Should More People with Type 2 Diabetes Use a CGM?

The continuous glucose monitor (CGM) has been hailed as vital technology for good blood sugar management in type 1 diabetes. But although it could provide similar benefits to people with type 2 diabetes, the expensive technology is not yet widely available for type 2 patients. 

Enthusiasm is growing for the use of CGMs for patients with type 2 diabetes, but some experts remain skeptical. And some of the critical decision-makers still need to be convinced before access will really expand.

Patients with type 2 diabetes typically experience fewer intense and unpredictable blood sugar swings than those with type 1. Only a minority of patients with type 2 diabetes have been prescribed insulin, and only a minority of them use rapid-acting insulin multiple times a day, the way that patients with type 1 require. 

Many experts are eager to give patients with type 2 a new tool to help manage their condition. And nothing would make CGM manufacturers happier than to sell their products to the type 2 market; for every patient with type 1 diabetes, there are about 20 potential customers with type 2. But scientists have yet to make the case that the CGM is so helpful to patients with type 2 diabetes that it justifies its high price.

Current Guidelines

So far, the American Diabetes Association has only recommended CGMs for patients with type 2 diabetes that are on “intensive” insulin regimens – patients that are using insulin pumps or multiple daily injections to control blood sugar levels aggressively.

It certainly makes sense for patients on intensive regimens to get the earliest access to the tech. Frequent blood sugar readings allow these patients to dose insulin for meals, exercise, and corrections far more precisely. The alarm function can be a literal lifesaver in the event of low blood sugars.

However, millions of patients with type 2 diabetes use only basal insulin, and millions more do not require insulin at all. They may not need to make multiple insulin dosing decisions every day, and may have a less critical need for low blood sugar alarms, but the device could still play a huge role in improving their glucose management.

Many people with type 2 diabetes are eager to use a CGM but cannot pay for it out-of-pocket. Some find themselves in the disheartening circumstance of knowing that they can only access this valuable technology if their control gets worse.

But a new study may help change this situation.

The MOBILE Study

Dexcom, the manufacturer of the popular G6 CGM system, recently unveiled the results of a randomized clinical trial pitting its continuous glucose monitors against traditional blood sugar meters. The studies were published in the medical journal JAMA and presented at the recent Advanced Technologies & Treatments For Diabetes (ATTD 2021) conference.

The MOBILE study looked at 175 adults with “poorly controlled” type 2 diabetes who used basal insulin but had not been prescribed multiple injections of mealtime insulin. The participants began the trial with an A1c between 7.8% and 11.5%. They were randomized into two groups: those given CGMs, and those given blood sugar meters.

After eight months, both groups had improved A1c’s, but the group using CGMs improved much more: −1.1% vs. −0.6%. On average, the CGM users spent about four more hours in range and four fewer with very high glucose (>250 mg/dL).

Those improvements appeared to apply across the board. When researchers split the study group into different subsections based on age, education level, or “diabetes numeracy,” the group using the CGM always had significantly better results than the group using fingersticks.

second study was published in the same edition of JAMA; this one observed the outcomes of patients that began using Dexcom CGMs in real life (without any intervention by the researchers). Patients with type 2 who initiated CGM use were overwhelmingly likely (97%) to be using intensive insulin regimens, just as the guidelines recommend.

The results? Type 2 CGM users improved from an average 8.2% A1c to 7.64%, an even larger improvement than patients with type 1 enjoyed in the same study. They also experienced significantly less hypoglycemia than they had previously.

Dexcom, unsurprisingly, was ebullient, describing the publication of the two studies as “a pivotal moment in diabetes care innovation.”

Skeptical Experts

Not everyone agrees that CGMs should be prescribed to more patients with type 2 diabetes. In March, Kaiser Health News argued that there is actually very little evidence that the technology does much good for most patients in the type 2 community.

