Mark Andrews: A Tight End with Type 1 Diabetes

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

By Katie Doyle

The Baltimore Ravens didn’t choose just any offensive lineup during the 2018 NFL draft – a key part of their strategy is Mark Andrews, a tight end from the University of Oklahoma who has been managing his type 1 diabetes since before he started playing football and into his rookie season.

Beyond Type 1 spoke with Mark about his pre-game rituals, how technology like the Dexcom G6 helps him stay on top of type 1 on long Sunday afternoons, and why it’s important to use his high-profile career to educate and advocate with National Diabetes Awareness month coming up.

How have you managed your diabetes through major life changes, like going away to college, playing a division 1 sport, or going through the NFL draft?

I was diagnosed at 9 years old, and it was the first time I ever saw my dad cry. At that moment, I knew it was serious because it wasn’t something my dad did very often. And since then, my family has been my rock. I was lucky enough to have a dad who was also a doctor and had an understanding of diabetes when I first was diagnosed.

Personally, I wasn’t very nervous. I knew that one day I wanted to move out, play football at a Division 1 level and ultimately play in the NFL. It’s something I was always very diligent about. I wasn’t going to let my nerves or anything else get in the way of that. My mom probably worried most, but my dad was instrumental in instructing my whole family in what to expect and what to know. I rely on them a ton. Using a CGM allows them to be a part of it and know my numbers at all times. It gives them peace of mind to be able to check in on me.

Mark

Image source: Beyond Type 1

How does your family support you from across the country?

My mom will always be my mom, so she still checks on me regularly. Last week, she texted me and said, ‘Hey, I don’t think you have enough complex carbs on board, you’ve been going low and trending low a lot. Just want you to eat something that gives you more complex carbs. I love you, hope you’re having a good week; I’ll talk to you soon!”

It’s awesome to get a text message like that and know my family has my back. After that, I ate a peanut butter and jelly sandwich just to have that background complex carb and went about my day. It’s always good having people look out for you — the more eyes you have on someone with diabetes, the better.

I’ve got a teammate right now named Orlando Brown whose dad had diabetes so he’s incredibly well-informed. He was my college teammate and now he’s my NFL teammate with the Ravens. He’s always wondering what my numbers are, and I actually share my numbers with him from my Dexcom.

When did you feel comfortable enough to talk to your friends and teammates about diabetes?

At first, I remember feeling a little bit reserved and not being totally open about it. I’d go hide in a corner to test. I also remember the first time my friends saw me testing my blood sugar. I was 10 or 11 years old, and they saw blood and thought it was cool. I was kind of in the spotlight because they were so interested in what I was doing.

That opened me up to be more vocal and to share what I’m doing and how I deal with things. After that, I became really comfortable sharing what I deal with having T1D and how I deal with it and sharing with others. I was very open talking to my coaches, and I had my parents to help me out with that, and they still do that to this day. Ever since then, I’ve always wanted to talk about it and shed light on what people with diabetes have to do.

Tell us about your pre-game ritual.

I do something a little bit different: I wear a pump, so I use that for basal (25%) and I use Lantus for my other type of basal (75%) on a normal day. But on a game day, I’ll go 100% Lantus — that allows me to be off the pump for long periods of time but not have to worry.

Knowing your body is key. Knowing what I put in my body and how it will affect me is something that I feel has been instrumental for my health. I’m a big fan of complex carbs; I eat peanut butter and jellies, especially on game days or the day before a game, just allowing myself to have that complex carb to hold me over while I’m exerting a lot of energy.

Having my Dexcom, and the way it allows me to see my blood glucose trends and see what foods react a certain way has been huge for me. There’s a lot that goes into diabetes management, and I think it’s incredible that I can rely on Dexcom and not have to prick my fingers all the time. It really sets me up for success on the field.

Who are your role models?

I didn’t know anyone else with diabetes growing up, but I have my dad, who is extremely knowledgeable and always researching different things. He’s the reason I went to 100% Lantus for game days.

I can remember, at a young age, having diabetes and seeing Jay Cutler in the League, and being able to tell myself that it’s possible. I adopted a mindset that this disease is a part of who I am, but it’s not going to define me and it’s never going to stop me in achieving my dreams. Football is my passion, it’s what I love, but now it’s my job, and diabetes is something I refuse to let affect my job.

You seem like you have a ritual down for games, but how about during the NFL draft? How were you feeling then?

There’s so much work that had been put into that moment, from my mom driving me to soccer practice, to all those hard hours put in on the field, it all lead to that moment of actually playing in the NFL. It was kind of scary to know that that you’re putting your future into someone else’s hands — into 32 organizations’ hands — but this has been my dream for a very, very long time.

Why is it important for young athletes with type 1 to have role models?

To be put on this stage, I’ve always wanted to give back and for me, that’s with diabetes — that hits home for me. Helping kids with diabetes is something that I’ve found has given me the most reward: raising awareness and talking to people about how I use technology and what I do with it, it’s to help people with everyday life and share some of that.

I’m going to work as hard as I can to be the best tight end that I can be, and hopefully one of the premiers tight ends in the League. I want kids to see where I’m at today, like I saw Jay Cutler, and I hope it inspires them to go out there and play sports and be active — to follow their dreams, no matter what they may be. A professional football player? Great! Go out and achieve it. Or if anything else, you know, This guy’s playing football at the highest level, then I can do anything else!

Source: diabetesdaily.com

Tackling Carbs with Tech

Many people who live with diabetes avidly avoid eating carbohydrates, as historically speaking, it has been notoriously difficult to cover carbohydrates appropriately with exogenous insulins. But with access to better, faster insulins and the uptick in the use of patient-friendly technology, things are changing, and people’s diets (and their feelings of freedom) have expanded more than ever. Here are the best tech-friendly hacks to tackle the carbohydrate conundrum.

MyNetDiary

This popular app has a searchable database with nearly a million food entries for people to access and look up carbohydrate counts on the go. The company also has a separate Diabetes app that allows users to track blood glucose levels, HbA1c results, and insulin doses, to track their progress over time. If you’re looking to lose weight, MyNetDiary can create a diet plan to meet your needs. You never have to feel restricted when eating meals with family or friends, having all your carbohydrate counting needs right at your fingertips.

