Build Your COVID-19 Diabetes Go Bag

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

By Jordan Dakin

When it comes to being hospitalized in the midst of the COVID-19 pandemic, it’s natural to worry about that possibility and while we hope we can stay home at all costs, being prepared for any scenario is the best course of action. As a result, packing a go bag in the case of a hospital visit during this time is crucial.

Most important? Pack your bag with 15 days of supplies to be on the safe side. The CDC recommends up to 14 days of quarantine in some cases for those who have been exposed or infected depending on the time it takes for symptoms to develop, so being prepared for a lengthy hospital stay just in case is advised.

The nature of COVID-19 is tricky because it requires isolation and even if you’re hospitalized for something diabetes-related, you run the risk of being exposed to COVID-19 in a hospital setting. Make sure you have all you need as it will be difficult for loved ones to get items to you if you are in isolation during a hospital stay.

Antiemetic or Anti-Nausea Medication

Zofran or any other antiemetic medicine is helpful to have on hand in case you do contract a mild form of COVID-19 to keep yourself from throwing up, as this can be dangerous and lead to DKA (diabetic ketoacidosis).

Carbs and/or Glucose Tabs

This may seem obvious, but it is so important. Be sure to pack some hard candy, fruit snacks, fruit juice, glucose tabs and gels, and any other preferred fast-acting carbohydrates.

Beverage(s) to Prevent Dehydration

This could include sports drinks, water, or a mix-in hydration powder with little to no carbs.

Ketone Strips and Glucagon

If you are sick, BGs are harder to manage and DKA can be a dangerous reality if you’re needing more insulin than normal while having trouble keeping carbs or fluids down. As a result, you should test for ketones more frequently when you are sick.

Insulin, Syringes, Pen Needles and Pump Supplies

Having backup methods to administer insulin is important in the event of a pump malfunction.

Testing Supplies Like a Blood Glucose Meter, Lancing Device, Lancet and Test Strips, Plus Sensors If Using Continuous Glucose Monitoring (CGM)

In some hospitals, it’s been difficult for patients to have their glucose levels checked hourly because healthcare workers don’t have enough personal protective equipment (masks, gloves, etc) to go in and out of patient rooms that often. Because of this, people with diabetes should be prepared to do their own testing and monitoring of blood glucose (BG). Bringing a backup method for testing aside from your CGM is also recommended in case sensors fail or other malfunctions occur.

Alcohol Swabs, Hand Sanitizer, Bandaids and Medical Tape

Disinfecting and keeping things clean and protected during this time is especially important.

Any Necessary Medications and Other Important Medical Details

This includes an itemized list of medications you’re currently taking, allergies to medications you might have, your physician’s information and emergency contact information.

Personal Protective Equipment

Pack your own gloves and masks or face coverings just in case. If possible, it might also be good to remember to wear PPE when entering the hospital to prevent excessive exposure to COVID-19.

Other Necessary Electronics and Chargers

Be prepared and bring any necessary cables to keep phones and tablets charged, especially if you’re using any kind of smart device to help monitor BGs.

A hospital stay during this time might sound scary, but it is important to take care of yourself and be prepared. If you are sick and have gone into DKA as a result and can’t keep down fluids, hospitalization becomes necessary and waiting only makes DKA more severe and life-threatening.

Source: diabetesdaily.com

Sugar Summit Backcountry Offers Carb-Conscious Options for Outdoor Adventure

For everyone, and especially for people with diabetes, consistently making healthy food choices is vital to feeling good and staying healthy. This can be especially difficult when spending many hours or days out in nature. Unfortunately, many temperature-stable foods that are marketed for campers, hikers, and alike are often full of preservatives, artificial ingredients and sugar.

Enter Sugar Summit Backcountry, a company focused on delivering healthier and carb-conscious foods to support your outdoor adventures. I received some products to try at no charge for the review and all opinions are my own.

