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

Diabetes Love Letter: An Ode to Mandi’s Late Parents

By Mandi Franklin

To my late parents:

It was the winter of 1990 and I was spending the week at my aunt and uncle’s house while my parents were chasing sunsets in the Caribbean. I loved sleepovers at their house – we would play “grocery store,” paint my fingernails, and stay up late.

This time was different…

“She’s drinking so much water. She can’t seem to quench her thirst,” my aunt said to my mother when she called to check on me.

I was so thirsty that I would climb on top of the bathroom sink and gulp water from the faucet like a parched cat. My aunt and uncle knew something was wrong.

Photo credit: Mandi Franklin

My parents caught the next flight home and I was rushed to Sinai Hospital in Baltimore, Maryland.

This is when the perfect world we once knew changed for me and my family.

“She has juvenile diabetes and we need to give her insulin,” explained the ER physician to my parents. Imagine hearing that your little, previously healthy 3-year-old now has a permanent disease that will need to be managed with multiple fingersticks and numerous injections daily.

Confused. Angry. Sad. Guilty. Numb. These are things that I am sure my parents felt at this moment.

Over the next few days, we learned how to cope with my new life with the help of the medical team, nurses, dietitians, child life specialists, and of course family support.

From that day on, my parents vowed to never treat me differently and promised that I would live a “normal” childhood.

Photo credit: Mandi Franklin

Looking back, I admire them for how they tackled this diagnosis and disease. I never felt like I couldn’t do something due to my illness. I was able to dance, play sports, go on vacations, and have sleepovers.

I have been living with type 1 diabetes for 29 years. There are days when I want to throw in the towel and say “OK diabetes, you win.” The other days are just like yours, except with a few extra pokes and a special ability to count carbohydrates.

My parents taught me to live my life and never let my disease get in the way. Because of this, I do what I love and continue to chase my dreams.

In conclusion, don’t ever give up.

Thank you, mom and dad, for raising me to be a strong, independent, resilient, goal-crusher who just happens to also have type 1 diabetes.

Love you always,

Mandi

More about the author on her website and Facebook Page.

Source: diabetesdaily.com

Accepting a New Type 2 Diabetes Diagnosis

One of the toughest transitions in life can be a new diagnosis of type 2 diabetes. Either for yourself or a family member, the initial shock of diagnosis is sometimes hard to take and can require some getting used to.

In this first installment of a four-part series on type 2 diabetes, here are five ways to adapt to a new diagnosis in your family and the best ways not only to cope, but to thrive with type 2 diabetes:

There’s No Shame in a Diagnosis

There is nothing to be ashamed of with a type 2 diabetes diagnosis. Type 2 diabetes is simply the body’s response to becoming insulin resistant or the body’s inability to produce enough insulin naturally (more symptoms listed here). There are many risk factors that contribute to a type 2 diabetes diagnosis, but genetics and environmental factors do play a role. You may be discouraged upon diagnosis, but there’s no shame in having diabetes, and there’s no shame in taking charge of your health and taking care of yourself.

Today Is the Perfect Day to Be Healthy – Start Now

Not next week or next month, or even next year. Today is the perfect day to begin. Once you have a diagnosis, make sure you’re prepared with a glucometer, test strips, and a lancet device to start monitoring your blood sugar. You may also have a prescription for metformin or insulin that should be filled. Your doctor probably referred you to a nutritionist to come up with a meal plan, and maybe they’ve recommended regular exercise. Start small. Include more vegetables at your next meal, and aim for a short walk before bed. Taking small steps to improve your health today will lead to lasting health benefits down the road.

Assemble Your Care Team

This includes both professional and community support. Diabetes affects the whole family, and it’s important to have their physical and emotional support. You will need to enlist the expertise of not only your physician, but also an endocrinologist, and perhaps a nutritionist or maybe even a therapist. Caring family members can offer emotional support during this time of transition, and researching local support groups or diabetes advocacy organizations where you can find community will be a tremendous help in the weeks and months to come.

Don’t Operate from a Position of Fear

Make no mistake, type 2 diabetes is a serious disease that can cause devastating complications if left untreated, but it does not necessarily need to incite fear. You can live a long, happy, and healthy life with type 2 diabetes. This is an opportunity to tune into your body and make healthy, positive changes for the road ahead. Healthy lifestyle choices you make now can prevent complications later on in life.

