Your Brain and Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Brett Goerl and Matthew Garza

Recent studies have shown a link between brain diseases like Alzheimer’s and Parkinson’s and diabetes.  Unfortunately, these conditions are becoming more common as our population grows older. Find out more and ways to improve brain health.

What are neurodegenerative diseases?

The term “neurodegenerative diseases” refers to a range of diseases in which the cells in our brains break down and can no longer perform their designated functions associated with movement or mental ability, according to the EU Joint Programme – Neurodegenerative Disease Research. The most common neurodegenerative diseases that affect people with diabetes are mild cognitive impairment (MCI) and dementia, which includes Alzheimer’s disease.

As we age, it is completely normal for our memory, thinking, and judgment to slightly decline. However, MCI occurs when our mental abilities decline faster than expected and begin to interfere with our daily lives. Age is by far the biggest risk factor for MCI, but diabetes, smoking, high blood pressure and cholesterol, obesity, and depression can further increase a person’s risk of developing MCI.

In around 10-15% of cases each year, the mental decline seen in MCI may progress further, making it difficult for us to carry out a healthy and happy life. When this happens, it is called dementia. The two most common types of dementia that affect people with diabetes are Alzheimer’s disease (AD) and vascular dementia.

While the symptoms of AD and vascular dementia are similar, they are caused by two different processes that occur in our brains. AD is thought to be caused by the abnormal build-up of proteins in the brain. One protein is “amyloid,” which clumps together in spaces around brain cells. The other protein is “tau,” which get tangled up inside brain cells. Vascular dementia, on the other hand, occurs when the blood vessels in our brain become narrow or start to bleed. This reduces the brain’s ability to get the oxygen it needs to keep brain cells healthy and for the brain to function properly. In both cases, brain cells become damaged, leading to a wide range of problems such as memory loss, worsened judgment, and personality changes.

AD is the most common form of dementia in the US, making up 60-70% of dementia cases. In the US, an estimated 5.4 million people of all ages are affected by AD, and one in eight people 65 years and older suffer from it. Considering the 14.3 million adults aged 65 and older in the U.S. who have diabetes, and it is easy to see why Alzheimer’s disease and diabetes are two of the most common diseases of aging. And recent research has suggested that they may be linked in various ways.

How do neurodegenerative diseases like Alzheimer’s and vascular dementia relate to diabetes? 

We often think of diabetes as a problem with our metabolism since the lack of insulin (in type 1 diabetes) or insulin resistance (in type 2 diabetes) affects our body’s ability to maintain normal blood glucose levels. However, our brain consumes the most glucose compared to any other organ in our body. While the brain accounts for roughly 2% of our body weight, it uses almost 20% of the sugars we eat or release from our body’s stores.

An increasing amount of research shows that people with AD and other forms of dementia experience insulin resistance in the CNS (central nervous system, which includes the brain and the spinal cord), similar to what people with type 2 diabetes experience in other areas of the body, such as the muscles, the liver, and the fat. Scientists have yet to determine exactly what the relationship between diabetes and AD or other forms of dementia may be caused by, but there are a few theories that have been proposed.

  • One of these theories focuses on brain insulin resistance, which is when brain cells stop responding normally to insulin, leading to problems related to the ways our brain cells communicate, use energy, and fight infection.
    • Insulin receptors can be found in many areas of the brain, where they are involved with brain cell growth, communication, and survival. While insulin levels are lower in the brain than in the bloodstream, all the insulin that makes its way to the brain comes from the same insulin produced in the pancreas – it crosses over what is known as the blood-brain barrier (or BBB). This barrier prevents unwanted things from the bloodstream from entering the brain. However, injected insulin does not cross the BBB. The reduced transport of insulin across the BBB may be why brain insulin levels are lower when the body experiences insulin resistance (such as in pre-diabetes and type 2 diabetes) and in diseases such as AD.
    • Insulin in the brain is known to help control our metabolism in certain other organs of the body, like the liver and fat tissue. The hypothalamus, the part of our brain that controls hunger, thirst, and emotions, is highly sensitive to levels of insulin in the brain. The association between type 2 diabetes and brain health may be due to problems with insulin’s actions in the hypothalamus, increasing a person’s likelihood of developing whole-body insulin resistance.
  • Diabetes also increases the risk for damaged blood vessels, leading to heart disease and stroke. Damaged blood vessels can starve the brain of oxygen, leading to cognitive decline and vascular dementia.
  • Diabetes disrupts how our bodies produce amylin, a hormone related to insulin that helps our bodies digest food. People with obesity and pre-diabetes often have high amounts of amylin, some of which can circulate and cross into the brain. Studies have shown that amylin can interact with the same protein deposits in the brain known to cause AD.
  • Experiencing hyperglycemia for long periods of time can degrade the myelin sheath (a protective layer that surrounds your neurons). This leads to issues in how your nerves send and receive signals to your body. It can also lead to your brain cells dying.

Type 1 diabetes could be a risk factor for dementia for many of the same reasons as type 2 diabetes. In particular, the cardiovascular complications such as heart disease and stroke that are associated with type 1 diabetes could provide an explanation for its relationship with vascular dementia. Additionally, higher rates of cognitive dysfunction for those with type 1 diabetes could be related to frequent cases of hyperglycemia and hypoglycemia. Indeed, severe hypoglycemic and hypoglycemic events are associated with increased dementia risk for older adults with type 1 diabetes.

Is diabetes a risk factor for developing neurodegenerative disease? 

On average, people with diabetes experience slightly more cognitive difficulties associated with MCI across their lifespan, but experiencing cognitive difficulty does not mean you will eventually get diagnosed with dementia or AD. The prevalence of type 2 diabetes and neurodegenerative diseases, however, both increase with age, meaning it is more common for older people (65+ years) with type 2 diabetes to get diagnosed with vascular dementia or AD.

Data suggests that people with diabetes have a 73% increase in the risk of developing any type of dementia and 56% increase in the risk of developing AD compared to people who do not have diabetes. This makes diabetes one of the strongest risk factors for getting dementia aside from aging. Health measures like A1C, cholesterolhigh blood pressure(or hypertension), and eGFR are negatively impacted by diabetes and may also be associated with cognitive performance and neurodegenerative diseases.

  • In the ACCORD-MIND trial, the largest and most rigorous study on diabetes and the brain to date, higher A1C levels were associated with lower cognitive function in people with diabetes. Similarly, another study found that the risk for dementia increased as a person’s A1C level increased, regardless of whether or not the person had type 2 diabetes.
  • A recent analysis of over 100 studies found that higher levels of LDL cholesterol (known as “bad cholesterol”) was an independent risk factor for the development of AD.
  • High blood pressure in middle-aged people has been linked to future cognitive decline and dementia, and in particular, vascular dementia. This may be due to high blood pressure in the brain causing damage to blood vessels, such as small blockages and bleeding.
  • In a study on kidney health and dementia recently published recently, researchers found that lower rates of kidney filtration (as measured by eGFR) were associated with higher risk of onset of both vascular dementia and AD.

What about Parkinson’s Disease?

Parkinson’s Disease (PD) is another neurodegenerative disease associated with aging. In PD, the cells in your brain deteriorate and begins to affect a person’s ability to perform daily activities associated with movement. Symptoms can include tremors (rhythmic shaking), muscle stiffness and rigidity, and PD can even slow your movement in a process called bradykinesia. It can also lead to other symptoms not associated with movement such as disrupting sleep, constipation, anxiety, depression, and fatigue.

