Five Reasons Why I Choose Multiple Daily Injections

Since the day I was diagnosed, I have had people telling me I should consider an insulin pump. Seven and a half years later, I still say no. My A1c has always been in a healthy range, and I am fine with only having one device, the Dexcom G6 continuous glucose monitor (CGM), on my body. I know pumpers rave about their tight control and I am truly amazed by the pump’s capabilities, even more so now with the new features on the Medtronic 670G. However, I prefer a KwikPen, which is true to its word — it is quick and easy and just the way I like it!

Here are my five top reasons for being on team MDI (multiple daily injections):

1. No Kinks or Knots

I constantly hear stories of people waking up with a blood sugar in the 300s, and they had no idea. This is because there was a kink or knot in their tubing and the insulin wasn’t getting into their body all night long. Yes, if they are wearing a continuous glucose monitor (CGM), it should have alerted them, but that sounds like a pain you don’t get from the poke of a pen!

2. Fewer Bruises and Scar Tissue

Don’t get me wrong, the pokes of 6-8 injections a day does add up, and I do have bruises on my body. But have you seen the needle on those pump infusion sets? They are a lot longer and thicker than my Humalog pen. Also, the cannula stays in your body, therefore, leaving much larger holes. This means more bumps and bruises and also means more scar tissue.

3. No Crazy Calculations

As I mentioned above, I am amazed at what a pump can do. It can give you a precise amount of insulin right down to the decimal point. It can also tell you what your insulin on board (IOB) is. My pen can’t do either of these things! However, I do use Humalog Luxura, which is a half-unit pen so I can get more accurate dosing. Also, I mostly eat low-carb, so my dose is usually between 1-3 units. I prefer not having to count every carb I consume; math is not my strong suit!

4. Quick and Easy

KwikPens are quick and easy and take one second to use! I compare these seconds of my day to a lifetime of walking around with another device attached to me, tubing included, and that’s just not for me. Between CrossFit and being a mom, the tubing would not be kind to me.

5. I Don’t Have to Carry Around My Pancreas

When people first recommended the pump, I really only focused on not wanting to wear something else attached to my body. What I didn’t consider was the fact that I would have to actually carry around my new pancreas! When I went to my first type one weightlifting event, Bolus & Barbells, I was so surprised to see everyone with their phones in one hand and their stand-in organ in the other. I imagine that showering and going to the bathroom is a little more challenging than it is for the average Joe!

Photo by Allison Caggia

While I know there are many benefits to wearing a pump; it is just not something I am considering at this time. For me, the fewer reminders of this disease, the better. And with another device attached to me, especially with tubing, I would feel tethered. If I were to consider a pump, it would be the Omnipod since it is tubeless. For now, I will remain loyal to team MDI.

Are you someone who is on multiple daily injections and won’t have it any other way? Or are you someone who was MDI and made the switch to a pump and are glad you did? Share your story!

A previous version of this post has been updated.

Source: diabetesdaily.com

How Two Irish Brothers with Type 1 Diabetes Brew Their Own Zero-Sugar Beer

Beer has a special place among the foods and beverages that are problematic for people with diabetes. Enjoy a few cans or pints and the carbohydrate content can push your blood sugar way up … just before the alcohol brings you back down with a thud. While there are lower-carb beers available, it’s mostly “lite” megabrews, the type of stuff that the beer lover might find thin and tasteless.

As exciting as the explosion of the craft beer industry has been, those delicious, lovingly-made microbrews can be even more trouble. The more flavorful the beer, the higher the carbohydrate count is likely to be. And the smaller the brewery, the less likely you’ll have any idea how many carbs are in a bottle.

Beer lover Seán Deeney had never given much thought to beer’s sugar content until last spring, May 2020. That’s when, in the midst of the coronavirus pandemic, he was diagnosed with type 1 diabetes.

“I only figured that out because I’d just been diagnosed with Crohn’s disease a couple of months before, in February. So, it was not a great year.”

Seán, age 23, lives in Dublin. He’s just completed his university degree. And despite the incredible bad health luck, he’s bounced back pretty quickly.

His transition to life with diabetes was smooth in part because he was already fairly familiar with the disease: his brother James had also been diagnosed with type 1 diabetes, only a few years previous.

Actually, it was James that first alerted Seán to the likely meaning of his symptoms. James used his own blood sugar meter on his brother, and “it was way up, above 20 mmol/L [360 mg/dL].” By the time Seán went into the hospital, he was in the beginnings of ketoacidosis.

“But it wasn’t even too bad. I kind of had a general idea of all the stuff you have to do, how you take insulin, how you check your blood sugars. And it was helpful to have someone I could ask all the time.”

The two had already been collaborating on homebrewed beers, and with each now sharing notes on diabetes management, they were bound to start talking about diabetes-friendly beer.

“My brother has been brewing his own beer for years, and he worked in a brewery as well, Carlingford Brewing Co. We’ve made all sorts of types of beers. Basically anything you can think of, we’ve at least made an attempt at doing.”

“It was only a few months ago that I started really liking these brut beers. It’s a really dry style of beer, so it isn’t very sweet, and I’d wanted to do one for a while, so we looked up how you actually go about doing them. But we didn’t know before we looked it up that there was almost no sugar in them.”