Think of What This Adds to Your Life

A type 2 diabetes diagnosis is not the end of your life. Instead of thinking in terms of deprivation, think of what this adds (and can add!) to your life. More exercise. More opportunities to go outside. More excuses to walk your dog, or play with your children or grandchildren. More vegetables on your plate. More reasons to see your doctor and keep a closer eye on your health. More reasons to be thankful that you have the opportunity to get a firm grasp on your health in the here and now. Think in abundance and be grateful.

A type 2 diabetes diagnosis does not need to bring misery and sadness to your life. It can be an opportunity to connect with yourself, get in tune with your body, and lead you to start or continue to make healthy choices to prevent complications later on in life. And that’s something to cheers to.

Have you recently been diagnosed with type 2 diabetes? How has the diagnosis affected your life so far? Share this post and comment below!

Source: diabetesdaily.com

Shadow’s Edge: Video Game Designed to Help Kids Cope With Chronic Disease

Being a kid is hard enough as it is. Add in having a chronic disease and it can make those very special years potentially very isolating ones. Shadow’s Edge is a virtual reality game that allows children to process and express their feelings about their disease — or whatever else they may be going through. This mobile game can help change the experience of a serious diagnosis, or challenging times, by combining art therapy and cognitive behavior therapy and giving children a safe place to not feel so alone.

Action video games can help reduce depression in teens and Shadow’s Edge hopes to help bring positivity and community to those who need it most. Founder and philanthropist, Sherri Sabrato Brisson, is a brain cancer survivor who initially co-wrote a book, “Digging Deep: A Journal for Young People Facing Health Challenges ” with Rose Ofner, to help kids process their chronic disease or serious illness and it had great success. She then met Rosemary Lokhorst, who is now the game producer because of how much she loved the concept and that is how Shadow’s Edge was born.

Shadow’s Edge is a free and completely donation funded, virtual city that has just been overtaken by a storm, much like our lives after being hit with a diagnosis of some kind. The storm removes all the color from the city, much like our disease has the potential to take away some of our happiness…if we let it. The object of the game is to bring back the color to the city through writing and art, which helps empower the player to take on whatever it is they are going through.

Shadow's Edge

Photo credit: Shadow’s Edge

So far, Shadow’s Edge has worked with many organizations and university clinics in the US, Brazil and in Europe, focusing on kids and teens with cancer, and has received very good feedback, especially from doctors. Currently, they are running a complex research study nearby the Lurie Children’s Hospital in Chicago, with more than 100 kids testing Shadow’s Edge. So far, the results have been fantastic, and the game is helping these children build up the resilience to tackle the challenges they are facing.

I was able to chat with Sherri to find out more about Shadow’s Edge and their plans for the future.

Sheri, the journey you went through with brain cancer must have been so traumatic. Did writing your first book, Digging Deep: A Journal for Young People Facing Health Challenges, prove to be therapeutic? What about creating this game?

As a survivor, I can tell you, I know how difficult it was for me to even know how I was feeling at the time, let alone be able to express these feelings.

On my 25th anniversary of survivorship from brain cancer, I envisioned a world where every young patient has real-time access to the tools he or she needs to build emotional resilience through their experience.

I started by co-authoring Digging Deep: A Journal for Young People Facing Health Challenges, with Rose Offner, MA. I donated 35,000 journals to hospitals across the country, but it still wasn’t enough. So, we decided to meet young people right where they are—on their phones, playing games.

Seeing the success of your book shows that there is a need for resources and tools for people who have serious illnesses or a chronic condition. How do you think Shadow’s Edge can help fill that gap for our children?

Just like the physical journal, Shadow’s Edge helps teens build their emotional endurance to tackle the challenges they face through the power of their personal narrative. There are very few resources directed at teens today. Our aim is to meet them where they are – on their phones, playing games. So this time, teens are engaged through their medium—their phones or tablets—to express themselves through writing and now, covering a city in graffiti! Through gameplay, teen players realize they needn’t stay in their confined world—they have the power to reshape their world into whatever they choose. Through their expression, they can create beauty where there was once dilapidation: There can be light; There can be color; There can be hope. And, there can be a community.

“When starting to play Shadow’s Edge, a teen may not even know how they feel or what is troubling them. As they continue through their journey, they often discover they are at a different place emotionally in the end—there may be a sense of resolution, a greater understanding, a place of peace”.

