When a Child’s Type 1 Diabetes Takes a Toll on Couple’s Relationship

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

By Bonnie O’Neil

“You have to fly home now!” was all I could say before bursting into uncontrollable sobs. “Austin has diabetes.”

My worst nightmare had come true — my 5-year-old son was just diagnosed with the same disease that claimed my brother’s life when he was eight years old and has afflicted my sister since she was sixteen. We had been in New Jersey that weekend celebrating my mother’s birthday when my suspicions began to mount, but I kept them to myself. On Sunday afternoon I drove our three children home to Connecticut, while my husband flew to Florida for a business trip.

By Monday afternoon I could contain my suspicions no longer. I purchased a urine test kit at the pharmacy and made the diagnosis myself, in the first-floor powder room of my Connecticut home. Urine testing for diabetes wasn’t new to me — because of my family history, I had done hundreds of tests over the years, both as a child and later, as an expectant mother.

The nurse shepherded my son and me into the pediatrician’s office while my other two children waited in the waiting room. She attempted to allay my fears with comforting words, but I knew. And the meter knew. We had entered a new reality.

“You caught it early, his blood sugar is only 387, no ketones, no need for hospitalization. Here’s the address of an endocrinologist, you have an appointment tomorrow.” The doctor’s words rang out in muffled tones, as if through a tunnel. No insulin? No hospitalization? The irregularity of what he was proposing didn’t feel right, but nothing felt right about this so I tried to suppress my fears for my son’s safety.

Returning Home

Once home, I settled the children and called my husband. Never before had I asked him to return from a business trip. Being strong was always important to me, but I knew I didn’t want to muscle through this alone. I barely slept that first night knowing my brother didn’t survive his T1D diagnosis. Pulling Austin into bed with me, I watched over him like a mama hawk until moonlight gave way to the break of dawn.

Austin and I saw the endocrinologist the following morning before my husband could get home from Florida. The doctor was a kind man who tried his best to assuage my worry and Austin’s fears about diabetes. Austin received his first shot of long-acting insulin and I found I could breathe again. We were to return two more times that week — with my husband — to check on Austin’s dosing and so we could be educated and trained. Austin still wasn’t given any fast-acting insulin, so we were told to keep his carbs to a minimum.

“The prescribing and monitoring of Austin’s fast-acting insulin will be up to his new doctor,” the endocrinologist told me.

Did I neglect to say that we were moving to Philadelphia less than a week after Austin’s diagnosis?

Two weeks after my son’s diagnosis, he finally received his first dose of Novolog. I had yet to learn about sliding scales and insulin-to-carb ratios, glucose tabs, and glucagon. It was time to play catch-up and learn all we should have been taught in those earliest days of diagnosis, when the world is still frozen in time and parents push pause to get themselves up to speed.

Graduation had come and we were caught not having gone to class.

Thankfully I at least had some familiarity with diabetes from my sister, but that’s not the same as managing it yourself. And so, I spent every day reading and researching, in hopes of better understanding my son’s disease. And my husband spent every day at the office.

I’m sure the doctors in Connecticut thought they were offering us a gift in not hospitalizing our son, but they unwittingly deprived us of the space to pause amidst the crisis and learn. With no real diabetes education under our belts, we eventually returned to our established routines — I took care of the children while my husband went off to work.

As we settled into that pattern, a certain asymmetry developed in our relationship that created a dissonance between us. The more I learned, the less qualified he felt to participate in our son’s care. And the less he learned, the less capable I felt he was to participate in managing our son’s diabetes.

Reset, Roles & Responsibilities, Respect

Even if offered the best diabetes education at the time of diagnosis, unhealthy patterns in the caregiving couple’s relationship can unintentionally be established very early on. It’s important to step back and take inventory from time to time to evaluate where we are and where we’d like to be. Often there’s a great chasm separating those two spaces.

To undo some of the unhealthy patterns we’ve fallen into requires us to take the time to reset our expectations. We begin by nurturing a relationship built on open communication so each partner feels safe in sharing what they’re observing. Setting aside time for occasional check-ins to see what might need resetting is the best way to change unhealthy patterns before they get too well established.

When we’re engaging in a reset conversation, we have to give an honest and open look at our respective roles and responsibilities. Some of these can’t easily be changed because of work or family constraints. Others have been artificially created if an asymmetry has developed in the relationship. Openly sharing our feelings of abandonment and judgment from our partner is critical to moving forward. One partner likely needs to be willing to accept help, while the other must be willing to participate more.

Above all, when seeking to reset our unhealthy patterns, offering respect to one another is paramount. Respect is the opposite of resentment. Resentment breeds in the gap between our expectation of our partner’s actions and the reality of how s/he chooses to act. We provide fertile soil for resentment to grow when we refuse to allow our partner’s responses to be different from our own. But, when we stop asking the question, who’s right and who’s wrong, we begin to operate out of respect.

Parents are the heart of any family. It’s worth spending a little extra time to take inventory and evaluate what might need a reset. And you may just rekindle a little love along the way!

Source: diabetesdaily.com

10 Ways to Avoid Overnight High Blood Sugar

My biggest challenge when it comes to managing my blood sugars is the overnight hours. I know it is largely in part to the fact that I am a nighttime eater, consuming most of my calories after 7 pm. But I have also done some investigating and noticed my blood sugars naturally rise around 9-10 pm, so I am fighting an uphill battle. I started looking for some tips and tactics to try in order to improve my nighttime blood sugar levels.

Here are 10 tips on how to lower your overnight numbers, which will give you a better night’s rest too.

1. Basal Testing

This should come first no matter what issues you are having when it comes to your blood sugars. Without knowing the proper dose of “background” insulin your body needs, it becomes much more difficult to figure out how to dose for meals, creating a rollercoaster of events. In Gary Scheiner’s book “Think like a Pancreas” he explains basal testing in an easy-to-understand and methodical way.

2. Don’t Eat Too Close to Bedtime

Many people confuse this statement to mean that you can gain more weight by eating late at night. This simply not true. It comes down to a science and so long as you are in a caloric deficit, it doesn’t much matter when you take in your food. However, if you eat too close to the time you shut your eyes, it becomes more challenging to stay on top of your blood sugars. Eating about two hours prior to when you shut the lights will give you more time to assess how your blood sugar is trending, and (if needed) get your blood sugars back in range so you can get some sleep.

