Using Smartphone Tracking to Identify Patients with Depression (ADA 2020)

At the American Diabetes Association (ADA) 80th scientific sessions last week, Dr. Ashutosh Subharwal, Department Chair and Director of Department of Electrical and Computer Engineering at Rice University, put together a compelling presentation that showed the benefits of using smartphone sensors to measure behavior-biology pathways and use those findings to assess, treat and improve healthcare outcomes for depressed patients living with diabetes.

Scaleable Health Labs believes that there should be a bio-behavioral sensing layer to healthcare using simultaneous, non-invasive and accurate measures to provide clinicians with data to better help their patients. They feel using quantitative data from a sensor-based automatic measurement will be more useful than asking patients questions and having their answers be based on their own perception. For example, when asking patients how often they exercise, their answer may vary drastically from the data from their sensor.

The presentation focused on 3 areas: Mobile bio-imaging, behavioral sensing, and data science for health.

Dr. Subharwal proposed two questions:

  1. Can we track depressive/anxiety states?
  2. Can we measure loneliness?

Can We Track Depressive/Anxiety States?

Depression is a common comorbidity of diabetes and is often undetected and untreated. A study explored this in adults and adolescents, using a tool called SOLVD: Smartphone and Online Usage as based eValuation for Depression, by way of a smartphone as a wearable for tracking depression.

The two clinical pilots for SOLVD consisted of the following:

  • Bi-weekly clinical visits.
  • Logging feelings in a MoodReminder Module.
  • The MobileLogger Module, which has the sensor logging social use (phone calls/texts), mobility (GPS/steps/accelerometer) and phone usage (screen time, screen light, etc.), all while being respectful to keep any conversations private.
  • A new parent app for the teenage pilot that used the parent’s feedback as a sensor to measure their children’s mental well-being.

Using this combinational sensor data allowed clinicians to track who, when and for how long the patient was speaking with or texting an individual. They were able to track where the patient was going and the duration of time spent at each location. There were also many other extracted features from the smartphones related to communications, mobility and sleep collected daily, as listed in the chart below.

Key Findings

This method proved to be a useful way to continuously track a patient’s mental state. The patients did not find it intrusive and were willing to be tracked. They saw a strong correlation between the daily self-reported moods and different diagnostic questionnaires in both teens and adults. Also, when patients had fewer phone calls/text messages and shorter frequency of these exchanges, it was predictive of higher depression symptoms. Additionally, as the number of steps walked decreased, there was an increase in the participant’s depressive state.

In both studies, there was a correlation between the data collected from the smartphone and the patient’s psychometric scores, and a noticeably stronger correlation in the moderate to severely depressed participants. The data indicate that the more depressed a patient was, the less mobile and social the person became. This information can help providers to better assess and treat their patients.

Can We Measure Loneliness?

Sociability is crucial to our overall well-being and lack of social encounters are indicators of loneliness. The traditional measures of sociability are often questionnaires, patient self-tracking, the UCLA loneliness scale but all of these require participant effort and many times the report lacks enough detail to draw any conclusions.

SocialSense, an in-person social network (IPSN) is able to track real-life, in-person interactions through audio data. This tracking device is able to detect conversations, detect social scenes and context as well as turn-taking behaviors, with no content analysis to respect participant’s privacy.

The Sociability Clinical Pilot at Baylor College of Medicine (emailed waiting for confirmation) spent 1 week audio-tracking their participants, using the daily smartphone app sensor features discussed above, along with patient baseline psychometric measures.

Key Findings

A decrease in sociability was seen among patients with depression, including fewer longer conversations and fewer social contacts. The SocialSense reports were consistent with the self-reports. SocialSense was also able to detect audio self-talk conversations amongst patients with psychosis.

Conclusions

  • Most patients are willing to be monitored via technology (>80% adherence).
  • These tracking studies are among the first of their kind to study adolescents and adults who suffer from depression. They are also the first to use the new tool for psychiatry, the parent app.
  • Data from the participant’s phone sensor and usage features correlated with symptoms of depression, which was even more pronounced in the moderate to severely depressed patients.
  • The data we can get from wearables can help better evaluate a patient’s mental well-being and develop the most appropriate solutions.

What are your thoughts on the subject? How would you feel about your activities being tracked for health purposes?

Source: diabetesdaily.com

Improving the Transition from Pediatric to Adult Care for Patients with Diabetes (ADA 2020)

At the American Diabetes Association (ADA) 80th scientific sessions, Dr. Robert Zimmerman MD, Vice-Chairman of Endocrinology and Director of Diabetes Center Cleveland Clinic, and his team discussed the importance of creating a smooth and seamless transition from pediatric to adult care.

This time of transition is considered a high-risk time for patients living with diabetes. Diabetes aside, these patients are dealing with other life stressors that often emerge at this point in their life. Coming off their parent’s health insurance, going off to college or out in the workforce, and having to pay their own bills can create a lot of stress. Because of this, patients often neglect their diabetes care. Having a transition plan in place from pediatric to adult care can help these patients feel empowered and equipped to handle their own diabetes care as they become young adults.

Key Takeaways

  • Each year, thousands of adolescents with both type 1 and type 2 transition to young adults and also from pediatric to adult care.
  • The developmental stage between ages 18-30 is defined as the period of emerging adulthood.
  • Due to life stressors, this is a period where many are distracted from their diabetes care.
  • During the first phase of transition, around age 18-24, many patients feel overwhelmed and have a tendency to reject parental control.
  • During the second phase of transition, at about age 25-30, the young adult tends to take on more responsibilities in life and usually starts to place more importance on diabetes management.
  • The period of emerging young adulthood is considered a high-risk time for patients with type 1 or type 2 diabetes.

