Is Healthcare Provider Knowledge of Diabetes Lacking?

People’s experiences with healthcare providers can vary widely. When it comes to living with diabetes, many people expect that their healthcare providers, even if they’re not specialists, will be at least somewhat knowledgeable about their health condition. Many have found however, that while endocrinologists and diabetes education specialists tend to be more attuned to the ins and outs of diabetes management, even their knowledge can be outdated, while the knowledge of other providers, is sometimes starkly lacking.

Meanwhile, two informal polls in two separate diabetes social media groups, highlighted that over 85% of people with diabetes expect any healthcare provider (even if not a diabetes specialist) to have a basic working understanding of diabetes, at the very least the two major types and general treatment options.

Nevertheless, when the asked to share their own experiences, many reported a lot of confusion and uneducated statements about diabetes from various healthcare providers. The consensus during the crowdsourcing research tended to be “while we expect it, we do not routinely see it.”

We asked people to share some of the comments that they received about diabetes from healthcare providers. Here are some surprising responses and stories to ponder:

“When did you have your insulin pump surgery?”

“Type 1 diabetes develops over 2-3 days, not months.”

“He was a big baby so clearly he’s was a diabetic when he came out.”

“You will kill your child with this low carb nonsense… I will not stand by and watch you do that… I’m sure one of the other doctors will call CPS with this.”

“Diabetics like you are only allowed 4 eggs a week. Period.”

“You should eat more carbs, it’ll stabilize your blood sugars.”

“Do not correct under 13 mmol/L [~234 mg/dL].”

“You need to eat a minimum of 45 g carbs per meal.”

“If you don’t like seeing high fasting blood sugar numbers in the morning, don’t test your blood sugar then.”

“You will likely be dead from diabetes by age 30. If by some miracle you are still alive, you will be blind, on kidney dialysis, and in a wheelchair due to amputations.”

“Are you sure you have type 1?”

“It’s probably best if you stop sports and strenuous exercise.”

“If you go low-carb, you’re going to kill yourself.”

“An A1c below 6.5 is dangerous.”

“You don’t have to bolus for corn or peas, they are freebies.”

“Your insides are destroyed from having diabetes so long.”

One woman shared the following story:

“When my daughter was diagnosed at age 2 (I had diagnosed her and had to fight with her pediatrician to test her blood, because her urine test was normal. We already ate low-carb, so I had to feed her a high-carb meal and take her back and storm the pediatrician’s office and force them to give her a test, which came back at around 500, at which point they finally sent us to the ER). After diagnosis, the endo told us she needed at least 100 g carbs for each meal (at age 2!!!), plus 30–50 g snacks in between meals. Insanity! They had her on massive amounts of Lantus, NPH, and Novolog. They told me to feed her lots of ice cream before bed every night to hold her steady at around 200, which was a great night-time number for a kid that age! I swear I still have PTSD from that whole experience! Nightmare! I had to fight with them every step of the way!”

Such stories amassed very quickly, with many nodding their heads at having similar experiences. Is there perhaps a gap in basic diabetes education, in particular for non-specialists?

Image credit: Haidee Merritt. Republished with permission. Please visit her Etsy store for more original work and gifts. 

Almost all will likely agree – while we cannot expect every healthcare provider to be fully attuned to the latest developments in diabetes diagnostics and treatment, an accurate knowledge of the basics should be a requirement – especially with the high number of diabetes diagnoses, and undiagnosed or misdiagnosed patients.

Moreover, ensuring better understanding of diabetes and its management across the board, for all providers, is highly likely to improve patient outcomes in various situations, including recovery from illness and surgery, and more effective prevention of numerous diabetes-associated complications.

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What are your thoughts on this issue? Have you ever had a surprising conversation about diabetes with a healthcare provider?

