The Healthiest Choices at the 10 Biggest Fast Food Chains

Fast food: so temptingly convenient, but so fraught with danger. Most fast food joints specialize in exactly the sort of starchy, crispy, greasy food that people with diabetes are supposed to avoid. Nothing triggers those frustrating sticky blood sugar highs like the delicious blend of fat and carbs found in pizza or French fries. And it doesn’t help that they’ve been loaded with lip-smacking sodium, expertly engineered to keep you reaching for more—and why not order a large soda to wash it all down?

There’s no doubt about it, a fast food menu can be a minefield. But despite some notable recent setbacks—like in 2020, when McDonald’s discontinued its salads—the fast food options for healthy eaters are mostly growing. And as diners continue to demand more healthy options, it means you’re less and less likely to get a weird look when you ask for a lettuce-wrapped burger.

We’ve ranked America’s ten biggest fast food chains, from the healthiest to least healthy, and selected the best diabetes-friendly option at each one.

#1 – Panera Bread

Panera Bread must be the only major chain that specializes in food that most Americans would identify as healthy. The chain has grown like crazy in the last decade, proving that we can crave more than just grease and sugar. And while you might not guess it from a restaurant with the word “bread” in its name, it’s also a great option for people with diabetes. There’s a beautiful variety of low- and medium-carb salads and soups, some of which don’t need much customization at all. Skip the pastries—and don’t even think about the mac & cheese bread bowl—and you’ll probably do just fine.

Best choice:

It’s tough to beat a classic Caesar Salad with Chicken. This dose of delicious lean protein only has about 500 calories and 17 grams of net carbohydrates, even with the croutons included.

#2 – Chipotle

Chipotle stands alone in the fast food landscape as an exemplary keto-friendly option. It’s always been easy to customize your order at Chipotle, and as a result the chain has been popular with the low-carb crowd for years. (Double protein? No problem.)

Chipotle has always prided itself on using high quality ingredients prepared fresh on the premises. While doctors may bristle at the characterization of sour cream and slow-cooked carnitas as “healthy,” at least we can be sure that they’re not likely to spike your blood sugar. And Chipotle has embraced the carb-avoiding community to a unique and commendable degree: the latest innovation is cauliflower rice, launched nationally in January 2021.

Best choice:

For easy one-click ordering, choose from Chipotle’s line of “Lifestyle Bowls,” including several different Keto Bowls. Or start with a Salad, which swaps the Burrito Bowl’s white rice for lettuce, and add whichever ingredients you feel comfortable with.

#3 – Subway

It’s very easy to eat low-carb at Subway—any time you can see your food assembled in front of your eyes, it’s going to be easier to control what ends up in your body. Subway has also recently Chipotle-fied their menu and now offer a selection of salads and protein bowls.

Best Choice:

The Black Forest Ham Protein Bowl has only 9 grams of net carbs, and less sodium than other dishes in the category, along with a ton of chopped veggies.

#4 – Wendy’s

Wendy’s has several healthy options, at least as far as fast food burger joints go, and is easily a better choice than the more popular burger chains coming next on this list. The chain offers multiple salads, both as entrees and sides, and savory wraps. (And you can always order a burger without the bun.)

Source: Wendy’s

Best Choice:

The Southwest Avocado Salad is a complete meal that doesn’t require any fuss when you order it. Grilled chicken, bacon, avocado and southwest ranch dressing: all told, it’s 560 calories, and only 10 grams of net carbs.

#5 – Taco Bell

Tortillas everywhere means blood-sugar spiking simple carbs can be tough to avoid here. Taco Bell is one of several joints on this list that have recently de-emphasized salads, but in this case it’s not much of a loss, as the salads here tended to just be tacos and burritos in a slightly different shape. But Taco Bell has always been happy to customize your order, and a newer menu addition has really opened up the possibilities.

Best Choice:

The Power Menu Bowl is Taco Bell’s attempt at Chipotle-style fare, and they want you to customize your order. You can go light on the rice and beans, or omit them entirely, add extra meat: whatever you’d like.

#6 – Chick-fil-A

You might be surprised to learn that the crispy chicken juggernaut, not often associated with prudent dining, has openly courted keto diners. Chick-fil-A has grilled chicken sandwiches and several salad options, and it’s an easier place to find healthy choices than you probably imagined.