The writer noted that the small number of studies of the CGM’s efficacy in type 2 diabetes have so far come up with conflicting results; several find little benefit. And while the data from the two new Dexcom studies wasn’t yet available, it might be wise not to take the results of industry-sponsored science at face value. Several of the older studies that found good results for continuous glucose monitoring were similarly organized by CGM manufacturers, including Dexcom.

Dr. Katrina Donahue, director of research at the University of North Carolina Department of Family Medicine, was one skeptical expert quoted in the article: “I don’t see the extra value with CGM in this population with current evidence we have… I’m not sure if more technology is the right answer for most patients.”

Money Talks

Price is going to be a big issue. Dexcom, Abbott, and any other competitors not only have to convince patients and doctors that the CGM is can help type 2 diabetes. They also have to convince insurance companies that it’s worth paying for.

That might be a tough job. Many CGMs users are already acutely aware of how expensive the product can be. If the benefits to patients with Type 2 that do not require intensive insulin treatment are less dramatic, insurance companies will be less enthusiastic about covering the system.

Some doctors agree. Dr. Silvio Inzucchi, director of the Yale Diabetes Center, was quoted by Kaiser Health News: “The price point for these devices is not justifiable for routine use for the average person with Type 2 diabetes.”

Short-Term CGM Use

Interestingly, the results of the two studies suggest that the improvements in glycemic control were not the result of increased insulin use but improved patient engagement. The CGM can serve as a constant gentle reminder of the importance of glucose management. Hopefully, the thinking goes, CGM users are more likely to make good eating or exercise decisions.

That finding might help support the advance of temporary CGM use for patients with diabetes. If the CGM works primarily by informing its user about the glycemic impact of different lifestyle decisions, maybe people could benefit from only a week or two of CGM use. They might learn lessons that they could put use to improve their glucose management even after ceasing to use the device.

The temporary CGM has long been rumored as the next big step for patients with type 2. Some healthcare providers already have CGMs that they will loan to patients for short-term rentals, and Dexcom has recently made its CGM available on a trial basis through its Hello Dexcom initiative.

Moving Forward

JAMA simultaneously published an editorial arguing for expanding the use of CGMs for patients with Type 2 diabetes. Authored by doctors Monica Peek and Celeste Thomas of the University of Chicago, the letter calls for “important policy changes in Medicare eligibility to CGM for type 2 diabetes and institutional changes that promote its use in primary care.”

The writers also noted that patients “from racial and ethnic minority populations, those in low-income groups, and other socially marginalized groups are disproportionately affected by type 2 diabetes,” and that improved access to CGMs could especially help the most vulnerable diabetes patients.

The MOBILE Study is just one step, but perhaps a significant one, in widening access to the CGM for the type 2 community. Advocates will hope that such data will convince the diabetes authorities, especially the American Diabetes Association, to expand their recommendations.

Source: diabetesdaily.com

Community Table: Women’s Health and Living Empowered with Diabetes

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

During our third Community Table discussion, Beyond Type 1 sat down with a group of experts and community members to discuss women’s health and living an empowered life with diabetes within both the type 1 and type 2 communities, and share helpful resources and personal perspectives. Watch the discussion in full!



Speakers included:

Partial transcript of conversation below, edited for content + clarity.

What’s the one thing you wish someone had told you about women’s health and diabetes?

Dr. Gomber: It’s okay to not strike that perfection of 100%. It’s absolutely all right if you can’t figure out how to deal with everything, including your hormones. As a person living with type 1 diabetes and as a trained physician, I realized it by trial and error by realizing that hormones are something which I need to adjust, make a balance myself.

Lexie: There are so many things that can affect your body in so many different ways. Nobody ever really explained to me what insulin resistance was, and everything that can come from insulin resistance. I recently got diagnosed with PCOS (polycystic ovarian syndrome) at the beginning of 2020 and it’s been a crazy journey. My husband and I have been trying to get pregnant and for the past 3 or 4 years, I’ve had irregular menstrual cycles. I just thought it was normal.