Differences Between Pediatric and Adult Care

  • Pediatric Approach
    • Family-oriented
    • Holistic
    • Visits are with both child and parents
  • Adult Approach
    • The patient is autonomous in their care
    • Individualized counseling
    • The patient makes their own decisions regarding care

Major Risks During Transition

  • Suboptimal Glycemic Control
    • Only 32% of patients between 13-18 years old met ADA goals
    • 18% of children under 18 achieved the ADA recommendation for A1c
    • 56% of adults achieve an A1c of 7%
  • Neglect of Diabetes Care
    • Older teens and young adults tend to disengage from health care
    • Both short-term and long-term complications can occur as a result of neglecting care

Factors That Increase the Risk of Hypoglycemia and DKA

  • The loss of parental guidance
  • Less frequent doctor visits
  • Work/school stressors that take precedence over diabetes care
  • Consumption of alcohol
  • Change in physical activity
  • Different dietary patterns than once had under parental care
  • Lack of motivation to stay on top of health

Patients Face Many New Challenges During This Period

  • Psychosocial challenges include worrying about the future, lack of a plan or goal in place for managing their diabetes, feeling anxiety, or being overwhelmed with care, handling uncomfortable social situations regarding diabetes.
  • Psychological issues are prevalent during this time, although these can occur at any time while managing a chronic condition. Feelings of depression, anxiety, eating disorders and suicide are all concerns that need to be addressed during this time.
  • Pregnancy is another issue that arises during this period of emerging adulthood.
    • Contraception use is lower for adults with diabetes from the age of 20-44
    • 39% of adults with diabetes do not use contraception compared to 27% of adults who don’t have diabetes
    • An increasing number of women with pre-existing diabetes are becoming pregnant and having children
    • Only 1 in 4 women with diabetes age 16-20 were aware of the risks involved with getting pregnant with diabetes and the importance of optimizing glycemic control before and during pregnancy in order to maximize the odds of conceiving and delivering a healthy baby.
  • Other health risks that can happen at any age for people with diabetes seem to be most prevalent during these years: alcohol use, illegal drugs, smoking, driving and hypoglycemia.

Current ADA Recommendations for the Transition

  • Pediatric health care provider works with the patient and parent planning for transitioning starting up to 1 year prior
  • Preparation focusing on self-management for emerging teen
  • Preparation should include the differences between pediatric and adult care and should help guide the patient on major decisions such as health insurance, etc.
  • The provider should prepare and provide a list for the patient and new adult doctor summarizing the patient’s medications, assessment of skills, history, etc.
  • Healthcare providers need to recognize all the changes during this period can lead patients to neglect care.
  • The transferring provider should provide patients with specific referrals to adult physicians that would best fit the patient’s needs.
  • The transferring physician should empower patients and provide them with any educational materials and resources that can help them to stay on top of their diabetes care.
  • Care must be specific to the patient and strive to avoid both short term and long term complications.
  • The provider must evaluate and treat emerging teens with any disordered eating behaviors or affected disorders.
  • On-going appointments should take place every 3 months for patients on insulin and every 3-6 months for patients with type 2 who are not taking insulin.
  • Screening guidelines should be followed for both microvascular and macrovascular issues as well as the management of lipids and hypertension.
  • Birth control, drug use, driving, STDs, etc. should all be discussed with the teen and their parents by both the transitioning and adult physician.
  • Both providers should make sure the patient is getting primary and preventative health care and feels comfortable with the care and support they are receiving.

Transition Options Available at The Cleveland Clinic Foundation

  • Transition clinic: here, adolescents are taught how to manage their diabetes on their own. They are then introduced to the adult care endocrinologist who oversees the patient’s care after this first visit. The follow-up with the adult endocrinologist can happen on the transition floor or at Adult Endocrinology at the diabetes center.
  • Transition shared medical visit: In this instance, a shared medical appointment takes place instead of their traditional appointment and the goal is to make the transition as smooth as possible for the patient.
  • Adult endocrinology office visit: patient goes directly to the referred adult endocrinologist.

Cleveland came up with an Autonomy Checklist which helps patients to learn necessary information that they should have while transitioning to more autonomous care.

Group Visits

Cleveland Clinic put into place group visits that take place approximately every 3 months where they have an educational speaker, review A1cs, glucose readings and insulin adjustments to engage the adolescents as well as give individual exams.

Cleveland Clinic’s Transition Recommendations Moving Forward

  • Creating flexible appointments: nights, weekends and special availability while young adults are home from college are important. Virtual appointments and classes will likely be the main way of interacting for this group. Dr. Zimmerman stated that their office went from “1% virtual visits to 75% in approximately one week’s time”.
  • Building relationships: community support groups led by a provider, monthly events and taking advantage of organizations and apps like College Diabetes Network (CDN), where they can connect with others living with diabetes is useful.
  • Transition simulation nights where young adults going off to college can go through possible scenarios and problem-solve together as a group. Questions like “my insulin fell and cracked open, where can I get insulin in the middle of the night?” or “My blood sugar suddenly is dropping, but I am in the middle of taking an exam, what should I do?” would be addressed.

Conclusion

Young adults transitioning from pediatric to adult care are a high-risk group that needs a supportive and comprehensive system in place, where caretakers understand the unique complexities of this life stage. Creating a seamless and specific transition plan will help guide these patients to achieve optimal health during these years.

Source: diabetesdaily.com

A Letter to My 12 Year Old Self: Diabetes, 20 Years On

Dear Chrissy,

It’s June 20th, 2000, and right now you’re in the emergency department of the King’s Daughters Children’s Hospital in Norfolk, Virginia. You were supposed to be on a weeklong vacation with your siblings and parents, frolicking in the salty seawater and eating cotton candy on the boardwalk of Virginia Beach, but instead, on day three of the trip, you’ve been rushed via ambulance to the ER, feeling weak, nauseous, and on the brink of unconsciousness. You’re small. An active cheerleader in your middle school, you’ve lost over 30 lbs in a little under a month, which is striking on your lithe frame. Every nurse notices how underweight you are.