Who They Are

The company was founded by a husband and wife team, Christine and Kevin, and inspired by Christine’s type 1 diabetes diagnosis. The couple had always enjoyed adventuring in nature, but Christine found that there were few carb-conscious options available that she could easily bring along on their trips. So, they aspired to create products that are nutrient-dense, healthy options and are both shelf-stable and delicious:

“We make delicious, nutrient-packed meals for camping, backpacking, or wherever the trail takes you.  We create small-batch, carbohydrate-conscious and high-protein meals adaptable for omnivores and vegans alike, and support sustainable and local ingredients whenever possible.”

Available Products

The company has several different products, including trail mix and cereal, as well as larger meals, like curry chicken, sweet potato stew, and vegan chili.

I sampled the Chia Crunch “Cereal,” Torreys Trail Mix (which is vegan and gluten-free), as well as the Golden Cliffs Curry Chicken.

My favorite product was the trail mix. With only nine all-natural ingredients and plenty of fiber, it was a great combination of sweet and salty, and the high protein and fat content can help in maintaining energy levels during long-duration exercise.

I also really liked the Curry Chicken meal. It was easy to prepare (requiring only hot water to reconstitute) and contains just four wholesome ingredients (plus seasonings). It is low in carbohydrates, high in fiber, and packed with plant-based protein to keep you going. I thought the spice level was perfect and both my husband and three-year-old daughter enjoyed it (OK, she just picked out the peas, but that is a big win in the toddler book)!

Also, the serving sizes were very generous, and I thought the pricing was very reasonable, given the high quality of the ingredients.

You can find the full product page and pricing information here.

Summary

I highly recommend checking out these products if you’re in search of lower-carb and more wholesome options to bring on your next outdoor adventure. Many of these products will appeal to vegetarians and vegans or anyone looking to incorporate more plant-based meals and snacks. Most products are gluten-free as well, so are also a great option for those with sensitivity to gluten and Celiac disease.

As the camping and hiking season kicks off across the country, why not try something new that is both delicious and good for you!

Have you tried this line of foods? Please let us know what you think in the comments below and happy adventuring!

Source: diabetesdaily.com

Charlie Kimball and His Driving Force to Success

The COVID-19 outbreak presents unique challenges for those of us living with diabetes.  Charlie Kimball, a professional IndyCar driver and father of two and lives with type 1 diabetes. His sport (and job!) is now on hold, and he is home trying to manage his diabetes, eat healthily and stay fit, all the while adjusting to life as a family of four. Charlie and his wife just had a baby in March, amidst the COVID-19 pandemic. I thought it would be nice to talk to Charlie about how he is managing despite what is going on in the world.

Charlie, congrats on your new baby! And thank you for taking the time to talk to me!

How long have you been living with type 1 diabetes?

It’s hard to believe that I’ve been living with type 1 diabetes for 17 years. At age 22, my diagnosis felt devastating and I stopped racing mid-season, unsure of how I could possibly continue to pursue a career as a professional racecar driver.

Each year on October 16, when I celebrate my “diaversary” (that is, the anniversary of my diabetes diagnosis), I reflect on the support I’ve received from the diabetes community. They, along with my wife, my healthcare team and my IndyCar family, all play a role in how I navigate and manage my diabetes.

Did your diagnosis play into your choice of becoming a professional race car driver?

Although I was actively pursuing a career as a professional racecar driver before my diagnosis, I believe racing with diabetes empowers me to be an even better driver. Physically, I have become even more in tune with my body and more connected with my team since my diagnosis. I’ve also found it really rewarding to represent people living with diabetes as part of the Novo Nordisk Race with Insulin program to reinforce the idea that diabetes doesn’t have to stop you from following your dreams.

Charlie Kimball, A.J. Foyt Enterprises Chevrolet

What challenges did you face in this profession due to your type 1 diabetes?

At the time of my diagnosis, it was mid-season while I was racing in Europe and I took some time off to figure out blood sugar testing, insulin management, and how to get back on the track. Thanks to my amazing support system, I was back in a race car three months later and claimed a podium finish in my first race back.

When I decided to move back to the US and race in IndyLights (the feeder system to IndyCar), my endocrinologist, Dr. Anne Peters, met and worked with the IndyCar medical staff to create a plan to get me back behind the wheel.