 

Source: Chick-fil-A

Best Choice:

Perhaps the single healthiest entry on the entire list, and certainly the simplest, Chick-fil-A’s Grilled Nuggets are pretty much just chunks of marinated chicken breast, served fresh off the grill. Okay, meat on a plate isn’t terribly exciting, but combine with a side salad and some less sugary dressing—try the buffalo or ranch sauces—and you’re in business.

#7 – Dunkin’

Just like Domino’s and its “Pizza”, Dunkin’ has dropped its “Donuts” in a bid to grow its menu and its market share. Good news: that means more options for us. You’ll still want to avoid any donuts, and tiptoe around the rapidly growing menu of super-sugary coffees and teas. But people love Dunkin’s black coffee for a reason, and the newer hot breakfast menu has some diabetes-friendly possibilities.

Best Choice:

Try a Turkey Sausage Wake-Up Wrap. Dunkin’s wraps top out at just 15 grams of carbohydrates, and in addition to the traditional ham, sausage and bacon, you can choose turkey or BeyondMeat’s vegan sausage. They also offer sandwiches on thin multigrain bread—and of course you can ask them to hold the starch entirely.

#8 – Domino’s

Our first real challenge. Domino’s has dropped the “pizza” from its name, but most of the newer entrees remain tricky, like pasta and sandwiches.

Domino’s does have a Caesar’s salad available, but we’ve already recommended two salads, and besides I’m not sure that Domino’s is the first place I’d go for fresh ingredients.

Best choice:

If you’re bored with salads already, try the Chicken Wings. They are dusted with a little starch to make them crispier, but even so don’t pack much of a carby punch. A side of Mild Buffalo Wings clocks in at 260 calories and about 10 grams of net carbohydrates. Some of the other sauces can get pretty sugary—it’s probably best to avoid anything with “sweet” or “pineapple” in the title.

#9 – Burger King

Burger King seems to have mostly removed salads from its menu, which makes healthy ordering a challenge. And while there’s plenty of fish and chicken on the menu, nearly every last scrap of it has been enrobed in breadcrumbs and deep-fried. Grilled chicken may be available at certain locations. Just about the only thing on the national menu within spitting distance of “healthy” is the side of apple sauce—hardly a meal.

Best Choice:

Your best bet is probably to order any Burger with No Bun. The chicken nuggets may be another option—an order of 10 has only 25 grams of carbs. If you’re lucky, your location has Grilled Chicken Sandwiches and Side Salads too, but these are not reliably available.

#10 – McDonald’s

The world’s biggest fast food chain does not make it easy to eat healthy. It was, admittedly, pretty big news in the 80’s when McDonald’s unveiled a line of salads. It was somewhat less noticed more recently when McDonald’s pulled them off American menus entirely. The fast food behemoth no longer has so much as a single side salad on the menu. The grilled chicken was lost to the same purge. It’s slim pickings now!

Best Choice:

Errrr … do we have to pick one? The only really healthy choice at McDonald’s is to eat less instead of more. The simplest burgers, from the Hamburger to the Double Cheeseburger, use a bun with about 28 grams of net carbohydrates. You can manage to put together a keto meal by refusing the bun altogether. Either way, please hold the fries.

Fruit & Maple Oatmeal is a lonely healthy-ish (but high carb) option for breakfast. The Sausage Breakfast Burrito has more potential as a keto option, if you were to scrape the filling off of its tortilla.

Conclusion

In some ways, it’s easier than ever to find healthy and diabetes-friendly fast food. Chipotle has led the way in the protein bowl revolution, and now there are many joints that will dish you up meat and veggies with little or no added starch and sugar. If there’s a single takeaway here, it’s to be wary of the biggest burger chains, which are sliding backwards, contrary to the trends, and making their menus even less healthy. If you choose the wrong restaurant, you might find that there’s no right answer.

Source: diabetesdaily.com

The Top Tips for Your Best A1c Yet

Tip 1: Protein – Including some protein, whether plant or animal-based, at every meal, will help with satiation and with post-meal glucose spikes.

Tip 2: Movement – Consistent physical activity and movement each day will help increase your insulin sensitivity. Any type of exercise or movement is suitable!

Tip 3: Portion Sizes – Knowing what and how much you’re eating will help reduce guesswork with insulin dosing or food tracking.