The glucometer at the Urgent Care your parents took you to this morning simply read, “HIGH”. When the nurse looks at your parents and says the words, “your daughter has diabetes”, it’s the first time you’ve ever seen dad cry. You’re completely terrified that the word “diabetes” has “die” as the first syllable. Are you going to die? Thankfully, no. Not today, and not within the next 20 years, either.

The next few years will be hard, actually, they all are. Sadly, even though diabetes is technically “manageable”, it never really gets any easier, but you’ll become tougher. You will try out four different insulin pumps before you find one, at the ripe old age of 30 (and spoiler alert, it’s tubeless). You’ll prick your tiny, fragile fingers literally thousands of times, but in 15 years (the time will fly by, I promise), you’ll use a seemingly magical machine that checks your blood sugar 288 times per day for you, without you having to do A THING, and it’ll transmit the numbers to your telephone (those things are cordless in the future, too). Eventually, but I’m getting ahead of myself now, those numbers will talk to your insulin pump for you, and make dosing decisions while you drive, or work, or makeout, or go running, or read a novel. Science is pretty neat.

Once you start the 7th grade, you won’t tell anyone about your new mystery disease. Honestly? You’re embarrassed. The only other people you’ve ever met with diabetes were your elderly next-door neighbor’s sister and Wilford Brimley, from TV. You make your mom pinky swear that she won’t tell your friends’ moms, and you promise yourself that you just won’t attend sleepovers until you go away for college. Please don’t do this to yourself. Spare yourself the heartache. Diabetes will give you physical battle scars and mental wounds, but it will also develop some of the most beautiful attributes people will love about you: your compassion for others, your enthusiasm to live in the moment, your fearlessness in the face of adversity, your humility, your grace.

You’ll be the only 13-year-old girl drinking Tab at your bestie’s summer birthday party. Don’t be embarrassed. Exotically-flavored seltzer waters will be all the rage in 20 years. You’re just ahead of your time.

You’ll grow up quickly. You were always conscientious, polite, and studious, but having diabetes will make you disciplined, strong-willed, and courageous–you won’t really have a choice in the matter. Diabetes will toughen you where you’re soft; diabetes will break you open.

You’ll become obsessed with counting carbs (trust me, this is good), and dosing correctly (also good), but will become preternaturally focused on food and nutrition. You will deny and deny and deny. You’ll eat an apple when everyone is enjoying an ice cream; you’ll swear that string cheese is more fun than cookies. This can sometimes be good in the name of a better hba1c, but please, let yourself be a child for a little while longer. You’ll cry, because having a chronic disease can be very lonely and sad sometimes, and it’s okay to be sad sometimes, too. Go to therapy. It’ll be worth it.

Your mom will make you go to diabetes camp. You will resist going at every turn. You will cry and scream, and when she drops you off at the loading dock of Camp Setebaid, you swear you’ll never talk to her again. But by night three, you will have forgotten all about the hardships of living amongst “nons”. You’ll meet some of your closest friends at diabetes camp, and they’ll last a lifetime. You’ll have camp crushes, and camp kisses, and still remember campfire songs until your mid-30s. You’ll go waltzing with bears, and do the polar bear swim, and learn how to build a campfire, and get lost in the woods under a velvety night sky, and will learn how to use a cleavus, and will eat two dozen chocolate chip cookies one night when you accidentally replace your dose of Lantus with Humalog (oops). You’ll pee your pants laughing, and cry every summer when camp ends. You’ll make many friends along the way–friends who get it, who get you, for the first time ever. You’ll lose some of them over the years, to diabetes, or depression, or both, and will weep at their funerals. Your best camp friend will be in your wedding party in 17 years.

You’ll become tough. You never asked for this life, but you sure have made a point of living it to the fullest. There will be many doctors who will try and tell you things you can’t or shouldn’t do: join the swim team, play competitive sports, travel abroad, go to college out of state, have children–and you’ll prove most of them wrong. You will learn to not take no for an answer. You’ll develop an iron will. You’ll become gritty as hell.

Diabetes will encourage your interests in health and well-being, and out of college you’ll be a social worker, eventually getting your master of public health (I don’t think this degree exists in 2000, but it’s coming down the pike). You’ll be a vegetarian. You’ll run marathons. You’ll climb something that’s called a 14er (I know you live in Pennsylvania, but someday, when you live in Colorado, this will be a very big deal). You’ll find your dream job of working in diabetes advocacy, that will take your passion and use it to help thousands of other people who struggle with the same issues you do. You’ll change lives for the better.

One day, you’ll meet a man at work, who’s sweet and kind and compassionate. One evening, still in the early days of dating, you’ll notice he bought three containers of glucose tabs and stored them in his pantry without telling you. “Just so you feel safe here,” he says. Three years later, you’ll marry him.

In 20 years, you won’t have everything all figured out, but you’ll know more about who you are, and who you want to be. And diabetes, in large part, has helped to craft that. I know you’re seeing dad cry right now, so why don’t you go give him a hug and let him know everything will be okay. Because, really, in time, it will be.

Love,

Christine

Source: diabetesdaily.com

How to Get Out of a Diabetes Rut

We’ve all been there at one point or another: whether it’s a sudden or gradual process, we are just not where we want to be when it comes to our diabetes management. For those who live with a demanding and chronic health condition, managing it can be thought of as a form of self-care. The truth is, when we do our absolute best to manage our blood sugar levels, this is likely to make us feel better physically and emotionally, while also reducing the risk of various health complications.

What do you do when you feel that your diabetes care is suffering, and you are stuck in a less than desirable pattern? Here, we share some tips, as well as notable quotes from members of the diabetes online community.

Tips to Getting Back on Track

When you realize that you are not where you want to be as far as your diabetes management, take a step back, a deep breath, and consider the following steps:

Admit and Accept

You are not where you want to be right now. That’s OK. Be honest with where you currently are but remind yourself that you are worthy of self-care (including optimal diabetes management). Accept yourself where you are, while also acknowledging that you wish for things to be better.