As with other neurodegenerative diseases, research has been conducted to identify if there is a link between diabetes and PD. In particular, one study from 2018 showed an association between the two conditions. The researchers looked at the English National Hospital Episode Statistics and Mortality Data from 1999-2011 and divided the data into two cohorts, those with type 2 diabetes (2,017,115 people) at the time of hospital admission and those without (6,173,208 people). It was found that those with diabetes had a 30% higher chance of developing PD than those without, and the younger a person was with diagnosed type 2 diabetes, the more likely their chance of developing PD.

Though researchers do not yet understand the exact way that diabetes and PD are related, they do have a few hypotheses. Namely, there is the chance that certain genetic abnormalities that lead to diabetes may also lead to PD; even if one of these conditions does not directly cause the other, people who have one may be more likely to also have the other. In addition, when diabetes and PD coexist in a person, they may create a more hostile environment in the brain, leading the neurodegenerative processes underway in PD to speed up and be more severe.

What are strategies to reduce the risk of developing a neurodegenerative disease?

There is evidence that leading a healthy lifestyle can reduce your risk of developing diabetes-related complications like dementia or PD. For example, heart attacks and stroke can increase the risk of developing vascular dementia; therefore, lifestyle modifications that help you maintain an ideal blood pressure and levels of cholesterol for your age and health status are important. This can be accomplished by exercising regularly and consuming a diet low in saturated fat, salt, and sugar.

Below are some other tips for improving brain health, which can go a long way in reducing the risk of neurodegenerative diseases like AD. The good news is that many of these strategies are also recommended for managing diabetes.

  • Take control of your blood glucose levels by aiming for a greater time-in-range (TIR). To learn more about time-in-range goals, click here.
  • Smoking is associated with higher rates of dementia. In a recent review, smokers were 40% more likely to develop AD than non-smokers. Given that people with diabetes are at an increased risk of developing dementia, smoking is likely to increase this risk further. If you smoke or experience nicotine addiction, talk to your healthcare professional about a plan to quit or cut back.
  • Keep blood pressure at the target discussed with your health care provider (which might be 130/80 mmHg or less, if you are at high risk of cardiovascular disease) by exercising regularly and eating a diet low in salt (aim for less than 2,300 mg of sodium each day)
  • Take your diabetes medications consistently and as directed by your healthcare team. Some early evidence shows that certain diabetes drugs, like GLP-1 receptor agonists, may be beneficial for brain health. In fact, exenatide, a GLP-1 receptor agonist, is currently in clinical trials for treating PD.
  • A very active area of research focuses on the dementia-preventing effects of having an active and stimulating mental life and rich social networks. Working to maintain an active and socially rich lifestyle could help prevent some of the effects of diabetes on dementia risk.

If you are 65 years of age or older and have memory concerns or other cognitive complaints (i.e., brain fog, depression, personality change), talk to your healthcare provider about getting a cognitive assessment. Learn more here.

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

This Is Your Brain on Diabetes (ADA 2021)

The brain affects diabetes, and diabetes affects the brain, a complex relationship that goes in both directions.

For many patients, the brain-metabolism connection means challenges and health declines. Most people that have experienced hypo- and hyperglycemia are well aware of the way that blood sugar troubles can inflict brain fog and other minor short-term malfunctions. Unfortunately, that’s just the start of it. The cognitive dysfunctions associated with diabetes can become permanent.

The first days of the recent American Diabetes Association Scientific Sessions featured several sessions on the intersections between brain health and diabetes. Some presenters sketched out the scope of the problem; others suggested potential solutions. Patients with both type 1 and type 2 have a lot to think about.

The Vicious Cycle

At the heart of the brain-diabetes relationship is a negative feedback loop that pushes people towards bad decision-making and bad health outcomes. Hyperglycemia leads to both short- and long-term cognitive impairment, which leads to increasingly poor glucose management decisions, which leads to more cognitive impairment, a vicious cycle if there ever was one.

Australia’s Dr. Fergus Cameron sketched out this dynamic:

Source: ADA 2021 Presentation

This feedback loop helps define how and why brain issues tend to snowball as the years go by.

The Developing Brain

Diabetes can impact brain function at every age, but perhaps most important is its immense effect on the developing brain. Acute and chronic hyperglycemia during those early, critical years of development can easily cause lasting damage.

Many of the most important negative cognitive effects of type 1 diabetes seem to occur in the first days and weeks leading up to diagnosis. Just days after diagnosis, children already perform more poorly than expected on intelligence tests. “We’re seeing impacts right from the get-go,” said Dr. Ferguson.

The severity of hyperglycemia at diagnosis is also significant: children that are diagnosed during diabetic ketoacidosis (DKA) see much more cognitive impairment than children that never experience that critical state. That difference alone might mean as much as 6 points of IQ, on average.

We don’t like to dwell on immutable factors—today, you cannot change the circumstances around your diagnosis or that of a loved one. It is more important to people with diabetes to learn what they can do now to help improve their health and quality of life. The answer to that is clear: avoid chronic hyperglycemia.

Mental Issues Accumulate

The effect of chronic hyperglycemia is cumulative and comprehensive. As people with type 1 diabetes age, they perform worse on tests of executive functioning, IQ, information processing speed, and memory. The differences are bigger in high school than in elementary school, and the gap just continues to widen throughout adulthood. A 2019 study found that an incredible (and terrifying) 48% of older adults with longstanding diabetes displayed “clinically significant cognitive impairment.”

Dementia and Diabetes

Dr. Anna Marseglia, a neuropsychologist with Sweden’s Karolinska Institutet, took the baton to discuss cognitive impairment and dementia in old age. Most of her talk referred to patients with type 2 diabetes, although it’s possible that patients with other forms of diabetes could still benefit from her conclusions.

Diabetes is a major risk factor for dementia—in fact, the link between metabolic dysfunction and late age mental decline is so clear that Alzheimer’s disease has sometimes been called type 3 diabetes.

But diabetes is not destiny—the risk of dementia is significantly amplified by lifestyle.

The Power of Activity

Dr. Marseglia presented the results from her own study, a look at thousands of older Swedish adults with diabetes, to see if an active lifestyle might prevent progression to dementia. Researchers tried to track both the number of leisure activities that participants enjoyed and the strength and extent of their social connections. Would an active social life reduce the risk of dementia?

The answer was yes, and the correlation was enormous, as you can see in the graph below. “Inactive” adults with diabetes were vastly more likely to develop dementia than “active” adults, whose risk was barely higher than that of people without diabetes. Dr. Marseglia suggested that if all of the adults in the study had led “active” lives, as many as 48% of dementia cases could have been avoided.

Source: ADA 2021 Presentation

The study suggests that while both diabetes and social inactivity are hazards in and of themselves, the real danger is when those two conditions coexist.

Accordingly, Dr. Marseglia highlighted two broad strategies to improve one’s risk of late age cognitive decline. The first is to employ strategies that reduce physical cardio-metabolic burden: improved glucose control, healthier diet, exercise, weight loss, quitting smoking, and so on. The second is to create a kind of resilience within the brain through education, challenging work, and vibrant social activities.

The protective effect of an active life is physically verifiable. Adults labeled “inactive” actually have significantly smaller brains than active adults. Activity, by preserving brain volume, somehow overrides the vascular damage associated with diabetes.

An active life to fight dementia doesn’t just start in old age—good health, mental stimulation, and social activity early in life will also protect the brain from decline decades later.

Executive Functioning in Teens

Teens have a particularly tough go of it; typically, they are the age bracket with the highest A1c.