3. Take Advantage of Technology

If you are fortunate enough to own a continuous glucose monitor (CGM) , you should make the most of its features. Keep the alarms set to a high and low blood sugar number that you are comfortable with to help wake you if damage control is needed. You can also share Dexcom with a loved one who could alert you of dangerous numbers if you are unable to wake from the alarm on your own. Pumps like Tandem Basal Control have become extremely popular, as they can release insulin if your blood sugars get too high allowing you to focus solely on dreaming of a cure!

4. Try to Relax

It is known that stress can lead to higher blood sugar numbers and can also contribute to insulin resistance. When stress hormones like cortisol kick in, it can raise blood sugar levels, which is often what you see in the morning with dawn phenomenon. Additionally, stress hormones are known to increase insulin resistance. “Hyperglycemia is particularly exaggerated by elevations of cortisol and epinephrine in diabetes as a consequence of an altered response of the liver to these hormones,” scientists summarize. Put down your phone, drink some hot tea or read a good book in order to relax and put yourself in the right mindset for both in-range blood sugars and restful sleep.

5. Carb Count and Dose Accordingly

If you are taking insulin, this is something you likely do on a regular basis. Since I am so picky and stick to the same foods, I really don’t count carbs at all. I use the “WAG” strategy (wild a** guess), but this could wind up costing you a good night’s sleep. Make sure to count your carbs, know your carb-to-insulin ratio, time your dose correctly and keep your fingers crossed. Pumps have calculators built in to help make this easier for you and if you are on shots, you should check out the InPen, which has been a lifesaver for me in regards to getting my doses right and keeping my blood sugars in range.

6. Set Alarms and Stick to a Routine

Setting alarms will not only help remind you to take any oral medications and/or insulin but setting an alarm in the middle of the night can allow you to do a quick correction or chug some water if you are experiencing high blood sugars. Many times, if you take your medication or basal insulin an hour too soon or too late, it could impact your blood sugar levels.

7. Adjust Doses If Necessary

We are often so busy that we forget that many different things can affect both our medication and insulin doses. If you recently lost weight, started exercising, are taking steroids, changed your diet, or have become pregnant, to name a few, you should check in with yourself and your health care team to make sure you are taking the proper amount of medication. Ensuring that you are will no doubt give you better results at all times including the hours of rest.

8. Don’t Exercise Too Close to Bedtime

Many of us have busy schedules that only allow for nighttime workouts. If this is the case, try to fill up on protein-rich foods prior so that you don’t wind up with too much insulin in your system a few hours later when you are trying to fall asleep. Also, weight training can spike our blood sugar meaning you may wind up having to correct it. Being awake and alert for a few hours after a workout can only help your blood sugar management.

9. Be Wary of Delayed Blood Sugar Spikes Due to Protein

There are many times when two hours after dinner I am pleasantly surprised by my blood sugar number. But, I notice it starts to slowly creep up shortly after. Unlike carbs that quickly break down to glucose, protein can trigger a blood glucose rise that takes place over several hours. If your dinner is protein-heavy make sure to check your blood sugars a few hours after to troubleshoot any blood sugar spikes.

10. Stay Hydrated

Water plays a key role in keeping blood sugars in range. If we are adequately hydrated, the glucose levels in our blood can’t become too concentrated resulting in hyperglycemia. Water has the ability to reduce blood sugar by diluting the amount of sugar in the blood. Staying hydrated can also help you in your weight loss efforts. My advice is to make sure you get your water in throughout the day so you’re not paying for it with trips to the bathroom all night!

It isn’t easy to schedule in “troubleshoot my overnight numbers” to our already busy schedule, but taking the time to heed some of the above advice is sure to help your numbers improve, allowing for a more peaceful night.

Do you have trouble with your overnight blood sugars? Do you have any advice that worked for you? Share and comment below!

Source: diabetesdaily.com

Survey Reveals the Heavy Burden of the Pandemic on People with Diabetes

The COVID-19 pandemic has now been ongoing for over a year, and even with the light finally visible at the end of the tunnel, it is undoubtable that it will have lasting effects, for years to come.

Late in 2020, we partnered with the American Diabetes Association (ADA) to conduct a survey-based analysis to assess the effects of the COVID-19 pandemic on Americans living with diabetes.

Approximately 2,600 responses were collected from the Thrivable online patient panel. People from all 50 states shared their experiences during the pandemic, describing the impacts on access to healthcare, food, outlook on receiving a COVID-19 vaccine, and more.

Key Findings: Reduced Health Care and Food Access

  • About 4 of 10 Americans with diabetes delayed seeking routine medical care, with more than 50% stating the fear of COVID-19 exposure was the primary reason.
  • About 1 in 5 Americans with diabetes have foregone or delayed getting an insulin pump or continuous glucose monitor (CGM).
  • More than 1 in 4 stated their access to healthy food was reduced, with about 1 in 5 relying on food assistance programs.
  • Almost half who receive assistance report that the food they receive negatively affects their diabetes management.
  • About 1 in 5 people who receive nutritional assistance report not having enough food to eat.

Moreover, about 1 in 5 Americans with diabetes have reported having to choose between buying food vs. affording their diabetes supplies.

The effects of the COVID-19 pandemic are widespread and span across multiple facets of people’s lives. For people with diabetes, many of whom are already struggling to afford their healthcare expenses, the financial effects of the pandemic may be particularly grim.

Perspectives on the COVID-19 Vaccine

When asked about their comfort level of receiving a COVID-19 vaccine as soon as it is made available to them, people with diabetes reported being more likely to want to receive it right away as compared to data collected from the general population.

Less than half as many people with diabetes stated that they would never want to get the vaccine as compared to data on the general population (10% vs. 21%, respectively).

It is perhaps not surprising that people with diabetes feel more strongly about receiving a COVID-19 vaccine than the general population. Currently, the Centers for Disease Control and Prevention (CDC) state that people with type 2 diabetes  “are at increased risk  of severe illness” from COVID-19, while people with type 1 diabetesmight be at an increased risk for severe illness.”