See the Goal

What do you want to change, exactly? Are you shooting for a specific A1c or time-in-range goal? Do you want to check your blood sugar more frequently? Are you looking to change your diet to better manage your blood sugar? Is it time to dig out your CGM and/or do some basal testing? Are you planning to start an exercise routine? How many times a week and what exactly will you do? Be very specific about what you wish to accomplish (no matter how big or how small).

Make a Plan

Now that you have identified your goals, it’s time to make an action plan. This means being specific about what your intentions are and knowing exactly which steps you will take to get there. For example, you may want to set alarms to remember to check your blood sugar. You may want to designate a specific day to check if your basal insulin dose is set correctly. You may want to carve out an hour every weekend to meal plan for the week and make sure that you’re setting yourself up for success by having all the right foods on hand. Whatever it is that you plan to do, write it down.

Regroup and Recharge

Maybe you’re feeling overwhelmed or you feel that you have tried and failed too many times? That’s OK, too. Consider regrouping by focusing on achieving an unrelated task that will bolster your mood and confidence. Whether it’s a gardening project that you’ve been putting off, cleaning the bathroom, or clearing out your inbox, accomplishing any task that needs to be done can help you recharge your mental focus, making it easier to eventually return to the more challenging stuff.

Take Action

You’ve identified your goals and made an action plan. Now, it’s time to take action! Consider rewarding yourself when you’ve hit a specific goal, big or small, and also give yourself grace if your progress doesn’t always look like you have imagined. There is a saying, “Don’t let perfect be the enemy of good.” While it’s important to acknowledge where improvement is needed and strive for it, it is perhaps equally important to acknowledge progress.

Finally, consider the following chart. Think about what boxes you have checked and where you might need improvement.

And, always remember you are not alone in this! Talking to your family, friends, and members of the diabetes online community can be invaluable to helping you get back on track.

More Insights

Here are some other thoughts to ponder, from members of the diabetes online community:

“They say take it one day at a time but really all you have are a series of nows. Can you ask yourself, in this moment, am I doing the best I can to care for my needs? You might be surprised how much more often you actually say yes than no. In my experience, acknowledging self-care helps build positive momentum towards your overall outlook.”

 

“Focus on gratitude. So much to be grateful for. Just start a gratitude journal and write down one thing every day you’re grateful for!”

 

“In 37 years as a T1diabetic I’ve hit a few ruts. When I recognize I’m in one…and maybe my control or attention to my diabetes is slipping…I mix things up!

Ditch walking daily for a bike ride, or just find a new walking trail. I dig through cookbooks and find a few new recipes to try. Visit a new grocery store, or just one in a new part of town, to search for a new ingredient. Send a social media friend request to someone you know is T1D and reach out! Crazy as it sounds…simple works too!! I change colors on my SugarMate app, replace my lancet and clean out my glucometer’s case.

And don’t be afraid to reward yourself! I can refresh my attitude and reward myself with a pedicure. I can bust through a mental block and treat myself to a car detail. Or I can accomplish a small rut-busting goal and splurge on a new bottle of wine!”

 

“I like to just embrace the rut. Yeah, I feel like poop mentally, so what. Let me lay around more than I usually do or whatever thing I feel like doing. Then, either talk about what’s happening with someone (I find this the easiest way to process it) then move on once it’s “over.”

I used to try to fix everything all the time. Now I just try to recognize I’m feeling a certain way for a reason, and let it happen instead of insisting that I change it. (Which is what I used to to all the time and [shocker] it never helped.)”

 

“I like to go back to basics. This usually means committing to fasting the next day to do a thorough basal test, or buying groceries to make a delicious but consistent meal for the next few days. This usually gives me a “win” within a day or two that can motivate me out of my rut!”

 

“For me it’s about taking back control. I got tired of all different groups of people telling me what I have to do in order to have good control. For example–a couple years ago I was told I need to wear a pump to have good control. When I found a way that worked for me-low carb and cgm–I finally felt that I could control how I approach diabetes and still have same (or better) results. Makes me feel empowered. When I get in a rut I just remember that ultimately I am in control and try to make little tweaks.
And wine, too.”

***

What are your tips to getting back on track when you feel stuck in a diabetes rut? Please comment below, we love hearing from our readers.

Source: diabetesdaily.com

Is “Brittle Diabetes” a Real Health Condition?

If you’ve been living with diabetes for some time, you’ve probably heard the term, “brittle diabetes”, and you may have even been told you have it (from a family member, a friend, or even a physician). This can be a controversial issue, as some people believe it doesn’t exist, some people feel that it’s an outdated label (for a condition that’s already so complicated and stigmatized), and some people feel that it’s accusatory (for a condition that’s already so hard to manage). On the other hand, there are people who truly do believe they have a form of diabetes that is particularly “brittle”, and that the category stands. So, what’s the deal?

Defining “Brittle Diabetes”

A quick online search defines brittle diabetes as a hard-to-control form of type 1 diabetes.  It is also called labile diabetes. People with brittle diabetes often have large swings in blood sugar levels, and the swings in blood sugar may require hospitalization. One’s symptoms for high and low blood sugars are similar to those with type 1 diabetes, but the difference is the amount of time it takes to go from hyperglycemic to hypoglycemic, often without apparent cause. This can prevent people with brittle diabetes from carrying out normal day-to-day activities.

According to the National Institutes of Health, only a tiny proportion of people with type 1 diabetes experience the drastic fluctuations in blood sugars that can frequently be described as “brittle,” affecting only 3 out of every 1,000 people with type 1 diabetes. Young, overweight women between the ages of 15-30 are most likely to be affected.