I know for me personally, when I was diagnosed with type one diabetes, finding community changed everything for me. I was so much better off mentally and emotionally and had a much better outlook on my future. How does playing this video game help children connect with others? 

Yes – connection is key to build resilience and to feel better! Teens asked us for a space that is theirs only, where they can express things for themselves, as they are not always clear or ready to connect. Interestingly, this working with oneself helps to reach out. Additionally, the game has an in-game sharing space (once you reach the new level, Disillusionment). There you receive a means to see other players’ art and provide messages of support and where you can publish your graffitis. The community aspect is one that we are focusing on to expand – it is the key ask of players to build on.

I could see how the concept can be applicable to many different obstacles a child could be facing, what other areas are you focusing on and what do you hope to accomplish?

We are expanding the content so that teens facing a variety of difficult situations can benefit from it – these can be changes in the family like a divorce or death of a family member, bullying, anxiety, stress, depression, identity questions.

Shadow’s Edge has the potential to help so many children going through hardships. Where do you see Shadow’s Edge going from here?

We are working on expanding the community aspect of the game. We want to create a community around self-expression where teens facing all kinds of challenging situations can share, collaborate to create art, find psychoeducational content and just connect with each other.

As a brain cancer survivor, what message would you like to share with people facing a health battle of some kind? 

Your challenge does not define who you are, you define this. When you are ready, take an active role in opening up–every time you tell your story you tell it a little differently, this make you integrate it and see new perspectives. Practicing this also supports you to understand you are stronger than you think, getting comfortable with your story and owning it as a part of you, but not all of you.

Shadow’s Edge is available on both IOS and Android, and available in 6 languages.

They also have a special website dedicated to helping parents and healthcare professionals who are helping a young person with illnesses, see more information at www.diggingdeep.org.

Source: diabetesdaily.com

Parenting with Diabetes: I Taught My Two-Year-Old Daughter How to Be My Caretaker

This content originally appeared on diaTribe. Republished with permission.

By Cherise Shockley

diaTribe Community Manager, Cherise Shockley, shares the story of her diabetes diagnosis and how that diagnosis affected her family

I was diagnosed with latent autoimmune diabetes in adults (or LADA, a type of diabetes between type 1 and type 2) in July 2004, at the age of 23. I was a newlywed, my husband, Scott, was deployed, and I had just finished five-and-a-half years in the Army Reserve. I was placed on oral medication (glipizide), and I began to manage this form of diabetes with diet and exercise, knowing that someday I would require regular insulin for the rest of my life.

In March of 2005, Scott returned from deployment, and a month later we found out I was expecting our first child. Nine months into my diabetes diagnosis, I was carrying my first child; I was temporarily placed on Regular and NPH insulins, because I had to stop taking my oral diabetes medication during pregnancy. At the time, I did not have a continuous glucose monitor (CGM) – the first version of the Dexcom STS wasn’t invented until March 2006,  as my colleagues at diaTribe wrote about here.

My pregnancy was smooth-sailing aside from my diabetes, which took quite a toll on me, but I knew if I did what I could to manage the condition, my little girl would be okay.

Eight months after I gave birth to my daughter, Niya, we said our good-byes to our families and moved from Kansas City, Missouri, to our new duty station in Southern California.

From the time my daughter was one year old, until she was reached two, I was taking oral medication, and my hypoglycemic episodes were few and far between. When I did experience hypoglycemia, I was either at home or at work, and my husband or my coworkers could help me out.

After my daughter turned two, I noticed that my medication was no longer working. With the help of my nurse practitioner, I tried everything in my power to get oral medication to work for me, but it was time to see an endocrinologist.

A few days after my first visit, I met with a nurse practitioner. He told me, “Your beta cells are still present, but we do not want to burn out what little function you have, so I recommend you start taking insulin.” I paused. Although I knew this day was coming, it was like hearing “you have diabetes” all over again.

When we began talking about pump therapy, I asked for something easy to use, knowing that my two-year-old daughter would be my primary caretaker.  I wanted Niya to be able to help me if she needed to.  With my husband working late hours and traveling, we made a decision to teach my daughter how to manage my diabetes. We taught her how to call 9-1-1, how to treat my lows with apple juice, and eventually, how to shut my pump off. In the back of my mind, I wanted her to know how to manage diabetes just in case she received her own diagnosis later in life.