Photo credit: GreaterGoods

GreaterGoods Nourish Digital Scale

This food scale is a game changer for those who cook with lots of fresh produce, where carbohydrate counts can vary quite a bit. This scale lets the user view nutrition facts for over 2,000 foods in the scale’s built-in database, and create up to 99 more custom entries. Measure individual ingredients, track full meals, and calculate daily carbohydrate intake much easier with this digital scale.

InPen

This revolutionary device is the only FDA-approved smart pen insulin system that helps prevent users from “stacking” their insulin doses and take the right amount of insulin at the right time. This device works in tandem with a phone app, where users can track insulin on board/active insulin, personalize your doses, sync with continuous glucose monitor (CGM) or glucometer data, and share reports with others. The pen itself is compatible with Humalog, Novolog, and Fiasp, and will even dose in half units. Eating carbohydrates has traditionally been much harder on multiple daily injections, but advancements such as the InPen are making strides to make life much easier for people with diabetes.

Use Alternative Pump Boluses

If you are an insulin pump user, dosing for a high carbohydrate meal can also be difficult, especially if the meal also has a moderate amount of protein and fat (which can delay the absorption of the glucose in the meal). To handle that, try opting for a combination bolus (a.k.a. Combo Bolus or Dual Wave Bolus,  for Animas or Medtronic users, respectively; Omnipod, Tandem t:slim users will use “Extended Bolus”). This is a hybrid delivery mode: a specified portion of the total insulin bolus is delivered upfront, as a normal bolus, while the rest is delivered over a specified period of time as an extended/square wave bolus.

For example, given a 12U dose delivered as a 60/40 combination/square wave bolus over 3 hours: 60% of the total dose (7.2U) will be delivered within seconds of pressing the “deliver” button; the remaining 40% (4.8U) will be delivered equally every few minutes over the next three hours. The result is an initial dose to cover faster-digesting foods, plus an extended amount of insulin action to deal with the slower-digesting foods (which tend to be fattier or have more protein), and to prevent postprandial spikes in blood glucose. Utilizing these settings can be extremely helpful when you’re eating foods like pizza, pasta, Chinese food, Mexican food, or ice cream. Always consult with your diabetes healthcare provider before making any changes to your dosing routine.

Dexcom CLARITY Diabetes Management Software

Photo credit: Dexcom

Dexcom Clarity App

This software can be helpful for patients already using the Dexcom continuous glucose monitoring system, but are wanting to track and change problematic patterns in their blood glucose. This app lets you set target goals for your blood sugars, will track time-in-range, detects patterns of highs and lows and will alert you to them, and will even give the user a predicted HbA1c result. You can also choose to share your data with your health clinic to make changes to your insulin routine or insulin to carbohydrate ratio in real time, and to really find what will work best for you for optimal management.

Living with diabetes is never easy, but thankfully technology has made counting carbohydrates and eating easier than ever before. What apps or tech has helped you to navigate food, eating, and counting carbohydrates? What’s worked best and what hasn’t? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

Going Virtual: The Future of Diabetes Care

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

By Todd Boudreaux

Ashlyn Mills is a physical therapy assistant in an outpatient setting in Florida, working with people with orthopedic and neurological disabilities. She was diagnosed with type 1 diabetes when she was 19 years old. Ashlyn recently started using DreaMed’s telehealth platform to see an endocrinologist, and spoke with Beyond Type 1 about the shift to virtual care.

Beyond Type 1: To start, can you tell me about your diagnosis, and how you originally managed your diabetes?

Ashlyn Mills: I had a strange diagnosis, it was caught a little bit early. I was already being followed by an endocrinologist for some other issues and we started noticing some higher blood sugars on labs. My A1c wasn’t incredibly high so they put me on a Dexcom and started monitoring my blood sugar so they could see what kind of patterns I was experiencing. My fasting blood sugars crept up higher and higher and they went ahead and added basal insulin at that point. I was insulin dependent about three months after my diagnosis.

They diagnosed me with type 1 from the start. They did say that it looked like a latent onset (LADA), but it was pretty clear that it was type 1 from the get go. I was using insulin pens at that time.

Tell me about your treatment since diagnosis.

I live in a rural area in Florida. There’s not an endocrinologist around here. I had been seeing an endocrinologist at the Mayo Clinic in Jacksonville, which is about a two and a half hour drive for me, and that was just because that’s who came recommended by my primary care physician. I was diagnosed at the Mayo Clinic and followed up with endocrinology there for the first two years after my diagnosis. The nurse practitioner that I was seeing there actually left and came to a clinic that was about an hour and a half from my home, and I had a good rapport with her. I went ahead and followed her.

Her and I had come to the understanding that it was difficult for me to see her every three months, so instead I saw her every six months. It became a little bit of an issue for me being able to talk with someone in between if I had issues, which is how I found DreaMed. I could find somebody to bridge the gap between those six months that I’m going without seeing a doctor in person. Now, I’m able to communicate with someone whenever I want to.

How have you been keeping up with your job as a healthcare worker living with T1D during the pandemic?

Florida did a stay at home order back in March. About mid April my employer decided, “We’re going to send everybody who is high-risk home.” I worked from home for about two months and then the numbers started looking better and they sent me back to work. Now, I’m working in the clinic every day and it is nerve wracking. I’m still working but I’m quarantining from my family right now because I was exposed at work.

I go through phases where I feel like I would be fine if I got it but then I have bad blood sugar days and I’m like, “This is it. If I get COVID I’m doomed because my blood sugar was over 200 mg/dL all day today.” Overall, I think I would be okay but I do worry about being hospitalized. I think that’s my biggest fear with the whole entire thing is ending up in the hospital with no family there to be with me. I pray every day that I stay well but I am working and the numbers in our county are rising quickly

How did you find out about DreaMed and what was that process like getting started?

When I was sent home and started doing telehealth with my patients I realized this is easy, there shouldn’t be any reason why I can’t do this.

At the time my endocrinologist’s office was not offering telehealth appointments, even in the midst of COVID-19. I started doing a little bit of research and found DreaMed. I went on the website and signed up for more information. My experience as a provider doing telemedicine is what led me to push to try to find someone that could do the same with me as a patient.

How does DreaMed work?