Source: diabetesdaily.com

How Coming Out Helped Me Accept My Type 1 Diabetes Diagnosis

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

By Peter Friedfeld

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

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

As he pulled out two boxes he said:

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

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

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

My New Normal

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

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

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

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

Learning From the Past Life Challenges

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

Diagnosis

Image source: Beyond Type 1

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

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

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

Finding myself again

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

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

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

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

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

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

Diagnosis

Image source: Beyond Type 1

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

My Story Is Only One Story

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

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

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

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

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

Source: diabetesdaily.com

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

Updates on the Environmental Triggers of Type 1 Diabetes (ADA 2020)

The onset of type 1 diabetes (T1D) usually entails a genetic predisposition to developing the condition, as well as an “environmental trigger” (such as a viral infection, or another exposures). As we previously reported, a multi-center international research effort called TEDDY (The Environmental Determinants of Diabetes in the Young) has been investigating potential environmental triggers that may induce the onset of type 1 diabetes in children since 2004.

As described in the most recent press release:

“TEDDY is aiming to discover viruses and nutritional factors that interact with genes to “trigger” immune destruction of the beta cells, marked by the appearance of islet autoantibodies. The study enrolls infants identified as “at-risk” for developing T1D and follows them for 15 years to look for the appearance of various beta-cell autoantibodies and diabetes. TEDDY has also studied biomarkers that can predict faster or slower progression to diabetes after the autoimmune destruction has begun.”

Now, new data on environmental connections between type 1 diabetes as well as celiac disease were just presented today at the American Diabetes Association (ADA) 80th Scientific Sessions. Dr. Marian Rewers, MD, PhD from the Barbara Davis Center for Diabetes at the University of Colorado School of Medicine, along with other presenters, provided the new research updates.

Key Takeaways

Here are the major highlights:

  • It appears that beta cell destruction often begins very early in life; as early as in the first two years of life.
  • There may be two distinct subtypes of type 1 diabetes that are characterized by differences in their genetics, immune system, and various metabolomic markers.
  • The value of HbA1c as a predictive factor for developing type 1 diabetes may differ between youth and adults who develop the condition.
  • Presence of enterovirus B in stool samples is predictive of islet autoimmunity development in children.
  • The gut microbiome composition tends to be different in children who develop islet autoantibodies as compared to those who do not. The use of probiotics may help to mitigate this risk.
  • Use of antibiotics WAS NOT shown to be related to autoimmunity.
  • Vitamin D, vitamin C, and polyunsaturated fats may carry preventative benefits against autoimmunity, although this needs to be validated in further studies.

Another interesting update was concerning the environmental determinants of celiac disease. There is some overlap in the genetic factors that are associated with the development of type 1 diabetes and celiac disease. Interestingly, recent research has identified a link between the consumption of gluten early in childhood and an increased risk for developing celiac disease among those with a genetic predisposition.

Dr. Rewers had this to say in summary:

“While T1D and celiac disease share a lot of genetic characteristics, there are intriguing differences in the ways these diseases develop and progress,” added Dr. Rewers. “TEDDY is contributing exciting clues for design of future trials to prevent both T1D and celiac disease.”

Conclusions

The multidisciplinary international TEDDY research effort continues to uncover important pieces of the complex puzzle to explain exactly how and why certain individuals develop type 1 diabetes and other autoimmune conditions. Understanding the relationships between genetic predispositions to autoimmune disease and how they may be triggered is critical to the development of effective preventative strategies in the future.

Stay tuned for more research updates from ADA 2020!

Source: diabetesdaily.com

New Therapy Shows Promise in Children with Newly-Onset Diabetes (ADA2020)

Research is ongoing around the world concerning the delay of progression and the prevention of type 1 diabetes. The etiology of the disease has been extensively characterized, but all the events and processes that drive and maintain autoimmune attack on the insulin-producing cells are still not fully understood.

One avenue of current investigation involves the clinical application of Tregulatory (Treg) cells. This population of immune cells have many functions, and importantly, serve to help the body recognize the self (“self-tolerance”) and to prevent aberrant attack on healthy tissues (autoimmune disease).

Dr. Piotr Trzonkowski, M.D., Ph.D from the Medical University of Gdansk in Poland has focused his career on investigating, developing, and applying cell-based therapeutic approaches. He presented his most recent work as part of the late-breaking poster session in the Diabetes Prevention category at the American Diabetes Association (ADA) 80th Scientific Sessions this weekend.