Other Insights: Barriers to Clinical Trials Participation

In addition to exploring the financial burden of the pandemic and assessing readiness to receive a COVID-19 vaccine, we also gathered information regarding previous participation or willingness to participate in a clinical trial. As per the recent press release,

“People with diabetes have participated infrequently in clinical drug trials in the past (only 11% report having done so), but the majority – 60% – say they are likely or very likely to participate in such a study in the future. Yet nearly a quarter of those who responded to the survey said they didn’t know how to participate in a drug trial if they wanted to do so.”

Check out the full press release from the ADA as well as the more data below:

New Data Alert: COVID-19 Brings Crisis of Access for Millions Living with Diabetes

Effects of the COVID-19 Pandemic on People with Diabetes

Methodology and Panel Demographics

These figures are based on Thrivable’s survey of more than 2,500 people with diabetes nationally, between December 7th and December 14th, 2020

  • A multiple-choice survey was distributed online to people with diabetes (U.S. residents) who signed up for the Thrivable Insights panel.
  • Participants were not compensated for their responses.
  • Data was analyzed using Qualtrics and Excel.
  • Details on panel breakdown include:
    • N = 2,595
    • o 47% with type 1 diabetes, 53% type 2
    • o 69% female, 31% male
    • o All 50 U.S. states are represented

Source: diabetesdaily.com

How Race and Ethnicity Affect Diabetes Prevalence, Management, and Complications

This content originally appeared on diaTribe. Republished with permission.

By Julia Kenney, Matthew Garza, and Eliza Skoler

Black, Indigenous, Hispanic, and Asian individuals, and people of all non-white racial and ethnic groups are more likely to have diabetes and diabetes-related health complications than their white peers. Here’s how social determinants of health lead to differences in diabetes care and outcomes, creating racial, ethnic, and economic health disparities in the United States.

According to the 2020 National Diabetes Statistics Report published by the Centers for Disease Control (CDC), diabetes affects over 34 million people in the United States – that’s more than one in ten people. However, diabetes does not affect all communities equally. As with many conditions – such as heart disease, chronic lung disease, and chronic kidney disease – a person’s race, ethnicity, and socioeconomic status influences both their risk for developing diabetes and their access to diabetes management resources. The health disparities that exist among the many races in the US are not attributable to genetics or biology alone, but also to socioeconomic factors and social determinants of health that disadvantage people of color.

Though genetics and biology do play important roles in diabetes prevalence and complication rates, this article will focus on the societal factors that affect the lives of people living with diabetes – such as access to healthy food, healthcare, employment, and other socioeconomic factors. We aim to specifically explore the racial health disparities that disadvantage communities of color. We will also highlight some of the factors underlying the concerning patterns in diabetes prevalence, management, and complications, and share ways to promote health and access to care for people with diabetes, regardless of race and ethnicity.

Defining Key Terms

  • Race & Ethnicity – Race is a socially constructed way to group individuals based on skin color and physical features. There is no specific set of genes that defines a race. Ethnicity is also socially constructed, and it categorizes people based on a shared sense of group membership (like language, culture, history, or geography).
  • Socioeconomic status – Socioeconomic status is a measure of a person’s economic and social standing. This term is often used interchangeably with social or economic class.
  • Health disparities – Health disparities are differences in health outcomes among various populations or communities. They are closely linked to social, economic, and environmental disadvantages that affect groups that have systematically experienced greater obstacles to health (due to factors including race, gender, age, sexual orientation, and economic status.)
  • Health equity – Health equity is the goal that every person, regardless of their background or circumstance, is able to live a healthy life with full access to quality healthcare and other health resources. Achievement of health equity requires valuing every person equally and addressing avoidable inequalities with focused, societal efforts to eliminate injustices and health disparities.
  • Social determinants of health – These are factors that influence a person’s health but fall outside the scope of a healthcare professional’s influence. They are the conditions in which people are born, grow, live, work, and age. For example, social determinants of health can include a person’s race, gender, socioeconomic status, education, and where they live and work; these factors are often longstanding and have multi-generational effects. Social determinants of health are one of the major causes of health inequities – the unfair and avoidable differences in health status.
  • Systemic racism – Also called institutional or structural racism, it is defined by systems and structures (such as medicine or the healthcare system) that have procedures or processes that disadvantage people of color.

Systemic racism lies at the center of this article. As we discuss racial health disparities and their underlying causes, keep in mind that these factors are a result of the long-standing structures that affect the lived experiences of people of color – they are not attributed to the personal decisions of individuals.

A Look at Racial Health Disparities in Diabetes

What do health disparities actually look like in the US? The data show concerning patterns: Black, Indigenous, Hispanic, and Asian populations are more heavily affected by diabetes than their non-Hispanic, white counterparts, in diagnoses, management challenges, and diabetes-related complications.

The CDC’s diabetes statistics report showed alarming differences among races in the estimated percentage of adults with diabetes (both diagnosed and undiagnosed) in the US from 2013 to 2016:

  • Black, non-Hispanic: 16.4%
  • Asian, non-Hispanic: 14.9%
  • Hispanic: 14.7%
  • White, non-Hispanic: 11.9%

While these differences in rates are stark, the evidence shows that diabetes prevalence is not dependent on race from a genetic or physiological standpoint alone. For example, in this study from 2007, when researchers accounted for socioeconomic factors, the differences in rates of type 2 diabetes between racial groups were reduced. This supports the idea that socioeconomic factors that disadvantage people of color are a significant cause for these health disparities.

In a 2017 study published in the Journal of Racial and Ethnic Health Disparities, a team of researchers from Meharry Medical College and Vanderbilt University found that there were differences in the quality of diabetes care between racial and ethnic groups. Using the 2013 Medical Expenditure Panel Survey (MEPS) data, they looked at adherence to five ADA-recommended services over one year that indicate quality of diabetes care. Compared to white individuals, Hispanic, Black, and Asian individuals received fewer diabetes management checks, including A1C tests, eye exams, foot exams, blood cholesterol tests, and flu vaccines. Even in adjusted models which controlled for factors like insurance coverage, poverty, and education, some of the disparities remained. Most notably, Hispanic, Black, and Asian individuals were still less likely to receive the two recommended annual A1C checks. The researchers showed that this difference in quality of care occurred partly because populations of color had less access to health insurance and diabetes management education, compared to white populations.