They asked me what state I lived in and they connected me with an endocrinologist here in Florida, Dr. Kava. I set a telemedicine appointment with her and she spent about an hour with me on that first call. I think you can view it as a replacement service for your current endocrinologist or just an add-on to your current care.

Was it surprising your appointment lasted for an hour?

Dr. Kava would have spent as long as I wanted her to with me. My normal appointments in the clinic, I drive about two hours to be seen for maybe 10 minutes. Most of the time there’s not too much to discuss at those appointments you just make a few changes, but she asked all about my personal life, including my mental health during the pandemic. She really seemed invested in me as a person, too, not just diabetes.

She nitpicked my data because I told her I’m a little bit of a control freak. She said, “If you want tight control I’ll help you.” She spent a long time combing through all of my graphs and figuring out what we could do to get things even tighter than they already were.

Has any diabetes provider before Dr. Kava asked about your mental health?

That’s the first time I recall that happening. When I was first diagnosed I had a diabetes educator talk with me about mental health and diabetes to prepare me for what may be to come with my mental health. They assume if your control is good you’re doing okay with your mental health, but that’s not always the case. I don’t necessarily quit caring for myself when I feel burned out but that doesn’t mean I’m not struggling mentally with it.

It was Dr. Kava spent a good bit of time talking with me about mental health and diabetes and how my mental health was doing with COVID-19 and all of that so I was very impressed with that.

Were there any other specific suggestions that stuck out to you?

Most adult endocrinologists seem stuck in the stone ages a little bit. Dr. Kava looked at my data and she said, “You’re on a closed loop system. The system is going to suspend you if you’re going to go low. If you want to stay below 140 or if you want to stay below 120 I can help you get your settings there.” That was the first time that I had ever had someone be willing to be that aggressive with my care, but I felt like she was totally game for whatever I wanted her to help me do.

Do you think that you’ll continue using DreaMed?

Yeah, ideally I would like something to bridge the gap right now. Although my endocrinologist has started offering telemedicine I’d like somebody that I can talk with through DreaMed and not feel like I’m bothering. When you’re bothering your endocrinologist a lot of times you’ll get an unexpected bill; it would be nice to pay the monthly fee and have somebody at my fingertips whenever I need them. If my endocrinologist quit offering telemedicine I would love for DreaMed to replace my current endocrinologist. As much as I love her it’d be nice to do telemedicine and not have to drive two hours to be seen by someone.

Do you have any advice for someone living with type 1 who doesn’t currently have access to a local endocrinologist?

I just think if anyone’s trying to figure out what to do in the time of pandemic or just tired of driving to see an endocrinologist as frequently as they do, I would suggest looking into DreaMed. They’re currently offering a three-month trial. I have no dog in the fight, I’m not being compensated to say anything about them. You have nothing to lose. They are very honest and I think it’s worth giving a try.

Source: diabetesdaily.com

Making the Most of CGM: Uncover the Magic of Your Ambulatory Glucose Profile

This content originally appeared on diaTribe. Republished with permission.

By Cindy Takigawa and Frida Velcani

What’s an AGP report, and what does it show? Why does my AGP matter? How can I use an AGP report to improve my blood glucose levels and time in range?

Having diabetes is a full-time job: you have to simultaneously monitor your diet, activity, stress, and even sleep. On top of that, you need to calculate and manage the number of carbs you consume in each meal, and keep careful tabs on your blood sugar levels. The Ambulatory Glucose Profile (AGP) report, developed by the International Diabetes Center, is a tool that provides a simplified way to look at data on your blood glucose patterns and trends. It has been recognized as a standard of care for reporting continuous glucose monitor (CGM) data by the American Diabetes Association. In this article, we explain what an AGP report is and how you can use the information to help you navigate your diabetes management.

CGM App

Image source: diaTribe

What is an ambulatory glucose profile report?

An AGP report is a standardized, single-page report that includes glucose statistics like time in range, a summary glucose profile, and daily glucose graphs. It converts blood glucose readings from a CGM device into a detailed picture, allowing you to quickly visualize the time you spend above and below your target range. The report is based on at least seven days of CGM data, with 14 days of data (or more) considered ideal. Currently, many CGMs include a version of the AGP report in their devices and reporting software.

An AGP report that summarizes data provided by self-monitoring of blood glucose (SMBG) is currently being developed. This article focuses on CGM AGP reports.

Why does my ambulatory glucose profile matter?

The AGP report is the same no matter what device you use – it allows your healthcare team to assess blood glucose levels and trends in a standard way for everyone they see. Below you’ll find sample AGP reports from Abbott, Dexcom, and Senseonics.

The AGP report shows patterns in a user-friendly way so that people with diabetes can easily identify the times of day when glucose levels are consistently low, high, or fluctuating. The general goal for people with diabetes is to have their glucose levels stay within the target range of 70 to 180 mg/dL for at least 70% of the day, spending less than 4% of their time in hypoglycemia (under 70 mg/dL). The information from an AGP report can help you have a discussion with your healthcare team about goals for your diabetes management and ways you can achieve them. The data offered by this report can help make your care far more precise and effective.

What exactly does your AGP show?

The standard AGP (designed by the International Diabetes Center and shown above) will show your data like this:

  • Glucose Statistics and Targets: This section displays metrics including average glucose, glucose variability, and Glucose Management Indicator (GMI), which can be thought of as your predicted A1C. It also includes the dates and number of days in the report, as well as the percent of time that the CGM was used to collect data. While time in range goals can be individualized, the expert-defined goals for various groups of people with diabetes can be found in this section. You can read more about time in range targets here.
  • Time in Ranges: This color-coded bar chart helps you visualize the percentage of time spent above and below your target range.
  • Ambulatory Glucose Profile: This graph combines all of your glucose readings over time to display your trends across a 24-hour period. At the end of this article you can find examples of what this will look like for your specific CGM.
    • Black line: the median of all the readings. Half of your glucose values are above the middle black line and half are below.
    • Green lines: this is your target glucose range.
    • Dark blue area: 50% of glucose values lie in this area.
    • Light blue area: 90% of glucose values lie in this area. This percentage may differ between AGP reports. The International Diabetes Center report includes 90% of glucose values, while the Eversense report shows 80% of glucose values.
    • Dotted blue lines: 5% of the highest and lowest glucose values are above and below this line, respectively.
  • Daily Glucose Profiles: Each box shows your glucose pattern from a single day.
    • Yellow area: instances of high glucose (hyperglycemia).
    • Red area: instances of low glucose (hypoglycemia).