The research focuses on utilizing Treg cell therapy in combination with an antibody against a molecule called CD20. This molecule is expressed by immune cells populations (B cells) that are involved in mediating autoimmune disease (read more about anti-CD20 therapies here and about targeting B cells for type 1 diabetes therapy here).

Study Design

This phase II clinical trial utilized the combinational treatment (TrCD20) as part of a study that enrolled 36 children with a recent type 1 diabetes diagnosis. The participants were divided into three groups: control , Treg therapy alone, or the combinational therapy (TrCD20). All patients were followed for a period of two years, and various clinical parameters, such as blood glucose levels and beta cell function, were evaluated and compared between the groups.

Major Outcomes

The main finding in this study was that patients who received the combinational therapy fared better than the other groups with respect to multiple parameters, including fasting and stimulated c-peptide levels (c-peptide is a measurement of insulin production). Also, patients in both treatment groups exhibited lower HbA1c levels and lower fasting blood glucose levels throughout the study. The researchers noted that:

“TrCD20 group was in partial remission defined as insulin dose below 0.5 IU/kg up to +21 months. The longest insulin independent follow up lasted 18 months. The end of the remission in Tr group was noted at +18 month and in controls at +12 months. At the +24 months daily insulin requirement and HbA1c levels were significantly lower in TrCD20 as compared to control group.”

Conclusions

This phase II clinical trial demonstrated increased efficacy of combining cell-based therapy and antibody treatment to achieve longer beta-cell function in children with newly-diagnosed type 1 diabetes. Importantly, in addition to the potential glycemic management benefits, delaying the progression of type 1 diabetes at the early stages may also allow for the clinical application of several novel therapies aimed at halting disease progression.

For example, consider the following research that we have reported on over the last year:

Personalized Therapies for Type 1 Diabetes Take Center Stage 

TrialNet Updates: New Treatment Delays Type 1 Diabetes Onset 

“Inverse Vaccine” to Treat Type 1 Diabetes Passes Phase I Clinical Trial

We will continue to keep you posted of ongoing developments and promising new approaches. Please stay tuned for our ongoing coverage of the most recent research presented at the ADA Scientific Sessions.

Source: diabetesdaily.com

Research Trends with Dr. Maria: Beta Cells, Botox, and More

Dr. Maria Muccioli holds degrees in Biochemistry and Molecular and Cell Biology and has over ten years of research experience in the immunology field. She is currently a professor of biology at Stratford University and a science writer at Diabetes Daily. Dr. Maria has been living well with type 1 diabetes since 2008 and is passionate about diabetes research and outreach.

In this recurring article series, Dr. Maria will present some snapshots of recent diabetes research, and especially exciting studies than may fly under the mainstream media radar.

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Even Very Slightly Elevated Blood Glucose May Impact Beta Cells

When diabetes first develops, a reduction in insulin production initially results in just a slight elevation of blood glucose. A just-published study by researchers at the Joslin Diabetes Center employed cell culture and mouse models to assess how very slight elevations in blood glucose levels might affect the beta cells. Interestingly, the scientists discovered that even slight perturbations in glycemia (*as little as “being only 11 mg/dL higher than controls) could result in gene expression changes in the beta cells. The major conclusion of the investigation was that “mild glucose elevations in the early stages of diabetes lead to phenotypic changes that adversely affect beta cell function, growth, and vulnerability.” Continuing to investigate exactly how the early stages of diabetes may affect disease progression may aid in the development of treatments aimed at slowing or halting disease progression by preserving or improving beta cell function. This study also underscores the importance of early diabetes detection and treatment.

Different Subtypes of Type 1 Diabetes Classed by Age at Diagnosis

The pathophysiology of type 1 diabetes is complex, although it is generally accepted that in most cases, a genetic predisposition and an environmental trigger result in disease onset. A research study that was recently published in the journal Diabetologia aimed to investigate different subsets (endotypes) of type 1 diabetes by evaluating the level of insulin production from recently-diagnosed patients. Interestingly, the authors report that in patients who were diagnosed prior to age 30, “there are distinct endotypes that correlate with age at diagnosis”. Specifically, the new research showed that those who were diagnosed at a very young age (before seven years old) exhibited more defective insulin processing as compared to those diagnosed at age 13 and older. The scientists believe that stratifying type 1 diabetes cases by endotype will prove useful in the most appropriate design of immunotherapies to treat the condition.