 

Ben Tzeel a registered dietitian, certified strength and conditioning specialist, joins Diabetes Daily to discuss nutrition, ways of eating, and getting the most out of your diabetes management tools and tactics. He is the owner of Your Diabetes Insider, an online nutrition and fitness coaching business that focuses on individuals living with diabetes. He has lived with type 1 diabetes since he was seven years old.

Source: diabetesdaily.com

Achieving a 6.0% A1c by Eating 40 Grams of Carbs Per Meal

My 6-Month Experiment

“6.0”. I didn’t think I heard him correctly. I asked my endocrinologist to repeat himself. “I said 6.0%. You’re A1c was 6.0%.” My mouth gaped in astonishment. Practically non-diabetic. The lowest A1c I have ever had in my 10+ years of type 1 diabetes.

How Did I Do It?

Over the past ten years since my diagnosis with type 1 diabetes, I would consider myself a “good diabetic”. That means multiple fingersticks a day, remembering to bolus at mealtimes, and an overall idea of what kinds of foods were entering my body. My A1c hovered between 6.8-7.4% — which my doctors thought was just fine. I had a strong desire to lower my A1c, but nothing in the past seemed to significantly work.

About a year ago, I began medical school and became inspired to take better control of my diabetes. I began doing a lot of reading on the subject and started to toy with the idea of lowering my carb intake. There have not been many (if any) conclusive studies on the effects of low-carb diets in type 1 diabetics, yet I had a hunch that something like that could be my long-desired solution. I decided to perform a six-month-long clinical trial testing the effects of a low-carb diet on a particular type 1 diabetic — me.

The Rules

I recognized that diabetes is a lifelong condition and that any new diet I would undertake would have to be sustainable over a long period of time. Many popular diets only allow minuscule portions of daily carbs, and I knew that would not be maintainable long term. I didn’t want my diet to be unbearable and rebound. I, therefore, decided at the start that my diet was not to lose weight, and was not to start eating healthier. I allowed myself to eat cookies, cake, etc. (although I did naturally end up eating more vegetables in order to stick to the rules of the diet).

The diet consists of just one golden rule, plus 2 common sense rules.

The Golden Rule:

  • Maximum 40g of carbs at one sitting (eating to treat/prevent a low doesn’t count)

The Common Sense Rules:

  • Don’t eat any foods that make my blood sugar go wonky (some examples for me are pizza, bagels, and deep-fried foods)
  • Always try to bolus at least 15 minutes before eating

As part of The Golden Rule, each “sitting” is separated into three-hour chunks. For example, let’s say I eat lunch one day consisting of a hamburger (meat is zero carbs, the bun is 25g) and an apple (15g). Two hours later, I find myself hungry. What are my snack options at this point? Well, since I already reached my 40g maximum and it is within three hours of my meal, I must wait one more hour (i.e., three hours from my lunch), at which point the clock resets. I can then eat a snack up to 40g. However, let’s assume my lunch consists of just a tuna sandwich (2 slices of bread=30g). Two hours later, I find myself hungry. What are my options at this point? I can eat up to 10g of carbs because my lunch was 10g shy of the 40g limit.

I also toyed with the idea of imposing a daily maximum on carb intake, but I later nixed it. As mentioned, I wanted this diet to be highly sustainable long term, and I felt that a daily carb maximum might impede that goal. Also, diabetes diets that impose daily carb maximums are somewhat controversial in the medical field. Some medical professionals believe that such diets could even be harmful to people with diabetes, and I wanted to stay clear of that controversy.

Why Did I Think It Might Work?

Most people who start low-carb diets are trying to lose weight. Although I did lose a few pounds since I started this diet, this was not at all my intention in this endeavor (although truthfully, it was nice to finally fit into my wedding suit again). The reason I began doing this is twofold:

Reason #1: The Post Prandial Spike

Following a meal, there is inevitably a spike in blood glucose. The size of the spike is proportionate to many things (the types of carbs eaten, the timing of insulin injection, etc.). However, my personal experience has shown that for me, the spike is most directly related to the number of carbs I eat. Therefore, fewer carbs = smaller spike. (Similarly, giving at least 3 hours between meals allows time for the spike to come down).