Risk Factors

The most significant risk factor for brittle diabetes, is (of course) type 1 diabetes, as it is a subset of the disease. Other risk factors include mental health issues like depression, anxiety disorders, and high stress. People whose bodies release too much cortisol (from high-stress situations) can experience temporary insulin resistance, which can spike blood sugars and worsen fluctuations, even when you’re not taking less insulin or eating more. Alternatively, those with digestive issues due to gastrointestinal nerve damage, celiac disease, or gastroparesis may experience a more “brittle” form of diabetes, due to malabsorption of nutrients, and thus may face unpredictable insulin dosing requirements. Young women who have a history of eating disorders are also at a higher risk for brittle diabetes.

Diagnosis

Diagnosing brittle diabetes can be difficult. Oftentimes, a diagnosis of brittle diabetes will accompany a psychological diagnosis such as depression or anxiety, and the two conditions can feed into each other. A person with high cortisol levels, depression, and stress may neglect to eat a healthy diet, which can exacerbate the fluctuations in their blood sugar levels even further, and out of control blood sugar levels can worsen depression and anxiety. One study showed that people with brittle diabetes have a greater hormonal response to stress than those without brittle diabetes.

Treatment

The treatment of brittle diabetes will often include treating any underlying psychological disorders first, and to control the level of stress one is experiencing. It can be helpful to consult with a counselor who specializes in diabetes. Psychotherapy has proven effective in treating those with brittle diabetes and achieving better health outcomes. Those with brittle diabetes may require a long, in-patient hospitalization (in a controlled environment), where food, exercise, and stress is monitored closely, to achieve better baseline data for more successful long term control.

Additionally, people with brittle diabetes may find that wearing a continuous glucose monitor (CGM) and an insulin pump can help them achieve better health outcomes than using multiple daily injections as their insulin therapy. If an insulin pump or CGM will not work for your lifestyle or budget, reducing carbohydrates in your diet and establishing a regular exercise routine and way to handle stress can help minimize the drastic fluctuations in blood sugar levels.

Important to Note

It’s important to remember that the official diagnosis of brittle diabetes is extremely rare, and usually accompanies an underlying psychological disorder, like depression, anxiety, high levels of cortisol, or an eating disorder. Sometimes people with type 1 diabetes who struggle with malabsorption of nutrients in the gastrointestinal tract (from gastroparesis or celiac disease) may also suffer from these extreme fluctuations in blood glucose, which may present as ‘brittle’.

It’s normal for people with type 1 diabetes to have extreme fluctuations in blood glucose (and that may be why you’re insulted if someone deems your diabetes “brittle”), and it not be officially characterized as brittle diabetes. However, if you fear that you may have this rare condition, seek medical care immediately. Hospital stays are much more common in people with brittle diabetes, and attending school and/or work is much more difficult. While not fatal in and of itself, people with brittle diabetes are much more vulnerable to experiencing a diabetic coma and suffering severe complications. Talking with your healthcare provider can help you understand more about this condition, and can help you make a plan to manage or prevent it, and address the underlying digestive and/or psychological issues that may be worsening your blood sugar levels.

Have you been diagnosed with “brittle diabetes”? How have you managed this condition? Do you think it warrants a separate diagnosis? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

Minding Your Mental Health During COVID-19

I recently saw someone on social media refer to this as a “great pause’ and while I think it is wonderful that many people are viewing this time as an opportunity to spend more time with their family and to appreciate the simpler things that life has to offer, there are many people going through a very different, and traumatic, journey.

In just the United States alone, 1 out of every 5 people suffer from a mental illness and 1 out of every 25 people suffer from a severe mental illness. For those who are afflicted, it is oftentimes difficult to get through the average day without feelings of anxiousness, irritability, depression, etc. Add in a global pandemic and many of what they were told were “irrational” fears have now come to life. The feelings of isolation, fear, grief, loneliness, financial worry are all very real right now and we need to find a way to cope.

So how do we take care of our mental health while also acknowledging that it is a very scary time and that there is a lot that we don’t know? That is an uneasy feeling for anyone, let alone someone who struggles with mental health issues. Like all other things in life, I do believe it comes down to balance.

Routine

“The secret of your success is found in your daily routine” by John C. Maxwell is a great quote that is quite applicable at this time. I find that if I get up and get dressed, I have a more productive day than if I lie around in my pajamas. Also, keeping to a schedule (while of course allowing flexibility) for meals will not only keep you focused on what you are doing but can also make for more predictable blood sugars. Just these small steps can lead to less mental anguish.

Prescribe Yourself a Daily Dose of News

Try to limit your news consumption to a level that works for you. Many of us wind up leaving the television on and that can be very unhealthy to listen to and watch all day long. Either allow yourself a certain amount of time watching or pick a few times throughout the day to do a quick check-in. Also, make sure you pick one or two reliable sources that you trust and stick to those news mediums.

Stick with Your Mental Health Care Plan

If you are on medication, make sure you continue to take your medication as prescribed by your healthcare provider. If you are experiencing difficulty or feel the medication isn’t working properly, make sure to call your doctor as they are still available to take their patient’s phone calls and available for teletherapy. And if you haven’t sought professional help in the past but feel the need to do so, check with your health insurance to see what affordable options are available to you. There are also free hotlines that you can use:

  • Mental Health America Hotline: Text MHA to 741741. Mental Health America is a nationwide organization that provides assistance through this text line. You will be linked to someone who can guide you through a crisis or just provide information.
  • National Suicide Prevention Lifeline1-800-273-8255. Crisis intervention and free emotional support are available, which is helpful when you need confidential assistance during a time of emotional distress for you or a loved one. The helpline is open 24/7, and a live online chat is available as well.
  • Crisis Text Line: Text CONNECT to 741741. Specialized crisis counselors are just a text message away on this free, confidential 24-hour support line. To further protect your privacy, these messages do not appear on a phone bill. The text line also provides services and support if you are upset, scared, hurt, frustrated, or distressed.