How can I interpret an ambulatory glucose profile report?

An AGP report combines several days of blood glucose readings into one snapshot. Once you have identified daily patterns, you can work with your healthcare team to adjust your medications and insulin dosing to spend more time in range. You may also discuss timing of food or physical activity, what you are eating, or ways to reduce stress. Here are some steps you can take to understand your data:

1.     Look at your time in range. The goal is to shift the numbers into the 70 – 180 mg/dl target range while having fewer lows and extreme highs. Each AGP report includes a bar chart of your time in range; one way to see this goal in action is to aim for more “green” and less “red” on the bar chart.

2.    Keep track of the usual times you wake up, go to sleep, eat meals and snacks, and are physically active. Food, activity, medication doses, and dozens of other factors can affect your blood glucose levels. Recording these activities and their timing will help you understand your AGP report and the patterns you see.

3.    Identify times when your glucose levels are lowest and highest, and look for times of more variability. Speak with your healthcare professional about what factors may be causing highs, lows, and variability in your AGP and how you can reduce them. The wider the shaded blue areas on your report, the more variability there is in your glucose levels.

4.    If you can, compare your current and past AGP reports, and create an action plan with your healthcare team. What strategies did you use previously to make changes? Identify a few steps to improve your glucose patterns moving forward.

To learn more about how people with diabetes and healthcare professionals can use AGP, click here. For more resources on time in range, check out diaTribe’s comprehensive library here.

Abbott AGP

CGM App

Image source: diaTribe

Dexcom AGP

Dexcom

Image source: diaTribe

Eversense AGP

AGP

Image source: diaTribe

Source: diabetesdaily.com

REVIEW: Companion Medical’s InPen, A Smart Delivery System

Companion Medical’s smart insulin delivery, the InPen, is a reusable injector pen plus user-friendly mobile device which allows individuals to improve their diabetes management. I choose multiple daily injections (MDI) over a pump for various reasons, but I cannot deny that a pump allows for more precise calculations. With InPen, people on multiple daily injections can achieve the same accuracy plus so much more!

What Is It?

The InPen is a reusable injector pen that not only helps you calculate your doses but also keeps a log of insulin data for up to a year. The InPen connects, via Bluetooth, to the smartphone app, and keeps track of all your insulin deliveries.

InPen is now approved for all ages (7 and over, or under the supervision of an adult), who are insulin-dependent. The pen can deliver between .5 units to 30 units of insulin, dialed in half-unit increments. The pen is compatible with the Lily Humalog, Novo Nordisk Novolog and Fiasp U-100 3.0 ml insulin cartridges.

InPen is compatible with all Apple iOS devices that support iOS 10 or greater. It is also compatible with Android (more info about compatibility here).

What Does It Do?

I made sure to use this pen for about a month before writing my review. I am in awe of how easy this pen makes my management. Up to now, to be quite frank, I am guilty of a lot of “WAGS” (wild a** guesses) and then winding up too high or too low. I also really never kept tabs on when my last insulin dose was, so would find myself stacking quite often. Thanks to InPen, a lot of this carelessness has been eliminated. Here are all the amazing things it can do:

1. Insulin delivery information

The InPen connects to the app via Bluetooth which allows the app to store your insulin delivery information and shows you how much insulin you have taken and how much you have on board. There have been so many times when I would correct a high, not realizing I still had insulin on board, which led to episodes of hypoglycemia. As you can see here, your information appears in real time from your lock screen.

InPen Screenshot 1

Screenshot from Companion Medical

2. Built-in calculator

The InPen has a built-in calculator to help you get the most accurate dose possible. Your physician enters your settings, and it will give a recommendation on how much to dose. It takes into account your previous insulin delivery, your current blood sugar and the number of carbs you are eating. Since I have been using this feature, my blood sugars have improved greatly.

InPen Screenshot 2

Screenshot from Companion Medical

3. Reminders

It also has a reminder to take your long-lasting insulin. There have been so many times when I can’t remember if I took my Tresiba. I know this is a common problem for people on daily injections. This takes the burden off of the individual and has proven to be one of my favorite features.

InPen Screenshot 3

Photo credit: Companion Medical

4. Reports

The InPen generates reports that you can share with your healthcare team. These comprehensive reports will allow for easier decisions regarding changes to your diabetes management.

Screenshot from Companion Medical

5. Temperature alerts

The InPen comes complete with temperature alerts! It will notify you anytime your pen is in temperatures too hot or too cold which could make your insulin ineffective. This will come in handy during my next vacation or even if I leave my bag in the car for too long.

6. Syncing to Dexcom

InPen can sync up to the Dexcom continuous glucose monitor, via the Health app. This allows you to see your continuous glucose monitor graph on your logbook and reporting feature of the app.

Screenshot from Companion Medical

How Can I Get the InPen?

Many commercial insurance companies cover InPen, you can fill out this form and a representative will contact you about your copay. They also have a copay assistance program.  Commercially insured InPen customers will not have to pay more than $35 dollars a year which is a small price for better control.

Conclusion

I think InPen is a game-changer for anyone on multiple daily injections. With all of the capabilities the InPen offers, I can achieve better blood sugar numbers. I feel more in control of my diabetes because now I am confident that I am administering the right doses. I am also avoiding stacking insulin, which means fewer blood sugar roller coasters, and now I also have reminders to take my long-lasting insulin.

InPen can also help empower children to make better choices and manage their own diabetes. You can even sync two different pens if a child wanted to leave one pen at school and one at home.

Using InPen has helped me take back some control of my diabetes. It allows me to feel more in control and allows me to spend less time thinking about my condition. I can’t imagine going back to MDI without InPen in my toolbox and highly recommend this to anyone else who prefers injections over the pump.

Source: diabetesdaily.com

Can You Manage Diabetes Well Without Lots of Money?

If you live in a country like the United States, where the majority of health insurance is privatized and there is no strong social safety net, it can feel as though managing a chronic disease like diabetes requires nothing but lots of money. And it does. As of 2017, diabetes cost the United States a staggering $327 billion dollars per year on direct health care costs, and people with diabetes average 2.3x higher health care costs per year than people living without the disease.