Reason #2: The Guessing Hypothesis

Guess how much a single banana would cost you at your local grocery store. Go ahead, guess a price. You may have guessed 15 cents. 25 cents? 50 cents? One dollar? $1.50? The actual price is about a quarter. You may have guessed a quarter (you may have even bought a banana before and this, therefore, was not a guess). Or you may have been off by a bit. You may have even been off by a lot. However, most likely your guess was not off by more than a dollar. Now guess the price of 500-seat Boeing 747. Go ahead, think of a number. A quick Google search priced it at $357 Million. Was your guess off by a couple million? The point here is clear: when dealing with larger values, our estimates tend to have larger ranges of error. By keeping the carbs low, we are giving ourselves a better chance of correctly estimating our carb intake.

Conclusions

My main goal was to achieve better control of my blood sugar and somewhat lower my A1c. Yet, since the start of my diet, I’ve reaped numerous benefits and gained far more than I could have expected. My A1c has dropped a full percent, a stark reduction to a degree I had not anticipated. My day-to-day blood sugar has become much more predictable, and those horrible whacky-blood-sugar days that all people with diabetes experience have become much less common. Additionally, my average daily insulin usage dropped from 50.2U a day to 40.8U – almost a 20% decrease! As a nice fringe benefit, I lost a few pounds and really feel better overall.

One thing that people often ask is if my lower A1c came at the expense of more frequent hypoglycemic episodes. When I started this diet, I did indeed see a slight increase in hypos along with my tighter glucose control (however, I cannot quantify this with an exact number because I don’t have records of my hypo occurrences prior to starting this diet). Once I began noticing that my lows were becoming more frequent, I made a conscious effort to keep an eye on my CGM (Continuous Glucose Monitor) and be more aggressive in preventing them. Following that adjustment, I believe I have been having just as few hypos as I did before I started this diet.

I want to point out that my 40g maximum per meal is a completely arbitrary amount. It’s an amount that is feasible for me and is also fewer carbs than I was normally eating per meal. If you are reading this and thinking that you could never manage on such a meal plan, I would suggest coming up with your own maximum-carb-per-meal formula and giving it a try. Every person with diabetes is different, and this plan may not be the solution for everyone looking to gain better control of their blood sugar. However, this diet has had huge advantages for me, and I believe that there are aspects of it from which every diabetic can gain.

This article is not intended to be a substitute for professional medical advice. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition.

Source: diabetesdaily.com

ChipMonk Keto Bites: A Decadent and Wholesome Dessert

It has been just over a year since I first reviewed the fabulous assortment of cookies offered by ChipMonk Baking, a new company dedicated to “bringing back keto dessert for so many people who are struggling with challenges like diabetes, the keto lifestyle, and celiac disease.”

The company has since expanded, now offering a variety of other goods, including keto bites, dry mixers, sweeteners, and more on their website. I recently had the opportunity to try out the Keto Bites, and overall, I was very impressed. I received the products at no charge and all opinions are my own.

What Are “Keto Bites”?

Keto bites, much like they sound, are very low-carb, high fat, bite sized desserts. Somewhere between a muffin and a brownie in texture, they are available in a variety of flavors, including:

They are made with almond flour, butter, and eggs, and include allulose and monk fruit as the sweeteners. Some other natural ingredients used include psyllium husk powder, konjac powder, and fibers from plant sources, such as lemon and Norwegian kelp. All products are gluten-free and come in at only 1-2 g net carbohydrate per bite!

My Review

I really liked these! They were filling and delicious and did not affect my blood glucose levels, requiring a minimal and predictable insulin bolus. My personal favorites were the Toasted Coconut and White Chocolate Macadamia flavors, whereas my four-year-old really liked the Chocolate Chip Pecan variety. Even my 1-year-old approved of these, which is saying a lot. He preferred the Peanut Butter ones.

Overall, I enjoyed the chewy texture and thoughts all the flavors were tasty. Most importantly, these were filling and very easy to manage blood sugar-wise. I also appreciate the wide assortment of flavors – something for everyone!

The price point wasn’t the lowest, at a bit over $1 per each bite. However, you get what you pay for, and the ingredients used, texture, and taste all delivered! I would recommend trying these out for anyone who has a sweet tooth but needs to be mindful of sugar and carbohydrate content for health reasons.

You can purchase these directly from the company website. Be sure to check out the FAQ section and read the multitude of positive reviews, as well.

Finally, for a longer shelf-life storage, consider storing them in the refrigerator.

Have you tried Chipmonk Baking products yet? Let us know your thoughts in the comments. Know of any other pre-packaged desserts that are easy on blood sugar levels? Please share!

Source: diabetesdaily.com

Quiz: How Engaged Are You With Your Diabetes?

