The Benefits of Working from Home with Diabetes

COVID-19 has officially changed the way the world runs. More than ever, people are staying home (whether by choice or mandate), spending more time with their families, avoiding public events, and yes, working from home. Essential employees, such as frontline healthcare workers, grocery store clerks, sanitation crews and workers rendering city services, are still having to report in person, but COVID-19 has made a third of Americans (over 100 million people) switch to home work.

This can be extremely beneficial if you live with a disability or chronic disease, and can be helpful if you live with diabetes. And while Americans still work more than anyone else in the industrialized world, working from home can help balance the stress of diabetes management. Here are some of the benefits of working from home if you live with diabetes.

No Commute

Let’s face it, commuting is not fun. The average American working full-time (8 hours a day, 5 days a week) commutes an average of 4.35 hours a week and over 200 hours (nearly nine days) per year. That is a lot of wasted time. With rising costs of living and stagnant wages, more people live farther and farther from their jobs, and have longer commutes than ever, which can cut into both one’s sleep and time for exercise. “Commuting” from your bedroom to your home-office leaves more time for quality sleep, morning exercise, and a healthy breakfast, which can set your blood sugars up for an excellent day, which can increase work productivity as well.

Not commuting will also save lots of money that would normally be spent on parking, car maintenance, tolls, and gasoline. Even if you normally take public transit to work, metro and bus tickets add up quickly! Working from home is also much better for the environment; transportation accounts for one-third of all greenhouse gases produced in the United States. Staying at home for cleaner air is an easy and simple way to help the planet.

Healthier Meals

Takeaway Chinese food or pizza at lunchtime can be a blood sugar nightmare. Working from home affords people the ability to cook easy, healthy meals in their kitchens, which is not only a healthier option, but saves money, too. It’s easy to cook lentils or beans in a slow cooker, or wash and chop up fruits and veggies for a quick grab and go snack if you get the afternoon munchies. Additionally, check out these easy, low-carb recipes that you can quickly make from the comfort of your own home!

Fewer Sick Days

People who work from home both take fewer sick days and get sick less often (no sharing germs in a communal setting or on the train en route to work!). Also, going into an office with a mild cold or flu can be miserable, but doing some work from home is almost always accessible. Plus, diabetes can mean dawn phenomenon, a kinked pump site midday, or a bad low that would previously require coming in late or leaving early- none of which would be necessary with a work from home schedule. It’s healthier for everyone!

No Judgement

Ever take a correction dose during a meeting, and get the side-eye from a nosey coworker? Ever have someone compare your diabetes to their distant relative who died of horrible complications from diabetes (when you never asked for the story?). Are people always questioning what you’re eating (or not eating), or how much you exercise (or how much you don’t)? Working from home prevents judgement and prodding questions, and you can go about your day and take the best care of yourself without intervention from others.

A Flexible Schedule

This can depend on your organization or company, but many offering work from home will grant their employees some flexibility in their schedules. If you have an endocrinologist appointment in the morning, shifting your work schedule back an hour or two can prevent the need to take personal leave for the entire day. Likewise, a flexible schedule can allow for a lunchtime run, which can counteract high blood sugars in the afternoon. Need to change your pump site or CGM midday? Working from home can let you do all that while still getting you work done. Flexibility is key to excellent diabetes management, and working from home makes it much easier.

Have you been working from home since the COVID-19 pandemic hit? How has it benefited you and your diabetes management? Is there anything that you particularly like or dislike about working from home? Share your story in the comments below; we love hearing from our readers!

Source: diabetesdaily.com

Control-IQ: The Good, the Challenges, and Tips

This content originally appeared on diaTribe. Republished with permission.