“It turns out it’s basically similar to a normal beer, except you put in glucoamylase, an enzyme that breaks down the complex sugars into more basic sugars.”

“Normally, the reason that the beers have sugar in them – which is what will mess with your blood sugar levels – is that there are unfermentable sugars that remain in the beer, sugars that the yeast isn’t able to convert into alcohol. It’s just a byproduct of how you make it. But this enzyme glucoamylase actually breaks down these unfermentable sugars and makes them into fermentable sugars, so the yeast can convert all of the sugar into alcohol, and there will be no sugar left in the beer at all.

“We were looking at this and thinking, ‘If there’s no sugar left in the beer, surely it shouldn’t affect your glucose levels.’ So we tried one out, and it worked! You can go and drink eight pints of it and it won’t affect your blood sugars at all. Neither myself nor my brother has seen levels rising from drinking it.”

A warning – please don’t take this as an endorsement to drink eight pints of beer, which is probably a bad idea, diabetes or not. Seán (who is still in the honeymoon period) and James have never noticed their blood sugars drop after drinking beer, but your experience may significantly vary. It’s well-known that alcohol, which prevents the liver from releasing glucose the way it normally does, can cause blood sugar drops and dangerous hypoglycemia, especially when taken in excess. I cautioned to Seán that his own experience might change over the years, too.

Seán Deeney, enjoying his beer

To be clear, Seán hasn’t had his beer scientifically analyzed or anything. He’s not a chemist. But he’s convinced that his brut homebrew has significantly less sugar than any other beer style he’s tried, if not absolutely zero. It’s been nothing but steady blood sugar lines for both brothers:

“We both have CGMs. He has the Dexcom, I have the Libre. You can really see the lines, and it just won’t go up at all.”

Brut beers are usually done in a clean, bitter, highly fizzy IPA style, almost like a beery champagne, but Seán has tried the glucoamylase in other recipes as well.

“Normally it’s only a pale ale or IPA that people put this enzyme into. But I really like German wheat beers. So I decided I’d try and make a wheat beer with this enzyme as well.”

“It did exactly what it was supposed to do. You end up with no sugar at the end, and a really tasty beer. So I’ve been doing it with a few others – a rye, and a Kolsch, and all the sugars completely ferment out.”

“We’ve had some fun in naming them as well. The first one, the IPA style, we call it Insulin, because it keeps the levels down. The wheat that I like to make we have now called Diawheaties.”

And his non-diabetic friends approve:

“Everyone seems to like it. They tend to be quite nice, easy-drinking beers. We wouldn’t make them just for the zero sugar if they were no good. They’re as good as the normal beers.”

“It’s really handy. It’s one less thing to worry about.”

 

Source: diabetesdaily.com

Imagine Spotlights: Community Manager Tiana Cooks Talks T1D + Pageantry

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

By Beyond Type 1

Imagine Spotlights is a weekly video series produced as part of ADA’s virtual Imagine Camps for kids and teens. Hosted by Rob Howe, this series features conversations with inspirational individuals affected by diabetes and offers a fun learning experience for campers and their families. Watch the first interview with Tiana Cooks below!



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

You were a senior in high school when you were diagnosed – did you have the typical symptoms?

That’s a great question, and I always think back to that time since I remember it so clearly, and I think it was at least a month before I started feeling a little sick. I don’t know if any of you have bathroom passes, but at my school, they gave us this sheet. And on this sheet, we had about 15 passes to use the entire school year. And if we didn’t use our passes, we received extra lunchtime. I had saved all of my bathroom passes. I had all 15 passes left. And then I remember in one week, I went through the entire sheet of bathroom passes and I was so mad at myself. I remember telling my teacher, “I have to go to the bathroom,” but I was all out of my bathroom passes. So my teacher said, “Tiana, are you okay?” And I said, “That’s a great question.”

I wasn’t feeling great. I was obviously using the restroom a lot. I was very thirsty. I was losing a lot of weight. And then I went to my track coach and said, “Coach, I’ve lost 10 pounds in the first two weeks of the season, what is going on?” And he said, “Well, you probably just lost it because you’ve been running so much.” And then I remember this is when it really hit me. I thought, why is my vision blurry? I remember waking up one morning and I couldn’t see. And so I pulled out my phone and I typed in my symptoms. The first thing that popped up was type 1 diabetes, and I thought, this is it.

Do you ever try to strike up conversations with others you see wearing a pump or continuous glucose monitor (CGM)?

If I see someone else with diabetes, we’re automatically friends. There was one time I was waiting in this line to order food for 15 minutes, and all of a sudden I saw someone with a Dexcom on and I thought, Am I going to stay in line? Am I going to go talk to them? And I chose to go talk to them. I went over and introduced myself to them because I just feel like it’s so rare. They call it seeing a diabetic in the wild. And it’s so rare to see someone that has their equipment on as well.

Can you speak to stigma and stereotypes in the pageant world? How do you battle people’s assumptions about living with diabetes?