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

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

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

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

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

When I’m at a birthday party, I: 

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

How often do you go to the Endocrinologist? 

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

My favorite low snack is:

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

How often do you change your lancet? 

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

When my blood sugar is stubbornly high, I: 

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

How do you clean an insulin pump or CGM site? 

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

Do you take “rest” days? 

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

How do you give yourself a break from diabetes?

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

Answer Key

If your answers are mostly As:

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

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

If your answers are mostly Bs:

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

If your answers are mostly Cs:

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

If your answers are mostly Ds:

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

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

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

Source: diabetesdaily.com

Dexcom Share Etiquette

Life is safer than ever for people with diabetes; continuous glucose monitors, hybrid closed-loop insulin pumps, faster-acting insulin, and more accurate carbohydrate counting and precision medicine have saved thousands of lives and make the day-to-day with diabetes easier than ever.

One element of that technology that has been a godsend for parents and loved ones of people with diabetes is Dexcom Share. This feature of the G6 Dexcom continuous glucose monitoring (CGM) app allows the patient to share their glucose data with up to 10 other people, who receive all glucose levels, trends, and alerts to their cell phones 24 hours a day. But what is lifesaving for some seems too intrusive for others.

This article will outline Dexcom Share etiquette and what you should do if you’re in a sticky Share situation.

The CGM Revolution

Continuous glucose monitors save lives. What was unheard of only a decade ago is now ubiquitous in the diabetes community. Many people (thanks to widespread private insurance coverage and Medicaid expansion covering this expensive equipment in more states than ever) with diabetes wear these sensors on their skin, giving them up to 288 blood glucose readings per day.

More and more of these systems do not require calibrations, so kids and adults alike are more free from constant finger pricking, unpredictable blood sugars, and stubborn HbA1c levels without an apparent cause.

CGMs make life with diabetes easier, more predictable, and more manageable for patients and their caregivers. First introduced with the G4 Dexcom system in 2015, the Dexcom Share app has been revolutionary in that it allows loved ones of people with diabetes follow their blood sugars and be alerted to both high and low levels at all hours of the day.

It seems like a simple solution for kids, teenagers, and adults who may struggle with hypo-unawareness or to just act as a second set of eyes on an all-too-often complicated disease, right? Wrong.

Diabetes Is Personal

Diabetes and blood glucose data are personal. Some people are super open and accessible about their diabetes, but others are not. A 19-year-old away at college may be shy about sharing all of her blood sugar data with a new boyfriend, or she may be trying to exert her independence and prefer not to have her mom constantly texting her, asking if she’s treating her midnight low.

And while it seems counterintuitive (why wouldn’t we have as many safeguards in place as possible?), letting (mature) kids and teens learn to manage their diabetes on their own and step into their autonomy is important for growth.

While the feature is absolutely vital for younger children and people who suffer from hypo-unawareness, if you have a child or teenager who is very independent, mature, managers their diabetes well, and isn’t comfortable with the Share feature, it’s worth the conversation and shows you respect them if you’re open to not utilizing it. Ultimately, the decision is up to the person living with diabetes, and remember, people have been thriving with diabetes for decades before this technology ever even existed.

Safety Comes First

There are, however, caveats. If you’re struggling with open communication with your teenager, your loved one suffers from hypo-unawareness, or your child is traveling for the first time without you, the Share feature is an excellent way to stay alerted to overnight lows, stubborn highs, or worrisome trends that may need addressing.

It’s important to also remember the reason for the Share app: to better equip people with diabetes and their loved ones to protect the health and safety of the person living with diabetes. It’s not to nag, hassle, or judge them for their actions (or inactions).

Share followers should not criticize or belittle someone’s blood sugars; there are no “good” or “bad” blood sugars. Blood sugars are just information directing someone to what they need to do next (like take insulin, exercise, or eat something to treat a low).

The Share app is simply one more tool one can employ to improve their diabetes management and nothing more.