Doctors never put two and two together for me that PCOS and insulin resistance are linked in a lot of cases. Years ago, when I was in college, I had an endo tell me, “Hey, you’re showing signs of insulin resistance.” But he never said anything else. I thought, “Okay. Well, my A1C isn’t that bad so I’m good.” I never made any changes because I didn’t know what that actually meant.

Whenever I was going to see my OBGYNs they never really connected the dots for me either. When I said I was having irregular cycles it was just, “Okay, well let’s put you on birth control.” It wasn’t, “Maybe this is linked to your diabetes.” I never had any idea until I went and did my own research.

Jessica: How many people actually have diabetes, and I wish I would have told myself to reach out to other people with diabetes sooner. When quarantine hit, I made an Instagram just so I could talk to other people because I’m the only one with type 1 and no one in my family has type 2. It seemed like I was an outsider sometimes and I really needed to know that I am not alone in this.

Marina: Diabetes management is much more than counting carbs, then giving insulin, and having a blood sugar of 110. It is so much more than that. It is emotional health, it is wellbeing, it’s so much more. Sometimes we want to have a feeling of control, and we control the food or we control whatever thing we can. That’s really the beauty of what I do is ask how we can have a positive relationship, and a holistic view in how we eat.

What should people know if they’re heading into the age of menopause that might help them out a little bit with that?

Dr. Porter: It is important to understand everyone’s body is going to react very differently to menopause, and you need to be your own advocate with your OBGYN to tell her that things are not going right. They might need to adjust your blood sugar management routine because it’s counterproductive.

When it comes to menopause, there is this one massive hormone called progesterone which acts as a complete monster when it comes to blood sugars. Progesterone actually increases your blood sugars. You need to adjust your insulin regimen to understand how your body is going to react to progesterone. Also, during menopause, there are other additional things that you can incorporate into your regimen like incorporating exercise or yoga. Which will improve your insulin sensitivity and help incorporate that resistance that is coming up with progesterone in your body.

What’s a challenge that you’ve faced that taught you how strong you are as a woman living with diabetes?

Marina: I just bring it back to pregnancy. I think that’s been my most challenging moment because again, I’ve studied. It wasn’t necessarily new to me, but these are new human beings. Once they were born, it was like, “Wow, you’re healthy.” That is all that matters, nothing else. That really proved to me how resilient people with type 1 diabetes are. We really have an extra skill, like we have two brains. We’re able to not just manage our blood sugar, but also be a mom, be a doctor, be a wife, be all of these different things on top of all of the demands of diabetes.

Lexie: There have been different phases years of my life that always reminds me how strong I am. So, the first thing was looking back at the time I didn’t realize it, but Aussie kids, little young kids on Instagram, like giving themselves an injection or changing their pump site. And I’m like, “Oh my gosh, they’re so young.” And then I’m like, “Let’s see. You were doing this same thing.” Then I’ve given myself insulin while driving. I inject it, and in my mind, before I would go somewhere, I’m already calculating, “Okay, I’m going to be gone for this long. Let me go ahead and get this number of snacks.”

Growing up with a chronic illness, it forces you to have compassion for any and everybody which has helped me be able to support others. I don’t think I’ve ever really felt more accepted and loved by a community like the diabetes community. It just teaches you to love people.

A question from a community member: “I was diagnosed at age 41. I’m now 44. I also live with Hashimoto’s. I’ve been using Dexcom for a year and the Tandem pumps in september. Will I ever learn my body?”

Jessica: Yes, you will! Obviously my experience is different than yours, but you just got to take it day by day. Again, find someone who is just like you. There’s someone else out there dealing with the same thing.

Lexie: I agree that you will learn your body, but also know that your body is going to change all throughout your life and diabetes is literally a journey. You’re never going to get to like a destination where it’s like, “Okay, I’ve got it. I’m good for the rest of my life.” That’s why it’s definitely important to connect with other people who are going to be with you on this journey literally for the rest of your life. Because your body is always changing. Like everybody has said, it makes such a huge difference to feel like you’re not alone.