Trends in care translate to trends in diabetes outcomes – including complications and death rates. A study from 2014 looked into racial and ethnic differences in diabetes complications and mortality. Black, Indigenous, and Hispanic individuals had higher rates of retinopathyend-stage kidney disease, and amputations than non-Hispanic white individuals. Furthermore, these groups were more likely to die from diabetes than non-Hispanic white Americans:

  • Indigenous populations were 3 times more likely to die from diabetes
  • Non-Hispanic Black Americans were 2.3 times more likely to die from diabetes
  • Hispanic Americans were 1.5 times more likely to die from diabetes

Just as with the risk of diabetes, people of color are not genetically predisposed to diabetes-related complications due to race alone. A combination of social and environmental factors plays into a person’s ability to successfully manage their diabetes.

How Genetics and Biology Are Involved

Racial and ethnic categories are not as closely associated with genetics and biology as some people think. In fact, categories such as white, Black, Asian, and Hispanic are defined more by society than by any set of specific genes. However, to fully address the factors that affect diabetes prevalence and outcomes, we must understand the role of genetics and biology. Studies have shown that there are biological differences among races that correspond to how a person metabolizes (or utilizes) glucose, their insulin sensitivity, and how fat is distributed in the body – however, a person’s family history of diabetes is more telling of their genetic risk for that condition than the color of their skin. The research on how genetics, biology, and race all intersect and interact to influence diabetes is complex; there is still much to determine.

As discussed, genetics alone do not explain diabetes-related health disparities among the races. Furthermore, we cannot reduce the large health disparities by focusing solely on biological factors, which are largely predetermined; we must instead focus on the socioeconomic factors and social determinants of health that exacerbate racial disparities, which are in large part founded in longstanding systemic racism. Below we describe some of the many elements of systemic racism that affect a person’s ability to manage their diabetes and receive quality diabetes healthcare.

Main Causes of Racial Health Disparities in Diabetes Prevalence

The factors we discuss here are influenced by systemic racism that is built into the social, economic, and political fabric of the United States. The systemic racism that people of color experience results in things like lower wages, fewer academic and professional opportunities, and reduced community resources. With this in mind, factors like income, unemployment, health insurance, and food and exercise environments are not entirely personal choices, but can be explained by a number of external causes.

Income 

In the US, there are major racial differences in wealth. A 2018 Kaiser study offered this breakdown of people living below the federal poverty level:

  • 1 in 4 Indigenous people
  • 1 in 5 Black people
  • 1 in 5 Hispanic people
  • 1 in 10 white people

Further statistics on income and poverty levels can be found in the US Census Bureau’s 2019 report, which confirms the racial disparities in poverty rates. People living with incomes below the federal poverty level in 2018 were earning only $12,000 a year (or $25,000 for a family of four). These families – and many above the federal poverty level – often can’t afford the nutritious food, safe exercise opportunities, and healthcare needed to prevent and manage diabetes.

Unemployment and Health Insurance

People of color in America are also more likely to be unemployed. According to the US Bureau of Labor Statistics, the rates of unemployment in 2019, broken down by race, were:

  • 6.6% of Indigenous people
  • 6.1% of Black people
  • 3.9% of Latino and/or Hispanic people
  • 3.1% of white people

These unemployment rates and racial disparities have been further exacerbated by the COVID-19 pandemic, which dramatically increased unemployment rates in the US. Though unemployment is closely tied to income, it can also influence a person’s access to health insurance, since many people receive health insurance from an employer.

Stat

Image source: diaTribe

The high cost of healthcare means those who are uninsured or underinsured often do not get the care they need, including preventive healthcare (such as annual check-ups and prediabetes screenings) and instead must rely on inconsistent care. Unfortunately, Black, Indigenous, and Hispanic people are less likely to be insured in America. According to a Kaiser study of non-elderly individuals in the US, these were the rates of uninsured people in 2018:

  • 21.8% of Indigenous people (identified as American Indian or Alaskan Native
  • 19% of Hispanic people
  • 11.5% of Black people
  • 7.5% of white people

Food and Exercise

A healthy diet and regular exercise are known to reduce the risk and improve the outcomes of type 2 diabetes. However, Black, Hispanic, and Indigenous communities in the US have less access to healthy foods and experience higher rates of food insecurity than white communities. According to the USDA, more than 35 million people lived in food insecure households in the US in 2019, including:

  • 25% of Indigenous people
  • 19.1% of non-Hispanic, Black households
  • 15.6% of Hispanic households
  • 7.9% of non-Hispanic, white households

Food insecurity is most common among low-income communities, which are disproportionately occupied by people of color. Moreover, food deserts (where there is little to no access to healthy foods) and food swamps (full of unhealthy fast-food options) are located primarily in minority neighborhoods. These communities are often faced with local food options that put them at an increased risk for diabetes: more small grocery stores with limited choices, fast food restaurants, and liquor stores, and fewer supermarkets with fresh fruit and vegetable options, bakeries, and natural and whole foods.

In addition to less access to healthy and affordable food, people of color often also have less time, money, and overall access to venues for exercise. This article from the New York Times about the racially exclusive culture around jogging is an eye-opening example of the barriers to exercise that many Black people face. Even at a time when some of the world’s most elite runners are African or Black, Black runners and joggers (in America, especially) often engage in protective measures such as running only during the daytime, steering clear of certain neighborhoods, or wearing Ivy League sweatshirts to deflect any suspicions that could lead to racist attacks.