Control What You Can

Many of us are sitting at the edge of our seat on a daily basis waiting for the next big piece of news to be released. Will there be antibody testing available soon near me? Are they opening my state sooner than I’d like? Are my children’s schools going to open back up this year? While these are all valid questions and concerns, we cannot allow them to take up too much space in our minds. Whatever the case will be, you will navigate the situation and do what is best for you and your family. A great quote to remember is “If it’s out of your hands, it deserves freedom from your mind too.” – Ivan Nuru ”

mental health

Photo credit: Sandis Helvigs (Unsplash)

Keep Your Mind and Body Active

This hasn’t been easy for any of us despite what your experience has been. Whether you’re dealing with the loss of a loved one or simply needing a ten-minute break from your toddler, your emotions are valid. Give yourself a few minutes a day to have a small pity party but then try to move on. Get active by taking a bike ride, going for a walk or take a road trip and get lost on a new adventure.  Exercise your mind by staying connected to friends and family. And when you’re alone, try out a challenging crossword puzzle or start a journal. Keeping busy will not only keep you from feeling lonely, but it will also be beneficial to your overall wellbeing.

This pandemic is affecting us all differently but there is no doubt it has been mentally and emotionally challenging for all. Make sure to acknowledge that while mental illnesses may be invisible, they are very much real and should be treated with care. You owe it to yourself and your loved ones to make yourself a priority during this challenging time.

Source: diabetesdaily.com

How to Navigate Blood Sugars During a Pandemic

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

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

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

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

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

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

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

Check Your Basal Insulin Dose

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

Jennifer Smith RD, LD, CDCES, explains:

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

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

Photo by iStock

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

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

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

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

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

Reduce Stress

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

Mindfulness and Meditation Apps

Staying Active at Home

Taking Care of Your Mental Health

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

Create (and Stick to) a Routine

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

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

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

Make Use of Technology

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

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

Photo credit: geralt (Pixabay)

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

Lean On Others

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

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

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

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

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

***

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

Source: diabetesdaily.com

Pregnancy, Delivery, and Postpartum Care During the COVID-19 Pandemic

Almost any pregnancy is full of excitement but can be stressful at times. Add in having diabetes and living through a global pandemic, and it can be quite anxiety-provoking. This article summarizes how recent policy changes due to COVID-19 may be affecting women with diabetes who are currently pregnant or have recently given birth.

A High-Risk Pregnancy

For women with diabetes, pregnancy is automatically classed as a high-risk affair. Although a healthy pregnancy is very possible with any type of diabetes, a lot of emphasis is placed on optimizing glycemic management, and women are closely followed with extra appointments and ultrasound scans throughout the pregnancy, and in particular, during the third trimester.

Telemedicine and In-Person Appointments

For those who are going through pregnancy during the COVID-19 pandemic, certain appointments may be possible to achieve via telemedicine. For example, if you’re working with an endocrinologist to manage your blood sugar levels, odds are, that can be achieved largely through telemedicine (or email). However, certain other checks (like ultrasounds), or if a woman is experiencing concerns or complications, there is no substitute for an in-person healthcare provider or even a hospital visit.

Ask your provider(s) which in-person appointments they expect you to keep and why. Also, keep in mind that there will likely be additional precautions, like waiting in your vehicle, instead of the waiting room, for example.

To curtail the spread of the novel coronavirus, most doctors’ offices and hospitals have now implemented strict policies concerning the number of visitors who are allowed at appointments. Most will find that for all (or almost all) appointments, women will be asked to come to their appointment without any additional visitors.

Of course, these new policies, while important, also can bring up considerable emotional issues. Pregnancy is supposed to be an exciting time, most often shared with loved ones, like your partner and family. Milestone appointments, attended alone, may feel bittersweet.

To help increase support during these times, ask your healthcare providers what their specific policies are and inquire whether it is possible to have your support person or people attend with you virtually. For instance, you may find that your practice will allow your partner to phone in via videochat to virtually experience a milestone ultrasound, and will give them an opportunity to ask any questions that they might have. While not the same as under normal circumstances, this can offer women more emotional support during these exciting (and challenging) times.

Labor and Delivery

One fear that many women are expressing these days (and rightfully so!) is one of having to labor and deliver their babies without a support person. While formal “birth plans” are notorious for falling apart (at least somewhat, as no birth is predictable), this is perhaps the first time in our recent history that women have to worry about not being able to have their emotional support system in place for the big event.

It appears that most hospitals are balancing the need for limiting viral spread with the importance of emotional support for patients during this critical time. Most likely, your hospital will allow one support person to attend your labor and delivery (although this may not be the case everywhere, especially in COVID-19 disease epicenters). However, be prepared that they may not be able to accompany you during the postpartum hospital stay. Ask your hospital ahead of time what the policy is (also for vaginal delivery vs. c-section) so you can be prepared. Also, you may find that (if deemed appropriate) your discharge from the hospital may happen sooner than what is typical.

Diabetes online community member, Shannon M. (who has type 1 diabetes) described to us her challenging experience with delivering her baby boy amid the COVID-19 outbreak:

“I planned on being induced at 39 weeks but was induced the day I hit 38 weeks due to the doctors personal concern about the virus. The hospital was also thinking of starting to allow no help in the delivery room and they wanted to make sure I had someone there with me, as well as to get in and out of the hospital before the virus spread got even worse. My biggest concern the entire time ended up being for the virus rather than health of the baby in general.

While I was in labor, they decided I needed an emergency c-section and took me into another room. I was concerned about going into so many different rooms because that increased my chances of getting the virus rather than being afraid of the c-section itself.

After everything, my baby was taken to NICU for low blood sugars. As I had expected this, I wasn’t too worried, but again, worried about his extended stay in the hospital because of the virus. This also meant I had to visit him daily in the hospital, which concerned me, trying to not get the virus myself and transfer it to him or the rest of my family.

They only let me recover one day in the hospital from the c-section, when it’s usually three days. The social worker admitted to me the cases were getting bad in our hospital and just wanted everyone who didn’t absolutely have to be there, out. Everyone had to wear masks and gloves throughout the hospital. One of my nurses continued to not wear her mask around me and it made me very paranoid.