After a month of her daughter using Control-IQ, Katie Bacon reviews the pros and cons of the algorithm and shares her family’s tips and takeaways

When the email came through in early April that our daughter, Bisi, could now download the software to run Control-IQ on her t:slim insulin pump, the timing seemed perfect. After all, our family was staying at home due to COVID-19, so we had plenty of time together to do the training and figure out the new system and how it worked for Bisi and her blood glucose levels. Plus, from everything I’d read about COVID, keeping blood sugars as stable as possible was more important than ever, and it seemed like Control-IQ could help us with that. (The Control-IQ algorithm uses data from Dexcom’s CGM to lower insulin delivery when a low is predicted and to increase insulin when a high is predicted – learn more about Control-IQ here.)

Bisi has now been on the new system for about a month, and while it hasn’t been a magic bullet and we’re still learning, Control-IQ has improved Bisi’s time in range by about 5% (and we’re hopeful that her time in range will continue to improve). Also, even more importantly, it’s improved her quality of life – and ours, as the parents who watch out for her. When I sat down with Bisi recently to ask her about the change, I got her perspective on the burden she feels diabetes has placed on her ­– and the power of Control-IQ to lighten that load. She told me that before using Control-IQ, at any given time 30-40% of her focus was on diabetes. I was taken aback by this percentage, since Mark (my husband) and I have always tried to take some of the weight for her. As she told me, “It feels demanding, like a lot of pressure, as if someone’s poking my head.” But with Control-IQ, she says, she doesn’t need to worry about much except bolusing insulin at mealtime. She has fewer highs, fewer lows, and she says she feels better physically than she did before. “For as long as I can remember, diabetes has been a main focus of my life, but it really shouldn’t be that way. So it’s been nice not to focus on it as much,” she said.

In terms of what Bisi has experienced over the past few weeks since switching to Control-IQ, I’ve divided my thoughts into the pros and cons of the system as we’ve experienced it; I’ve also included tips drawn from what we’ve learned from Bisi’s endocrinologist and DCES.

Pros of Control-IQ:

  • Graph

    Image source: diaTribe

    We’ve found that Control-IQ works particularly well at night, when Bisi isn’t eating anything or bolusing. While our nights had already improved with Basal-IQ (which did a good job minimizing Bisi’s lows), Control-IQ brings down any highs as well (see the graph on the right). I’d say that when Bisi’s pump only dealt with the lows, we still had to wake up maybe six to eight nights a month, on average – and sometimes multiple times in one night. But in the month since Bisi started on Control-IQ, we’ve only had to wake up three times. This is a big change in our quality of sleep (and quality of life).

  • Control-IQ helps keep blood sugars down during the day. As before, Bisi’s blood sugars are less stable during the day, when her activity is variable and when she’s eating meals and snacks. But now, Control-IQ raises her basal rate when she’s headed high and gives modified boluses (60% of what’s called for) if the highs are sustained. We’ve found that her blood sugar does not rise as steeply, according to her CGM, and also that it often tops out at a lower number than it used to.

Cons of Control-IQ:

  • There were a few instances where Bisi had sustained lows that were more difficult than usual to counteract with carbohydrates. These instances have all been when she’s started exercising with a lot of active insulin on board, due to Control-IQ turning up her basal rate in response to a high. Before using Control-IQ, if Bisi’s blood sugar was high, she (maybe with a reminder from me) would have to make a decision to either turn up her basal or give a correction. If she knew that she was going to get exercise in the near future, she wouldn’t do either of those things. But now they happen automatically, so she’s sometimes stuck with too much active insulin on board. It requires a different kind of thinking and a different kind of planning than before.
  • Both Bisi and I wish there were a little more flexibility in Control-IQ so she could set her own target. Bisi used to set her target at 100 day and night, and would often run at 80 or 90 while she was sleeping. With Control-IQ’s built in Sleep Mode target of 110, Bisi runs a little higher than she is used to, especially at night.