Male and Female Offspring May Be Differently Affected by Maternal Diabetes

Hyperglycemia during pregnancy can negatively affect the offspring. A study published in April 2020 in the journal Brain, Behavior, & Immunity – Health indicates that the effects of hyperglycemia on central nervous system development may affect male and female offspring differently. Notably, the authors concluded that while hyperglycemia could cause developmental defects in males in females, when it came to “impairments in recognition memory,” specifically, it was found that only the females were negatively affected. Although this research was performed in rodents, it offers valuable insights into how maternal diabetes may affect offspring development in a sex-specific way. Notably, it was also demonstrated that insulin administration to achieve strict glycemic control mitigated the negative effects, once again highlighting the importance of optimal glycemic management before and during pregnancy.

Botox Injection Plus High-Protein Diet for Obesity Treatment

Interestingly, the injection of botulinum toxin (Botox) has been shown effective in the treatment of obesity. A research study recently published in the journal Obesity Surgery evaluated the efficacy of botulinum toxin injections alongside a calorie-restricted, high-protein diet for weight loss. Participants were assigned to one of three groups: 1) botulinum toxin treatment only; 2) botulinum toxin treatment + calorie-restricted/high-protein diet; or 3) calorie-restricted/high-protein diet alone. Excitingly, the results showed that patients who received botulinum toxin treatment prior to initiating the diet protocol achieved faster weight loss and experienced more positive effects in improving comorbidities. The authors theorize that botulinum toxin treatment may help “facilitate adaptation to the new diet style”.

“Kitchen Intervention” in Type 2 Diabetes Education Helps Improve Outcomes

Several educational intervention programs aimed at improving glycemic management in patients with type 2 diabetes were compared in a recent initiative by the Milwaukie Family Medicine center in Oregon. A traditional diabetes education class was implemented for one group of patients, while a second group was assigned to the traditional education program, along with a “health-focused, budget-friendly cooking class” provided by the Providence Milwaukie Community Teaching Kitchen. Hemoglobin A1c measurements were acquired at baseline, and at several months post-intervention. The recently published results demonstrated that patients who participated in the cooking class intervention, lowered their A1c levels more, on average, than those who attended the traditional education program alone. Although this initiative was a small one and yields very preliminary results, the outcomes suggest that intervention programs focused on real-life applications (like budgeting and cooking) may afford better patient outcomes.

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Please share your thoughts with us and stay tuned for more recent research updates!

Source: diabetesdaily.com

To the Doctor Who Told Me I Couldn’t Have Type 1 Diabetes

Dear Dr. N,

I walked into your office, hopefully optimistic. I was having stomach issues for quite some time and was lackadaisical about it, and it worsened. I checked out a local “mom” Facebook group to find some gastroenterologist recommendations. Your name was mentioned a few times, and your office was less than a mile from my house. I also was hoping to see a woman, so I was thrilled find see this local recommendation and made the appointment.

You came in with a smile, looked me in the eye, and shook my hand, as it was our first time meeting. I immediately felt calm and confident that I picked a good name out of the virtual hat. Until you asked me about the forms, I had just filled out. “I see here you have type 1 diabetes?” you asked. I recited my usual response that yes, I did, for only six years, diagnosed at age 37 and with no family history.

This was the moment that I lost all faith in you as a doctor and as an educated civilian. You looked up at me and started to explain, “Type 1 is diagnosed at birth.” Umm, no, it’s not. And what really felt like a kick in the gut was when you started to lecture me on the two different types of diabetes, explaining condescendingly, that since I was diagnosed as an adult, I have type 2.

It took everything I had not to walk out. After all, I needed the appointment. I needed your expertise. I understand your schooling isn’t in endocrinology, but the lack of pretty basic knowledge was quite concerning.