Tips for a Less Intrusive Share Experience

If the person with diabetes in your life is begrudgingly allowing you to follow their blood sugars via Share, here are some tips you can employ to make the experience less intrusive:

  • Always have a discussion with your child or teenager if you’d like to follow their blood sugars with the Share app. Do not hide it from them. They will find out.
  • Set the high blood sugar alarm high and the low blood sugar alarm low. If you set your follow alarms to go off at 160 and 80, your phone will constantly be buzzing, and you’ll constantly be texting your child/teenager asking them if they’ve taken their insulin or treated their low. Really only set alarms for safety, not to be a bother.
  • Use Share for a trial period. Test the system out, and if it’s stressing both of you out, turn it off for a while before trying it again.
  • If you notice your loved one is running particularly high or low, do not comment on trends unless they ask for advice or if they have an Endocrinologist appointment coming up, adjustments can be made then unless it’s threatening their health.
  • Do not text them to see if they’ve treated their high or low blood sugar unless it is jarringly so. If they are 78 mg/dL after exercise, you don’t need to tell them to drink juice, but if they crash in the middle of the night at a slumber party and their blood sugar is 39 mg/dL, it’s best to call immediately to make sure they’re okay.
  • Make this a fun, learning experience! Praise them for the progress they’re making, and remember, with diabetes there is no perfection.
  • Respect their boundaries, and if their thoughts and feelings on Share change overtime, revisit the topic and decide how you’d like to proceed together.

Everyone with diabetes is different, and their care and management will be too. Some people are more private about their blood sugars, while others enthusiastically request input from other people on advice and tips for improving their levels.

Allowing the Dexcom Share app into your life is a great privilege, but it shouldn’t be taken advantage of. Using it as a tool to help improve your loved one’s health and diabetes management can come with great benefits if approached with caution and a heavy dose of respect.

Do you utilize Dexcom Share for your loved ones, or do you share your blood sugars with family and friends? What boundaries have worked best for your situation? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

Amylin: The Forgotten Hormone

Most everyone knows that when someone has type 1 diabetes, their pancreas lacks the ability to produce the hormone insulin (or their pancreas doesn’t make enough insulin, as in the case of type 2 diabetes). What isn’t so well known is that the pancreas also produces another helpful hormone called amylin that people with diabetes also lack! A crucial hormone that was once unknown and not prescribed for diabetes management is now recommended for most people with diabetes to take via injection. So, what is it? This article will describe what Amylin is and why it is important.

What Is Amylin?

Amylin is an amino acid polypeptide hormone that is released by the pancreas at the same time as insulin, although in much smaller quantities (at a ratio of approximately 1:100).

Amylin is a crucial hormone that acts as a sidekick to insulin in people without diabetes. It is produced by the pancreas and helps inhibit glucagon secretion, preventing the rapid spike in blood sugar, and also helps slow gastrointestinal emptying and curbs appetite.

The hormone assists insulin in controlling postprandial blood sugars. Unfortunately, people with diabetes not only lose the ability to produce insulin, but they also lose the ability to produce amylin as well.

Why Is Amylin Important?

People without diabetes don’t have to worry as much about controlling their appetite, managing hormonal levels, or juggling their blood sugars because they naturally produce both insulin and amylin. Amylin inhibits the release of glucagon when eating (preventing blood sugar spikes), slows the digestion of food from the stomach, and curbs appetite.

People with diabetes can sometimes struggle with these issues due to lacking both hormones, but for patients in the United States, amylin analogs are available (via a daily or weekly injection before meals) to mimic the functions of this important hormone.

The Benefits of Amylin Analogs

Amylin analogs, like Symlin (approved in 2005 for use in the United States), have been shown to cause weight loss, lower HbA1c levels, and reduce the average amount of insulin needed to manage blood sugars in people with diabetes. Amylin analogs can be used to treat both type 1 and type 2 diabetes in conjunction with insulin therapy. Although not approved for use in children, several studies have shown that amylin analogs are safe and effective when taken by adolescents. Doctors may prescribe amylin analogs off-label to children under the age of 18.

People with diabetes can take injectable amylin analogs before meals to help with postprandial blood sugar levels and help manage both appetite and weight gain.

Potential Side Effects

The most common side effects of amylin are:

  • Nausea
  • Vomiting
  • Headache
  • Hypoglycemia (especially if used in conjunction with insulin)

These side effects typically occur at the beginning of treatment and decline as the body adjusts to the medication.

Research shows that the regular use of amylin analogs in people with diabetes lowers HbA1c levels, fasting blood glucose levels, triglycerides and cholesterol levels, increases time-in-range (TiR), and helps people with diabetes manage their appetite and lose weight. It also reduces blood sugar variability, helping to prevent long-term complications. Talk with your doctor about whether incorporating amylin analogs into your diabetes management therapy is a good choice for you

Source: diabetesdaily.com

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

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