Anxiety, depression, and diabetes burnout are distressingly common in the teenage years. Such mental health issues can easily throw diabetes decision-making out of whack. As Oregon’s Dr. Danny Duke stated, “When we’re emotionally dysregulated, it affects all of our other executive functions.”

Executive functioning, explained Oregon’s Dr. Danny Duke, is the part of the brain that’s “in charge of making sure things happen when and how they’re supposed to happen.” It’s like “the conductor of the orchestra of our thinking.”

Good executive functioning is of paramount importance to all humans, but especially to those with diabetes, who must almost continually balance short- and long-term costs and benefits. And because executive functioning usually does not fully mature until age 25, it’s no surprise that teens can have so much difficulty managing their conditions.

Some teens have better executive functioning than others, and those that struggle to make good diabetes management decisions need as much help as they can get. Otherwise, the vicious cycle will rear its ugly head once again: poor executive functioning leads to reduced glycemic control, and reduced glycemic control leads to poor executive functioning.

While Dr. Duke focused mostly on the ways that executive functioning failures could lead to dangerous blood sugar swings, he had little doubt that the converse was equally true:

I’ve worked with a lot of these kids that are hanging up there in the mid-300s [mg/dL], doing the bare minimum necessary to stay out of DKA. When we get them back down into range, they’ll often say ‘Wow, I had no idea how bad I felt and how foggy I was thinking.’

A Family Affair

For kids and teens, good diabetes decision-making is a family affair. Dr. Maartje de Wit, of Amsterdam University Medical Center, pointed to several studies assessing the role that parental executive functioning plays in diabetes management success.

Naturally, in younger children, parents will make all significant treatment decisions, but even as children age, parents continue to play a surprisingly big role in treatment success (or lack thereof). Studies show that, for example, maternal executive functioning skills have a significant influence on a child’s A1c levels, and that both the father’s and mother’s involvement played a big role in delivering better glucose control, especially when the children had executive functioning issues themselves. This did not change as children aged, even as they presumably took on more of their own management decisions.

This sounds obvious—less disciplined kids need more help—but it’s not necessarily so easy to determine who needs help, and how to help them.

Identifying and Improving Executive Function Issues

Children and teens with subpar executive function, when asked why they can’t adhere to their diabetes treatment regimen, may say things like “I forget” or “I’m lazy,” or “I don’t know why.”

Whether by nature or nurture, executive function problems are often shared between parents and children. In a presentation aimed at medical professionals, Dr. Rachel Wasserman encouraged practitioners to consider disorganized or scatterbrained parents a real warning sign of potential executive function issues in children.

If you recognize these sorts of behaviors in your child (or in yourself!), it might be worth trying to work with your child to improve his or her executive functioning skills.

Dr. Wasserman recommended activities that require repeated practice and offer progressive challenges. That could describe schoolwork and related academic pursuits; it could also describe athletics like martial arts and yoga.

Today there are also a dizzying number of scheduling apps that people with diabetes can use to help enforce good habits. More old-fashioned techniques, like alarm clocks and post-it notes, can be equally effective. Dr. Wasserman cautioned that advanced diabetes technology, such as insulin pumps and continuous glucose monitors, as helpful as they can otherwise be, do not necessarily lessen the cognitive load on the executive functioning system.

Takeaways

Diabetes has a significant negative effect on cognitive abilities. In type 1 diabetes, this effect can begin very early in life, with the first bouts of acute hyperglycemia leading up to diagnosis. In both type 1 and type 2 diabetes, the damage wrought by high blood sugars is cumulative, and symptoms are likely to get worse over the years.

Hyperglycemia can also set a vicious cycle in motion, whereby high blood sugars cause bad decisions, which just cause more high blood sugars.

The best way for a person with diabetes to avoid cognitive decline, probably, is to avoid chronic and acute hyperglycemia—the more time you spend with your blood sugar in a healthy range, the more likely that you will avoid accumulated damage to your brain.

It also may be possible to strengthen executive functioning skills and make the brain more resilient to age-related decline by enjoying a robust social and intellectual life. Hobbies, education, challenging work, and community involvement—in short, an active and stimulating mental life, at every age—may protect against eventual decline.

Source: diabetesdaily.com

Technology is Great, but Most Kids with Diabetes Still Need More Help (ADA 2021)

Recent decades have brought incredible advances in diabetes technology, but children and teens are still struggling to meet recommended glycemic targets.

There are almost a quarter-million young people in the US with diabetes (more than 75% with type 1 diabetes), according to the American Diabetes Association. For youth especially, early detection and optimal management are of utmost importance; with many decades of life ahead, keeping blood glucose levels in check today can help reduce unpleasant (and deadly) diabetic complications decades down the road. Prudent diabetes management also has immediate benefits and can have a huge impact on quality of life.

What’s the scope of the problem, and what can be done about it? Scientists at the American Diabetes Association (ADA) 81st virtual Scientific Sessions relayed the striking results of several studies on the state of things today for kids and teens with diabetes. Here are some of the most notable findings.

Youth A1c’s Are Not Improving

It has long been the case, unfortunately, that the majority of pediatric diabetes patients routinely do not meet their treatment goals, most often assessed via quarterly A1c testing. A team of researchers across the US reported on recent trends in recently diagnosed youth, as part of the SEARCH for Diabetes in Youth initiative. The major conclusion?

HbA1c levels remained stable but higher than recommended across discrete cohorts of SEARCH youth with type 1 diabetes duration ≤ 30 months, particularly among non-white youth.

In fact, the average A1c levels among young people with diabetes remain quite high; despite rapid advancement in technology use and newer insulin formulations, the report shows no significant change between average A1c levels between 2002 and 2016. The average A1c held steady at about 7.9%.

How Much is Technology Helping?

Now, for some better news. It appears that early use of continuous glucose monitoring (CGM) technology is associated with lower A1c levels. As reported by Dr. Priya Prahalad of Stanford Children’s Health, newly-diagnosed youth (2018-2020) who were offered CGM initiation early on had markedly lower A1c levels than those from a previous cohort that did not initiate CGM therapy.

Unfortunately, while the A1c differences between the two groups were significantly different at 6, 9, and 12 months after diagnosis, the average A1c level was still at or above 7%, for a considerable proportion of study participants. These results underscore the value of CGM use in improving diabetes management in young people, but also demonstrate the need for more effective management strategies in this group.

Trouble at School

A report from Dr. Christine March and her team at the University of Pittsburgh illustrated the unique challenges that children face on school days vs. weekends. In this study, CGM data from hundreds of children with diabetes were analyzed to assess trends in blood glucose levels (specifically, the time-in-range, TIR metric) across hours of the day and night, as well as on weekdays vs. weekends. The main result?

For weekday school hours, median TIR (70-180 mg/dL) was 52.4%; only 34 (15%) of youth met a TIR goal of >70%… Weekday and weekend CGM metrics were clinically similar, though TIR was statistically higher and time high/very high (>180 mg/dL) lower on weekends… Notably, TIR early in the school day was nearly half of TIR during similar weekend hours, perhaps relating to sleep/meal schedules.

Moreover, the team looked at various attributes, like insulin pump use, duration since diabetes diagnosis, and A1c level to see if there was a connection with the time-in-range metric. They report that younger age, shorter diabetes duration, and lower A1c levels were associated with more TIR during school hours. Interestingly, insulin pump use appeared to have no effect in this study.

Technology and Diabetes Distress

Several researchers posited that youths with diabetes and their caregivers have very different perceptions regarding the emotional impact of advanced diabetes technology.

Can Tech Reduce Family Conflict?

