. For some, this tech has also led to lower A1c, more time in range, and fewer hypoglycemic events. As we work to get better access to diabetes technology and medications for all who need them, we’re also looking forward to what’s next in diabetes tech – dual hormone artificial pancreas systems that keep blood sugar levels in a healthy range using both insulin and glucagon delivery.

Existing artificial pancreas (AP) systems, also known as hybrid closed loop systems, integrate insulin-only pumps and CGMs using a programmed algorithm that allows the insulin pump to “make decisions” in insulin dosing based on the blood sugar number provided by the CGM. In the current systems, the insulin pump can dose insulin in response to high blood sugars, but has no way to directly address a predicted low blood sugar other than lowering or stopping insulin delivery, or suggesting external actions (such as eating carbs) be taken. Even with this limitation, current AP systems are shown to significantly improve daily time in range, a key measure for safety and quality of life in those living with diabetes. But what if we could more closely mimic a fully functioning pancreas?

Enter, the Dual Hormone Artificial Pancreas

Also known as the bihormonal artificial pancreas (BHAP), several companies have been working on these systems over the last decade, but the last few years show promise toward a streamlined, effective, easy-to-use BHAP.

In late 2019, the FDA granted breakthrough device designation to the iLet™ pump system, made by Beta Bionics. Breakthrough device designations create an accelerated regulatory review process for a product or therapy that “has potential to address unmet medical needs.” Essentially, it shows priority for a solution that is believed able to create a large impact on people’s lives, beyond anything currently available.

Beta Bionics’ intentions for their iLet systems are ambitious – they aim to provide their system in insulin-only, glucagon-only, or bihormonal with both insulin and glucagon. Additionally, their algorithm is unique, in that the wearer must only enter their body weight, “with no need to count carbohydrates, set insulin delivery rates, or deliver bolus insulin for meals or corrections.

The iLet system was granted breakthrough designation with the use of insulin analogs that are currently approved for usage in an insulin pump, alongside Zealand Pharma’s dasiglucagon, recently approved by the FDA for use in an autoinjector and prefilled syringe. Dasiglucagon, a glucagon analog (i.e. a synthetic lab made version of the naturally occurring hormone), is stable as a liquid, versus old formats of glucagon in which a powder and liquid had to be mixed immediately before use.

Beta Bionics’ insulin-only AP system is currently in Phase 3 clinical trials, with its BHAP system slated to be one to two years behind, having completed a Phase 2 at-home use trial in 2019. Phase 3 trials of the BHAP system are expected in 2021.

Other insulin and glucagon BHAP systems are also in development, with additional companies looking into a dual-hormone format pump using insulin and pramlintide (commercial brand name Symlin), aimed at better mimicking natural absorption rates of food, leading to better time in range.

The Bottom Line

As we get closer to diabetes technology that more closely mimics a fully functioning pancreas, affordable access to both life-improving diabetes technologies and life-sustaining insulin remains key. Robust diabetes technology has the power to greatly improve quality of life, particularly when coupled with affordable, equitable healthcare.

Source: diabetesdaily.com

Real Stories, Real Data, Real Results – Using Your CGM to Improve Time in Range

This content originally appeared on diaTribe. Republished with permission.

By Matthew Garza

In this video on understanding your ambulatory glucose profile (AGP) report, pediatric endocrinologist, Dr. Amy Criego from the International Diabetes Center, uses real-world AGP examples to show how small steps and manageable goals can lead to more Time in Range. 

Continuous glucose monitors (CGM) are an amazing tool; the data they provide can help you learn more about your diabetes and dramatically improve your diabetes management. You can work with your care team to improve your Time in Range (TIR) based on data from your CGM. The International Diabetes Center’s Ambulatory Glucose Profile (AGP) report is a standardized, single-page report included in your CGM software that is based on your last 14 days of glucose data. It shows key measurements – including TIR, a summary glucose profile, and daily glucose graphs – that can be used to assess your diabetes management and outcomes and inform any changes you should make.