Moreover, to have someone, let alone a medical professional, tell you that the disease that you battle day in and day out, is in fact, not the disease you have, takes poor bedside manner to an entirely new level. The sleepless nights, the bruises on my body, the low that put me in the back of an ambulance must have been a figment of my imagination. I quickly started to defend my disease and defend the fact that yes, I DO have type 1 diabetes, and I have been on insulin since the day I was diagnosed.

You looked like you barely believed me as you confidently smirked and went on to jot down your notes. You confirmed my age at diagnosis and went on to say, “What took them so long?” This is when I really should have walked out the door. Instead, I was furious and blurted out, “If I had it for much longer, I would HAVE BEEN DEAD.” Clearly, you have zero understanding of this condition.

After I reluctantly went on with the examination, the outcome was that you recommended a colonoscopy because you didn’t like “me or my family’s history.”  As you started to lay out the details of the preparation and what to expect, you told me to stop all insulin the day before. What? Stop all insulin? You couldn’t have said that. But you did. And I responded with, “Do you mean fast-acting insulin because if I stopped taking all of my insulin, I will likely show up tomorrow in DKA (diabetes ketoacidosis).” This is when I knew I was definitely not returning.

I was angry. I was disappointed. I felt helpless. I was not going to let a doctor who had zero knowledge of my disease, try to convince me that I didn’t have type 1 and almost put me into DKA perform my colonoscopy. I canceled my appointment the next day and decided not to give them a reason why. But three weeks later, it is still making my blood boil.

Please educate yourself. Please listen to your patients. Please do not give out dangerous misinformation. Please, I beg of you.

Source: diabetesdaily.com

Book Review: Diabetes Essentials

Diabetes Essentials: Tips & Recipes to Manage Type 2 Diabetes, is a brief, easy-to-understand, illustrated introduction and guide to living with type 2 diabetes, that was recently published by registered dietitian and diabetes educator Karen Graham, and endocrinologist Dr. Mansur Shomali. I received the book for review at no charge and all opinions are my own.

My Review

When a person is newly diagnosed with type 2 diabetes it can feel isolating and overwhelming, especially for those who were previously unfamiliar with the condition and what diabetes management entails. This short, easy-to-understand, illustrated guide covers the main concepts and provides concrete advice to help set new patients on the right path to healthy living with diabetes.

The information in the book is organized in easy-to-read “top-ten” lists and focuses on many categories that are relevant to life with diabetes, including diet, exercise, blood sugar management, healthy lifestyle choices, weight loss, mental health, planning for pregnancy, and much more. The information covers the basics, without going into detail, and is in line with the commonly prescribed medical advice that is typically offered to patients with diabetes.

Throughout, the book offers helpful and specific tips that aim to help people with diabetes better understand their condition and improve their health. From advice on mindful eating to smoking cessation to preventing and identifying complications, this book covers so many aspects of living well with diabetes. I particularly liked the list with advice for getting through the first 10 days after a diabetes diagnosis, as well as the guide to different doctors’ appointments.

A considerable section of the book is dedicated solely to “diabetes-friendly” recipes, including a sample ten-day meal plan, along with ideas for salads, soups, dinners, snacks, and desserts. Most of the recipes are moderate in carbohydrates, high in fiber, and low in fat. Detailed nutritional information is provided alongside each recommendation.

One section I liked, in particular, discussed trending research and recent diabetes advancements. These included a discussion of continuous glucose monitoring technology, as well as newer insulins and diabetes medications. The authors also cited some relevant information from the national Diabetes Prevention Program (DPP). I thought this section was particularly useful to help new patients understand how recent advances in care (even if not yet practiced in the mainstream) can help people with diabetes better manage their condition.

The last section of the book consists of quizzes on various topics to help readers reinforce their understanding of the educational materials. This also provides a fun way to learn about some common misconceptions. Finally, the detailed index at the end makes it easy to quickly find a specific topic of interest.

Summary

Overall, this text provides a competent and easy-to-understand overview of type 2 diabetes basics and advice for newly diagnosed patients. It informs without overwhelming the reader with too many details and provides concrete strategies to help manage the condition and related health issues.