My baby is still in the NICU. It has now been 13 days and I still have anxiety visiting him. I don’t leave his room to eat or use the restroom unless I absolutely have to. It’s been a horrible experience and cannot wait to get him home. I also live in Essex county NJ, which is the second-worst infected county in the second-most infected state, as we are 20 minutes from NYC.”

Postpartum Care

In addition to possibly leaving the hospital earlier than expected, women are likely going to experience more isolation than they normally would. Importantly, this can affect the rates of postpartum depression, which is of great concern.

Taking time every day for essential self-care and human connection is important for all new moms and is perhaps even more critical during these tough times. Having a support system in place, even if you’re only able to communicate remotely, can help women feel more supported.

Photo credit: smpratt90 (Pixabay)

While many women will probably attend their 6-week postpartum check-up (especially for birth control, like an IUD), this may not be the case for those who don’t have any upcoming procedures, questions or concerns (I actually cancelled my own 6-week postpartum check-up that was supposed to take place mid-March). Be sure to bring up any physical or mental health concerns to your doctor right away. Don’t forget that many issues can be addressed via telemedicine (e.g., mental health appointments), so you can safely stay at home with your baby.

Also, don’t forget to check in with your pediatrician’s office about what their policies are. Most likely, only one parent will be able to attend the child’s well-visit appointments. Some appointments may even be postponed, depending on the specific circumstances.

Jennifer A., who delivered her son at the end of March, describes:

“My son has only had one appointment over a phone chat. It was OK. I prefer to keep him safe but I also want to make sure my son is healthy and growing right and that is hard to tell over a phone.”

Conclusions

Going through pregnancy, labor and delivery, and the postpartum period, while also managing diabetes, is difficult enough but can feel overwhelming during a global virus pandemic. Understanding that the inconvenient policies are there to help protect you and your baby, and getting the mental health and emotional support you need during and after pregnancy is key to keeping the big picture in mind and being able to enjoy this very special time.

Are you currently pregnant or have recently had a baby during this crisis? We’d love to hear about your thoughts and experiences.

Source: diabetesdaily.com

Keeping Your Immune System Healthy

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

By Mariana Gomez and T’ara Smith

Perhaps you’ve read about boosting your immune system to protect you from infections and other illnesses, including the Coronavirus. But, there aren’t any magic foods, supplements, or one-size-fits-all solutions to boosting your immune system because it’s a complex network of cells, organs, tissues, and proteins. Still, healthy living provides its benefits, including keeping our immune systems strong, and research is being conducted to study the effects of nutrition, exercise, mental health, and others on our immune response.

How Diabetes Impacts Your Immune System

Type 1 diabetes is an autoimmune disease. There is not enough evidence to identify the cause but we know that our immune system insulin-producing cells are destroyed. We now know that people with type 1 diabetes are more likely to have a co-occurring autoimmune disorder. The reason that co-occurring autoimmune disorders are so common isn’t yet known. We also know that hyperglycemia can affect our immune system’s response so it would represent a barrier for recovery and fighting virus and bacteria. This does not happen only in type 1 diabetes (T1D) but other types of diabetes as well.

People with type 2 diabetes should be aware of the impact the disease has on their immune system as well. Hyperglycemia in diabetes is a probable cause of the disruption of how the immune system functions. Humans also produce “natural killer” cells that are critical to human immunity. A study showed people with type 2 diabetes have lower counts of these cells compared to those without diabetes and with prediabetes. This makes it harder to defend the body against viruses, diseases, and diabetes-related complications.

Overall, people with diabetes are more susceptible to common infections such as the flu and pneumonia. To protect your immune system, stay up-to-date on your doctor’s visits, get vaccinated against the flu, and get screened for complications.

Essential Nutrients for a Strong Immune System

Another way you can protect your immune system is through nutrition. With a healthy diet, food can help protect you against illnesses and help improve recovery. Different foods contain different quantities and types of nutrients and micronutrients. Therefore it is important to include a variety of food groups in your diet. Vitamins A, B6, C, E, magnesium, and zinc play important roles in our immune function.

How Vitamins + Minerals Help Your Immune System

Vitamins and minerals are known as essential micronutrients. Even though they are needed for our health, our bodies can’t make them on our own or enough of essential micronutrients, therefore, they must be obtained through food. There are nearly 30 vitamins and minerals the human body can’t make on its own. A healthy diet will include different groups of foods that contain some of these nutrients.

Micronutrient malnutrition results in a lack of vitamins and trace minerals that can affect the response of our immune system to fight different health conditions. The NIH lists the recommended dietary allowances (RDA) for vitamins and minerals. While this provides general guidelines for different age groups, please talk to a nutritionist or your doctor about recommended intakes for you.

Vitamin A is an anti-inflammation vitamin that helps develop and regulate the immune system and protect against infections. This Vitamin can be found in sweet potatoes, carrots, broccoli, spinach, red bell peppers, apricots, eggs, and milk. While vitamin A is important, it is possible to consume too much of it. High intake of vitamin A from supplements and some medications can cause headaches, dizziness, coma, and death. According to the NIH, pregnant women shouldn’t consume high doses of vitamin A supplements.

Vitamin B6 helps improve immune response to the increase in the production of antibodies, a protective protein produced by the immune system to fight antigens in the body. Vitamin B6 is found in a variety of foods. Food sources of vitamin B6 include pork, fish, poultry, bread, eggs, cottage cheese, tofu, and wholegrain foods such as oatmeal and brown rice. Getting too much vitamin B6 from food is rare. However, from supplements, long-term use for a year or more can lead to nerve damage.

Vitamin C also known as ascorbic acid, helps your immune system by fighting free radicals that cause cancer and other diseases. It’s a popular nutrient to fight or treat the common cold. While focusing on vitamin C consumption may not prevent you from getting sick, it could decrease the length and severity of cold symptoms. It also helps by stimulating the formation of antibodies. This vitamin can be found in oranges, grapefruit, tangerines, red bell pepper, papaya, strawberries, tomato juice, among others. Too much vitamin C can cause diarrhea, nausea, and stomach cramps.