Lala: You’ve only had diabetes for three years, you’re a baby. There are things that you’re going to keep learning for a very long time. I’ve had type one for 23 years. As you know, I just learned new things from this conversation. There’s always a learning curve and the learning curve is long. Have patience with yourself.

Marina: Sometimes it just takes either a visit to somebody that knows to say, “Hey, have you noticed this, this and that?” And it might take somebody that might have that experience or that education or that has gone through the same thing to say, “I did not know that.”

So just know that there are people that are educators, doctors, or people that have diabetes that could just help you out in a professional way as well to say, “Hey, look at your Dexcom. This is what’s happening. Have you noticed this?”

Source: diabetesdaily.com

The Power of the Diabetes Online Community

By Nate Allman

Daily management of the beast that is type 1 diabetes (T1D) can be challenging, at best, on a good day. I am 29 years old and was diagnosed at age 12. Thankfully, I had a good support system in place. My mom, a nurse, and my dad, who worked as an EMS/Firefighter, helped me start my journey, as did my older sister. I learned as much as I could, as quickly as I could. I memorized the carb counting nutrition guide book my parents bought me, which made calculating my doses a lot easier.
Into my late teens, early twenties, my fear of hypoglycemia and the dangers of my sugar going too low caused me to keep my blood sugar higher than it should have been. I would consistently have readings above 600mg/dL, and my A1c was 12.4%, an average blood sugar of 360mg/dL. I got to the point where I gave up on trying to manage it. Diabetes had taken control of my life. I had let it.
I suppose I had been ashamed in a way of being a diabetic. Which, looking back now, I find ridiculous. Five years ago, a change took place. I was scrolling through Facebook when I came across a fellow T1D. This person was a friend of a recent acquaintance of mine. He replied on a post with a photo comment, in which I saw his insulin pen. That was the first time I really saw someone openly displaying their diabetes. I had felt like it was something I needed to hide away.
I liked the comment and replied to him. I had never really been around many other people with type 1 diabetes, not since I was first diagnosed and in a clinical setting. I was in my mid-twenties at the time and never realized how lonely I was. I still had the support of family and friends, but no one can truly understand this unless they are living it themselves. When I received a Facebook message from this diabetic, my life forever was changed.
I was invited to a couple of different Facebook groups, only for type 1 diabetics. They welcomed with open virtual arms. I found a family of people who struggled with and fought the same battles as I had. I learned more from these people than I ever thought possible. I learned about the Continuous Glucose Monitor, Dexcom, through this group. In fact, when I went to see my endocrinologist at the next office visit, I asked her about getting a Dexcom and she did not even know what it was! I was finding out things my doctor hadn’t even heard of.
After starting my CGM, my A1c started to improve drastically. In one year it lowered from 12.4% to 7.4%. I, as of last month, am now at a 5.7%. Having access to the diabetes online community (DOC) is without a doubt the best thing to have happened in my 17 years of being a diabetic.

Nate meets some of his online diabuddies in real life | Photo credit: Nate Allman

Since 2004, the tools available to assist in treating diabetes have advanced. I now have a connection to others just like me, all around the world, and can share my life with my DiaFamily, through Snapchat, Facebook and Instagram. From receiving Christmas gifts and care packages to meeting up with these amazing people in the real world, I am forever grateful to have found my place in the DOC. It has given me the resources and strength to take control of my life. Diabetes is still hard, but it makes all the difference to have a group of people to share that burden with. The power of the Diabetic Online Community is truly awe-inspiring.

Source: diabetesdaily.com

Rush for COVID Vaccine Hinders Diabetes Tech Advancements

Modern science is amazing. The COVID-19 pandemic, which is still shaking the world as we know it, is quickly getting controlled due to fast scientific progress and the vaccine rollout (in the United States, at least).