Diabetes is also devastatingly expensive personally: the cost of insulin has risen over 1200% in the past few decades, with no change to the chemical formula. In 1996, when Eli Lilly’s Humalog was first released, the price for a vial of insulin was $21. In 2019, that same vial costs around $275. Studies show that 1 in 4 people ration insulin simply due to cost. Diabetes Daily recently conducted a survey study, with almost 2,000 participants, of which an overwhelming 44% reported  struggling to afford their insulin.

So where does this leave patients who don’t have tons of money to spend on insulin and supplies, or who don’t have adequate health insurance coverage for the technology to help prevent complications? Can you manage diabetes well without lots of money? The short answer is yes. The long answer is a bit more complicated.

Best Practices for Managing with Less

If you have insurance coverage, but are unable to afford a continuous glucose monitor (CGM) or insulin pump, it’s advisable to follow best practices for optimal diabetes management. According to the Mayo Clinic, one should test their blood sugar:

  • Upon waking
  • Before meals and snacks
  • Before and after exercise
  • Before bed
  • More often during illness
  • More often when traveling or changing a daily routine
  • More often if on a new medication

One study has even shown that following a lower carbohydrate diet can improve health outcomes, reduce complications, and cut down on medication costs for people living with diabetes.

The study goes on to say that, “…insulin dependent diabetics can expect to half or third their insulin requirements. Less insulin injected results in more predictable blood sugars and less hypoglycemia.” However, no patient should ever feel pressured to follow a low carbohydrate diet solely to control the cost of their medications. There can be more effective ways to manage the cost of medications and supplies.

Photo credit: Adobe Stock

No Matter What You Think, Get Coverage

People with diabetes need health insurance coverage. In the short term, this makes sense, as insulin and things like insulin pumps, continuous glucose monitors, syringes, and test strips are expensive. But it also makes sense long term as well. People with diabetes can face serious complications as they age: diabetes is the leading cause of adult blindness and amputations, and is a leading cause of stroke, kidney failure, heart disease and premature death in its sufferers. Having health insurance helps pay for things like surgery, preventive screenings, doctors’ appointments and follow-up care, and any additional medicine and needs that’s needed.

It may seem cheaper to forego coverage, but don’t. Check to see if you’re eligible for Medicaid in your state. If you are, this comprehensive coverage will help you access affordable medication, doctors’ visits, emergency and preventive care. If Medicaid is not an option, see if you qualify for a tax subsidy on the federal or your state’s health exchange. There, you can find a range of affordable options that will cover your diabetes care and (especially) insulin prescriptions.

Get Help Paying for Insulin

Even if you have health insurance coverage, the cost of your insulin may be prohibitively high. According to the CDC, between 2007 and 2017, the percentage of adults aged 18-64 enrolled in a high deductible health plan rose from 10.6% to 24.5%. These plans have a high dollar amount that consumers must meet before their plan kicks in to help pay for things like prescriptions or hospital stays. Some high deductible health plans have deductibles as high as $10,000. This means that someone with diabetes could potentially pay the full $275 a vial for their insulin, every time they fill their prescription, until they reach their $10,000 deductible. These types of plans are cheaper monthly (have lower premiums), but don’t offer great coverage.

If you need help paying for your insulin, you can get low cost insulin through these assistance programs:

  • Eli Lilly’s $35 Co-Pay Program: Launched in early April in response to the COVID-19 crisis, Eli Lilly is introducing their Lilly Insulin Value Program, which allows anyone with commercial insurance and anyone without insurance to fill their monthly prescriptions of insulin for $35.
  • Novo Nordisk: Novo Nordisk has recently launched a $99 program, where people needing insulin assistance can purchase up to three vials or two packs of FlexPen®/FlexTouch®/Penfill® pens or any combination of insulins from Novo Nordisk Inc. for $99.
  • Sanofi: Launched in 2019, Sanofi’s program allows people living with diabetes in the United States to pay $99 for their Sanofi insulins (with a valid prescription), for up to 10 boxes of pens and/or 10 mL vials per month.
  • Medicare: Medicare recently unveiled a pilot program that would cap the cost of insulin. The Medicare Part D Senior Savings Model would cap insulin co-payments to $35 per month, starting in January 2021. Seniors must sign up for a plan that will qualify under the pilot during the open enrollment period, which is October 15 through December 7.
  • Buy a State-Regulated Health Plan: If you live in Colorado ($100 per prescription per month), Illinois ($100 per 30 day supply), Delaware ($100 per 30 day supply), New York ($100 per 30 day supply), Utah ($30 per 30 day supply), West Virginia ($100 per 30 day supply), Maine ($35 per 30 day supply), New Mexico ($25 per 30 day supply), Virginia ($50 per 30 day supply), Washington ($100 per 30 day supply), or New Hampshire ($30 per 30 day supply) and you buy a state-regulated health plan, you are eligible for a copayment cap on insulin (implementation dates pending, but Colorado was the first bill to be implemented and it went into effect January 1st, 2020).

Check the fine print of any health insurance plans on the federal or your state’s exchange to see if they are eligible for the copayment cap. More states are introducing legislation in 2021, so keep an eye out for a bill proposing some similar changes in your state!

Get Help Paying for Supplies

Several companies have launched affordability programs in response to the COVID-19 pandemic. A few new programs are:

  • Dexcom: Is offering up to two shipments of 90-days of Dexcom G6 Continuous Glucose Monitoring System supplies, with each shipment consisting of one transmitter and three boxes of three sensors for $45 per 90-day supply shipment. For existing customers only, if you qualify.
  • Omnipod: Is offering a six-month supply of products (60 pods) free of charge. The program is focused on current US customers who have lost jobs and health insurance as a result of the pandemic.
  • One Drop: This online subscription package charges the consumer a monthly fee, and you get access to cheaper test strips, online personal health coaching, and a mobile app to track your progress. If your health insurance doesn’t adequately cover test strips, this can be an affordable and effective way to go.
diabetes advocacy

Photo credit: T1International Instagram

Advocate for Change

If you see or are experiencing injustice, you should always try and advocate for change. This means writing letters to your elected officials, calling your members of Congress, petitioning your health insurer, testifying for bills that support better health care coverage, and raising your voice to improve policies that will benefit all people living with diabetes. Get involved in the diabetes online community on Facebook or Twitter. Sign up to become an advocate with T1International. Donate to your favorite diabetes charity who’s working to make things better.