People do often stigmatize people with diabetes. They think that just because we’ve got diabetes, we can’t eat certain things or we can’t participate in certain events and that is totally not true. It is present in pageantry as well, people don’t think that we can do pageants because we have diabetes. People don’t think that we can participate in different athletic events because of diabetes. And I think one thing that I’ve learned after participating in various events, whether that be track or softball or basketball or pageantry, there’s always going to be people that have their own opinions. And sometimes those opinions will not be positive, and that’s okay because we just have to educate others about diabetes.

Before I started competing in pageantry, I also had stigmas about people who competed in pageants. Before I had diabetes, I didn’t know what it was. And so until we continue to educate ourselves and others, it will be hard to be fully aware of what people go through. So the more we advocate and the more we continue to tell people and educate them about diabetes, I think the more that stigma is going to go away. I just want to say this, even if people at school say mean things about you because you have diabetes, you just have to know that you’re special and that you have to have that confidence. You have to be confident regardless of what people are saying about you because you know that you’re enough and regardless of what anybody says, you’re capable of doing anything in this life just as good or even better than anybody else.

What advice do you have for people who want to get involved and give back to others living with diabetes?

I would say, if you want to get involved, do what makes sense for you. Just because Tiana is very vocal about her diabetes and just because Tiana loves to talk to other people about it doesn’t mean that you have to. If getting involved for you just means telling people that you meet the warning signs of diabetes, then do that. It might look like being vocal in your community and not online. There’s this huge misconception that in order to be making an impact, you have to be posting or talking about it, and that’s totally false. You can make an impact in your own way. Maybe you write cards to people at your local hospital. That’s how I started, I volunteered at my local hospital.

There are also support groups going on in the community. And we have an online community, our Beyond Type 1 app, and that community is just a great way to meet other people with type 1. There are just so many ways to get involved and it doesn’t look like competing in a beauty pageant all the time. It doesn’t. Or it doesn’t look like having a platform online. I actually helped set up support groups in my community, and those were super fun. Sometimes there would be five people, and other times there would be 50 people at the support groups. It’s just cool to build that community and that support network.

Source: diabetesdaily.com

Be Prepared: Surviving Natural Disasters with Diabetes

This content originally appeared on diaTribe. Republished with permission.

By: Amber Clour

Amber Clour was born and raised in Norman, Oklahoma. Twenty-one days after her eighth birthday, she was rushed to Children’s Hospital where she spent two weeks learning how to live her new life with type 1 diabetes. In 2015 she co-founded DiabetesDailyGrind.com and the Real Life Diabetes Podcast.

It may not be possible to anticipate every emergency, but for those with diabetes, it’s especially important to prepare for the unexpected. Hear how people with diabetes survived natural disasters, what they learned about planning ahead, and the advice they have for others.

Susan Hoagland, 70, who lives with type 1 diabetes, worked up until the day before Hurricane Katrina hit New Orleans in August 2005. Then like most people in the path of the hurricane, she headed out of town.

“In my mind, I was only heading to Austin [Texas] in anticipation of Katrina for a long weekend and didn’t pack all of my medications and supplies,” she said. Hoagland didn’t have a prepared container of supplies, including medications, food, hypo treatments, glucose monitoring devices packed and ready to go – something she would later regret.

***

Dealing with diabetes management every day takes considerable effort, and even when we’re on our A-game, things can at times get overlooked. It’s important to anticipate what might be needed in the case of a natural disaster, so that the fight or flight response due to an adrenaline rush doesn’t get the better or you and your health.

Growing up in Tornado Alley (Oklahoma) means long ago I developed a game plan for emergencies, so that an impending tornado, and the need to leave my home, would not imperil my diabetes management.

I wanted to reach out to others who have been in this situation, and to Carol Atkinson, an expert at the Diabetes Disaster Response Coalition, to hear more about surviving natural disasters and the tips and tricks they have found helpful. The bottom line is that everyone should be prepared to leave their home in case of an emergency with everything they need to make it through the crisis. Being prepared and having everything ready to grab and go means when a natural disaster strikes, you don’t have to face making layers of decisions, delay your departure, or augment your flight or fight response.

To be prepared, think about all the supplies you will need:

  • Medications: Put a supply of all your medications in separate containers to last a week or longer, and think about how to keep insulin at the right temperature, such as an instant cool pack.
  • Injection supplies: syringes, your insulin pens, extra pump supplies
  • Food, a source of glucose, water to stay hydrated: a supply of glucose tabs works really well, some bottles of water, and some food that doesn’t spoil
  • Monitoring supplies – like my CGM, a backup blood glucose meter and strips, and a way to measure ketones
  • Copies of prescriptions
  • An emergency contact list contact in case of an emergency
  • Cellphone charger
  • Batteries, an ID, and cash

***

The morning before Hurricane Katrina hit the banks of New Orleans, Hoagland was in a panic ­– not a good mindset when it comes to making sure she would have everything she would need to survive the catastrophic storm. As she gathered her things in a hurry, she realized she had nowhere to go. She called her son and daughter-in-law, who called friends until they found a place in Austin where she could stay. Despite the fact that it takes eight hours to drive to Austin from New Orleans, she left unprepared.

“I drove straight for two days because you couldn’t stop; there was nowhere to stay,” she recalled. “The rest areas were packed and I had to keep moving. I was fearful for my life and my animals – we had to make it to Austin. It was a nightmare and I wasn’t prepared. In retrospect, I was in survival mode, fueled by adrenaline and weathering high blood sugars.”