Having an effective vaccine come to market within a year of the appearance of a novel disease is unheard of; most medicines take decades for adequate approval processes within the Food and Drug Administration (FDA) to be completed. This feat is incredible.

That being said, with all of the rush to get a vaccine to the masses, the FDA pushed the Pfizer, Moderna, and Johnson & Johnson vaccines literally to the front of the approval line, delaying other important medical and technological advancements, including those related to diabetes.

While the vaccine did (and should!) take precedent here, the delays have been tough for people with diabetes in many ways. 

The head of the FDA’s device center, Jeff Shuren, described a “tsunami” of product applications from companies hoping to join the fight against the COVID-19 pandemic.

Those applications include over 1,200 submissions for products like diagnostic tests, ventilators, and digital technology, all of which have slowed their work in other diseases, including diabetes.

Shuren went on to say that review times had begun to increase amid growing backlogs due to the high volume. 

The agency is trying to make as much space as possible to approve COVID-19 related vaccines, medicine, and technology quickly to end the pandemic, which has taken precedence over almost everything else. Experts suspect that the FDA may not be able to meet its own timelines going forward.

In addition, lockdowns and social distancing regulations halted clinical trials and product releases. It’s been a tough year for diabetes tech firms to get much done.

The following products, and their release dates, have been most affected by the pandemic:

Senseonics’ 180-Day Eversense Glucose Monitor

The Eversense continuous glucose monitor (CGM) is a device implanted under the skin that lasts for 90 days. The newest version of their CGM system aims to double its lifespan to 180 days without changing a sensor.

What was supposed to be released in early 2021 now faces delays of up to two months for its application to the FDA while the agency tasks its staff with emergency reviews of coronavirus tests and other medical devices. The new release date of the model is scheduled for mid-2021.

The Omnipod 5 (Originally “Horizon”)

Insulet’s Omnipod 5 system, which utilizes CGM data to make automated adjustments to basal insulin throughout the day, will be the company’s first hybrid-closed loop system.

Similar to the T-slim Control IQ system, this insulin pump will provide mobile app control and insulin dosing from a smartphone, eliminating the need to carry their hallmark Personal Diabetes Manager (PDM) around to control the release of insulin.

While significantly delayed due to the COVID-19 pandemic, Insulet said during its Nov. 4, 2020 investor update call that it had recently finished its clinical trial and was finalizing its FDA submission.

They hope to launch their product by June of 2021.

Medtronic 780G

Also known as the Advanced Hybrid-Closed Loop (AHCL) system, this system will improve upon its first iterations of the hybrid-closed loop system, the 670g and 770g. Hoping to seek approval for adults and children as young as two, this system includes:

  • A CGM sensor that will require just one calibration on the first day of wear and no further calibrations after that
  • Automatic correction bolus delivery every 5 minutes, in conjunction with CGM readings, that can automatically bolus for missed meal doses.
  • A lower glucose target range, adjustable between 100-120 mg/dL
  • Different insulin duration times, to adjust for the “tail” of your insulin (eg, Fiasp vs. Humalog)
  • Built-in Bluetooth to share data and provide remote software updates

Due to the pandemic, the approval for this device has been delayed, but Medtronic confirmed that it had submitted its application for review to the FDA in February, 2021.

They hope to have a commercial launch sometime in 2021.

Dexcom G7

The much-anticipated Dexcom G7 continuous glucose monitor (CGM) was also delayed due to the pandemic, but it should be worth the wait. You’ll no longer need to buy separate transmitters; each sensor is a complete and disposable transmitter/sensor integrated system. Some other great features include:

  • No calibrations, much like the G6
  • At the start, wear time will be 10 days, but eventual use will include a 14-15 day feature, also without any calibrations
  • Smaller and thinner: the newest CGM will be 60% smaller than the G6
  • One hour warm-up period

Dexcom CEO Kevin Sayer said that the company eventually plans to have different versions of the G7 for different people.