Show up at your state capitol and talk to people about what it’s like to live with diabetes, how expensive it is, and how crucial good coverage and affordable medications really are. You can live a great life with diabetes, but coverage, laws, regulations, and policies can always be better. And things won’t improve until we have everyone at the table, advocating for change.

How are you able to manage well with less to spend? What policies or changes would you like to see in the US healthcare system that would make management easier for you? Share this post and your story, below!

Source: diabetesdaily.com

One Year into DIY Looping

One year ago, I built a DIY hybrid-looping insulin pump, using my Dexcom G6 and Omnipod. For those who aren’t in the know, DIY “looping” is basically “hacking” your insulin pump with a single-board computer, such a Raspberry Pi or Riley Link, to make it communicate with an existing continuous glucose monitor (CGM) to make basal adjustments accordingly.

It’s important to note that this is NOT FDA approved, but the #WeAreNotWaiting community has been sharing information on how to build your own DIY looping insulin pump for years now, and I took the plunge in 2019.

In July I celebrated one full year on my looping system, and wanted to share my thoughts on 365 days of looping.

I Still Have Diabetes

I remember when I first set up my Riley Link and switched on “auto-mode.” I had this magical vision of never counting carbohydrates again, limitless runs without lows, and forgetting what the thirst of a high blood sugar felt like. Then I realized, just as quickly, that I still have diabetes.

Even though my Dexcom continuous glucose monitor (CGM) readings now communicate with my insulin pump and make basal adjustments accordingly, the “hybrid” part means that it doesn’t anticipate, nor account for, any carbohydrates eaten. I also need to tell my pump when I’m about to exercise, and for how long. Since the insulin pump does not operate on artificial intelligence (AI), it cannot anticipate what I’ll do next.

So yes, I still have lows on runs and I still have highs when I eat something that isn’t appropriately accounted for. I still have to count carbohydrates and no, I haven’t forgotten what the Death Valley-like thirst of a 350 mg/dL feels like, although it happens less frequently.

My HbA1c Isn’t That Much Lower

I have always been maniacal about tight diabetes control. My A1cs have hovered in the low 6s for the last 10 or so years. With Loop, I immediately thought that my control would be *perfect* and I would ride out the 4s and 5s into an eternal sunset. NOPE. My latest A1c was 5.9%, which I am rightly ecstatic about, but it’s less than 1% point lower than I was on MDI and a CGM.

The key difference is that my time in range has increased from around 30% to 75%, and the number of lows that I experience has gone down from around 3 per day to 3 per week. It’s easy to have a low HbA1c when you have highs and lots of lows to average it out- it’s much harder (and healthier!) to have a lower HbA1c with few lows. And plus, I just feel healthier. And that has made all the difference.

Dexcom graph by Christine Fallabel

It’s a Mental Vacation

Being a human pancreas 24/7/365 is not easy (why didn’t anyone tell us this at diagnosis?!). In addition to running a household and having a full-time job (and texting everyone back, and maintaining some semblance of a fitness routine, and trying to eat something green at every meal), being an organ all of the time is hard work.

More than anything, a year into looping has given me the mental break I didn’t know I needed. Sure, I still have to count carbohydrates, adjust for exercise, and dose for meals, but hours can go by where I don’t think about diabetes at all, and that never used to happen. My mental distress has gone way down, and I don’t experience diabetes burnout at nearly the frequency I used to. This also helps maintain my motivation to continue to take care of myself and my diabetes.

Dosing Is More Discreet

As I make my way through my 30s, this is less of an issue (if you have a problem with me dosing in public, the problem is you, not my diabetes), but looping has definitely made checking my blood sugar (read: checking my phone) and dosing (also read: checking my phone) way more discreet in public than manually testing my blood sugar and dosing used to be. It’s also more hygienic (I change my insulin pump with plenty of alcohol swabs every 3 days from the comfort of my home), and more convenient. This is perfect when I’m out at a crowded concert, or squeezed into a small table at a restaurant.

It can also cause issues. For instance, if I’m in a public place where cell phones aren’t allowed, sometimes it’s difficult to explain that my iPhone is actually durable medical equipment (DME) that I need to survive. Let’s just say there have been some teachable moments.

Loop app screenshot by Christine Fallabel

I Am Happier

When I was diagnosed with type 1 diabetes in June of 2000, my doctor told me that the cure was just 5 years away. I thought the cure was just around the corner, we all did. And learning that the “cure” is still out of sight, 15 years hence, has been a hard pill to swallow.

I’ve dealt with anxiety and the impending depression of only someone who has a chronic disease with no cause and no cure can experience, but having something like Loop feels like someone is finally on my side, looking out for me, and making things just a little bit easier when the load becomes too heavy of a burden to carry. I can go to sleep and know that my basal will immediately shut off if I start to go low overnight. I can relax if I’m digging into dinner at a friend’s house and I don’t know the exact carb count for a meal, knowing my basal will tick up to cover the difference.

Having a Loop feels a little bit like you have a certified diabetes educator (CDE) and best friend just sitting on your shoulder, making constant adjustments, never judging, and ensuring that you have a better go of it, a little bit of help when you need it. And that help has been life-changing. The cure may never have been 5 years out, but with Loop, I finally feel okay waiting just a little bit longer.

Do you DIY Loop? How has your experience been? Share this post and comment below; we would love to hear from you. Follow the #WeAreNotWaiting hashtag on Twitter to learn more about the DIY movement.

Source: diabetesdaily.com

Tandem’s Control-IQ Cleared for Ages 6-13: Automated Insulin Delivery for Children!

This content originally appeared on diaTribe. Republished with permission.

By Divya Gopisetty, Hanna Gutow, and Albert Cai

In exciting news, Tandem announced expanded clearance for the hybrid closed loop Control-IQ. The system is now available for children ages 6-13

The FDA cleared Tandem’s automated insulin delivery (AID) system, Control-IQ, for children ages 6-13, last week in the US. This system is designed to increase time in range for users and it does – see below for the data!