One of the many things we might forget as people living with diabetes is how much of an effect adrenaline and stress can have on our blood sugar. It is in our best interest to take the necessary precautions well in advance to lessen the burden on our health when disaster strikes. That includes having the technology you need to test your blood sugar, the medications you need to manage your glucose or other conditions, and back-up emergency supplies like food, batteries, and water.

I reached out to Atkinson, co-chair of the Diabetes Disaster Response Coalition (of which diaTribe is a member) and director of Insulin for Life USA, to find out what advice she has for how to survive the unexpected. She emphasized the importance of preparedness, especially for people living with a chronic illness.

“Always be prepared by building your preparedness kit well before disaster hits and make it customizable to your needs,” Atkinson said. “Be sure to check your kit every quarter to make sure nothing has expired. Other things to consider when packing your preparedness kit ­– a laminated copy of your prescriptions, photo identification, and cash.”

Atkinson suggests leaving the checklist to the experts so you don’t have to worry about making a list yourself. The Diabetes Disaster Resource Coalition makes it easy by providing a downloadable preparedness plan checklist. And you can find even more resources from the coalition here.

Natural disaster

Image source: Cynthia Celt

In 2016, Cynthia Celt and her husband, Mike, set off on an adventure in Costa Rica. After a four hour van ride in the middle of the night in heavy rain, the road was almost a foot deep with mud, and they found themselves stuck in a landslide.

Rescue trucks soon arrived to extract them from the sea of mud. Before Celt knew what was happening, her bag containing all her diabetes supplies was placed into a truck and took off into the dark hills of the unknown country without her. She rode in the back of another truck back to the now powerless resort safely, but without her bag.

“My phone was dead, so I didn’t have my Dexcom readings,” Celt said. “My meter, chargers, and cables were in the back of another truck, which didn’t matter because I had no electricity to charge them. I had little bits of all my diabetes supplies with me, but not nearly enough to sustain me for the entire trip. I was scared to dose as I couldn’t check and had just a candy or two that remained in my purse to treat possible lows.”

Not having access to your diabetes supplies is scary, but Celt said she learned some valuable lessons from this unfortunate experience, including:

  • Always have a blood glucose meter and plenty of strips. “I had somehow failed to bring a meter,” she said. “Lesson learned 100 times over. I now carry a meter and more strips than I will need with me in my purse, even if only headed out for just a few hours!” Make sure that you have all the diabetes supplies you need to manage high or low blood sugar – including your medications and insulin, emergency glucagon, glucose tablets or small snacks, and a blood ketone meter.
  • Having a cell phone battery charger can come in handy. “What saved me when I did get our bags was a 72-hour backup phone charger,” she said. “It allowed me to finally see my blood glucose digits in real time again!” Make sure you have emergency backup batteries and chargers.
  • Research what services will be available to you in the event of an emergency (hospitals, pharmacies, stores to pick up low supplies, etc.). Though this was not her first diabetes travel fumble, being stuck in the dark in a landslide rattled her enough that she now packs back-up diabetes supplies for her back-ups!
  • Don’t be afraid to cause a “fuss” or make a scene if it means having access to the things you need to stay alive. “I should have held onto my bag and helped them understand my life depends on these supplies,” she said. “I was afraid and embarrassed to make an already challenging situation difficult.”

Atkinson stressed that same point, “When evacuating or during any emergency situation,” she said, “define yourself as an insulin dependent person living with diabetes, if you are one. Speak up for yourself.”

In April 2021, Celt was thrown into yet another natural disaster scenario – one that that she had no way to prepare for.

She and her family were camping with friends in the sand dunes not far from their home in Boise, Idaho. They’re fairly seasoned campers, and this was supposed to be just a quick weekend getaway, nothing extreme as far as adventure goes.

She was cruising along in their kayak with her young daughter Madeline and her friend while her husband was in another boat fishing with the others.

“I began to feel the air change and heard sirens from a nearby air base,” Celt recalled. “I saw picnickers scrambling on the shore and then I looked up. What I saw was something I can hardly detail with words. The largest, most sky covering, thunderous sounding wall of sand was charging towards us. It was picking up trees and boats, tossing around bikes and pieces of campers on the land.”

Natural disaster

Image source: Cynthia Celt

Later they learned the storm had overturned semi-trucks and vehicles along the highway. It was what is known as a Haboob, a desert sandstorm common on the Arabian peninsula.

Thankfully before it hit, they were able to make it to shore. Celt grabbed the two small children and slung the dry bag carrying all her diabetes “gear” over her arm.

When out on the water all of her diabetes supplies are always stashed together in a single dry bag. That makes it easy for her to “grab and go”.

“I ran for the hopeful safety of our SUV perched on a shore ridge,” she said. “We piled in and watched as it thundered toward us.”

After several hours they were able to drive to their camper, only to find it ravaged by the storm. The winds did not let up for three days, and they slept in their SUV overnight. However, this time they were a bit more prepared. Celt said, “We always keep an emergency/hidden stash of low supplies, food, and water in the vehicle when camping.”

This scenario was a stark reminder of how quickly disaster can hit. Celt’s words of advice: “It’s impossible to be prepared at all times when living with diabetes. But having your supplies organized, and easy to access and grab on the way out, is incredibly valuable.”