In this video, Dr. Criego shares real-world AGP reports from three people with diabetes:

  • Lee is a 20-year-old who has had type 1 diabetes for seven years. He currently uses a blood glucose monitor and insulin injections and his A1C is usually high. He struggles with consistent monitoring of his glucose levels, especially due to an unpredictable schedule.
  • Joe is a 17-year-old who has had type 1 diabetes for 11 years. He has been using a CGM for a long time and is working to increase his independence with his diabetes management.
  • Jill is a 10-year-old who has lived with type 1 diabetes since the age of two. She uses a CGM, and though her parents currently give her insulin injections, the family is interested in exploring insulin pumps to see how they could help her diabetes management.

Dr. Criego discusses how each individual’s care team used data from their AGP report to set attainable goals that could be achieved by making small adjustments to their diabetes management. Even though these examples focus on people with type 1 diabetes, you can definitely still learn from them if you have type 2 diabetes – and be sure to watch Dr. Anders Carlson’s video which includes examples for people with type 2 diabetes.

To learn more about the AGP, check out “Making the Most of CGM: Uncover the Magic of Your Ambulatory Glucose Profile.

Watch our other videos in the “Shedding Light on the AGP Report” series:


Listen to this video at your leisure or fast forward to the section that most intrigues you!

  • 0:00 Introduction
  • 0:33 Analyze Your Report and Improve Your TIR
  • 0:56 The Different Parts of the AGP Report
  • 2:00 What is Going Well and Where are You Now?
  • 2:37 Learning from Lee – How seeing your glucose data can help improve issues caused by inconsistent monitoring by taking small steps towards achievable goals
  • 7:00 Learning from Joe – How understanding your TIR metrics can help teens gain confidence in independent diabetes management
  • 11:33 Learning from Jill – Looking at your AGP report to see how an insulin pump can help with hypoglycemia unawareness and TIR
  • 15:09 When Should You Call Your Care Team?
  • 16:42 Closing Remarks

This article is part of a series on Time in Range.

The diaTribe Foundation, in concert with the Time in Range Coalition, is committed to helping people with diabetes and their caregivers understand Time in Range to maximize patients’ health. Learn more about the Time in Range Coalition here.

Source: diabetesdaily.com

Dexcom Share Etiquette

Life is safer than ever for people with diabetes; continuous glucose monitors, hybrid closed-loop insulin pumps, faster-acting insulin, and more accurate carbohydrate counting and precision medicine have saved thousands of lives and make the day-to-day with diabetes easier than ever.

One element of that technology that has been a godsend for parents and loved ones of people with diabetes is Dexcom Share. This feature of the G6 Dexcom continuous glucose monitoring (CGM) app allows the patient to share their glucose data with up to 10 other people, who receive all glucose levels, trends, and alerts to their cell phones 24 hours a day. But what is lifesaving for some seems too intrusive for others.

This article will outline Dexcom Share etiquette and what you should do if you’re in a sticky Share situation.

The CGM Revolution

Continuous glucose monitors save lives. What was unheard of only a decade ago is now ubiquitous in the diabetes community. Many people (thanks to widespread private insurance coverage and Medicaid expansion covering this expensive equipment in more states than ever) with diabetes wear these sensors on their skin, giving them up to 288 blood glucose readings per day.

More and more of these systems do not require calibrations, so kids and adults alike are more free from constant finger pricking, unpredictable blood sugars, and stubborn HbA1c levels without an apparent cause.

CGMs make life with diabetes easier, more predictable, and more manageable for patients and their caregivers. First introduced with the G4 Dexcom system in 2015, the Dexcom Share app has been revolutionary in that it allows loved ones of people with diabetes follow their blood sugars and be alerted to both high and low levels at all hours of the day.

It seems like a simple solution for kids, teenagers, and adults who may struggle with hypo-unawareness or to just act as a second set of eyes on an all-too-often complicated disease, right? Wrong.