Thoughts and Tips for using Control-IQ:

  • We have found that being consistent about pre-meal bolusing is even more important with Control-IQ than it was before. If Bisi waits too long to bolus, her blood sugar goes too high, she gets more basal and an extra 60% bolus from Control-IQ, and then her blood sugar goes too low later on.
  • While it might seem like Control-IQ could enable people to be a little freer in what they eat, so far it has emphasized the benefits of eating low carb as the best way to avoid food-related spikes and insulin-related dips. No matter how good an algorithm is, it’s always going to be reactive rather than proactive, and we’ve found that the smaller the inputs in terms of number of carbs eaten, the more smoothly Control-IQ works. (I think this is partly why it tends to work better for Bisi at night, when she’s not eating anything, than during the day.)
  • Bisi’s endocrinologist validated our sense that exercise-related lows can be steeper with Control-IQ, since you tend to have more active insulin on board. Because you can’t do a temporary basal rate with Control-IQ, she suggested that we set up an alternate program with basal rates cut by 50%. If Bisi knows she’s going to exercise, she can turn on this alternate program 90 minutes to 2 hours before. Or, if she’s eating beforehand, she can put in fewer carbs/give less insulin. Either way, the trick is remembering.
  • During Bisi’s most recent appointment, her endocrinologist pointed us to a feature of Bisi’s Tandem reports that’s helpful to look at as a way to adjust settings. She told us to focus on the difference in the Logbook section between the Basal Total Delivered and the Basal Profile Setting, as a way to tell whether her basal rate at any given time should be raised or lowered; the closer the settings are to the amount of insulin that’s being delivered, the more smoothly the Control-IQ algorithm will work. She also suggested that we “Marie Kondo” (streamline and declutter) Bisi’s basal rates, which had proliferated over time, to help us see more easily where adjustments need to be made.
  • We realized that if Bisi has a random high blood sugar, particularly at night, we should assume that something has gone wrong with her pump site. Before Control-IQ, pump site failure was only one of several reasons – including the dawn phenomenon and the meal she’d eaten the night before – that her blood sugar might have gone high. This realization has helped us reduce that middle of the night detective work, when your brain is at its foggiest. If Bisi has a persistent high, the problem is most likely the pump site, not the algorithm.
  • One adjustment that Bisi has struggled with is remembering to turn off her insulin when she takes off her pump to shower or play sports. (The Control-IQ algorithm is thrown off when the system doesn’t have an accurate sense of how much insulin you have on board.) This is a work in progress for us.

Even though we still feel like we have more work to do in terms of getting the best out of the new algorithm, Control-IQ has improved Bisi’s life in important ways. As Bisi’s endocrinologist told us, “It’s not perfect, and you need to think more about active insulin than you did before. But the goal with this is to have diabetes interrupt your life less than it did before.” For Bisi, the important aim of staying in range now requires less mental effort. As she said recently when looking at her CGM graph after 24 hours of Control-IQ: “This is pure gold.”

This article is part of a series on time in range made possible by support from the Time in Range Coalition. The diaTribe Foundation retains strict editorial independence for all content.

About Katie

Katie Bacon is a writer and editor based in Boston. Her daughter, Bisi, was diagnosed with type 1 diabetes in August, 2012, when she was six. Katie’s writing about diabetes has appeared on TheAtlantic.com and ASweetLife. Katie has also written for The New York Times, The Boston Globe, and other publications. 

Source: diabetesdaily.com

How to Navigate Blood Sugars During a Pandemic

Diabetes management is challenging enough as it is. It takes a daily and consistent effort, around the clock, to check your blood sugar levels, pay close attention to your diet and a multitude of other variables, all while making medication adjustments to stay in your target range. The constant management tasks already take a substantial amount of effort and headspace. It’s no wonder that when a particularly high-stress situation arises, it can make diabetes management especially tricky.

Right now, we are all living through a very stressful time, globally. As the COVID-19 pandemic continues, we are all doing our part in trying to slow the spread of the infection. Between school and university closings, bars and restaurants and stores being shut down, and the constant effort of social distancing, the changes to our daily routines are paramount. Not being able to go to the gym, socialize as we are used to, and the added stresses of childcare, not to mention unemployment concerns, are skyrocketing our stress levels.