Natural disaster

Image source: Amber Clour

In a different kind of emergency earlier this year, when the pandemic was raging, I packed my bags and relocated to San Antonio, Texas. My casita was the perfect isolation get away, until disaster struck. An unexpected cold front lingered in areas of central Texas where the people and the infrastructure were not equipped to handle below zero temperatures and power outages.

I lost power for days, but fortunately had a gas stove and access to a wood burning fireplace. I also was able to connect with neighbors, and we pooled our resources.

I didn’t fear freezing to death, but I worried my insulin might freeze. However, in the haze of stress I was feeling, I reminded myself the refrigerator wouldn’t get colder than it already was – and the insulation would keep my insulin from freezing. It wasn’t rocket science, but it was clear that my decision fatigue was in full swing. In a situation like this, when freezing your insulin is of great concern, diaTribe’s scientific and medical advisor Dr. Francine Kaufman suggested that you take out a fresh bottle of the insulin you need (basal, prandial, or both) and keep it either in a pocket or a small pack next to your skin. This way you know that you’ll have insulin that won’t freeze.

Stress, both mental and physical, can make diabetes management a nightmare. Keeping my cell phone charged for my CGM data was crucial. Luckily, my Subaru had plenty of gas, so once a day I would sit in the car parked on the street just outside my casita, crank up the heat and charge my phone.

But just when I thought we could get back to normal, our area was notified the water was not safe to drink. I’ve never been in a situation like this and was thankful to have the gas stove to boil water when needed. Not an ideal situation, but I managed.

This entire situation made me think deeply about what’s important when faced with a natural disaster and what things I can realistically do to prepare in advance. Here’s my checklist:

  • HAVE THE EMERGENCY KIT READY TO GO way before an emergency, with a list of all the supplies already in it and what you need to add before you go – like your insulin
  • If you are going to shelter in place, prepare by stocking up on your diabetes supplies and things like non-perishable food, water, batteries, toilet paper, etc., when your budget allows.
  • STAY CALM. It’s okay to be scared and worried, but having your wits about you will make it easier to focus on the items you need to pack.
  • It’s okay to ask for help whether it be for emotional support or supplies. Don’t be embarrassed to contact friends, family, neighbors, local shelters, food pantries, churches, and patient assistance programs. You can also always go to an urgent care facility or hospital if needed. Don’t hesitate in these situations and do what is best for your health and safety.

After some trial and error, I developed a system that makes chaotic situations easier for me to manage. I try to ask myself in these situations, what will I need to survive for at least the next 30 days? Below is a checklist that helps me stay focused.

  1. First, I inventory my supplies so I know what I have and where it is located.
  2. Then I locate a waterproof tub or bag (purchased well in advance) that I can pack my supplies into.
  3. Finally, I start packing my supplies, including:
    • Insulin in a refrigerated case – this is the very last thing I throw in the tub when I am headed to an emergency shelter
    • Syringes for my medication
    • A copy of all my prescriptions
    • Blood glucose meter and plenty of test strips
    • Any CGM supplies I might need including sensors, applicators, and my phone
    • Insulin pump supplies
    • Low blood sugar snacks and glucose tablets
    • Other medications I might need (such as an inhaler, blood pressure pills, glucagon pen, etc.)
    • My driver’s license, passport, cash, and credit cards
    • My diabetes bracelet or disability jewelry
    • Emergency supplies like a flashlight

No one wants to prepare for a natural disaster, but if you take the time now to make sure you have everything you need, you won’t throw your diabetes under the bus when catastrophe strikes.

Below are a few helpful sites to make your natural disaster preparation easy:

And check out some other articles you might want to visit for tips and tricks:

About Amber

Amber Clour was born and raised in Norman, Oklahoma. Twenty-one days after her eighth birthday, she was rushed to Children’s Hospital where she spent two weeks learning how to live her new life with type 1 diabetes.

Since then, her life has been filled pursuing her passion for art, advocacy, non-profit ventures and travel. In 2015 she stepped down as Executive Director for a community artspace and gallery she founded to co-found DiabetesDailyGrind.com and the Real Life Diabetes Podcast. Amber’s – no filter – approach to sharing an honest look into her daily life resonates with many in the diabetes community. She hopes her story and those of podcast guests remind ALL people living diabetes – you are NOT alone.

Source: diabetesdaily.com

Dr. Steven Edelman on Hypoglycemia + Glucagon

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

By Alexi Melvin

Dr. Steve Edelman, MD, is a diabetes specialist as well as the Founder of Taking Control of Your Diabetes (TCOYD) — an organization focused on empowering those with diabetes and encouraging them to “take a more active role managing their diabetes, and being self-advocates.”

Dr. Edelman recently took the time to chat with Beyond Type 1 about the importance of glucagon, among other key issues around hypoglycemia.

BT1: Thanks so much for speaking with us today Dr. Edelman — to start, can you talk about your personal background with type 1 diabetes?

Dr. Edelman: When I turned 15, I came down with all the drastic signs and symptoms and was diagnosed with type 1. 1970, they really were in the dark ages. So, my doctor put me on one shot of insulin and regular in the morning and we had urine testing and that was it. Could you imagine being on regular insulin just with breakfast?