To date, the only other hybrid closed loop system available for children is Medtronic’s MiniMed 670G, which is approved for children seven years and older. Control-IQ is the first system with automatic correction boluses and no fingerstick calibration (thanks to the Dexcom G6 sensor that it uses).

Control-IQ launched in January of this year for people 14 years and older. Since then, more than 40,000 t:slim X2 pump users have upgraded their pump software to Control-IQ. We saw very positive real-world data presented at ADA this year – in the first 30 days using Control-IQ, users’ time in range increased by 2.4 hours per day, and individuals were in active closed loop 96% of the time.

At the ATTD conference in February, the trial for Control-IQ in children presented strong results. Results from that trial were used to get this week’s FDA clearance. In that trial, we learned that:

  • Children using Control-IQ spent 67% time in range, compared to 55% for children using a sensor-augmented pump. This is a massive difference that equals nearly three more hours in range each day.
  • Children using Control-IQ reached 80% time in range overnight, compared to 54% in the control group – similarly, this change is even bigger, at over six hours more daily time in range.

Control-IQ still should not be used in children under the age of six, in people who require less than ten units of insulin per day, and in children who weigh less than 55 pounds.

For more information on the system, check out Kerri Sparling’s Test Drive of Control-IQ where her time in range improvement was quite impressive! You can also Katie Bacon’s piece on one family’s takeaways (her own!) from the first month of their teenage daughter using Control-IQ.

Source: diabetesdaily.com

How Coming Out Helped Me Accept My Type 1 Diabetes Diagnosis

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

By Peter Friedfeld

I’d like to tell you a bit about my journey. First, you have to understand something about me: as a lifelong hypochondriac, I always only ‘thought’ I got diseases. So imagine my surprise being diagnosed as a diabetic not once, but twice. The first time was in 2014, right after my 55th birthday when I was diagnosed as type 2. Then two years later in 2016 ­­I was re-diagnosed as a type 1.

I’ll never forget sitting in the office of my new Endocrinologist when he leaned over his desk and said thos­e words that I feared. “You are a type 1 diabetic.”

As he pulled out two boxes he said:

“You inject yourself with this every morning, and you inject yourself with this at every meal.”

I asked “For how long?”, thinking he’d say for a week, a month… And he looked at me straight and said …“for the rest your life!” That’s when the gravity of being type 1 began to sink in.

What I eventually came to understand is that taking my daily shots would be the easiest part of managing this disease.

My New Normal

I was scared to be alone in the early days, and not sure if I would wake up in the morning. After two years of finger pricks, I finally started to use technology (reluctantly) to help manage my Blood Glucose numbers. I remember my first night wearing my Dexcom sensor —which would wake me up if I went low overnight. I explained to my husband Patrick that we were in this together, and explained how when a sensor goes off I may need his help, especially if I’m experiencing a low, scared that I would sleep thru my alarm. Sure enough, that first night, my sensor went off and I hear Patrick wake up and say “ALEXA OFF!” and go back to sleep.

But in all seriousness, my husband has been incredible, and he is just one of the many people whose support has helped me successfully manage living with type 1 diabetes.

I struggled those first few weeks after diagnosis. I would go out with friends, unable to tell them the truth about my diagnosis, and hiding the fact that I was taking insulin. I felt isolated, alone, scared. I felt I had no future, no ‘normal’ life ahead of me. But these feelings were somewhat familiar, reminding me of a time, 35 years earlier, when I was struggling to come out as a gay kid.

This feeling of isolation —that once I ‘disclose’ who I am I will forever be ‘branded’ by others. I didn’t want to be thought of as type 1, just as I didn’t want to be thought of as Gay. But coming out back in the 80s taught me some powerful lessons that I would use on my diabetic journey.

Learning From the Past Life Challenges

I left the sheltered and at times suffocating world I grew up in on Long Island and moved to NYC in 1987, to what was then the heartbeat of gay NYC, at the intersection of Christopher and Bleecker Street. Coming out gay was a real struggle for me, much of which had to do with my own insecurities and hiding who I was for years. The secrecy had taken its toll. I knew I needed to reach out to find other people ‘just like me’. Finding my community created the instant connection that crossed all barriers, and a sense of belonging and acceptance was more than comforting, it was empowering. I had no idea at the time that this process of ‘finding community’ would provide the building blocks that would get me through a life altering diagnosis to come decades later.

Diagnosis

Image source: Beyond Type 1

The 80s were a unique time in the struggle for LGBT rights (Q was not part of the acronym then). It was before the internet, before Instagram and Facebook, which meant finding others would be easier in the big city then it was back in the suburbs–all IRL-in real life. We found a collective strength in ‘community’ that we had to build from the ground up. It was a time when gay culture and awareness was just beginning to evolve in a more public way. I was also living in ground zero of the AIDS crisis in America—where our community literally had to fight for our lives. As our friends and loved ones died, we shifted our community from connection to action. And it was in those very dark days, I understood there was strength in numbers, that organizing began on the streets and there was power in the ballot box. We could change the world by being open with who we are, by educating our friends and family, to engage and not isolate. In the process, I learned how to be an Advocate – and that I could help raise awareness only by becoming visible first.

Ultimately, through my connection with others and in finding my own voice, I learned to be proud of myself and comfortable in my own skin. I learned as a gay young adult, the only limitation I had was myself. It took me a while, and so many were part of that journey.

25 years later, being faced with a new challenge of my type 1 diabetes (T1D) diagnosis—I drew on the strength of the lessons I learned, and eventually it became clear to me that I would need to come out once again. I knew I needed to find my T1D community, and embrace being a type 1 diabetic.

Finding myself again

Diabetes is often referred to as an invisible disease. I hear, “…but you don’t look sick”, just like I heard, “but you don’t look gay”.

I started searching online — I guess where everything starts today. I found an amazing resource in Beyond Type 1, an online community over a million strong. I read an article about Yoga and type 1, written by a type 1 health Coach Lauren Bongiorno. Lauren helped me understand that I can live a happy and healthy life, and helped me take control of managing my disease.

Lauren connected me to Erik Douds, a global adventurer who was biking and hiking around the world. I realized if Erik was able to bike 3000 miles across America, (with only two weeks of training I might add) – I should be able to manage to Bike around the Hamptons.