Diabetes Is Personal

Diabetes and blood glucose data are personal. Some people are super open and accessible about their diabetes, but others are not. A 19-year-old away at college may be shy about sharing all of her blood sugar data with a new boyfriend, or she may be trying to exert her independence and prefer not to have her mom constantly texting her, asking if she’s treating her midnight low.

And while it seems counterintuitive (why wouldn’t we have as many safeguards in place as possible?), letting (mature) kids and teens learn to manage their diabetes on their own and step into their autonomy is important for growth.

While the feature is absolutely vital for younger children and people who suffer from hypo-unawareness, if you have a child or teenager who is very independent, mature, managers their diabetes well, and isn’t comfortable with the Share feature, it’s worth the conversation and shows you respect them if you’re open to not utilizing it. Ultimately, the decision is up to the person living with diabetes, and remember, people have been thriving with diabetes for decades before this technology ever even existed.

Safety Comes First

There are, however, caveats. If you’re struggling with open communication with your teenager, your loved one suffers from hypo-unawareness, or your child is traveling for the first time without you, the Share feature is an excellent way to stay alerted to overnight lows, stubborn highs, or worrisome trends that may need addressing.

It’s important to also remember the reason for the Share app: to better equip people with diabetes and their loved ones to protect the health and safety of the person living with diabetes. It’s not to nag, hassle, or judge them for their actions (or inactions).

Share followers should not criticize or belittle someone’s blood sugars; there are no “good” or “bad” blood sugars. Blood sugars are just information directing someone to what they need to do next (like take insulin, exercise, or eat something to treat a low).

The Share app is simply one more tool one can employ to improve their diabetes management and nothing more.

Tips for a Less Intrusive Share Experience

If the person with diabetes in your life is begrudgingly allowing you to follow their blood sugars via Share, here are some tips you can employ to make the experience less intrusive:

  • Always have a discussion with your child or teenager if you’d like to follow their blood sugars with the Share app. Do not hide it from them. They will find out.
  • Set the high blood sugar alarm high and the low blood sugar alarm low. If you set your follow alarms to go off at 160 and 80, your phone will constantly be buzzing, and you’ll constantly be texting your child/teenager asking them if they’ve taken their insulin or treated their low. Really only set alarms for safety, not to be a bother.
  • Use Share for a trial period. Test the system out, and if it’s stressing both of you out, turn it off for a while before trying it again.
  • If you notice your loved one is running particularly high or low, do not comment on trends unless they ask for advice or if they have an Endocrinologist appointment coming up, adjustments can be made then unless it’s threatening their health.
  • Do not text them to see if they’ve treated their high or low blood sugar unless it is jarringly so. If they are 78 mg/dL after exercise, you don’t need to tell them to drink juice, but if they crash in the middle of the night at a slumber party and their blood sugar is 39 mg/dL, it’s best to call immediately to make sure they’re okay.
  • Make this a fun, learning experience! Praise them for the progress they’re making, and remember, with diabetes there is no perfection.
  • Respect their boundaries, and if their thoughts and feelings on Share change overtime, revisit the topic and decide how you’d like to proceed together.

Everyone with diabetes is different, and their care and management will be too. Some people are more private about their blood sugars, while others enthusiastically request input from other people on advice and tips for improving their levels.

Allowing the Dexcom Share app into your life is a great privilege, but it shouldn’t be taken advantage of. Using it as a tool to help improve your loved one’s health and diabetes management can come with great benefits if approached with caution and a heavy dose of respect.

Do you utilize Dexcom Share for your loved ones, or do you share your blood sugars with family and friends? What boundaries have worked best for your situation? Share this post and comment below; we love hearing from our readers!

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.

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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

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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.

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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

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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

Dating with Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

Dating can feel daunting when you live with diabetes. Hear about dating from others with diabetes, and learn what you can do to prepare for dates.

My now-husband David and I met at a friend’s birthday party where there was bowling and a lot of birthday cake.

Knowing I had diabetes, he was surprised by how much cake I ate at the party. I love cake, so I had calculated the carbs and increased my insulin pump dosing accordingly. That night, Dave couldn’t understand how a person with diabetes could be okay eating a lot of cake.