For example, people with type 2 diabetes who don’t use insulin (or even the general public) might opt for a much simpler interface than people with type 1 diabetes, who will want all of the alarms and settings.

Abbott Freestyle Libre 3

For years, the FreeStyle Libre from Abbott Diabetes was a considered Flash Glucose Monitor (FGM), because it only reported blood sugar levels whenever a user scanned their sensor with a receiver or smartphone.

That will change with the new edition: The Freestyle Libre 3 will function as a real-time CGM, because it won’t require sensor scanning to get a “flash” of blood glucose data. It will instead provide trends and graphs to track blood sugars throughout the day.

The Libre 3 generates real-time blood sugar readings every minute (as opposed to Dexcom’s every 5 minutes), displaying the result on a mobile app on your smartphone. This version also has optional high and low blood sugar alarms, a feature introduced with the Libre 2 in 2020.

Additionally, the sensor is much smaller and thinner (a 70% size reduction), and is kinder to the earth, using 41% less plastic overall.

The Libre 3 received global approval in September 2020. The timeline in the US has been pushed backwards, but with clinical trials now complete, we’ll likely see the Libre 3 applications submitted to the FDA mid-2021.

While the hustle for an effective COVID-19 vaccine has been nothing short of miraculous, people with diabetes don’t want to wait any longer!

Hopefully, with the hastened release of the vaccine, we can see more diabetes technology hit the market in 2021. 

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.

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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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Image source: diaTribe

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.
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    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.

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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

Mommy Beeps: Parenting with Type 1 Diabetes

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

By Kim Baillieul

A few years ago, I sat at a park while my then two-year-old son played on the playground. A wave of dizziness fell over me right as I felt my continuous glucose monitor (CGM) start beeping. One, two, three – three beeps, confirming the low blood sugar I suspected.

Instinctively, I reached into my purse and grabbed the juice box floating among the loose change and used test strips. Of course, my son’s innate ability to sense whenever I have a sweet treat also kicked in, and next thing I saw were his big, blue eyes fixated on my hand.

“Mommy, can I have your juice box?”

Sure, my sugar had dropped in front of my son before, but this was the first time I had no distraction for him – no alternative snack, no books to read. Most importantly, it was the first time he asked me to share. I shook my head and told him no, but he persisted.

“Mommy, pretty please, can I have your juice box?”

My mind went blank.

How do you explain to a toddler that your juice box is literally keeping you alive?

What I Was Told

For years – even when I was still a child myself – I was cautioned about pregnancy. At 16 years old, my endocrinologist painted daunting pictures of a hypothetical future high-risk pregnancy: weekly doctor’s visits, insanely tight control, constant monitoring. A massive list of things that could go wrong. All of this became my reality over a decade later when I became pregnant with my son.

My high-risk pregnancy with him had overall, gone well, partially thanks to the hard work I put in to maintain a 5.1% average A1C, and partially thanks to luck. I was prepared for the extra scans. I was prepared for the drastic insulin changes. I was prepared for the constant vigilance. I was prepared for what could go wrong.

However, nothing prepared me for how to explain my type 1 diabetes (T1D) to my child. Or why suddenly, at this moment, I couldn’t share a simple juice box. Frankly, I was so dizzy, I couldn’t even get up off the bench.

“I’m sorry sweetheart, I can’t share. This juice box is mommy’s medicine.”

Later, after my sugars were stable, I thought about how to talk to my child about my chronic illness and the scope of what he needed to know. I wanted to achieve a balance – somewhere between knowing enough to be empowered but not so much that he’d become anxious; enough for him to understand what I was doing, but not enough for him to feel responsible for it himself.

All my life I had worked to overcome and ‘beat’ my diabetes, to not let it stop me, you know, upholding the usual mantras of strength. However, as I pondered how to talk to my kids about my type 1, I had to set that all aside. Pride had no place here.

The conversation remained informal, but honest.