Parenting

Image source: diaTribe

Many parents of children with diabetes share stories of not being able to sleep because they are worried about waking their child up in the middle of the night to check their blood glucose levels. In my family, my daughter was the person I woke up in the middle of the night when I experienced low blood glucose. Before I had a CGM, Niya was the person helping me check my glucose levels and stuffing glucose tabs or candy into my mouth in the middle of the night when my husband was not home.

From the time she was two, my daughter was my primary or secondary caretaker. Scott retired two years ago, so now Niya only helps me out when it’s just the two of us together. If she hears the alarm from my CGM, she asks if I am okay.

I never asked Niya how she felt about her role in helping me manage diabetes; I was nervous to interview my 13-year-old daughter, but I wanted to know how she felt.

Me: How did it feel growing up with a mother with diabetes?

Niya: I was a normal kid. I can eat what I want. I was able to learn how to manage your diabetes and help you when you needed help. I know how to recognize when you are okay.

Me: How old were you when you realized I had diabetes?

Niya: I was four or five. You asked me to film a diabetes video for you.  The hook in the song, “Who has diabetes? Help us stop diabetes,” made me realize that diabetes was a bigger issue. Diabetes was my normal – but the video helped me see that diabetes was also serious.

Me: Was there ever a situation that scared you?

Niya: We recently went to Disney Springs together during Friends for Life. You went really low, and I was scared that you weren’t going to be okay. I didn’t want anything to happen to you when I was with you; I didn’t want to be responsible. Diabetes is a lot of responsibility for a kid, but in some ways, I’m used to it.

Me: That was a scary moment for me, as well. It was the first time in a long time that I was not able to get my blood glucose levels to go up (with glucose tabs or candy). It was important to me to let you shop with your friend while the team at Disney Springs sat with me.

Niya: Thank you for letting me be a kid and not forcing me to live as if I had diabetes. I love you.

Me: Is there anything you would like to say to other children who have parents with diabetes?

Niya: It is sometimes difficult having a parent with diabetes. I now have two parents with diabetes, since my dad has type 2. I want other kids to know that they can navigate it – they will feel extra pressure that other kids don’t feel, but hang in there. When your mother is as special as mine, it’s worth it; diabetes is a big part of my family.

Source: diabetesdaily.com

Treating Type 1 Diabetes in Bangladesh: Dr. Kaufman and Life for a Child

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

By Francine R. Kaufman, M.D.

Greetings from Dhaka

Traveling over the city by air and then languishing in traffic forever to get to the hotel, I see what now seems typical of a developing country: cars, motorbikes, rickshaws, and people at a standstill jammed up in traffic with horns blaring like a discordant symphony; people living on the streets; old buildings with new structures next to them supported by cranes and rebar trying to reach for the sky.

Yesterday, I was at the main diabetes hospital all day seeing patients. I was with Graham Ogle, who runs Life for a Child and continues to deserve sainthood for his global work in bringing care, education, supplies, and life to close to 21,000 children around the world who likely would perish without his efforts. Graham is so humble and focused; he seemingly knows everyone and everything about the care of children with diabetes in Dhaka, as well as everywhere Life for a Child collaborates with local health care providers in over 40 countries.

Kid

Image source: Beyond Type 1

The diabetes hospital – called BIRDEM – is run by Dr. Bedowra Zabeen, an amazing woman and endocrinologist who is known worldwide for her work throughout Bangladesh. They follow over 7,000 children with diabetes (there are 9,000 total in all of Bangladesh); hundreds come in each day for outpatient care or to be admitted. The Life for a Child program follows 3000 children and young adults (up to age 26) and the Novo Nordisk program helps with another 3000 children. This means few can afford to buy insulin and supplies on their own since there is still insufficient support by the government or insurance programs in this country. From Life for a Child, they can only get regular and NPH insulin and 1-2 blood glucose strips per day. This is how I practiced pediatric diabetes 25-35 years ago. There are a few using newer insulins and even a few with insulin pumps, so if there are resources, families can buy better diabetes care than what is offered by these free charity programs.