Couple

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He has since learned.

The next day we talked more about what diabetes is, how food and insulin dosing intertwine, and how ongoing diabetes management requires both a daily and a long-term focus. Later on, when things got more serious, Dave asked for, and I found him, a book that covered more detail: Eve Gehling’s The Family & Friends’ Guide to Diabetes. While the book is now outdated and doesn’t cover some current medications and technologies, the focus on support is universal.

Dating with diabetes, like any dating, relies on honest communication. Supportive actions – such as keeping glucagon or sources of sugar readily available, or sympathizing with you, rather than dismissing you, when you vent about a frustrating aspect of living with diabetes – can go a long way. Whether a person with diabetes is just beginning to date, has been at it for a while, or is returning to dating after a hiatus – no matter if they are looking for a serious relationship or not – a thoughtful approach can reduce the challenges of dating with diabetes.

To Tell or Not to Tell

It’s up to you to decide when to tell someone that you have diabetes. You might feel you want to keep it quiet on a first or second date, especially if you don’t know if you’ll see that person again. Or, you may decide to be more open about diabetes from the start – especially before something like an insulin dose or treating low or high glucose levels needs to happen during the date.

It’s important to be comfortable with your diabetes yourself first, because it can be hard to open up and share it with someone else,” said Lexi Rosendahl, 21, who attends nursing school in Green Bay, Wisconsin. Rosendahl, who was diagnosed with type 1 diabetes at age 11, started dating Jordan Paulsen, 24, in October 2020, after meeting him on a dating app. She said she was nervous about disclosing her diabetes.

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“I was super up front about it, though some people said, ‘Don’t say anything right away,’ but I thought, ‘This is a part of me,’” she said. “If you are talking to someone, and they aren’t accepting or they make you feel bad, drop them. Don’t settle. Someone out there will love you for who you are.” This advice applies to anyone, with or without diabetes.

Rosendahl said Paulsen asked many questions on their first date, when they got ice cream.

“He said, ‘I want to know about this as much as possible,’” she said. “As a nursing student, I do a lot of educating, and I made a little chart he keeps on his fridge about what I look like if I am low. He is also good about throwing a bag of fruit snacks in his pocket in case I go low. I am pretty self-sufficient, but it’s nice to have someone who gets it. It’s really cool; I like to be independent but he is supportive but not smothering me.”

At the same time, many advise not overwhelming a new relationship with too many diabetes details. It’s a balance that can be tricky to strike.

“You don’t have to give a full dissertation on diabetes during your first date,” notes Stephanie Watson in an article for Healthline.com. Also, she writes, “be open about your condition but don’t dwell on it. Try to keep the conversation light. You don’t want to worry your date by talking about [long-term complications], especially if you’ve just met.”

Anyone who would be frightened away or otherwise dismissive of someone’s diabetes doesn’t deserve a moment of your time. If nothing else, someone who has a problem with your diabetes, cites inaccuracies or myths about it and isn’t open to learning why those myths are wrong, is sending indications that spending time with them will likely be more of a burden than bliss. Learning this makes it easier to move on to someone who will be so much better for you.

Ultimately, you already deal with the day-to-day aspects of diabetes. You want to be with someone who supports and promotes you during that journey – not someone who will make it harder.

Dating Logistics

Whether you’re having a date over a meal, an activity like hiking, or something low-key like watching a movie, plan ahead so you have what you need to keep your focus on the date, not on your diabetes.

Like anything else with diabetes, preparation is key.