Both Erik and Lauren taught me how important it is to be able to take care of myself—and to have the confidence to be able to do that. And they both had my back. They opened my eyes to the power of this community. A community that has since connected me to so many — Susan, Rob, Jillian, Eoin, Austin, Jesee, Sarah, Qiana, Mia, Luke, Danielle, Matt, Bill, Alison, Thom, Dom, Peggy, Sara, Annalisa, Rachel, Raquel, Evan, Nate, David, Gerry, Arron and so many more. Proud T1Ds and allies.

Once again, it was thru this community that I learned as a type 1 diabetic, the only limitation I had… was myself.

When it comes to advocacy and education today, I lean on those early years coming out as a gay kid. Only by being visible can I affect the change I seek. I am passionate about talking to others about having type 1 diabetes, injecting in public, proudly wearing my Dexcom and identifying myself as a T1D (Yes I have the Rob Howe Diabetic Hoodie).  I love connecting, learning, and sharing—and being part of a community that is stronger than any individual voice.

Diagnosis

Image source: Beyond Type 1

I now recognize that we need allies in our fight as T1Ds, and that our numbers are too small to move the needle ourselves. We need our voices to be heard, and that requires our non-T1D friends, family and work associates to help amplify our voices as a community in need—of acceptance, of understanding, of healthcare for all, and for the cure we deserve.

My Story Is Only One Story

Today, 1.25 million people in America are living with type 1 diabetes, and every day an additional 100 people are diagnosed —at least 40,000 people per year —it’s a staggering number of lives that are changed forever. 

For so many, our lives are filled with frustration, burden and struggle. We need insulin every day just to stay alive. Insulin is a life-sustaining drug, but it is not a cure. We need a cure. And until that day comes, we need to help each other live the best life possible. It is our responsibility, to ourselves and to the community we created and are part of.

As for my husband Patrick—when we exchanged our vows, we said “for better or worse”. Well, my goal is to somehow make this experience part of the ‘better’. His support since day one has been unconditional. He lives each day as the life of a type 1 partner—watching over me, working with me, making sure I am safe and loved.

Finally, I recall asking my doctor a question that many of us asked when we’re faced with a chronic illness or life-changing disease “why me?” My doctor said, “Peter, it’s just your thing.”

At that moment, I thought I was alone and isolated in my battle with my new LADA diagnosis. But the reality was once I learned to open myself up to others and to embrace community— a lesson I learned so many years earlier, it was no longer ‘my thing’.  Today, 6 years into my new life, I  choose to make it a positive experience: to support those who struggle, to be supported, to learn, to help create and foster community, and to do all I can to help find a cure.

Source: diabetesdaily.com

Diabetes Deadliest Mistakes

Whether you are living with type 1 or type 2 diabetes, you likely take medication that helps keep you alive and functioning properly. We continually measure, count and remind ourselves to take our medication and/or insulin very meticulously to ensure we are taking the proper medication and correct doses.

But we are human, and mistakes do occur. Sometimes these mistakes can be deadly.

Recently, while mid-conversation, I managed to take 18 units of Fiasp instead of my long-lasting insulin, Tresiba. This has happened to me one time before when I was first diagnosed when I took 16 units of Humalog instead of Lantus. My endocrinologist sent me right to the hospital because at the time I was new, nervous and unable to handle it on my own. This time, the moment I released the needle from my skin my stomach dropped to my feet.

Fiasp is even faster-acting than Humalog and I knew I had minutes to ingest a whole lot of carbs to counteract the large amount of insulin I had just taken.

I managed to inhale over 200 g of carbs in 20 minutes in the midst of a mild panic attack. I was nauseous, jittery and scared for what lay ahead. The day wound up being a series of lows but I was lucky I came out of it unscathed. Had I not realized I took the wrong insulin I could have easily passed out, had a seizure or died. My original plan for the day was to kick it off with a walk to a nearby shopping center so had I not realized, my blood sugars could have plummeted and I could have been left for dead on the side of the road.

I got lucky. We all have gotten lucky. Some have not. Many of us, unfortunately, know people who have lost their lives due to a diabetes mistake; and yes, sometimes their own.

I asked our friends in the diabetes online community what their biggest and deadliest diabetes mistakes were and this is what they had to say.

“I forgot a snack after breastfeeding and had my first hypoglycemic seizure. The first reading they could get was 27.”

“I am a type 2 diabetic and sometimes get shaky and I know I need a snack. I grabbed a brownie as I left my house but I wasn’t feeling any better. I realized that I grabbed a low-carb brownie so it wasn’t going to help raise my blood sugar! I wound up having to stop for a soda.”

“I’ve mixed up my insulin before. 27 units of Humalog is much different than 27 units of Levemir!”

“In my last year before I quit drinking, there were 2 distinct times I can remember where I was so low and so drunk I couldn’t figure out how to get food to save my life. One time I had my friend help me. The other time I went back to sleep and miraculously woke up the next morning.”

“I took some expired test strips from someone in the diabetes online community. For days I kept reading really high and couldn’t understand why. Finally, I rage bolused and took a hefty correction dose. I started seeing spots and beads of sweat formulated all over my entire body. My reading was 28. Turns out those test strips were bad and I could have killed myself trying to save a couple of bucks.”

“I forgot to check my blood before I had breakfast and had a banana and shot up to 500!”

“I recently bolused for a snack twice. I was low in the middle of the night but the snack was larger than needed to fix so I did took a partial bolus and went back to sleep. I woke up and didn’t remember taking any insulin so I did it again. Rollecoasting ensued. I’ll mess up worse, I’ve only been at this for 2.5 years.”

“Bolused for 80 carbs instead of 8 before a workout without realizing it. Dexcom alerted and I quickly realized how much IOB I had. Apple juice and gels to the rescue.”

“I’m on Zyloprim for my gout and I fill my pill case once a week. I accidentally put Zolpidem in and was wondering why I kept waking up so damn tired!”

It is safe to say that managing our condition can be risky at times. We are administering medication and insulin, which can be extremely dangerous if the wrong dose is given. We must remain diligent at all times to avoid errors, all the while realizing that we are human and we do make mistakes. Have grace with yourself.

Have you ever made a dangerous mistake? Comment and share below, hopefully, we can help each other to avoid similar occurrences.

Source: diabetesdaily.com

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