One study presented this week sought to determine whether the use of diabetes technology devices improved “family conflict” in teens with type 1 diabetes. In this evaluation of 60 participants, researchers found lower A1c levels in those using closed-loop technology. The technology also led to a significant increase in caregivers reporting lower levels of family conflict surrounding diabetes management. Perhaps surprisingly, the teenagers themselves did not seem to think that family conflict had been reduced by the closed-loop pumps.

Does Tech Alleviate Diabetes Worries, or Exacerbate Them?

A second study suggested that advanced technology use may actually provoke anxiety in children.

Dr. Fatemah Abdulhussein and colleagues from UCSF evaluated whether the use of advanced insulin delivery systems alleviated worry and fear of low blood glucose levels among patients and caregivers. The major findings?

Longer duration of diabetes, duration of pump use, and duration of CGM use were all associated with higher mean worry scores [among children, but not their caregivers].

That’s the cruel paradox of childhood diabetes in a nutshell: the longer a child has had diabetes, the more stress it causes. And superior management tools may only add to the emotional burden, rather than alleviate it.

Management Success Still Leads to Peace of Mind

The UCSF researchers also looked at diabetes treatment satisfaction scores and found that the only variable in the study that was associated with a lower treatment satisfaction score was higher GMI (glucose management indicator). They conclude,

These data suggest that despite recent advancements in diabetes technology, FOH [fear of hypoglycemia] and diabetes treatment satisfaction still remain significant concerns and need to be addressed in clinical contexts.

smartphone to detect depression and loneliness

Photo credit: Adobe Stock

Parents Experience Diabetes Distress, Too.

A lot of burden falls on the diabetes caregiver, too, and understandably so.

A team of researchers based in Washington, DC and Nashville, TN looked at “parental reports of diabetes distress [DD], diabetes-related family conflict, quality of life” along with patient A1c levels. A key finding that that higher A1c levels in young people were associated with a higher incidence of parental diabetes distress, related family conflict, and quality of life. Notably, female caregivers were more likely to experience distress than male caregivers. Researchers summarize,

Importantly, parental DD is related to children’s glycemic control, suggesting that increased psychological support for parents with teens with DD is warranted.

The Takeaways

A1c levels remain steady at about 7.9% for young people with diabetes in the US, still considerably higher than what is recommended by major health organizations. Some research shows that CGM utilization and the use of closed-loop insulin pumps can help improve diabetes management. Of course, cost and access also remain barriers for many when it comes to technology access.

Sadly, even with the use of advanced technology, it appears that patients and caregivers alike experience a considerable amount of distress in dealing with the demanding nature of diabetes management. Perhaps patients and families would benefit from increased emotional support as much as improved access to diabetes technology.

Importantly, A1c levels stood out in several studies as important determinants in patient and caregiver treatment satisfaction, as well as distress levels. Glycemic control should remain a paramount goal, not just for short- and long-term health, but also for emotional wellbeing. Helping youth with diabetes achieve or exceed recommended targets is likely to help lessen the mental burden of diabetes management and improve quality of life and family dynamics in the long term.

Source: diabetesdaily.com

How to Find a Good Mental Health Provider

If you live with any form of diabetes, you’re far more likely to suffer from depression and anxiety. An estimated 40% of people with type 1 diabetes and 35% of people with type 2 diabetes experience significant levels of “diabetes distress,” which can result in negative mental health repercussions, including diabetes burnout.

A mental health provider can be a crucial part of your medical team. Dr. Mark Heyman, the Founder and Director of the Center for Diabetes and Mental Health (CDMH), explains why:

Diabetes is a self-managed condition. This means that it is the person with diabetes, not their doctor, who is responsible for taking care of him or herself on a daily basis. Diabetes involves making frequent, sometimes life or death decisions under sometimes stressful and physically uncomfortable circumstances.

In addition, diabetes management is constant and can feel overwhelming. If you or someone close to you has diabetes, take a minute and think about all of the steps you take in your diabetes management every day. What to eat, how much insulin to take, when (or whether) to exercise, how to interpret a glucose reading, how many carbs to take to treat a low, the list goes on. Decisions, and resulting behaviors (and their consequences) are critical aspects of diabetes management. However, doing everything necessary to manage diabetes can become overwhelming – and feeling overwhelmed is usually no fun.

There are things you can do to help manage the mental distress of diabetes, including finding a good mental health provider that is especially positioned to help people with diabetes. This article will outline how to find the perfect fit!

Consider What You Want in a Mental Health Provider

Think of your mental health provider (or therapist) as someone you’re trying to develop a long-term relationship with. You want to be comfortable sharing all of your thoughts and feelings with this person, and be vulnerable with them as well.

Mental health providers become very close with their clients, so knowing what will make you uncomfortable is very important and crucial to knowing who you want to look for when searching for a provider. Some things you may want to keep in mind:

  • Gender (do you have a preference to work with only men or only women?)
  • Age (you may feel more comfortable working with someone much older or younger than you, or maybe you’d prefer someone closer to your age)
  • Religion (are you looking to connect spiritually with someone? Perhaps your religion is very important to you, or perhaps you’re looking to keep the interactions completely secular)

When you contact a provider’s office or complete an initial questionnaire for therapy, you’ll usually be asked some questions about basic preferences, such as those described above, to help match you with the best therapist.

You may also be able to research a mental health provider’s bio online to learn more about their areas of expertise before scheduling a visit.

Consider the Issues You Want to Address

There are many different types of mental health providers out there, and knowing that specific issues you want to address can help steer you in the right direction. Perhaps you’re suffering from substance abuse, or maybe you have developed anxiety around food. Maybe you and your spouse are struggling with your child’s new diabetes diagnosis, or you’ve noticed depressive symptoms that you want to tackle early. Different providers can help you manage different issues, so be cognizant of that. Some of the different types of specialists include:

  • LCSW – Licensed Clinical Social Worker
  • LMFT – Licensed Marriage and Family Therapist
  • NCC – National Certified Counselor
  • LCDC – Licensed Chemical Dependency Counselor
  • LPC – Licensed Professional Counselor
  • LMHC – Licensed Mental Health Counselor
  • PsyD – Doctor of Psychology
  • Ph.D. – Doctor of Philosophy
  • MD – Doctor of Medicine

But no matter what a provider’s background credentials entail, what matters most is their area of expertise. Reading up on a provider’s background information and bio can help you familiarize yourself with the areas of mental health they deal with, and can help you decide if they would ultimately make the best fit for you and your needs.

Consider Asking for a Consultation

Consider this an interview for the mental health provider you’re considering “hiring.” Some practices will offer a free, 30-minute consultation, so that you can get to know the provider before deciding to come on as a client. Some important questions to ask if you’re able to, are:

  • Are you a licensed provider? (while every state varies, a licensed provider has passed the minimum competency standards for training within your state)
  • What’s your educational background?
  • What is your treatment orientation? (this refers to the school of thought that the therapist draws from in understanding and treating mental health issues)
  • What is your area of expertise? (and if they say “chronic disease” or “diabetes,” that would be excellent!)
  • Do you accept my insurance?
  • What is the cost per session?
  • Are you a prescribing physician? (some providers may be able to prescribe medication for things like obsessive-compulsive disorder, anxiety, and depression)
  • What is your communication style?
  • Do you prefer short or longer-term therapy? (some providers are very short-term goal-oriented, while others prefer developing a relationship over a long period of time)

These questions are not a complete list, but it’s a good start to finding the perfect fit for you and your care.

Seek out Diabetes Experts

It can be very difficult to find the right mental health provider for you and your needs, and that’s especially true when living with a chronic disease like diabetes.