Diabetes Essentials costs $24.95 and can be purchased online here.

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Have you purchased this book already? Please share your thoughts with us in the comments below.

Also, check out this comprehensive list: The Best Books About Diabetes.

Source: diabetesdaily.com

If Your Blood Sugar Could Talk

The diabetes online community (DOC) is great for finding information, asking for advice but also for a much-needed laugh. Over the past few weeks, Levi Davenport’s video that humanizes his blood sugar has gone viral within our community and many are finding this two-part video series not only hilarious but therapeutic as well.

I caught up with Levi to ask him a few questions about his own type 1 diabetes (T1D), the way he copes and his intentions of this well thought out video. Please make sure to watch the two-part video at the end!

When were you diagnosed? How did you handle the diagnosis?

I was diagnosed with type 1 when I was 15 years old, in 2004. I was playing high school baseball, and looking forward to getting my driver’s license. The last thing I was interested in dealing with was diabetes.

Photo credit: Levi Davenport

Did you have a good support system from family, friends, and doctors?

Absolutely, I was surrounded by fantastic people – family, friends, and Vanderbilt Children’s Hospital. I had no family history. I caught a very bad stomach bug (think – very bad). Afterwards, over the next 10 days, I lost 14 lbs. and had what I later came to know were the symptoms of high blood glucose. A doctor visit later, I was told I was the proud new owner of a dead pancreas. That was it. I had a two-week hospital stay and then my parents drove me back and forth to Vanderbilt to go through the T1D ‘crash course.’ None of us knew anything about type 1 and to date, I am the only diabetic in our family.

Being a kid is hard enough. Did you feel different and isolated due to your new normal?

Internally yes, and angry. Externally no, but only because I chose to hide it from everyone — friends, teammates, girlfriends, teachers. I only told people about it when I absolutely had to. I did not handle the adjustment well.

Did your diagnosis affect any of your life decisions (what you wanted to be when you grew up, going away to college, etc.)? 

Not at all. I don’t let T1D stand between me and something I have my mind set on doing. You are only limited in life by what you are willing to do.

Did anything in your life have to change in order for you to optimally manage this disease?

Oh yes, I had several dark years. I lost an incredible amount of weight. I am 6’5 and went from fit to emaciated in a matter of 2 years. I dropped from 240 lbs to 186 lbs. The catalyst for me was my children. I was in bed one night and felt my shins and thighs tingling. I realized that it was the beginning of neuropathy. I gave thought to how many years I was shaving off my life by ignoring my health, and within 2 months I had an insulin pump, continuous glucose monitor (CGM), and a watch that showed my blood glucose.

Photo credit: Levi Davenport

Did you turn to your family and friends for support?

Not really, I am a pretty private person when it comes to feelings and emotions (working on that).  After years of shutting everyone down, I could definitely see that they were happy to see what was happening though. Especially my wife. Living with a 24-hour grump took great patience. Since starting on the pump/CGM I have regained the 50 lbs and I felt so much better that I no longer cared about who knew I was a T1D.

Once I found the DOC, the face of this disease changed for me. Not only the information I got from others living with type 1 but I made real friendships that helped me feel less alone. Did you go online for support and information? Have you made any online connections that have helped lessen the burden of this disease?

I turned to the DOC when I started learning about resources like Spike and Xdrip. Shortly after, I discovered the social media groups and pages. I couldn’t believe it. If you aren’t a member of a T1D page or group, you need to check them out. There is a wealth of knowledge to be had, as well as encouragement and community. Seeing all of the people participating, commenting, sharing experiences and advice was very motivating. It also was when I realized I needed to find a way to contribute to the cause.

You clearly have a great sense of humor, do you find humor to be therapeutic?

I definitely find it therapeutic. It is a great pressure relief valve. I spend most of my day focused, serious, and perhaps not smiling enough. People in my professional life were somewhat shocked to see me be silly in that video.

Speaking of humor, what do you think of all the diabetes jokes out there?

If it is funny, I can laugh at it. Diabetes wins if you let it get in your head.