  • If you are eating at a restaurant, look at the menu ahead of time to figure out what would be a good choice and what the carbohydrate count would be for that meal.
  • If you are drinking alcohol, know how alcohol affects your blood glucose numbers before the date. Sweet drinks will cause increases, while less-sweet drinks can cause your blood sugar to drop, especially if you aren’t eating at the same time.
  • If you take insulin, ensure you have a source of fast-acting carbohydrates on you (in a purse or pocket) so you can treat a low blood sugar early on, rather than needing to rush to find something to treat in the middle of your date.
  • If you’re planning an activity for the date, adjust your insulin if necessary to avoid low blood sugar, and eat a snack either ahead of time or carry one on the date to manage your glucose numbers.
  • If you use a glucose meter, take it with you and make sure you have enough strips, working batteries, and anything else you need to make it work correctly. If you use a continuous glucose monitor (CGM), make sure the sensor is functioning properly.
  • If you wear an insulin pump make sure it is working properly before the date; fill the pump ahead of time if it’s almost time for a site change or the insulin is running low.
  • If you use syringes or insulin pens, make sure you have them handy so you can take your medication easily before a meal or in case the date is going well and continues longer than you anticipated.
  • If you wear an insulin pump and it malfunctions, carrying a syringe and a vial of fast-acting insulin in a glucose meter kit can help you have access to your insulin immediately, instead of needing to end the date.

Finding out a partner is flexible when things happen can be reassuring, said Rosendahl. “We were ice skating when my Dexcom CGM failed,” she said. “We had to run back home so I could change the sensor out, and Jordan said, ‘No judgment, whatever you need,’ It was a nice sign of unconditional love.”

Being diagnosed with type 2 diabetes helped Liz Cambron identify some of the things she valued both in life and in a partner. Cambron, 29, who has a PhD in cellular and molecular biology and manages a research lab in State College, Pennsylvania, described herself as “a partier and drinker who ate a lot of fast food” before she was diagnosed with type 2 diabetes seven years ago. After her diagnosis, she changed her eating patterns, drank far less alcohol, and began working out each day. She now runs in half marathons, lifts weights, and is a partner in an on-demand online exercise program.

“It helped me re-evaluate my priorities and what type of life I wanted to live,” she said. “If I was dating a person who ate a lot of junk food or was a heavy partier, if I took the drinking or the partying away, the relationship didn’t last long and there wasn’t a lot there.”

Couple

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She met her fiancé, James Kopco, four years ago when both attended a group counseling program for graduate students at North Dakota State University. “I would vent about frustrations about having to deal with low blood sugar events in the lab,” she said. As they began dating, they would keep each other accountable by eating healthy meals and exercising together. “Voice what your needs are,” she said. She offered other advice:

  • “Many first dates are going out for a meal or a drink, and if you say you can’t, the person will expect an explanation. There is stigma around type 2 diabetes – that people are overweight – and it can be a challenging first impression. But diabetes is not something to be embarrassed by. You are not a stereotype and don’t be embarrassed to have open communication.”
  • “Be open with your healthcare team about your medications and any side effects. A lot of medications can affect your libido and that can affect your relationship. If that is putting stress on your relationship, don’t feel like you’re stuck on that medication.”

Dating Another with Diabetes

Some people go looking to date another person with diabetes and some just find each other. Shanna Walker, 42, is a recruiter at her local fire department in Spotsylvania, Pennsylvania. She dated someone for about a year; they met through an online dating site and lived about 40 minutes from each other.

“As we were talking, I mentioned I was a diabetic, and he was like, ‘Me too!’” Walker has lived with type 1 diabetes since age 16, while her boyfriend was diagnosed with type 1.5 diabetes (also known as LADA) at age 35, six years ago. “It was very convenient, to be honest. We both had a Dexcom continuous glucose monitor, and we gave each other supplies. We know about highs and lows, so it was nice not to have someone freak out when an alarm went off. We would kid and show each other our numbers to see whose were ‘better.’”

There’s at least one Facebook group devoted to single people with type 1 diabetes: T1der. Launched in 2019, the group exists for people to “Meet other single type 1 diabetics, complain about the struggles of dating as a type 1, post memes and more.”

Couple

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The group was started by Nathan Elmen, 24, who met his girlfriend, Heather Chambers, soon after the group began when she commented on his photo in a group post. Besides diabetes, they share career goals: Elmen is a registered nurse and Chambers is enrolled in the nursing program that he graduated from. The couple lives together in West Melbourne, Florida.