The American Diabetes Association (ADA) recently teamed up with the American Psychological Association (APA) and created a directory of mental health providers specifically equipped to meet the needs of people with diabetes. All providers in this directory are:

  • Currently licensed as a mental health provider
  • A professional member of the ADA (Associate, Medicine & Science, Health Care & Education)
  • Have demonstrated competence in treating the mental health needs of people with diabetes

Currently, the directory has about 60 providers, 40 of which provide pediatric services, and the list is rapidly growing. The tool is simple to use: enter your zip code and whether you’re looking for adult or pediatric services. The directory will then pull up diabetes-trained mental health providers near you. The directory also lets you access what types of insurance a chosen provider accepts, their office location, phone number, and more.

Finding an appropriate mental health provider can be a difficult but worthwhile challenge. Investing your time, money, and energy to improving your mental health as someone living with diabetes is absolutely worth it, and it is crucial that you find a mental health provider that is going to work best for you in getting your needs and goals met. Hopefully these tools will make it a little easier to get there!

Source: diabetesdaily.com

Community Table: Nutrition, Health + Wellness in the Black Diabetes Community

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

By JDRF-Beyond Type 1 Alliance

During our second Community Table discussion, Beyond Type 1 sat down with a group of experts and community members to discuss nutrition, health, and wellness in the Black diabetes community, and share helpful resources and perspectives. Watch the discussion in full!



Speakers included:

  • T’ara Smith, who served as the moderator for this event, was originally diagnosed with type 2 diabetes in 2017 but was re-diagnosed with LADA diabetes in 2019 and is Senior Manager of Beyond Type 2.
  • Keith Crear, who has lived with type 2 diabetes since 2017, is a sports photographer and multimedia specialist.
  • Alexis Newman, who has had type 1 diabetes for 37 years and is a registered dietician.
  • Dex Geralds, who has had type 2 diabetes since 2016 and works as a personal trainer and CrossFit coach.
  • Joy Ashby Cornthwaite, a dietitian and a certifies diabetes care and education specialist.

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

What does wellness mean or look like for you, and has your diagnosis changed the way that you live?

Dex: It’s balance. I know a lot of times when I’m with people who don’t typically know about diabetes, there’s a lot of things surrounding food that they believe I cannot have at all. Once you find the balance, you’re able to still eat some of the things that you’re eating before your diagnosis, maybe not at the same amount that you were eating before. Just finding balance with the way you eat, balance in the way you exercise. Whether it’s like myself who exercise maybe two hours a day or just going out for a 15-minute brisk walk. Just finding balance in what comes with that. The last thing in balance is just your mental health and making sure you check in with yourself and your feelings and your emotions and figure out what brings you happiness and joy.

Keith: It is a balance. It’s knowing what to eat, what not to eat, what to consume, when to consume it. Exercise is very, very important.

Alexis: For me, what it looks like is making sure that I am well, not only with how I’m eating, but also exercise. Making sure I’m honest and checking in with my friends and family, my support system, too. Also, the spiritual aspect of it. I’m a Christian, so making sure I’m connected in the sources that I feel encouraged in. When one of those are kind of out of whack, I don’t feel well.

Joy: I think of health on a continuum, and I encourage that in every day. In my family life, in my personal life, but also for those who I help to balance their journey with diabetes because everyone has their own journey and their whole complete individual. When someone comes to a session with me, I find out where on the continuum you are and what can we work on today? It has to come from you. It has to be what you want and not necessarily what I want. But I’m going to use my skills to get you to where you need to be.

What misconceptions have you encountered pertaining specifically to Black people with diabetes when it comes to fitness? What is some of the ways that you’ve helped your Black clients move past those stigmas and misconceptions?

Dex: The biggest thing is support in our community and in the world in general. If you’re overweight you get looked down upon and that can add to depression and lead to worse things. I know a big term going on right now is “unlearning” and taking everything, looking at it through a different scope, and then figuring out what brought you to this point and then what can I do to change this. It’s not just a one-stop shop kind of thing. It’s going to take a while for you to start to see changes for the most part. You have to create these better habits and getting through that way.

Learning to love yourself is vital, and when you learn to love yourself you want to do the things that’s right for you and you’re going to quiet that outside noise and put your blinders on and work for yourself and not think about the negative things that you might be getting from someone else. My family has a history of diabetes and obesity. My oldest sister, she’s lost 150 pounds now, but still just over 400 pounds. I remember things people would say to her growing up. Now that I support her and my family’s supporting her, she’s been on this incredible journey and losing weight because now she feels confident enough to do the things that once scared her or felt ashamed about. Being able to conversate and talk to my sister, or just clients in general, I’ve been able to learn what’s going on and been able to apply that to them in their journey in fitness.

Alexis: The kind of things that I’ve seen is that they believe that people think they’re lazy so they don’t want to push through that because they’re afraid of what people are going to think. I’ve also seen the fear of not knowing what to do overtake them in my discussions with my patients. Another idea is that they have this perceived idea of what exercise looks like, so really breaking it down into bite-sized pieces of like, “Look, as long as you’re like being consistent with the movement, whatever you choose to do, you can add on time, you can add on intensity. But, as long as you’re out there trying to move.” Those are the things that I have conversations with my patients about in terms of fitness.

Another thing too, is that an ideal weight of someone who’s African American may not be similar to another culture or race. We need to keep that in mind as we are discussing food, nutrition, health, and weight that the ideal weight that a doctor may have for you may not be appropriate. I think that needs to be said and also needs to be addressed when we’re talking to these patients about weight and health and glucose numbers and things like that.

Joy: When it comes to fitness, one of the great disservices, especially for the Black community, is to tell people that they need to lose weight if they’re moving. For many people who are living with diabetes, movement doesn’t always equate to weight loss. It also doesn’t always equate to better blood glucose values.

There’s a lot of things that go into thinking about exercise. When you’re telling someone that it’s going to make them better to exercise and they’re saying that their blood glucose is either crashing or going up way too high with exercise there’s a disconnect. You haven’t heard what they’re saying to you. You need to find out what people are experiencing in their exercise journey and then address those things and say, “Look, you may not lose weight, but let’s check your blood glucose before and after.” Celebrate the win over either the hyperglycemia that you have been feeling or the hypoglycemia that you were feeling if you didn’t pre-exercise meal or whatever reason. Celebrate the win that is more than weight.

How can we celebrate our culture or different types of Black cultures throughout the year, not just during Black History Month?

Joy: Support each other. I know for years I felt like I was the sole person saying, “Black people aren’t making ourselves sick with diabetes.” We need help. We need medications. We need diabetes health care and management. We need to know how to take care of ourselves and we don’t have to do that alone. Whatever we need to do we need to support each other and do it together and then we’re louder.

Dex: Our culture is so vast and rich, and it needs to be shared every day and whatever way possible. Whether it’s through social media or just through conversation or the way you dress, the way you wear your hair. It just needs to be expressed and be out there for people to see and enjoy and learn. I love my culture so much.

Alexis: Buy Black. There are so many amazing Black companies, I’ve been focusing on and amplifying those businesses on social media and telling my friends. I’m in a friend group and we’re talking about face care. I’m like, “All right, I’m using this” and they’re using this Black company. We’re just sharing information of these amazing Black companies that are out there. If we can’t do that, then no one else is going to. It’s really important to invest in Black businesses because they’re everywhere.

T’ara: Yes, please support Black businesses that you see, especially in the diabetes community. There’s so many Black people in the diabetes community who have businesses and organizations who could use amplifying on your social platforms. That social sharing could do a whole lot because you never know who can see their products, so please amplify it.