We know that stress levels can cause higher than normal blood glucose levels. As a result, many of us may be struggling with our diabetes management more than usual.

Jennifer Smith RD, LD, CDCES, Director of Lifestyle and Nutrition and Registered Dietitian, Certified Diabetes Care and Education Specialist at Integrated Diabetes Services explains:

“Stress comes in all forms and can effect each person a bit differently. Stress at work, from a presentation, a big project for school, studying, a terrifying experience like a car accident, a big game against the top opposing team, a performance in gymnastics, or even a scary movie – these can stimulate the “fight or flight” response in the body. The main hormones that are released in a time of stress are adrenaline and cortisol. The release of these hormones encourages the liver to dump glucose into the blood stream in order to provide a quick supply of energy to “get out of the situation”…our body still responds to stress as if we were running away from a Saber tooth tiger ages ago. This extra glucose can and will raise blood glucose levels. It won’t be the same for each person and different types of stress will cause a different rise in blood glucose, but this is the main reason for the typical rise from stress.”

In these unprecedented times, it is perhaps more than ever important to continue to care for our physical and mental health, and in particular, our diabetes. Optimizing our blood glucose levels can help promote optimal immune system function, which helps us fight off all kinds of infections more effectively. Also, keeping blood glucose levels in range as much as possible can go a long way in helping us to feel our best on a day to day basis, physically and mentally.

Here are some tips for optimizing our diabetes self-care during these high-stress times.

Check Your Basal Insulin Dose

For the many of us who are on a basal/bolus insulin regimen, whether using a pump or multiple daily injections, basal insulin doses (or rates) are the cornerstone of blood glucose management. If the basal insulin dose is too high, we might find ourselves with unexpectedly low blood sugar levels throughout the day or night, while if the dose is too low, we may be constantly chasing higher than desired blood sugar levels.

Jennifer Smith RD, LD, CDCES, explains:

“This the foundation of your diabetes management. Think of it like the foundation of a house – if you build it sturdy and strong then everything placed on top of it will hold stable. If you have a foundation that has holes in it, or it put together with shoddy materials, you are like to have to patch and fix it along with everything you build on top of it or it will all fall apart. Basal insulin is what we use to manage blood glucose without food in the picture. In a body without diabetes there is a fine coordination between insulin released by the pancreas in the fasting state and the livers release of glucose into the blood stream to maintain normal glucose levels. This happens whether or not there is food eaten. Getting the basal rates tested is the baseline of management to ensure that if you skip a meal, or for overnight when you aren’t eating, glucose levels stay stable without falling or rising more than 30mg/dl (1.6mmol). Having this set well will ensure that the bolus insulin you take to cover food or to correct blood glucose when it is too high is working optimally. It may need to be adjusted as you move through life, as hormones for growth, menstruation, stress and illness can change insulin needs. But, if you have your base basal set well, then adjusting for these variables is a bit easier to navigate.”

For most people, stress tends to increase insulin resistance, resulting in higher blood glucose levels. This means that many need more insulin during times of stress to stay in range. However, your response to stress may vary, so it is important to carry out basal testing to determine if your dose is appropriately set.

Photo by iStock

Below, you can find a previously published description of how to determine if your basal insulin doses or rates are working well for you. Once that cornerstone of insulin therapy is properly set, it will be much easier to troubleshoot other areas, like bolus and exercise adjustments. (*Note: always consult with your healthcare provider prior to making any changes to your medication doses).

To determine if the basal insulin dose is set correctly, one can fast for a specific number of hours without bolus (fast-acting) insulin onboard and monitor blood glucose levels to see if they remain steady. Importantly, the test should be performed in the absence of other complicating variables, like exercise, stress, or illness. The test should not be performed if your blood glucose level is low or high.