Your video has gone viral within the DOC. Did you expect such a positive reaction from our community?

I’m completely blown away. My channel ‘Between Two Lines’ is very new. I remember talking to my wife about making a funny video and being very nervous. Wondering if anyone would even think it was funny? Would anyone relate to it? You are really putting yourself out there to be ridiculed when trying to take something serious and use humor to encourage and inform. The T1D community is awesome. I’m glad people enjoyed the video and will certainly be making more of them.

What do you think makes it so relatable? What is one of your favorite moments? I know I laughed the whole time and have had the same thoughts and feelings as “Mr. Blood Sugar.”

I’m not sure I even know. Perhaps it is that many others feel the same way I do. Diabetes is stupid. I hate it. I hate everything about it. I wouldn’t wish it upon my worst enemy. But you know what? It isn’t going anywhere and I’m not going to let it steal the happiness from my life. So, I tried to find some humor in it.

My favorite moment was when “Blood Sugar” pulled his hoodie tight over his head to ignore me joking about muscles. Reminded me of my sister and how she responds to my younger brother and me bragging about fitness and working out.

What made you think of the idea in the first place?

There are a million funny videos out there that we all watch every day. I just thought I would take a stab at making one about being diabetic. It was important to me though for it to be funny, but not making fun of the fact that I had diabetes.

At the end of the day, what was your main objective of this video and what would you like people to take away from it?

The main objective of the video was actually to inform. Humor is a great tool for educating. I wanted people with diabetes to laugh, relate, and feel relief that they aren’t the only ones dealing with that garbage. I wanted non-diabetics to be able to watch the video and laugh – but learn about some of the things their diabetic friends, family, or coworkers deal with.

Thanks again for giving us all a laugh. I was away and having a tough time with my blood sugar and laughter was certainly the best medicine!

Part 1:

Part 2:

Source: diabetesdaily.com

Imagine 288 Fingersticks a Day: The Power of CGM

This content originally appeared on diaTribe. Republished with permission.

By Michael Hattori

Michael writes about his diagnosis with type 2 diabetes, and how he used a CGM to put his type 2 diabetes into remission

My name is Michael, and I have type 2 diabetes. In remission. This means that my body no longer experiences unusually high blood sugar levels, and I don’t have to take diabetes medications.

Diabetes remission would not have been possible for me without the help of a miraculous tool called a continuous glucose monitor (CGM). Let me tell you how and why.

I have been a nurse for almost 22 years. Although most of my time has been in the operating room, I started my career taking care of people with diabetes, most of whom were faced with complications from diabetes. I realized early on how immensely complex and challenging diabetes is – I never imagined that I would be diagnosed with type 2 diabetes.

Well! About six months ago, my weight had reached 200 pounds (I’m 5’3”), my appetite was growing, I began experiencing extreme thirst. The huge amounts of water I was drinking seemed to do nothing but drive me to the bathroom seemingly every five minutes. Now, as a nurse, I knew exactly what was happening. But it couldn’t be happening to me!

At first I thought, “Oh, this will go away. It’s temporary.” But after several weeks of symptoms, I realized I needed to do something. I asked one of my colleagues at work to check my blood sugar, and it was 298 mg/dl. I could not believe it. We checked again, and it was 300 mg/dl. Lab tests a few day later showed a fasting glucose of 305 mg/dl and A1C of 10.5%. I had diabetes.

Now, you may be thinking, “You’re a nurse, for crying out loud! How could this happen to you?” But the fact is, I’m also a human being, just like you. Having worked outside of diabetes care for over 18 years, I was as uninformed as most people, and just as frightened.

One of the general surgeons I work with was standing next to me, and I asked him what he thought I should do. He was genuinely shocked, and said, “I think we need to get you on metformin, an SGLT-2 inhibitor, and a DPP-4 inhibitor.” Fortunately, my friend and colleague, Jennifer, immediately interjected, “No! You have to try this CGM first!”

I had no idea what a CGM was, but I soon found out. And it changed my life – saved my life, really.