And then eventually when I was an undergrad at UCLA, I ran into some really good diabetes doctors and they got me on the right track, but I did have really poor control for a long time. I didn’t really realize the importance of it. Unfortunately, as a result, I do have complications, but the good news is they’re stable.

What inspired you to create TCOYD?

It dawned on me that the education to people with diabetes was really quite lacking way back to 1995. I went to the Joslin clinic for my training. I went to UCSC to do clinical research, and I realized, all of the education was just going to healthcare professionals.

Not that it wasn’t good, but that’s the only direction it was going. I decided to put on a conference for people with diabetes at the San Diego convention center in September of 1995 and that was the beginning of TCOYD. And I was just going to do one conference here. I had two young kids and so I was just going to do it once a year. And that was a lot of work. But the feedback was so powerful, and people were, it’s a great phrase, so thirsty for information that I just said, “you can’t just stop at one a year” and then slowly spread. And then we started putting them on around the United States.

I felt that it was still important to educate healthcare professionals and about 15 years ago I kind of gave up on healthcare professionals. They were really stuck in the mud, really hard to change their practice habits, so that’s why I focused on patients. Then about 15 years ago, we started this program called Making the Connection, where we brought people with diabetes and healthcare professionals together in the same learning environment. The healthcare professionals got their own lectures in their own room at the convention centers and patients got their own, but in parts of the day, we brought them together. It was all in an effort to improve the doctor-patient relationship because our system is pretty broken. People are pretty pissed off at their caregivers. And if you don’t have trust in your caregiver and if the caregiver doesn’t have empathy back, it’s a bad combination.

So now we do our CME programs in parallel with our patient programs, and now we converted to virtual and I think we did a really good job. I don’t get much credit myself. If you’ve seen some of the crazy videos we do to try to keep education entertaining. I think we have a combination of good content and entertaining. I think the future’s going to be virtual learning for us. We have a conference on Saturday and we have people signed up from 60 different countries, about 3000 people across the United States, every state.

What sparked your desire to bring awareness to hypoglycemia and the need for glucagon options in particular?

A lot of people do not remember that in the old days there were people dying of hypoglycemia and it still occurs. Thanks to the continuous glucose monitor (CGM), it has gone down dramatically. I haven’t had any patients recently pass away from hypoglycemia, but I’ve had 10 people through the years, and they all were the same. They all had really good control. They were told a zillion times that they need to avoid complications, get their blood sugars down, but we didn’t have tools to prevent severe hypo. After having type 1 diabetes for 10 years, you kind of lose your response to hypoglycemia and you lose your symptoms. It’s really a sad thing.

What are some of the main issues that lead to severe hypoglycemia today?

Being a diabetes specialist, I see some pretty serious stuff all the time including people who failed at using the old glucagon kit, which delayed therapy and caused unbelievable hassles. I also have an uncle who had type 1 and he died from hypoglycemia and he had severe hypoglycemia unawareness. He had no complications of diabetes. He was treated at the Joslin Clinic when he was diagnosed, but he was so strict. I could not get him to back off like my other patients. And he basically got low and didn’t realize it. And that was it.

How have glucagon options progressed?

With the old glucagon kits, you had to be almost like a chemist to put these things together. And think about it, the person administrating and getting the glucagon ready to give, they’re typically not medically oriented. They’re the mother, the sister, coworker. And you’ve got to squirt diluted fluid into a little vile of powdered glucagon, mix it up, make sure it’s all dissolved. Then you got to suck it back out into the syringe. Then you got to take the syringe and jab it into someone on the ground that’s typically having a seizure or biting their tongue or rolling over, or demonstrating pretty bizarre behavior, which can occur. And when someone’s like that, time is of the essence. Anything that could make the quick administration of glucagon in an easy way for almost anybody, no matter what type of background is, is so important.

What would you say is the biggest obstacle around glucagon access today?

I think the biggest issue today is people do not have a valid prescription for it. I always have this analogy, if you have a house or an apartment and it gets robbed and they steal everything that’s important to you, what do you do next? You get an alarm system on your house. And I always say that same analogy. If someone’s had a bad hypo, they always have glucagon with them, but they did not have one at the time that they really needed it when they had a bad hypo. So, we have to really say, “Yeah, it can occur even if you’re on CGM, especially if you’re a type 2 on insulin as well,” cause that happens. And you got to have a valid glucagon kit with you, a valid meaning unexpired. These new glucagon kits last much longer. They don’t expire as fast as the older ones do, so that’s also helpful.

What are some ways that the CGM can most effectively help avoid hypos?

Well, one of the things I do in clinic is to really check where people set their upper and lower alerts. I had a patient yesterday in clinic who has had type 1 for 60 years. Her A1C is unbelievable, but she does have hypo unawareness and her lower alert was 65. You have to convince people that the extra alerts are worth it to you.

A lot of people said they put their lower alert at 65 and they don’t realize this situation called the “lag time.” So, when your blood sugar is dropping, even if you have a diagonal arrow down compared to, even worse, one arrow down or two arrows down, looking at the Dexcom arrows, they don’t realize that the glucose in your circulation is probably much lower than it appears on the Dexcom monitor or your phone. Because the Dexcom sensor and other sensors too, they measure the glucose in the subcutaneous tissue, and there’s a lag between the subcutaneous tissue and the circulation.