Regardless of diabetes, dating should evolve naturally, Elmen says.

“My advice is to not force yourself into a relationship,” he said. “It can be like winning the Lotto sometimes, and you really just need to bump into the right person – that was how Heather and I met.”

Ultimately, diabetes is just one aspect about you, and when looking for a new relationship, it’s important to focus on all your positive traits. “Just be yourself,” said Walker. “Diabetes doesn’t define you.”

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

Upcoming Apple and Android Watches to Include Glucose Monitors

In 2015, when Apple first launched its smartphone “watch”, or “smartwatch” people all over the world flocked to the new device, but it clearly became evident that the most popular feature (besides telling time), was health and fitness tracking. Suddenly, literally within arm’s reach, users had the ability to not only track their steps and mileage but to track floors climbed, standing time, moving time, heartbeats per minute (HBM), electrocardiogram monitoring, and even check for atrial fibrillation (AFib), among other things.

Apple CEO, Tim Cook, had initially suggested that they would be cautious in adding medical tracking to the watch, as approval from the Food and Drug Administration (FDA) could slow innovation.

“We don’t want to put the watch through the FDA process. I wouldn’t mind putting something adjacent to the watch through it, but not the watch because it would hold us back from innovating too much, the cycles are too long. But you can begin to envision other things that might be adjacent to it, maybe an app, maybe something else,” Cook said.

But customer demand for health tracking proved unmatched, and the company decided to change its mind, slowly adding more and more health tracking capabilities with every new version of the watch.

It should come as no surprise that according to a report out of South Korea, the newest Apple Watch, the Series 7 as well as the newest Samsung Galaxy Watch 4 (both of which are slated to launch later this year) will feature continuous glucose monitoring, developed in partnership with MIT, as people with and without diabetes alike are finding a constant watch on their blood sugars to be extremely beneficial to one’s health.

Both watches promise a “no-blood sampling method” to detect blood glucose levels using an optical sensor, and the feature will be advertised to those with and without diabetes. Unlike popular continuous glucose monitoring devices like the Freestyle Libre or Dexcom, these watches will rely on non-invasive detection of blood glucose levels, which can be achieved via infrared sensors.

Since this technology would be truly groundbreaking, it would be all but impossible to launch without FDA approval, which means that both watches would have to face several clinical trials before being available for public consumption. Clinical trials take a lot of time and money and can mean delays in a launch, especially if the glucose-sensing technology is non-invasive (which has not been seen yet, especially for people with diabetes who rely on this technology to successfully manage their diabetes).

There are many doubters, including the CEO of Valencell, an optical heart rate sensor company, who stated in 2017 that non-invasive blood glucose tracking “would never happen”.

“It is completely impossible to have a truly non-invasive glucose monitor,” Valencell CEO Steven LeBoeuf said.

Additionally, unleashing this kind of technology for mass-consumption could have unintended consequences: Will high demand for the product raise or lower the price? Will people with diabetes be priced out of their lifesaving durable medical equipment? Will blood sugar monitoring become the newest “it” thing? Will companies like Abbott and Dexcom go out of business? Will test strips eventually be a thing of the past? Will health insurance companies be mandated to cover smartwatches eventually? Will smartwatches eventually loop with insulin pumps for automatic insulin delivery? Will this be a good thing or a bad thing for the diabetes community? Is it even possible to have reliable blood glucose readings without invasive technology, interstitial fluid, or blood samples?

Can two of the leading technology companies prove all of the doubters wrong? Can people with (and without!) diabetes finally be able to track their blood sugars without invasive tactics, and achieve better control, all through a smartwatch? Can Tim Cook and Samsung CEO Ki-Nam Kim prove everyone wrong? A lot seems to be in store for the latter half of 2021, so we will just have to wait and see!

Do you monitor your blood sugars from a smartwatch? How would having your smartwatch double as a continuous glucose monitor (CGM) help you? Do you see any negatives to such a device? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

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