Main Causes of Racial Health Disparities in Diabetes-Related Health Complications

Barriers to healthcare (such as a lack of health insurance or insufficient income) continue after a person is diagnosed with diabetes. Without ongoing, regular diabetes care, people face higher rates of health complications. Here are some of the barriers:

  • The high cost of insulin has made the life-saving drug inaccessible to many people, including people of color who have higher rates of unemployment and little or no health insurance. An American Action Forum report showed that insulin costs a person an average of $6,000 per year and found that one in four people with diabetes report rationing their insulin because they cannot afford the cost of their full prescribed dose.
  • Despite major advances in diabetes technology that make diabetes management easier, including wider use of CGM and insulin pumps, disparities exist in who has access to these tools. Black individuals are less likely to use an insulin pump or CGM than their white counterparts – which may be due to failure of the healthcare professional to write a prescription for technology, insufficient information about diabetes technology, an inability to afford these devices, or subtle racism on the part of the established medical system.
  • Even for people who have insurance, the costs of diabetes care and a diabetes-friendly nutrition plan can be challenging for people with low incomes.

Social and racial barriers widen diabetes health disparities. There is a history of prejudice against people of color in our healthcare system: Black, Indigenous, and Hispanic individuals can have the same income, insurance, and medical condition as white people yet still receive lower quality care due to systemic racism. In 2018, fewer than 12% of practicing physicians in the United States were Black, Hispanic, or Indigenous individuals. This means that there are fewer healthcare professionals who can earn trust and identify with communities of color. For more information on racism in healthcare, check out Unequal Treatment.

The Importance of Addressing Health Inequity in Communities of Color

It is clear that the disparities in diabetes prevalence, care, and management can be explained in part by of a number of social determinants of health, many of which are influenced by systemic racism. Every person with diabetes faces health barriers. But for many, the color of their skin can make successful diabetes management even more difficult and sometimes impossible. Every person with diabetes should have access to diabetes care, medication, and technology, and to living a healthy life with diabetes.

What Can We, as a Society, Do to Reduce These Disparities?

It will take extensive, collaborative, and creative work to address these disparities. We can begin by educating ourselves and others. Some good first steps include learning about the challenges faced by people of color with diabetes, about the people working to address these issues already, and about the ways to get involved. Check out some of our other articles on these subjects:

At diaTribe, we want to acknowledge the people and the organizations at the local, state, and national levels who are already doing the work needed to effectively tackle the health inequalities that lead to higher rates of diabetes and less favorable outcomes among people of color. In addition to those whose jobs focus on addressing health disparities, there are other ways for people to be involved in promoting health equity. Here are some ideas to consider:

No matter what skills or resources you may have, determine how your expertise might be of benefit – particularly if you are in the health field where you can address systemic racism and health disparities. The more we learn about how the social determinants of health and racism in healthcare contribute to a person’s risk for diabetes and influence their diabetes management, the better prepared we’ll be to knock down barriers to quality care.

We acknowledge that every person should have the resources to manage their diabetes and, in the case of type 2 diabetes, to prevent it. All people, and especially people in positions of privilege, have a responsibility to help break down barriers to equal care for underserved communities. As people with diabetes and their allies, we have to do the work – and build upon the work already being done – to address racial health disparities and create more equitable and inclusive healthcare for people of color – in fact, for all of us.

Source: diabetesdaily.com

Dexcom Super Bowl Ad: Did it Miss the Mark?

By Caroline Levens

 

Editor’s Note:

Nick Jonas, a music celebrity living with with type 1 diabetes (T1D) partnered with Dexcom and recorded a Super Bowl commercial for diabetes advocacy. Some in the diabetes community, however, feel that it missed the mark entirely. One of our contributors, Caroline, shared why.

***

When I first heard that Dexcom had an ad in the Super Bowl, I was quite surprised — but also really excited about the prospect of them bringing mainstream awareness to diabetes. Once I saw the ad, however, I was immediately disappointed, and I think it’s important to shed light on why the execution was so poor, in my opinion. 

First and foremost, the ad has Nick Jonas exclaim in a condescending tone “people with diabetes are still pricking their fingers…what??”

If you aren’t familiar with Dexcom, it’s a continuous glucose monitor (CGM), meaning it shares blood glucose readings every five minutes. And while it’s an amazing product, it’s not cheap — current Dexcom pricing without insurance is $4,744 per year. Insulin is an essential cost for diabetics, whereas Dexcom is a luxury. According to T1International, spending by patients with type 1 diabetes (T1D) on insulin nearly doubled from 2012 to 2016, increasing from $2900 to $5700, and one of every four patients with T1D has had to ration their insulin due to cost.

It goes without saying – spending $10k+ on diabetes annually is a lot of money. When we’re in the middle of a pandemic where many people have lost their jobs and insurance, the way Dexcom comes across here is quite inconsiderate. I can’t think of a single other product category where a brand would think it’d be okay to frame a product in this context. Sure, there are many categories where the luxury price point is out of reach for the average consumer. But you don’t see them with commercials rubbing it in “what, you can’t afford us??” The analogy isn’t perfect, but it’s comparable to a luxury appliance brand with a Super Bowl ad saying, “people are still washing clothes by hand and using clotheslines, what??”

Secondly, the ad is very misleading, and they even have to have a legal disclaimer “Fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings.” I’d love to meet a Dexcom user who no longer needs ANY fingersticks. I love my Dexcom, I really do – I’ve been a loyal Dexcom user since 2008 and am extremely fortunate to have it.

That said, the accuracy, though it’s improved over the years, is still not perfect. And, accurate blood glucose values are essential for insulin dosing precision. Many endocrinologists specifically recommend not dosing off of Dexcom’s value. I can’t even count the number of times I would have died – and no I’m not exaggerating – if I had trusted the value on Dexcom. There are also many times it has error messages and doesn’t display any values and you need to use fingersticks (in the past week alone, I’ve had 20+ hours of this). There are also 2-hour warm up periods where you may need to check your blood sugar levels. No doubt in my mind, Nick Jonas pricks his finger, but of course if you pay him enough for a commercial, he’ll say what Dexcom wants him to say.

Last but not least, there’s already a big stigma associated with fingerpricks. It shouldn’t have to be something people are ashamed to do — it’s absolutely vital for survival — but I’ve experienced it before myself, especially in high school, and even still occasionally am uncomfortable checking my blood sugar in work settings, around new people etc. New technology is great, but “othering” fingersticks does not help. 