Keith: Constant delivery of content from Black creators. Constantly delivering things from Black history that could be done every day. The way you wear your hair, the clothes. Just something that constantly keeps it in the public eye so it’s not condensed down to just one month. There are a lot of people out there that are doing it and it’s always great to see that. If more of us continue to do that it’ll shift the narrative and it will shift the visual aspect of how we’re seen in society as a whole.

Source: diabetesdaily.com

My Type 2 Diabetes Is Forcing Me to Find a New Reason to Live

By Abby Hanna

April 21st, 2021 was when it finally happened. It was around 1:00 am and I was dozing off in bed. With the melatonin in my system and a good day behind me, I had no reason to be up any longer. My nights were usually long and painful due to my anxiety and lively thoughts, but that morning I had a good enough day to let me sleep peacefully. An exceptional day even. I had gotten my blood work from the day before back, and it looked like everything was stellar. My doctor emailed me that afternoon- “Hello Ms. Hanna, your labs look good overall.” I had carelessly overlooked the note she left about my low cholesterol (I’ll just eat more avocado toast or something) and went on with my day proud of how my body was taking care of itself without me ever having to intervene.

And then came that night. That was supposed to be a peaceful night. Me dozing off in bed. Melatonin in my system. And something told me to check my email. I decided why not, noone ever sends anything important at 1:00 am, it’ll be a quick scroll and then right to bed. I noticed another email from my doctor, more blood work results from the other day. I clicked on the message that revealed the results, and it was as if someone had replaced that sleepy pill in my system with Adderall. I’ve never sobered up so fast. I actually had a little bit of research to do from the information that she gave me. What I was looking at wasn’t an email explaining my labs, but the actual labs themselves. With a bit of research and decoding, I had confirmed what I thought was true. A cold chill ran through me as I stared at my labs. I rubbed my eyes to make sure I wasn’t dreaming. No, those labs are correct Abby. You have type 2 diabetes.

It was like finding out that your deepest fears were true. Like looking under the bed and seeing that the boogie man actually was there, or feeling the pain of pinching yourself when you thought that you were dreaming. Or looking behind you and realizing that someone is indeed following you, or getting a test back with a big fat F that you couldn’t afford to fail, or opening your bedroom blinds to reveal a dark figure is watching you, or hearing the sputtering of your car breaking down in the middle of nowhere, or reading your lab results in the middle of the night that say: You. Have. Diabetes. It was the end of my world. My body purged itself of any reason to sleep and immediately filled itself with anxiety and anguish. I did eventually end up going to sleep hours later, after learning every single thing on earth about diabetes.

I actually entered a state of bliss for the next few days. I had found out that my A1c (the number that tracks your blood sugar and how much excess sugar you have in your body) was relatively low when it came to the diabetic range. If your A1c is 6.5 or higher, you have diabetes, and mine was 6.6. I felt great about that, and although I aggressively changed my diet the next couple of days, I held dearly to my truth, which was that I wasn’t that much of a diabetic, only a little diabetic. A diet diabetic, if you will!

I knew that when I had a phone call with my doctor she would reassure me that everyone else’s diabetes was bad and that mine was just fine and that with a couple of smoothies, I’d be diabetes-free and back to normal like everyone else. So I waited a couple of days for my appointment. I set up MyFitnessPal. Ate a couple more vegetables, just for kicks, because I knew that when you have diabetes lite like me, you just have to add an order of apples to your McDonald’s meal instead of throwing it out all together.

Monday came around and we finally had the conversation. She told me everything I already knew about diabetes due to my extensive research days before. I told her that my worst habit is eating once a day. She sent a couple of informational videos about living with diabetes and told me that a nutritionist would be calling me soon. And then I posed the question. “So this is like a short-term thing, right? My A1c is pretty low for diabetes, so I just need to get it even lower and then I won’t have diabetes anymore, right?” And then she told me that this diagnosis was forever.

I started sobbing. And I sobbed through the rest of my conversation with her. I sobbed while telling my mom. I sobbed while on my walk. I sobbed in the grocery store while I picked up the “5 best foods to combat high blood sugar”. I sobbed while sitting in the car thinking about how I couldn’t flip this to be something that it’s not. I realized that this was the first thing that I couldn’t run from. I had successfully coped with everything in my life with the help of food. Food was my sidekick, my refuge, my safe space. And with this, I couldn’t run to food. I actually had to do the opposite. I had to run away from food because if I ran to it, it would be the very thing that kills me one day. It made me think about my relationship with myself and my body on a whole new level.

For as long as I can remember, food has been my safety blanket. It was my hobby. I had always loved cooking and wouldn’t mind taking the extra 20 minutes to turn top ramen into fine cuisine, or slow cooking something in the oven to make the taste richer. I loved the crinkly sounds of a takeout order, the squishy packets of soy sauce and ketchup, the red Thank You’s staring at me with gratitude as I opened the bag to reveal what treasure I ordered for that day. I loved the sizzling sound of a raw egg hitting a hot pan. The bubbling boil of a ripe stew slowly melding its flavors over a low fire. Everything about food was special to me, it was an experience, and I unabashedly leaned into it. Eating was my favorite thing to do and I would eat if I felt sad, if I was happy, to celebrate, to commemorate, to combat boredom. Everyone is supposed to eat, obviously, but I wouldn’t shy away from giving myself my favorite foods whenever I wanted them. These tendencies got a lot worse during the pandemic. I was already fighting my depression with cheeseburgers and my anxiety with brownies. The addition of a global catastrophe was scary, but it was no match for pad thai, mac and cheese, and crab rangoon. I felt justified giving myself whatever I wanted whenever I wanted. And why should I feel bad? I hate my life so I’m gonna enjoy my meals because it’s the only thing keeping me from killing myself!

Oops. Did I just say that?

The thought came tumbling to the forefront of my brain as I sat in the car thinking about this new life I would have to live with diabetes. I realized that the only thing keeping me alive was food. Literally. I hated everything else, my depression had taken everything from me but the sweet taste of lemonade or the spicy kick of kimchi. I realized that I hated my body and thus didn’t care what went into it. Growing up with body dysmorphia has made me distance myself from myself as much as physically possible. And mental illness has made me work towards quieting my brain and running from my problems in any way that I can. So, I don’t do my hair, I wear big chunky outfits to hide my body, I let the root of my fears hide in the crevices of my brain, and I revisit my good pal Caviar because it’s the only thing keeping me from ending it all. And now I am forced to take care of my body.

Learning about all the things that can contribute to high blood sugar was probably one of the wildest parts of the diagnosis. Anxiety, bad sleep habits, and stress are three things that I am too familiar with, and three things that also can raise blood sugar. Not eating enough and not getting enough exercise are also three things that can increase your blood sugar, or put it at alarmingly low rates.

Being diabetic means being confronted with my body’s health and well-being for the first time. It doesn’t just mean having more smoothies but it means sleeping at an appropriate time and making sure that I’m not stressing about all the worries of life. It means drinking enough water because my body deserves water, and it means going on a walk because my body deserves to feel the warmth of the sun and the coolness of the wind. This is hard for me. Because I want to sleep all day and I want to stress eat. I want my first time of the day leaving the house to be when I pick up my Ono Hawaiian from the delivery driver. I don’t want to have to think about loving myself and what that really means. But I have to. I have to make the decision to prioritize myself even though indulgence has felt like prioritizing me this whole time. It clearly wasn’t. Because this is where it got me. I don’t know what self-love is and I’m scared to find out, but I know that my security blanket has been ripped from me, and although it’s cold and painful, I hope there is something worth it on the other side.