Jennifer said, “This [CGM] is the greatest thing ever! It measures your blood sugar every five minutes, 24 hours a day, and you don’t have to stick your finger to see the results!” I was intrigued, as I had heard rumors of such devices (and also hated sticking my finger). She said that it had become her “best friend” and that it helped her mother, who had type 2 diabetes for 20 years, to manage her blood glucose. The next day I spoke with my primary care provider, and one day later I had a Freestyle Libre CGM sensor on my arm and the determination to manage my type 2 diabetes with diet and exercise alone.

Over the next six weeks, I came to rely on my CGM as my personal blood sugar “GPS.” It allowed me to see how every single thing I did affected my blood sugar, and not only during waking hours, but also while I was asleep. I kept a log of everything I ate; the CGM helped me to see how it affected my blood sugar, both immediately and over many hours. Can you imagine how powerful a tool that is for people with diabetes? To see in real time what effect food has? And not for just one point in time, like a fingerstick, but every five minutes after you eat. Imagine, if you are taking insulin, how valuable that information would be to help with dosing. No more guessing – incredible!

I had also heard about intermittent fasting but was skeptical until I started reading and found agreement that it is not only effective in helping to manage blood sugars and lose weight, but that there are other long-term health benefits. Jennifer had been doing intermittent fasting for over a month and was very positive about it, so I decided to give it a try. One of the main reasons I was willing to try it was because I had my friend, the CGM, as my guide. Being able to check my blood sugar at any time provided me with the safety net I needed to try something as radical (to my mind, at least) as fasting. And guess what, it worked!

I am now a huge advocate of intermittent fasting. But– and this is a big but – it is not for everyone. Anyone using insulin or medications that might cause low blood sugar (hypoglycemia) must consult with their healthcare professional, and also preferably a diabetes care and education specialist, before starting any kind of fasting program.

Along with helping me with my diet, the CGM gave me immediate feedback on exercise. I knew that exercise would help manage my diabetes, but I had no idea just how big a difference it could make. I’m not talking about hours of hard, furious sweating and exhaustion; all I did at the beginning was walk. The diabetes care and education specialist who led my class told us that even a 10-15 minute walk after a meal can bring your blood sugar down significantly. Many of the people in the class were skeptical, but she made us promise to walk at least ten minutes after every meal, and to check our blood glucose before and after the walk. Everyone was amazed at how much it really did bring down blood sugars.

For those of us with CGM, we could monitor our blood glucose throughout the walk, without any fingersticks. For me, a 20-minute brisk walk after dinner would often bring my blood sugar down 60 points or more. It was so gratifying to be able to watch my blood sugar go down and down. It motived me to make walking part of my daily routine – I still try to walk at least ten minutes after every meal, especially dinner.

Having so much CGM knowledge at my fingertips 24 hours a day gave me the power to make informed decisions about exactly what and how much to eat, to experiment with favorite foods, and to see, in real time, the benefits of exercise. How could you ask for a better tool? Within a month, I was able to get my fasting blood sugar down from over 300 mg/dl to less than 150 mg/dl. After three months it was under 120 mg/dl, and after four months under 100 mg/dl, with an A1C of 5.2%. I lost 35 pounds and still plan to lose 20 more.

I don’t think I could have achieved this without a CGM. My CGM gave me the equivalent of 288 fingersticks a day! A CGM puts that huge amount of information right at your (now not sore) fingertips. Of course, it’s up to you to use that information. But as they say, knowledge is power, and this gives you the power to manage your diabetes, and not the other way around. The CGM is the ultimate tool to show you just how your behavior affects your blood sugar, all day long.

Michael Hattori

Image source: diaTribe

Diabetes was a wake-up call for me to improve my lifestyle, and the CGM was the tool that allowed me to do so quickly and effectively. I am now in remission and intend to stay that way.

I am now on the path to becoming a certified diabetes care and education specialist, so that I can share my story and help others understand and manage their diabetes. Surprisingly, the CGM is not available to all people with diabetes. I can’t imagine a single person with diabetes who wouldn’t benefit from this amazing technology: it is like going from seeing through a tiny pinhole to having a full 360-degree view. And the view is incredible!

Source: diabetesdaily.com

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