Dexcom, think about the little boy watching the Super Bowl who is already ashamed to prick his finger, knows Dexcom exists from diabetes camp (and from your lovely ad), wants it, his parents also want it for him, but it’s not a financial possibility. How do you think your ad makes him feel? Does it matter to you? Sure, the world’s not perfect. I 100% realize not everyone can get what they want. But this ad could have been approached in a completely different way that I believe would have delivered as strong as business results for Dexcom without doing any harm to the diabetes community. Dexcom had a big opportunity, and quite frankly, blew it.

Check it out for yourself and please share your thoughts in the comments:

Source: diabetesdaily.com

Gobble Review: Make Tasty Meals Without the Hassle

As many of us continue to stay at home more than usual, finding new ways to make creative, easy and healthy dinners is a priority for many. Recently, I tried out a meal kit delivery service from Gobble and thought I would share my thoughts as a mom of two living with type 1 diabetes.

I received the products at no charge and all opinions are my own.

Who They Are

Gobble is a meal kit delivery service that aims to make delicious, home-cooked meals fast and easy to prepare. Everything you need is sent out perfectly portioned, and each meal takes about 15 minutes to make. They offer a great variety of dinner menus and incorporate a lot of classic dishes that can please all kinds of palates, including kids’!

Services Offered

You can select from the traditional Gobble box dinner plan that features classic dishes, or opt for the Lean and Clean version, which features “lean proteins, healthy fats, and under 600 calories per serving” while still delivering the “and convenience and flavors of Gobble’s 15-minute dinner kits.”

For each option, you can select to have dinner delivered for either two or four people, either three or four days per week. You can customize your choices, and request accommodations for dairy-, nut-, and gluten-free items. Meals start as low as $11.99 per serving, and you can skip deliveries or cancel your subscription hassle-free.

My Review

I tried out three different meals from Gobble and was impressed with all of them:

Pan-Roasted Chicken with Green Bean Casserole & Mashed Potatoes: This one was a classic and rustic choice. We all enjoyed it, and I just skipped the mashed potatoes, to make life easier for blood sugar management. The green bean casserole was delicious and the skin on the chicken came out super crispy! My husband and four-year-old daughter loved it, too!

Miso-Glazed Salmon with (Soba) Noodles & Snow Peas: I am the fish-eater in the family, so I was thrilled to receive a well-portioned a fresh-looking piece of skin-on Salmon. Again, preparation was easy-to-follow, and quick, and the meal came out great! One caveat: I substituted my own edamame noodles in place of the Soba noodles to keep the carb count down. Delicious!

Citrus Chicken & Broccoli Stir Fry: This meal was an option from the “Lean and Clean” plan, and it was super quick to make! Most of the dinners I eat are basically some protein and non-starchy vegetables, so this was right up my alley. The sauce was a bit sweet, but I used it sparingly and was able to enjoy this filling and delicious meal without a blood sugar spike, which is always a win!

Summary

The two big factors that make the Gobble meal kit delivery service a winner in my book are:

  • They do not skimp on the protein!
  • The meals are really quick and easy to make (and most importantly, taste great, of course!)

Do you use a meal kit delivery service? Have you tried Gobble? How has your experience been? Please share your thoughts in the comments; we love hearing from our readers!

Source: diabetesdaily.com

Type 2 Diabetes and Insulin: What to Expect

Whether you’ve been newly diagnosed or have been living with type 2 diabetes for a long time, you may know that it is often a progressive disease. The longer someone lives with type 2, the more likely they are to need insulin therapy to manage their blood sugars. Often, but not always, people with type 2 diabetes start the management of their condition with exercise and diet alone, and then may progress to oral medications like Metformin, before finally (over the course of months or even years) requiring insulin to manage their blood sugar levels.

If this happens, you and your doctor will need to come up with a new treatment plan. But what can you expect? This article will describe what will and what won’t happen, and how to prepare when adding insulin therapy to your diabetes management.

There Is No Need to Panic

It’s important to remember that you haven’t done anything wrong if you get to a point where you need insulin therapy. Physicians used to prescribe insulin to people with type 2 diabetes as a last resort, but in recent years are prescribing it much sooner, due to the benefits of more stringent blood sugar management to prevent complications.

Since type 2 diabetes is often a progressive disease, many with the condition will require insulin at some point. You didn’t fail at diabetes management, and insulin is no punishment. Adding insulin therapy to your management toolkit is just another way to better meet HbA1c goals, enjoy better blood sugars, improve your quality of life, and even extend your life. Embrace it!

Insulin Does Not Inherently Make You Gain Weight

There is a common myth that insulin makes you gain weight. And this line of thinking is simply false. Here’s the connection between insulin and weight gain: When you take insulin, glucose from food is better able to enter your cells, making your blood sugar level drop. But if you take in more calories (eat more) than you need, your cells will also get more glucose than they need, and anything extra is stored as fat.

But this is obvious: the same process happens to people who do not have diabetes. People also believe that insulin causes weight gain because at diagnosis, people might be underweight (as a symptom of the disease), and finally getting the insulin they need into their bodies makes them gain the much-needed weight back. There are many side effects of insulin, but if you eat right, exercise, and take it as prescribed, extra weight gain is not one of them.

You Will Experience More Low Blood Sugars

One well-known and common side effect of insulin, however, is hypoglycemia. If you’ve traditionally managed your diabetes with exercise and diet alone, you may have rarely, if ever, experienced low blood sugar. Even oral diabetes medications, such as Metformin, rarely cause low blood sugars when taken on their own, but insulin is a whole different story.

You will need to work with your doctor to fine-tune your management, so you are able to take enough insulin to manage high blood sugars, while not taking too much where you will drop too low. It is a learning process, and it will take time.

Be better prepared by always carrying a snack on you, and making sure to check your blood sugar more often to prevent lows. Symptoms of low blood sugar include:

  • Dizziness
  • Slurred speech
  • Confusion
  • Extreme fatigue
  • Sweating
  • Rapid heartbeat

Symptoms of severe low blood sugar include:

  • Seizure
  • Loss of consciousness

Severe low blood sugar always requires immediate emergency medical attention and 911 should be contacted right away. Ask you doctor about a prescription for Glucagon,  an emergency injection that can be used to bring blood glucose levels up in case of an emergency.