 

Editor’s note: If you are struggling with mental health issues and diabetes, we urge you to seek professional help. The American Diabetes Association maintains a registry of mental health providers that have specially trained on caring for patients with diabetes.

Source: diabetesdaily.com

Quiz: How Engaged Are You With Your Diabetes?

Everyone manages their diabetes differently. As long as you’re thriving physically, mentally, and emotionally, each person needs to find a management style and level of engagement that will work for them and that they can stick to consistently. Take this quiz to better identify if you’re as engaged with your diabetes management as you think you are, along with tips for how to improve your diabetes management:

What time do you typically check your blood sugar in the morning? 

A. You’re supposed to test in the morning?
B. Whenever I remember, but definitely before my first meal of the day
C. As soon as I wake up, of course
D. I have a CGM, so I always know my blood sugar
E. My diabetes doesn’t require regular blood sugar testing

If your blood sugar is over 250 mg/dL, what do you typically do? 

A.Wait and see approach. It’ll come down eventually
B. Take some insulin (if applicable), but I don’t stress over it too much
C. I take insulin (if applicable), drink some water, and get some movement in
D. I take insulin (if applicable), test for ketones, drink tons of water and exercise for 20 minutes to bring myself down. No snacks until I’m in my goal range, either

When I’m at a birthday party, I: 

A. Always have the cake! And probably more than one slice; life is too short
B. I’ll have some cake if I’m craving it
C. Have the cake, but make sure to sneak a peek at the label for carb counts
D. Pretend I’m having the cake while finding a surreptitious way of sneaking it into the garbage. Vegetables are easier to bolus for anyway.

How often do you go to the Endocrinologist? 

A. What’s an Endocrinologist?
B. Usually, every year, if I can remember to schedule an appointment
C. Every 6 months or so
D. Every 3 months, right on the dot. I never miss a visit

My favorite low snack is:

A. Everything in sight. I usually overeat for my lows and need to then treat high blood sugars!
B. Candy!
C. Anything that’s within 15-20 grams of carbohydrates
D. Low snacks are not supposed to be fun. They’re measured out glucose to assist in a low blood sugar incident. I’ll eat a few glucose tablets and move on with my day

How often do you change your lancet? 

A. They’re…changeable?
B. Um….not often enough
C. Honestly? Every few years
D. After every time I lance my finger, duh!

When my blood sugar is stubbornly high, I: 

A. No stress, man! I didn’t ask for this disease
B. Feel pretty guilty, but it usually passes
C. Take a correction dose but realize that blood sugars aren’t good or bad, they’re just information to take into account, telling me what to do to better manage my diabetes
D. Berate myself mercilessly. I always feel guilty when I let my blood sugar go high. It’s all my fault

How do you clean an insulin pump or CGM site? 

A.You…have to clean sites?
B. I don’t do anything different, but I know I should
C. I usually change my sites after I shower, so nothing, but I’m clean enough
D. I always use an alcohol swab. You must take the risk of infection seriously!
E. I’m not on insulin or I don’t use an insulin pump and/or CGM

Do you take “rest” days? 

A. From what?
B. Yes, but I don’t have a strict exercise routine, either
C. I take a few rest days per week
D. I exercise 7 days a week and never take a rest day. Diabetes doesn’t take a break, so neither can I

How do you give yourself a break from diabetes?

A. I usually just ignore my diabetes
B. Diabetes just fits into my life. It’s mostly running in the background, honestly
C. I get regular massages and enjoy wine on the weekends
D. I never get a break from diabetes

Answer Key

If your answers are mostly As:

You are more hands-off with your diabetes, often neglecting your care and suffering as a result. You don’t often take the time to count carbohydrates, exercise, or test your blood sugar. This can be due to diabetes burnout, depression/anxiety, or denial of your condition.

Schedule an appointment with your care team or Endocrinologist right away to seek the help you need to get back on track with your diabetes. You may also need better support from family and friends, and even seeking professional counseling or therapy may help.

If your answers are mostly Bs:

You are permissive/indulgent with your diabetes. You don’t let diabetes stand in your way of having a normal life, but you’re not taking the best care of yourself, either. You are aware that you need to treat yourself better, but you’re not the best at prioritizing self-care or your diabetes management. Reach out to family, friends, and your medical team to get back on track and re-motivate yourself to get on the top of your diabetes game!

If your answers are mostly Cs:

You are doing a great job taking care of your diabetes with this more hands-on, authoritative management style. This style of management is characterized by high responsiveness and high demands. You realize the gravity of your condition and you work hard to take great care of yourself, without becoming obsessive or having diabetes completely rule your life. Great job and keep up the excellent work!

If your answers are mostly Ds:

You fall under the authoritarian/disciplinarian style of diabetes management, ruling your diabetes with an iron fist. You never give yourself a break, demand absolute perfection from yourself and your blood sugars, berate yourself if you make mistakes or act human, and can never relax about exercise, diet, or your life with diabetes.

You’ve got to give yourself a break, or you’ll face diabetes burnout and you’ll suffer more in the long run. Talk with your doctor, counselor, or therapist on implementing strategies that will allow you to give yourself some grace and make space for the humanness of diabetes.

How much thought do you put into your diabetes care? What level of engagement has worked best for you now or in the past? Has learning more about how you approach your diabetes care helped you handle your diabetes better? Share this quiz and comment on your experience below!

Source: diabetesdaily.com

Most Important Vitamins People with Diabetes Need

People with diabetes have special dietary requirements, but unfortunately, lots of important vitamins and minerals are lacking in the standard American diet. That’s where vitamins can play a crucial role in supplementing one’s health. This article will outline the most important vitamins that people with diabetes need to live their healthiest life.

Vitamin B12

People with diabetes with nerve damage in their hands and feet may see their symptoms worsen if they have a vitamin B12 deficiency. Vitamin B12 helps improve the health of red blood cells and boosts brain function.

Studies show that long-term use of the diabetes drug Metformin can lead to a vitamin B12 deficiency, and strong sources of the vitamin can be found in fish, dairy milk, meat products, and eggs. There are also vegan and vegetarian forms of Vitamin B12 that can be taken orally in pill form.

Vitamin D

Vitamin D deficiencies are common in people with both type 1 and type 2 diabetes, and a recent study out of Denmark has shown that people with diabetes who have a Vitamin D deficiency are at an increased risk of diabetes complications and premature death. Solving for this vitamin is cheap and easy: sitting in the sun for 15-20 minutes per day without sunscreen will restore most deficiencies, or Vitamin D can be found in fish, dairy products, or egg yolks.

Vitamin C

Increasing one’s intake of Vitamin C helps control the levels of sorbitol in the blood, which can be harmful at high levels and may contribute to retinopathy and kidney damage, which are common complications of diabetes. Vitamin C can also increase insulin sensitivity, reduce insulin resistance, and help people improve their HbA1c levels.

Vitamin C is found in many fruits (and juices) such as lemons, oranges, tomatoes, guava, watermelon, and strawberries, and is also readily available in supplement form. It is also abundant in vegetables like cauliflower, Brussels sprouts, broccoli, and peppers.

Chromium

Studies show that chromium, found in brewer’s yeast, improves insulin sensitivity and tolerance in people with type 2 diabetes. Chromium helps maintain healthy skin, hair, and eyes. It is effective at supporting the nervous system and enhancing immune system function. Chromium can be found only in trace amounts in foods like meat, spices, and grains, so people with diabetes should take chromium supplements.