When your Dexcom goes off or when your CGM goes off at 65, and if your trend arrow’s going down, you could be 45 or 40. So that’s really an important issue, especially for people that their symptoms aren’t as obvious anymore. You could be caught off guard. And I had multiple patients that has occurred with. And then unfortunately, as you know, the majority of T1Ds in this country do not wear a CGM and that’s the topic of a whole other story.

Does this lag time issue apply to a regular glucometer as well?

Yes. If your blood sugar is dropping, your meter or CGM may be perfectly accurate of the subcutaneous tissue at 65. If you checked your blood sugar with a meter, it’s still going to say 65, but your circulation that’s going to your brain might be 45. So, the lag time is key. You could have the most accurate meter or CGM in the world, it doesn’t affect the lag time.

Is there anything else that you would want people to know about glucagon options that you don’t think is discussed enough?

I would say this, people have to ask their caregiver for it because in a busy clinic, it’s typically the last on the list and it’s important that they ask for a glucagon prescription.

I think they need to know that there’s two now that are just as easy to use as an EpiPen. Obviously, one is the nasal spray (BAQSIMI). But these devices aren’t for them, they’re for people who are going to be around them and that they should get more than one if they’re going to be at work or out of the house a significant part of the day. And have their best friend or their coworker be on the cautious side because when you least expect it, it can happen.

Source: diabetesdaily.com

The Extraordinary Almost-Olympian Charlotte Drury and the Trials of Type 1 Diabetes

It was 2020 – right around the dawn of the pandemic in the United States – when Charlotte Drury’s athletic abilities mysteriously began to decline.

“I wasn’t building any muscle, I wasn’t getting any better. And I was training more and more because I could feel myself regressing. My skills just got worse and worse.”

Charlotte, now 25, is a trampoline gymnast. She’s a former world champion and knows her body well. She knew something was wrong.

“Am I just past my prime? Am I not trying hard enough?”

“Looking back, it’s nice to have an explanation that it wasn’t my fault.”

It wasn’t her fault. Charlotte Drury was about to find out that she had type 1 diabetes.

The Lost Year

If gymnastics fans already know Charlotte Drury for one thing, it’s for an earlier and unrelated health catastrophe. In 2016, with the Rio Olympics about to take place, Charlotte was considered America’s best female trampoline gymnast. In previous years she had won individual gold at both the World Cup and the USA Gymnastics Championships. But her Olympics dream was crushed when she broke her ankle during the final qualifying event of the season.

The tragic injury could have ended her competitive career, but Charlotte decided to give the Olympics another shot. She’s fearless—you sort of have to be to make a living flying 30 feet into the air while flipping and twisting.

“I was on top of my game when the pandemic hit. But suddenly, I was all by myself, and training started to get really, really hard. At first, I just chalked it up to training alone in the middle of a pandemic.”

“Later, I was struggling with some depression. I told myself, you’re probably just fatigued from the depression, it’s in your head, you just have to push through.”

It wasn’t in her head. Charlotte was suffering from acute hyperglycemia due to her undiagnosed type 1 diabetes. The critical lack of insulin in her body meant that she wasn’t getting energy from the food she ate. Insulin is a growth hormone and promotes fat storage; without it, our muscles falter, our bodies wither, and the calories we desperately need are flushed uselessly out with our urine.

Later she would recognize that there were other red flags – a bizarrely increased thirst, a new tendency to pee in the middle of the night. But as her body failed her in real-time, she found reasons to disbelieve what was happening.

“I basically gaslit myself into believing it was all in my head for almost a year.”

In December 2020, Charlotte visited her doctor to discuss her depression, which she mistakenly thought was at the root of her troubles. Shockingly, she was still four months away from understanding what was plaguing her. Finally, the mounting setbacks just became too much to ignore.

“In April [2021], we had a national team training camp. I knew how hard I’d been working, and I was looking at everyone around me and realized that there was something wrong with me. There’s absolutely no way I could be this far behind. Something was wrong.”

“There’s a lot of power needed in this sport. I could barely make my triples anymore, and I’ve been making those skills since I was 16.”

The Diagnosis

As soon as Charlotte got home from the camp, she called her doctor, who ordered up bloodwork. Soon thereafter the doctor called her and told her that she was experiencing a medical emergency.

“She said, ‘You have type 1 diabetes. You need to come in right now.’”

Charlotte’s A1c was 14.6%, and her blood glucose over 500 mg/dL. Despite the length of time it took to get a proper diagnosis, she can probably still thank her uncommon awareness of her own physical condition for avoiding diabetic ketoacidosis. Had she not been so in tune with her physical fitness, as professional athletes need to be, who knows how long it would have taken to make that call to the doctor?

Now at last she had an explanation, but a bittersweet one—her life had changed unalterably. And, oh yeah, if she wanted a chance to join the competition she’d spend her entire life preparing for, she had just a few months to figure everything out.

Charlotte Drury Bounces Back

For the first two weeks, she was “miserable.”