Your Medical Bills Will Go Up

Diabetes is a costly disease, as of 2017, was the most expensive chronic disease in the United States, costing over $327 billion dollars per year. While diet, exercise, and even oral diabetes medications are cheaper ways to manage type 2 diabetes, insulin is one of the most expensive chronic disease medications on the market in the United States, averaging around $285 per vial.

Be prepared for higher costs at the pharmacy counter, especially if your physician prescribes you fast-acting, analog insulins like Humalog, Novolog, or Fiasp. Cheaper, human-insulins are available over the counter at places like Walmart, although they are much slower-acting, are much older, and their efficacy may not be as good as modern insulins.

Make sure to sign up for health insurance, and make sure your insurance plan will cover prescription insulin at a decent out-of-pocket cost. See if you are eligible for Medicaid or Medicare for more affordable coverage.

If available, make sure to take advantage of your employer’s Health Savings Account (HSA) and work with your doctor to make sure you have been prescribed insulin that you can comfortably afford for the long-haul. More resources for affording insulin can be found here.

You Will Need Additional Support

Adding insulin therapy to your diabetes management is a big decision. You will need extra emotional, mental, and even physical support during this time. Insulin therapy is expensive, and the toll of managing low blood sugars for the first time can be tough. Insulin injections can sometimes hurt, finding new injection sites can be hard without a second set of eyes, counting carbohydrates more closely is time-consuming, and fighting off stigma and shame is real and can be hard on everyone. It is a big adjustment.

Getting support from family and friends, joining a diabetes support group, or simply becoming more engaged in the diabetes community can really help during this time. Make sure to enlist friends and family to help you, and be open and honest with them about your worries and struggles. Adding insulin therapy to your management is meant to help, not hurt, but it’s easier when you’re not doing it alone.

Insulin Can Improve the Quality of Your Life

When taking insulin, it is crucial that you work with your doctor and follow your treatment plan to better meet your health goals. The transition from managing with diet and exercise alone or solely taking oral medications to insulin therapy can be challenging, but with a growth mindset and preparation for what lies ahead, you can thrive on insulin therapy and vastly improve the quality of your life.

Source: diabetesdaily.com

New Dexcom Update: Your G7 Questions Answered

Last month, we chatted with Jake Leach, Dexcom’s chief technology officer (CTO) to get the latest scoop on the release timeline and new features of the Dexcom G7 continuous glucose monitor (CGM), a highly-anticipated diabetes technology that will be released in 2021. Many follow-up questions from our readers prompted us to follow-up further.

Without further adieu, here are your questions about the G7 answered:

There is no calibration, correct?

“This is correct.”

What about pharmacy vs. supplier distribution for the G7?

“We continue to focus on making CGM more accessible and easier to obtain for patients. Pharmacy is our preferred distribution channel and we have expanded pharmacy access for Dexcom CGM by nearly 80% since December 2018. This strategy will not change for G7.”

Now that the product is disposable, would this no longer be considered durable medical equipment (DME) and thus covered differently by insurance companies?

“The disposable aspect of the product has no impact on reimbursement.”

Do you anticipate working on integration with all the major pump companies?

“As the first iCGM on the market, and still the only one indicated for use with automated insulin delivery systems, Dexcom G6 is the forerunner in the category of interoperability and are advocates of patient choice in insulin delivery. G7 will be no different. With Insulet’s Omnipod 5 preparing for a first half of 2021 launch, we feel that our leadership in this category will result in us having integrations with the leading tethered pump on the market in Tandem’s Control.IQ, and the leading tubeless pump in Omnipod 5.

We are also very excited about the development progress that Lilly and Novo Nordisk are making in their Bluetooth connected smart pen technology and we continue to believe that the solutions we’re working on with those two teams will enable significant improvements in the user experience and ease the burden of diabetes in the MDI population, which represents the vast majority of intensive insulin users across the world.

Two years ago we stated that we believe that by 2023, 50% of our insulin intensive customer base will be using a connected insulin delivery device in combination with our CGM, and we believe that we are on track to hit that mark. Connected systems are truly the future of diabetes technology and we are working to extend our leadership in the category with these key partners and the tools that we have created to support these integrations, including our Dexcom artificial pancreas algorithm technology.”

Is there any evolution with the readout frequency (to be more frequent than every 5 minutes)?

“Patients and [providers] both tell us there isn’t a need for CGM systems to provide a glucose readout more frequently than every five minutes. This is especially true since Dexcom CGM has an Urgent Low Soon predictive alert that can warn users 20 minutes in advance of a severe hypoglycemic event (55 mg/dL), which helps give them time to take appropriate action before an event occurs.

Will G7 be approved for different wear locations (besides the abdomen)?

“We are conducting pivotal trials with the G7 in multiple wear locations, including abdomen and upper arm.”

Dexcom G7

Image source: Dexcom

In addition, Jake Leach had the following to say, highlighting his enthusiasm for the new developments:

“With G7, we’ve taken all of the great features that we’ve established with G6, features that have resulted in market-leading patient satisfaction scores, and have made them even better. G7 is a real time, factory calibrated continuous glucose monitor with iCGM level performance, a simplified application and start-up process, and a faster sensor warm-up time. We’ve packaged all of this into a fully disposable form-factor that is 60% smaller than our current G6 wearable and introduces significant cost reductions across the manufacturing process. This G7 wearable technology is paired with a brand-new app experience that includes real time glucose information combined with personalized insights designed to further enhance the unique value users get from Dexcom CGM. Take all of these features together and you can understand why we are so excited about G7 as a key driver of the growth story that we’ve laid out today.”

Are you excited to test drive the G7 CGM? Please share your thoughts in the comments!

Source: diabetesdaily.com

Why Your Breakfast Matters

People say that breakfast is the most important meal of the day. Then again, you probably get confused because you hear about people who don’t eat breakfast and do intermittent fasting… and they seem like they’re doing perfectly fine.