Curcumin

A 2013 meta-analysis shows that curcumin (the active ingredient in turmeric) lowers blood glucose levels, increases insulin sensitivity, and stabilizes blood sugar levels, helping to decrease the likelihood of complications in people with diabetes. Researchers also found that curcumin may play a role in diabetes prevention.

Turmeric and curcumin also help improve mood, which is important for people with diabetes as depression and anxiety are found at much higher rates in this population, aid in digestion, and even improve immune system health.

This extract can be found in over-the-counter supplements and can be added to foods in its natural form (Turmeric), found in the spice aisle of any grocery store. Make sure to consume turmeric with black pepper, as the spice enhances curcumin absorption in the body by up to 2,000%, maximizing its benefits.

Always work with your doctor and/or registered dietitian to determine which vitamins you should incorporate into your daily routine. Your doctor will most likely order a blood test or urine sample to determine what’s needed, but supplementing your diet with more vitamins and minerals can be helpful to achieve better blood sugars and lower HbA1c levels in the short term, and may even prevent long-term diabetes complications and premature death.

Source: diabetesdaily.com

MoreThan a Diabetic: Eritrea Mussa Khan

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

By Makaila Heifner

Eritrea Mussa Khan is 28 years old and has had type 1 diabetes for 18 years. She lives in Dallas, Texas with her husband where she works full-time in application development training for a large school district.

Recently, Eritrea joined the team at Diabetics Doing Things as a Content Creator and is a co-host on the podcast. Their new 4-part series “More Than a Diabetic,” features 15 members of the diabetes community who are all people of color. This series focuses on important topics like medical racism, representation in the diabetes community, and how we can collectively as a community do better to support Black and other people of color with diabetes.

Eritrea recently sat down with Beyond Type 1 to discuss the podcast, identity, and diabetes.

BT1: Do you remember what it was like when you were diagnosed? Had you had any prior knowledge of type 1?

Eritrea: No, I didn’t know anything about diabetes at all. I was eight, so I was pretty small. I remember that I sent my parents home when I got diagnosed because I was more worried about my siblings than myself and being like, “Hey, my mom has to get up early tomorrow and take my brothers to school. She has to go home and get some rest.” I took charge of a lot of my own care, but also my parents were foreigners to the country. Their understanding was limited because of language barriers so it was easier for me to take charge and be the translator, not just for them, but for myself so that I could understand everything firsthand. If I needed to take care of myself, I could do that. I was very much a little adult about it.

How did you become involved in the diabetes world and activism?

I started going to diabetes camps when I was really young. I was diagnosed in 2002, and I went to my first diabetes camp that same winter. The next summer I started to go to Camp New Horizons here in Texas with my brothers because it was offered to diabetics and their siblings. At 13, you can become a counselor in training (CIT), and so I became a CIT and then my brothers all grew up going to camp as well so then they became CITs. It kind of became a family thing. When I turned 18, I became a counselor and then I started volunteering every summer. I have a lot of friends with diabetes. I went to a lot of camps so it makes sense that I made a lot of long-lasting relationships. As I got older, I just tried to volunteer my time here and there. Last year in 2020 I met Rob Howe at a Diabetes Meetup in Dallas (pre-pandemic) and later got really lucky to be offered an opportunity to create content over at Diabetics Doing Things.

Do you ever feel burned out while working in diabetes?

I’m lucky enough that I don’t work in the diabetes space full time, and I don’t want to say never but I just feel it would be so hard. I know some people who work full-time in diabetes and seriously huge “Kudos,” because I feel like we already work full time in diabetes. There’s no vacation from this thing! I do definitely go through some burnout. I have a therapist. This is not a humblebrag. I am not okay all of the time, it’s hard out here. But somehow, I manage. I try to go for walks a lot so that I can really just look around the earth and realize that it’s so much bigger than just me and my experience and what I’m going through in my moment. I try to eat good food and enjoy as many small things as I can. It’s the small stuff that makes up the big stuff.

How did you come to create “more than a diabetic” and why did you feel like the space was so necessary for the community?

When Rob and I started talking about me working at Diabetics Doing Things, the conversation was really around doing things differently. There is a type of aesthetic or type of face of diabetes. That face is very common within the online community and I see it all the time, or even faces that look like mine, which is the very consumable Black girl: light skin, curly hair, very cute, blah, blah, blah. And I hate it. It’s ridiculous, Black people and people of color exist in all shades, shapes, sizes, types of diabetes. And their experiences should be talked about, represented appropriately. I wanted to create a space where people were going to have real conversations without mincing words to spare feelings. I thought that it was important for us to be honest, to be clear, and to have these conversations out in the open instead of continuing to talk about having these conversations. Something that’s always really bothered me about how systems of oppression are created is that the conversations about changing them are always being had by the same people who created the problem. It really felt like it was time for these conversations to be centered around the people who are impacted by the societal impact of erasing BIPOC experiences. So, that’s what we did.

When do you feel most empowered and who in your life contributes to that?

I always feel supported at home. I have the best husband ever who lets me go on hour-long rants about things and tells me, “Hell yeah.” Having the space and sometimes the bravery to say things that might make some people uncomfortable is crucial. I also work somewhere really great, and Rob is a really great person to work for. I always feel like Diabetics Doing Things is here to tell the truth, even if those truths may be a little bit uncomfortable sometimes.

Do you have a message for anyone that’s struggling with discrimination or racism?

I think we’re all struggling. I think every single person is struggling. But maybe something we could all think about more is just being intentionally kind. There’s a difference between being nice and being kind. We all need to be a little bit kinder and think more about the other person’s human experience. We need to be a little bit more intentional with that kindness. If we are being asked to speak somewhere, questions need to be asked. Who else is speaking? Am I taking up space that could be for someone else? Are all groups being represented here appropriately? Are we making this accessible for everyone?

It’s about being kind, being intentional, opening up doors for other people other than just ourselves. I know that we all want to get ahead, I know we all want to do well. That’s not what I’m arguing. I’m just saying that we can’t all do well when we’re ignoring the needs of other people in our community. You cant be an advocate for diabetes and then ignore BIPOC with diabetes or LGBTQ people with diabetes or type 2 diabetics. We all have diabetes. We all need to help each other.

What’s next for you? The podcast?

Diabetics Doing Things is still doing takeovers on Mondays. We do about two takeovers a month. It’s called “Doing Things Day,” and we hand over our account to somebody somewhere and they take us through a day in their life with type 1 diabetes. We’ve gone to places like Palestine, Lebanon, London, Georgia, Tennessee. We get to see a sliver of a moment in someone’s life, just a day. I really enjoy these takeovers because they allow us to go all over the world. It’s going to be really awesome. We’re covering some really cool new people in March.

For now, I know I am doing some more producing at Diabetics Doing Things, and I’m not really going anywhere. I’ll be here working on stuff, brainstorming what my next thing is.

I’m also working on a project that I’m really excited about. I’m looking for diabetics in the media. I love projects like these because I so enjoy going down a rabbit hole. Catching up on Steel Magnolias and Scrubs has been a treat. I’m really excited for what 2021 will bring to Diabetics Doing Things and what season two of More Than A Diabetic will look like.

Any last thoughts?

For anybody listening to any of these episodes, please just listen. That’s it, have an open mind. If you find yourself feeling something while listening, I invite you to lean into that feeling and explore it. This is not about just one singular person. What the ultimate goal of More than a diabetic was is to shed a spotlight on an issue that impacts all of us. It’s about a shared community experience that so many people who look like me, and who don’t look like me, have gone through.

Source: diabetesdaily.com

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