Many people prefer to perform basal testing in 8-12-hour spurts, so as not to fast for an entire 24 hours. For example, it can be quite easy to check the overnight basal dose by not eating after 6 pm and assessing the blood glucose trend from 10 pm to 6 am (in the absence of food or bolus insulin). To determine the basal dose efficacy for morning or evening hours, one would skip a meal and monitor blood glucose levels to determine whether the basal dose is well-set.

The basal insulin requirement may be very similar throughout the day, or it may vary. In particular, many individuals experience “dawn phenomenon,” whereby hormones stimulate glucose release by the liver in the early morning hours. When using an insulin pump, it is quite easy to adjust the basal insulin rate of delivery to accommodate any variations. For those on insulin injection therapy, it may be worthwhile to split the basal insulin injections into several doses throughout the day, to best match the requirements. These individuals may also benefit from taking a small amount of short-acting insulin upon waking to account for dawn phenomenon.

Accurate basal insulin dosing is the first step to achieve the best blood glucose control possible. Once the optimal doses or rates are determined, one should not need to worry about hyper- or hypoglycemia in the absence of food or other variables (like exercise). This will make it a lot easier to systematically start addressing other variables that affect blood glucose levels.

Reduce Stress

It may be easier said than done, but there are several, proven ways that we can reduce our stress levels. Whether it’s taking ten minutes to meditate every morning, making sure you get your exercise in, or connecting with loved ones through phone or video chats, taking time to care for our physical and emotional health can in itself help us to de-stress. In turn, our blood sugar levels will (hopefully) become more predictable and easier to manage. Check out some of these articles to help you get started:

Mindfulness and Meditation Apps

Staying Active at Home

Taking Care of Your Mental Health

And, as the weather finally improves for many of us, don’t forget about the benefits of time spent in nature. Between the vitamin D exposure and the exercise, you can gain a boost for your immune system and mental state by making it a priority to get outdoors as much as possible.

Create (and Stick to) a Routine

Maintaining some degree of normalcy by having a regular schedule can help us feel more in control and help keep us on track when it comes to our meal planning and exercise goals, which in turn, can have a tremendously positive effect on our diabetes management. A routine can be especially helpful when we find ourselves in a rut or experiencing burnout.

For example, if you’re struggling to check your blood sugar level on a regular basis, you can make a concrete plan of when exactly you will check each day. Next, keep yourself accountable by setting an alarm to do so. Moreover, consider trying out a diabetes management app, to help you stay on track.

If you find that your diet has suffered, try to plan your meals ahead for the week. Focus on nutrient-dense foods and get your family involved. Try out a new vegetable recipe or even a low-carb desert! Similarly, with exercise consider engaging all together at a set time, at least a few times per week.

Make Use of Technology

We are so fortunate to have the advanced technology we have today, diabetes-related and not. If you have found yourself in a rut, not wearing your continuous glucose monitor (CGM), or not utilizing the features on your insulin pump to their fullest extent, this is a great time to lean into the technology that can help us thrive during these difficult times.

Moreover, we can data share with our healthcare providers, providing them with detailed information about what’s working and what’s not. Ask your healthcare providers about telehealth appointments, if you haven’t yet!

Photo credit: geralt (Pixabay)

On another note, just using video conferencing to keep up with family and friends, or even just chatting about diabetes in a forum, is a gift that did not exist even 50 years ago! Making use of the internet to strengthen existing connections and make new ones is critical to our emotional health during these times, and can even help with diabetes management and emotional support.

Lean On Others

If you need help, reach out. If you are having a bad day, reach out to a friend for support. If you’re struggling with your diabetes management, reach out to the online community, as well as your diabetes provider. Don’t underestimate the power of social support, as well as having another pair of eyes to review your data to help you identify where you can make some changes to get back on track.

We may be socially distancing, but we are not alone! Lean into your community and make use of your provider’s expertise, remotely.