Vitamin E works as an antioxidant, which protects the cells from damage by free radicals and helps the body fight infections. This vitamin can be found in sunflower seeds, almonds, vegetable oils, hazelnuts, and spinach and other green leafy vegetables. There isn’t a risk of consuming too much vitamin E from foods. Precautions should be taken when taking supplements, which could interfere with other treatments such as chemotherapy or radiation therapy.

Magnesium is a nutrient that our body needs to regulate the function and work of our muscles and the nervous system. It is involved in the process of forming protein, bone mass and genetic material. It is found in legumes, nuts, seeds, whole grains, green leafy vegetables, milk, yogurt among others.

Zinc is found in cells throughout the body. It helps the immune system fight bacteria and viruses and is needed to produce proteins and DNA. During pregnancy, infancy, and childhood, the body requires zinc to grow. Zinc can be found in oysters, red meat, poultry, crab, lobster, cereals, beans, nuts, whole grains, and dairy products.

Drinks That Help Your Immune System

You can find or create your own drinks to help your immune system. Some beverages you may want to try at home that are high in important immune-friendly vitamins are:

*Juices may be high in carbs and sugar, so if you can, opt for unsweetened teas like green/chamomile teas, or whole fruits.”

Alcoholic beverages are generally fine to consume in moderation. Drinking too much alcohol can lead to a weaker immune system. Heavy drinkers are more likely to get pneumonia and drinking too much alcohol at once can slow your body’s ability to ward off infections.

Should You Use Supplements to Help Your Immune System?

Supplements are used in cases where diet is not able to sufficiently provide micronutrients. While supplements aren’t meant to replace a balanced diet, they’re used to help people with other health conditions and may be prone to nutrient deficiencies. Many vitamin and mineral supplements can be purchased over the counter. But, check with your physician or a registered dietitian nutritionist to see if you actually need them. If you’re taking other medications, talk to your doctor on how vitamin and mineral supplements can interfere with those drugs.

Other Things You Can Do to Stay Healthy

A healthy diet is definitely a big part of remaining healthy. Other things you can do on a regular basis to maintain your health is to practice good hygiene (i.e. washing your hands), see your healthcare provider routinely, keeping an emergency medical plan and your emergency contacts updated. Also, prioritize physical activity and refrain from smoking. From a mental and emotional health perspective, practice stress-relieving techniques and know the signs of diabetes burnout.

Source: diabetesdaily.com

Keys to Long Term Success and Preventing Complications

Contrary to popular belief, you can live a long, healthy life with type 2 diabetes, without developing complications. In its 2010 report, Diabetes UK found that someone with type 2 diabetes is likely to have a reduced life expectancy by up to 10 years, and someone living with type 1 diabetes is likely to have a reduced life expectancy by up to 20 years.

However, with advanced technologies and therapies, people are living longer and healthier than ever. Results from the University of Pittsburgh after a 30-year longitudinal study found that people with type 1 diabetes born after 1965 had a life expectancy of 69 years — longer than any study had ever previously found.

In part four of our four-part series on living well with type 2 diabetes, we will dive into the keys to long term success managing your condition, and how to prevent complications over the long term.

What Causes Complications?

It’s important to know what causes complications in people with type 2 diabetes. Not everyone living with diabetes will develop complications, but the occurrence of chronic hyperglycemia, or high blood sugar, can lead to heart disease, kidney failure, nerve damage, and retinopathy (the most common complications of diabetes). It’s important to keep your blood sugars in range as much as possible to help prevent the onset of these complications.

Keys to Long Term Success

A number of factors have been shown to help slow the progression of (or completely prevent) complications in people with diabetes:

  • Keep HbA1c in range – Studies have shown that keeping your HbA1c lower than 7% can prevent the onset of complications, and closely monitoring your blood sugar (testing regularly) can help tighten your control. Talk with your doctor about the ideal number of times she would like you to test per day, and make sure you always test before and after meals.
  • Take your medications as prescribed – Some people think that insulin is “bad” or they just don’t like the thought of taking a pill every day. You’re prescribed your medicine for a reason, and you should follow all doctors’ orders to take them as prescribed. Rationing or skipping doses can quickly lead to complications or even premature death.
  • Follow a sensible diet – You don’t need to go completely paleo or keto to have better blood sugars, but speaking with your doctor or seeing a nutritionist can help you develop an eating plan that will work for you that you can sustain. Be sure to include plenty of fresh vegetables, protein, and water. Eating similar foods, eating a low carbohydrate lunch (of 20 grams or fewer) and limiting meals at restaurants has also been shown to help improve blood sugar management in people with diabetes.
  • ExerciseExercise is one of the most important things you can do to prevent complications. Not only does it lower blood sugars, but it gets the heart working and the blood pumping, increasing circulation and strengthening your whole cardiovascular system. Exercise boosts your immune system, and increases serotonin in the brain, making you feel good and helping to prevent the onset of depression. According to our Thrivable Insights study, people with type 2 diabetes who have an HbA1c <6.5% are more likely (20% vs 8%) to exercise 4-6 times per week than people living with type 2 diabetes who have an HbA1c of 8% or higher.
  • Surround yourself with support – Diabetes is a marathon, not a sprint, and the journey can be lonely at times. A study from the University Hospital in Denmark found that loneliness may actually cause premature death by damaging the blood vessels of the heart, which can be compounded with a diagnosis of diabetes. Long term success with your diabetes care is much more likely if you surround yourself with supportive family and friends, or if you can find a community who will understand. Sharing your thoughts, worries, and feelings will help lighten your load, and you may just learn a thing or two that you didn’t previously know about diabetes and how to better care for yourself!

Have you had diabetes for a long time, and are thriving without complications? What are some of the best strategies you’ve employed to achieve success? Share this post and comment below!

Source: diabetesdaily.com

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