“Mentally I was just done. I thought there was no way I could go to the Olympics. There’s no way I can figure out how to manage this, get healthy and strong enough, and train in three months. It was really, really overwhelming.”

At first Charlotte was only taking basal insulin, so “I was still having these crazy mealtime spikes.” It took days of advocacy by her diabetes educator to get the prescription for fast-acting mealtime insulin that she so clearly needed. And she was still coming to grips with the enormity of her diagnosis.

“When I first was told that I had to start mealtime insulin, I just broke down and started crying. I have to do what every time I eat?

But once Charlotte started using rapid mealtime insulin, “it was an incredible turnaround.”

“After two weeks of getting my blood sugars back in range, I literally felt like a different person. A completely different person.”

Her training improved overnight. She regained energy and mental clarity. Her muscles came back to life.

“I had no idea how bad I was feeling until I started to feel good. And now I will do anything to feel this good. I will do the injections, I will monitor, I will wear whatever devices you want – anything to feel good again.”

And suddenly, the Olympics didn’t seem so far-fetched after all.

Trials and Tribulations

Charlotte’s comeback was never going to be easy.

In a mini-documentary filmed prior to her diagnosis—highly recommended for a good look at how insane trampoline gymnastics really is—Charlotte says that repeatedly bouncing as high as 30 feet into the air feels like riding a rollercoaster. The blood sugar rollercoaster was not what she had in mind.

Consider, for a moment, just how dangerous hypoglycemia could be in the life of a trampoline gymnast. Imagine first perceiving a severe blood sugar low while you’re soaring through the air, and what might happen when you land with anything less than precise technique.

The first time Charlotte got hit with a blood sugar low on the trampoline, “I immediately started crying and hyperventilating. ‘Something’s wrong, get me off the equipment!’”

Now imagine developing a comprehensive eating and insulin dosing regimen that allows you to maximize your athletic potential on the global stage, and doing it in a matter of weeks.

“I’m still in the days of figuring it out.”

Charlotte told me that trampoline training is more or less like the most difficult HIIT or CrossFit exercise you’ve ever imagined. 20 seconds of pure max effort, a minute or two of rest, and repeat. For two hours. Those intense workouts are usually preceded by some 30 minutes of vigorous warmup work, cardio that can drive blood sugar down before the stress and effort of the routine drives it back up. Good luck preparing properly for all that.

“It’s a lot of moving parts.”

Life still throws up curveballs. Just when Charlotte thought she had a system down, a trip to Italy for an important round of Olympic trials taught her just how powerfully unanticipated variables can impact diabetes management.

“Everything I knew went out the window.”

During her first practice in Italy, her blood sugar dropped from 100 mg/dL to 48 within 5 minutes. “It felt like I got hit by a wall. It took me three juiceboxes to get back to 70.” That hypo took a full 30 minutes to recover from, 30 minutes of vital practice time on competition equipment that she lost and couldn’t get back.

A Gold Medal Teammate

One of her “saving graces” has been her roommate, the Olympic gold medalist Laurie Hernandez, who has had close family members with insulin-treated type 2 diabetes. Actually, it was Laurie who first told me Charlotte’s story.

“Laurie came in clutch. She came to my doctor’s appointment, she came to my endo appointment, she was taking notes, she’s my Dexcom pal and when I go low in the night she opens a juicebox and brings it to me.”

“There’s a lot of things that I’m very grateful for. When it rains, it pours, but I’ve got a lot of friends and support to help hold an umbrella up.”

The 2021 Olympics

When I first talked to Charlotte, she had completed two of the three trial events that would determine which Americans would make the Olympic team. Despite her remarkable turnaround since beginning insulin treatment, she still wasn’t yet performing at her peak, and her scores reflected that. To make the Olympics, she told me, “I’m gonna have to pull out something pretty amazing in the last trial.”

She almost did exactly that. At the USA Gymnastics Championships in late June, Charlotte nailed her routine and placed second. It didn’t get her the coveted single spot as an Olympic competitor, but was good enough to get her named the alternate on the team. In the following days, she was downgraded to second alternate after a controversial decision to let another teammate re-try her routine. So, Charlotte will be going to Tokyo as a member of the Olympic team, but with an exceedingly low chance of actually competing.

There’s no question in Charlotte Drury’s mind that if she hadn’t developed type 1 diabetes, she’d be competing in Tokyo. But an entire year of frustrating and ineffective practice was just too much to overcome.

Looking Forward

Charlotte hasn’t ruled out another run on the Olympics. The Paris games are only three years away, after all, and her strong final performance has her optimistic about her potential to earn the spot that she might have already won twice were it not for medical disaster. She told me that she’d like to see what she’s capable of after she regains her peak physical condition and combines it with the hard-earned wisdom of the last five difficult years.

Meanwhile, she’s strategizing how to get started on her dream career, a good one for an uncommonly sensitive and fearless young woman. Charlotte wants to be a photojournalist, documenting global suffering and conflict, and is ready to throw herself into war zones to do it.

No matter what comes next, she’s determined that her new condition won’t get in her way: “This won’t stop me.”

“I want to be proud of how far I’ve come so quickly, but at the same time, I didn’t really have a choice, just like anyone with type 1.”

 

All photos courtesy of Charlotte Drury.

Source: diabetesdaily.com

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

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