Also, be aware of the following mental health hotlines and be sure to share them with anyone who may benefit:

  • National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
  • Crisis Counselor Hotline: Text HOME to 741741 to connect with a counselor

Also, you can visit this website for hotlines that are tailored to more specific mental health issues.

***

How has your diabetes management been affected by the COVID-19 pandemic? What are you doing to stay healthy? Please share your experiences with us in the comments below.

Source: diabetesdaily.com

Diabetes Isn’t “One Size Fits All”

I love the diabetes online community for everything that it offers: advice in times of need, hope in times of despair, helpful anecdotes and inspiring stories, and friendships formed across time zones and many miles.

One of the things that the diabetes online community sometimes does, though, is to try and prescribe how everyone with diabetes should live. One day, it’s the Dr. Bernstein diet, the next, it’s high-carb, low-fat. The Mastering Diabetes (mostly) fruit diet is so popular now that their book has even made the NYTimes Bestsellers list. People are jumping on diet and exercise bandwagons before they figure out what they truly need (and want!) in terms of their diabetes management, and what it should look like, day-to-day.

Parents are often left feeling guilty if they can’t “hack” their child’s insulin pump, and individuals with diabetes feel bad when they don’t (or can’t?) do CrossFit or maintain a super low-carb lifestyle. A once seemingly supportive community now raises an eyebrow if they spot you eyeing over a cookie during a meet-up group, or (god forbid) a sugar-sweetened beverage. But I’m here to say one thing: diabetes isn’t a “one size fits all” disease.

You are not a “bad diabetic” if you don’t have a DIY looping system, or if you don’t want to sit down and try to figure it out. You’re fine just the way you are if MDI or insulin pens work better for you, if you dislike skin adhesives, or feel claustrophobic always having something attached to you.

It’s okay if you spike every morning, without fail, due to dawn phenomenon, and if you don’t ever post your CGM graphs to social media. It’s okay if you don’t have a CGM (really, it’s fine). Or if you don’t take an SGLT2-inhibitor off-label. Or even want to try. There’s no perfect low snack. There’s no perfect meal.

Figure out what your body needs, and honor that. It’s okay if you don’t want to eat low-carb, high-carb, or in-between. Or if you’ve lived with type 1 for 15 years, enjoy your weekly ice cream treat, and don’t want to give it up. Figure out what you need and want, and do that. 

It’s okay if you don’t own a Myabetic bag, or can’t afford one, or think they’re ugly. It’s alright if you’ve never been to diabetes camp or don’t want to go. It’s alright if you don’t want to jump all into advocacy and chant, and rally, and cheer. It’s okay if self-care for you is sitting in a quiet room, and coming to a place of acceptance.

It’s okay if you don’t join any Facebook diabetes support groups, or seek out diabuddies in real life. It’s okay if diabetes is only a very small part of your life. It’s okay if it’s your whole life.

It’s okay if you don’t like going to the endocrinologist, or have to force yourself to see your eye doctor. It’s okay if you don’t like talking about your diabetes with others. Diabetes is not one size fits all.

It’s okay if sometimes you’re feeling overwhelmed, over-stimulated, and need to turn inwards, for yourself and rest sometimes.

There is no perfect way to (micro)manage, eat, exercise, handle stress, socialize (or not!), dose, count, or bolus. There is only the way that will work for you and your body. Find what works for you, and embrace that. 

Have you ever been pressured to manage your diabetes a certain way? Eat a certain diet? Exercise in a specific way? How did you deal with the pressure? Share this post and comment below; we would love to hear your stories!

Source: diabetesdaily.com

Diabetes is Not Unpredictable: A Troubleshooting Guide

I have been living with type 1 diabetes for over a decade and have experienced my fair share of learning experiences in diabetes management. One tenet that I often come across in the diabetes online community is, “diabetes is just so unpredictable!” In my early years of diabetes management, I somewhat sympathized with the sentiment. […]
Source: diabetesdaily.com

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