Work to Be Done

The patients come through like a torrent. First, a newly-diagnosed child, so emaciated and weak, she could barely stand up. Then 4 children who seemed to be about five-to-six-years old, not adequately treated because they don’t have enough glucose strips, and as a result no chance to appropriately adjust insulin doses. School was a problem for each, either they had to miss a lunch shot or their mother had to come to administer it – most often without first doing a blood test. One was very hyperglycemic because her parents were unable to deny her anything she wanted to eat.

There were also two adorable 17-year-old twin girls, diagnosed within a year of each other, who had just graduated from high school and were waiting to see if they could go on with their education. Despite sleeping late, missing shots, and pretty much de-prioritizing diabetes (the universal story of adolescence and young adulthood), their A1cs were still good, mainly because they had way too many low glucose levels. There were many more routine cases: children taking only two insulin shots per day, having too few blood tests, not having refrigerators to store their insulin (they use clay pots instead), and feeling stigmatized and ostracized.

Then came the really hard cases: a child with severe insulin resistance (likely a gene defect due to too many consanguineous marriages in this country) taking 200-300 units of insulin per day, a child with dermatomyositis (a severe autoimmune disease of the skin and muscles) taking 500 units or more a day and chemotherapy and suffering the crippling joint effects of this rare disease that is most often complicated by diabetes. The fact that her hands were stiff and crippled made it all so much more amazing that she is an artist.

There were a number of pubertal children and even prepubertal children with type 2 diabetes – it’s hard to find someone who is not overweight/obese in Dhaka City, and the children appear to be the most affected. Bangladesh has one of the highest rates of diabetes: 8-10% of the population is affected and it is expected to quickly increase to 13% – and this is mainly Type 2. There are higher rates of kidney complications, but the most difficult aspect of having diabetes in Bangladesh is the stigma, the lack of education concerning its cause (children and their mothers are blamed), and the chance that anyone – particularly a child – can succeed with this disease.

Why We’re Here

Our type 1 diabetes workshop in Dhaka was sponsored by Life for a Child, the Bangladesh Diabetes Association, and ISPAD (the International Society for Pediatric and Adolescent Diabetes), and was organized by Dr. Zabeen. Forty-five physicians and nurses, dietitians, and psychologists from 11 cities and areas across Bangladesh attended our lectures and presentations. Some of the participants flew to Dhaka from the north, took trains for hours, and then battled the Dhaka City traffic to get to the Dhaka Club. It was a parade of brightly colored, sparkling saris since most of the attendees were women; many of the men had red hair and beards from henna staining.

Kid

Image source: Beyond Type 1

Our lectures were intermixed with lectures delivered by Dr. Zabeen, Dr. Azad (who started the field of pediatrics in Bangladesh), and a few other physicians who related the Bangladesh experience in childhood diabetes, pregnancy and diabetes, Ramadan and diabetes, and nutrition and diabetes. They discussed the struggles of managing this difficult disease in an area of our world with unimaginable poverty, very limited access to lab testing, supplies and medications (all with no way to pay for them short of a charity program, like Life for a Child), and in a culture deeply rooted in both prejudice and misunderstanding about diabetes. Schools make no concessions for the children at all, blame is placed on mothers and the children themselves, and they are often denied basic opportunities.

A young, 26-year-old woman who was diagnosed with type 1 diabetes (T1D) at 7 years of age came to speak to the seminar attendees. As a result of having diabetes, she was devalued so her father married her off at age 14. As usual in the villages, she went to live with her husband’s family. Since she arrived 12 years ago, her mother-in-law has not allowed her to have food unless her husband is home – and he works all day. So she fasts all day long, gets frequent and severe hypoglycemia, and often takes no insulin at all. Somehow in the midst of this all, she had a baby 5 years ago, and this little 5-year-old girl was skipping and running around, and adorable.

After our lectures each day, we took selfies with the attendees, and we even danced after my lecture on physical activity. The sway of the saris was mesmerizing and the joy and laughter totally infectious. Amidst it all, their questions and comments revealed how committed they all are to advance diabetes care for children in Bangladesh despite all of the obstacles. It was a struggle to go to the airport, but I somehow sat in the backseat and resigned myself to the stop and go traffic, the veering of cars from one lane to the other, and the constant cacophony of horns. It seemed to fit with my simultaneous feelings of despair and hope – with a great belief in Dr. Zabeen and her teams of amazing health care providers and her patients willing to share their stories.

Source: diabetesdaily.com

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