So, who do you believe? What do you do? What’s the best thing for you? And most importantly, what’s the best thing for your blood sugars?

At the end of the day, we want to make sure our blood sugar levels are in the best possible place, and breakfast, should you choose to eat it, does play a massive role in that, as it sets the tone for the entire day. So, let’s make sure you’re crushing it at breakfast.

Here are three important considerations that you need to be thinking about when it comes to eating breakfast:

1. Insulin Resistance in the Morning

You might have noticed over time that no matter what you do, you eat something for breakfast that has plenty of carbs in it, and your blood sugar skyrockets. You could be eating cereal, you could be eating some toast–no matter what you eat, your blood sugar just goes to the moon, and it is super frustrating. “Why?” you wonder. “This makes no sense.”

However, here’s the situation: Your body produces a hormone called cortisol, which is not the friendliest hormone in your body. Why? Cortisol induces insulin resistance…and it peaks around 7:00 am. What else happens around 7:00 am? Breakfast.

What do many people eat for breakfast? High-glycemic carbs like cereal. So, if the time of day where you’re most insulin resistant coincides with the time of day where you may be eating the most carbs,  that might explain why your blood sugars spike so much.

What is one thing that you can do to reduce the frequency of that? It’s simple. Consider a lower-carb breakfast option. Now, I’m not saying you have to get rid of all of your carbs at breakfast–I’m just advocating to consider decreasing the amount of carbs you eat at breakfast if you notice you are perpetually having high blood sugars afterwards.

2. Caffeine

What is one of the staples in most people’s early morning meal? Coffee.

Why is that significant to you and your blood sugar? Caffeine can cause the liver to release glycogen, aka stored glucose, into the bloodstream. When that happens, your blood sugar starts to go up, despite coffee not having any carbs on its own (unless you add things to it).

If you’ve been drinking coffee for a while without taking any sort of consideration as to your blood sugars, and suddenly you’re noticing it’s trending up slowly but surely every single time you have it, the coffee could be the culprit and may need to be considered when calculating your breakfast insulin dose.

3. Protein

As a dietitian, I am supposed to tell you to always have a “balanced meal.” You know what that means (*yawn*). Have your carb source, your veggie or fruit, and your protein!

At the end of the day, it’s up to you what you choose to eat. We’ve already covered the carb sources in part #1.

One of the other major components we haven’t talked about yet? Protein, which can actually raise your blood sugar, especially depending on the type of protein that is consumed. Different proteins may affect your blood sugar in different ways.

And if you’re someone who decides to go lower-carb at breakfast because of reason number one, don’t forget this: protein can impact your blood sugar by causing glucose release from the liver.

Think of it like in The Hunger Games, when the Katnis says, “I offer myself as tribute.”

That is what carbs are doing when protein is consumed with it. Carbs protect protein, but especially without the carbs, protein is more likely to trigger higher blood glucose levels. Just another consideration for you to make sure you are having awesome blood sugars early in the day. Isn’t diabetes and metabolism fun?

Read more about how to account for protein in your diet here: How to Calculate Bolus Insulin Dosing for Protein.

With all this information you’re probably thinking, “Well, why even bother eating breakfast at all?” And that’s the greatest thing: you have the choice. You don’t have to eat breakfast if you don’t want to. But, many people do, since it gives them a good boost to start off their day.

So, with these three handy tips, you can hopefully dial in on your blood sugars a little bit more, which will then allow you to be able to have an easier rest of your day. Because remember: the beginning of the day is going to have a major impact over how the rest is going to go.

Source: diabetesdaily.com

Virta Health: An Unparalleled Leader in Reversing Type 2 Diabetes

Type 2 diabetes is a condition characterized by high blood glucose levels due to the inability to effectively utilize insulin (insulin resistance). It is well-known that it is often possible to reverse type 2 diabetes by adjusting lifestyle factors, in particular, through dietary changes and sustained weight loss. However, many patients are not able to achieve this.

Virta is a company that was founded in 2014 and has made it their mission to help people reverse their type 2 diabetes. In their program, “most patients achieve blood sugar control while removing medications like insulin, often in a matter of weeks.”

The program centers around utilizing a very low-carbohydrate (ketogenic) diet, tailored specifically to meet each patient’s need. The dietary change can help facilitate both weight loss, and improve blood glucose levels, often quickly, allowing for discontinuation of various blood glucose medications under medical supervision.

In addition to a health coach”, blood sugar testing supplies, a “smart scale”, the company offers a variety of educational resources, community engagement among patients, and personalized advice provided by medical experts.

“Powered by technology and data science, physicians and nurses provide expert medical care, when and where patients need it, via Virta’s custom-designed app medical records system.”

One of the main reasons that a very low-carbohydrate diet can work so well for many people with diabetes is depicted below.

Photo credit: Virta Health

In fact, a very low-carbohydrate approach as an integral part of diabetes management is becoming more and more accepted and recommended by medical professionals and health organizations. Learn more about the most recent research and recommendations about low carb for diabetes here:

Low-Carb for Type 1 Diabetes

Low-Carb for Type 2 Diabetes

Low-Carb for Pre-Diabetes

Check out some of the very impressive Virta clinical study outcomes in patients who utilize the program:

Additionally, the researchers noted weight loss as a “side-benefit”, with patients losing an average of 30 lbs., or 12% of their body weight, a clinically-significant result that was maintained at the one-year mark since the start of the trial. Even more strikingly, participants experienced significant cardiovascular disease risk reduction, lower blood pressure levels, lower levels of inflammation, and lower risk for fatty liver disease.

Of course, all these health improvements also translate to cost savings for both patients and health insurance providers. Many employers and health plans are now working with Virta to increase patient access to this treatment approach. To get started, you can fill out a short form to schedule a free call to determine the next steps in the process.

With superior success to a traditional diabetes care approach already established, Virta aims to continue to broaden its reach with the challenging and very admirable goal of “reversing type 2 diabetes in 100 million people by 2025.

Have you heard of or participated in this program? What are your thoughts on carbohydrate restriction as a primary means to achieve weight loss and tighter blood sugar management? Please share your thoughts in the comments below!

Source: diabetesdaily.com

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