Understand that mama’s body doesn’t work the way most other people’s do… I’m not sick, but it can make me feel sick sometimes… This is my insulin pump… This lancet is sharp, please don’t ever touch it.

He had a lot of questions.

Yes, Mommy beeps!… No, you won’t get it when I cough… Yes, even if I forget to cover my mouth… Yes, I can eat most anything as long as I’m careful… Yes, even ketchup… Yes, even ice cream… Yes, even ketchup ice cream – wait, that’s gross!

We both erupted in giggles.

A Universal Struggle

One of the beautiful things about the type 1 community is knowing you’re not alone. As I reflected on this intentional conversation, one of the first ‘growing up’ discussions I had with my son, I realized I’m not likely alone in facing this. Turns out, I wasn’t – the parents with type 1 community was peppered with struggling T1D parents facing the same hurdle. When I looked for resources, I didn’t find anything quite suitable for a type 1 parent.

Throughout my son’s toddlerhood, I captured my efforts in a children’s book I wrote called “Mommy Beeps: A book for children who love a type 1 diabetic.” It was a passion project of mine to provide a resource that didn’t otherwise exist, and hopefully help another family lessen the mental gymnastics of explaining type 1 diabetes to a child who doesn’t have it themselves. Every page is personal – down to the angry T1D on the phone dealing with a denied insurance claim. Because that is reality. Diabetes isn’t just about the finger pricks and injections – the medical and insurance logistics can be just as heavy. Extra doctor’s appointments, tracking of supplies, prescription refills – it all took time away from playing with blocks, giggling on the floor, or reading “Goodnight Moon” for the third time on a given evening.

As for my son, he took to my carefully crafted conversation well – and all of the impromptu ones that followed. Once, after a particularly harrowing high sugar, we planned a library visit to check out some books about the body, so he could find the “piece of Mama that doesn’t work.” We never made it to that page, though, because he was too fascinated by more amusing parts of the body (the toilet humor sure does start young).

A few years later, I braved the high-risk pregnancy world again and came out with a second little boy. The first time my type 1 diabetes interrupted our playing with trains, I talked to him, too. He shrugged it off and kept the train on its way to the station.

Later that night, he leaned into me. Pointing to my stomach, he exclaimed, “Mama’s Dexcom! I kiss it.” Clearly, something stuck in our conversation earlier that day. And I will take any win I can get.

They won’t know any other way, this will be their normal. And really, that’s a beautiful thing, because the T1D community is now just a little bigger.

Find out more about “Mommy Beeps” 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

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

Image source: diaTribe

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.

Couple

Image source: diaTribe

“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

Image source: diaTribe

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

Image source: diaTribe

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

10 Ways to Avoid Overnight High Blood Sugar

My biggest challenge when it comes to managing my blood sugars is the overnight hours. I know it is largely in part to the fact that I am a nighttime eater, consuming most of my calories after 7 pm. But I have also done some investigating and noticed my blood sugars naturally rise around 9-10 pm, so I am fighting an uphill battle. I started looking for some tips and tactics to try in order to improve my nighttime blood sugar levels.

Here are 10 tips on how to lower your overnight numbers, which will give you a better night’s rest too.

1. Basal Testing

This should come first no matter what issues you are having when it comes to your blood sugars. Without knowing the proper dose of “background” insulin your body needs, it becomes much more difficult to figure out how to dose for meals, creating a rollercoaster of events. In Gary Scheiner’s book “Think like a Pancreas” he explains basal testing in an easy-to-understand and methodical way.

2. Don’t Eat Too Close to Bedtime

Many people confuse this statement to mean that you can gain more weight by eating late at night. This simply not true. It comes down to a science and so long as you are in a caloric deficit, it doesn’t much matter when you take in your food. However, if you eat too close to the time you shut your eyes, it becomes more challenging to stay on top of your blood sugars. Eating about two hours prior to when you shut the lights will give you more time to assess how your blood sugar is trending, and (if needed) get your blood sugars back in range so you can get some sleep.

3. Take Advantage of Technology

If you are fortunate enough to own a continuous glucose monitor (CGM) , you should make the most of its features. Keep the alarms set to a high and low blood sugar number that you are comfortable with to help wake you if damage control is needed. You can also share Dexcom with a loved one who could alert you of dangerous numbers if you are unable to wake from the alarm on your own. Pumps like Tandem Basal Control have become extremely popular, as they can release insulin if your blood sugars get too high allowing you to focus solely on dreaming of a cure!

4. Try to Relax

It is known that stress can lead to higher blood sugar numbers and can also contribute to insulin resistance. When stress hormones like cortisol kick in, it can raise blood sugar levels, which is often what you see in the morning with dawn phenomenon. Additionally, stress hormones are known to increase insulin resistance. “Hyperglycemia is particularly exaggerated by elevations of cortisol and epinephrine in diabetes as a consequence of an altered response of the liver to these hormones,” scientists summarize. Put down your phone, drink some hot tea or read a good book in order to relax and put yourself in the right mindset for both in-range blood sugars and restful sleep.

5. Carb Count and Dose Accordingly

If you are taking insulin, this is something you likely do on a regular basis. Since I am so picky and stick to the same foods, I really don’t count carbs at all. I use the “WAG” strategy (wild a** guess), but this could wind up costing you a good night’s sleep. Make sure to count your carbs, know your carb-to-insulin ratio, time your dose correctly and keep your fingers crossed. Pumps have calculators built in to help make this easier for you and if you are on shots, you should check out the InPen, which has been a lifesaver for me in regards to getting my doses right and keeping my blood sugars in range.

6. Set Alarms and Stick to a Routine

Setting alarms will not only help remind you to take any oral medications and/or insulin but setting an alarm in the middle of the night can allow you to do a quick correction or chug some water if you are experiencing high blood sugars. Many times, if you take your medication or basal insulin an hour too soon or too late, it could impact your blood sugar levels.

7. Adjust Doses If Necessary

We are often so busy that we forget that many different things can affect both our medication and insulin doses. If you recently lost weight, started exercising, are taking steroids, changed your diet, or have become pregnant, to name a few, you should check in with yourself and your health care team to make sure you are taking the proper amount of medication. Ensuring that you are will no doubt give you better results at all times including the hours of rest.

8. Don’t Exercise Too Close to Bedtime

Many of us have busy schedules that only allow for nighttime workouts. If this is the case, try to fill up on protein-rich foods prior so that you don’t wind up with too much insulin in your system a few hours later when you are trying to fall asleep. Also, weight training can spike our blood sugar meaning you may wind up having to correct it. Being awake and alert for a few hours after a workout can only help your blood sugar management.

9. Be Wary of Delayed Blood Sugar Spikes Due to Protein

There are many times when two hours after dinner I am pleasantly surprised by my blood sugar number. But, I notice it starts to slowly creep up shortly after. Unlike carbs that quickly break down to glucose, protein can trigger a blood glucose rise that takes place over several hours. If your dinner is protein-heavy make sure to check your blood sugars a few hours after to troubleshoot any blood sugar spikes.

10. Stay Hydrated

Water plays a key role in keeping blood sugars in range. If we are adequately hydrated, the glucose levels in our blood can’t become too concentrated resulting in hyperglycemia. Water has the ability to reduce blood sugar by diluting the amount of sugar in the blood. Staying hydrated can also help you in your weight loss efforts. My advice is to make sure you get your water in throughout the day so you’re not paying for it with trips to the bathroom all night!

It isn’t easy to schedule in “troubleshoot my overnight numbers” to our already busy schedule, but taking the time to heed some of the above advice is sure to help your numbers improve, allowing for a more peaceful night.

Do you have trouble with your overnight blood sugars? Do you have any advice that worked for you? Share and comment below!

Source: diabetesdaily.com

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