With the recent news of the first person living with diabetes to be certified by the FAA for a First Class Medical, how great does it feel to know you are the first licensed driver in the history of IndyCar racing?

I first raced in go karts at nine years old and I come from a motorsports family. When I was first diagnosed, a friend helped me to put everything into perspective by pointing out that, while I’d need to manage my diabetes for the rest of my life, it was important – and possible – to get back behind the wheel. I’m really proud of my role as the first licensed driver with diabetes in the history of IndyCar racing, and I’ve never shied away from talking about living with type 1 diabetes. Now, I’m glad to see other drivers out there who are also living with diabetes on the track!

I know from my travels that there are incredible people with diabetes doing inspiring things all over the world. It never ceases to amaze me when I see people with diabetes following their dreams -– whether they are making history in their profession or they are simply accomplishing goals that they may not have considered possible, like running a half marathon

Photo credit: Charlie Kimball

When you heard the virus was picking up speed, what were your first thoughts? Fears? How did you prepare for staying at home?

We recently welcomed my son in March, so we were impacted by some of the same considerations new parents are facing during this time. But, when I held my baby boy for the first time, it was hard to think about anything else other than the love I had for my new family of four.

There have been a lot of changes over the last few weeks and while I’d love to be racing right now, this has been a good time to connect with my family, and an opportunity to plan for future races with both my healthcare and race teams.

Even though I am home, I am still committed to staying active, eating healthy and paying close attention to my blood sugar. Also, right now, a crucial part of my management plan, is making sure that I have enough medication at home and keeping track of when I need to reorder. Having a supply of insulin on hand is not a luxury. It’s a necessity, especially at this time. My partners at Novo Nordisk are working very hard to ensure patients still have access to their medicine. If anyone is having problems affording their medicine during this time, please visit NovoCare.com for information on how Novo Nordisk can help

I’m sure racing comes with a lot of stress and adrenaline. How do you recommend people handle unpredictable blood sugars due to the stress during this time?

Yes, you’re right, racing does come with a lot of stress and adrenaline. I manage that through careful planning every race weekend to ensure that my blood sugar remains in range. But everyone has their own stress and we all handle it differently. The everyday realities of work, family, and life inevitably create that, and I encourage everyone to just have a plan in place for all different situations.

As for our current situation, I’ve found that I’m handling it like everyone else, by washing my hands often and practicing social distancing. It’s been important for me to stay in constant contact with my healthcare team, so they can help me to adjust my diabetes management routine appropriately.

I keep a close eye on my continuous glucose monitoring (CGM) and that allows me to make small adjustments throughout the day if needed. I also take time to exercise, laugh with my wife and children, and connect with people who matter to me – albeit virtually these days. This all helps reduce that stress.

Charlie Kimball, A.J. Foyt Enterprises Chevrolet

How do you plan ahead for a race so that your blood sugars won’t get in the way?

I work very closely with my healthcare team on my plan for each race. We track everything from my workouts that week to my meal before I get on the track. Using this data to make a plan comes naturally to me – it’s the same way I approach driving a race car. On the track, my race engineers, strategists, and I utilize around 50-70 sensors that feed into the central brain of my car. They are calibrated so that I can monitor every detail during a race – think g-force, speed, throttle, RPM, tire pressure – and, importantly, my blood sugar levels. My blood sugar levels from my CGM are tracked and displayed on a custom screen that sits on my steering wheel and is relayed back to my team in the pit lane so that we can make adjustments as needed.

With IndyCar racing on hold, what are you doing to stay active and healthy? Both mind and body?

I’ve partnered with my team to develop a modified workout routine while I’m at home. While I’m not racing, it’s still so important for me to stay in shape so I can do my best when I’m back on the track. Beyond staying active, I’m focused on eating nutrient-rich foods, tracking my blood sugar levels, and taking my medication.

Technology has always been an important part of my diabetes management. With it, I’m able to monitor calories, carbs, hydration, and of course, my blood sugar. Lately, while I’m at home, using my CGM has been a helpful way to watch my blood sugar in real time throughout the day. For me, keeping a close eye on my numbers and taking a mindful, disciplined approach to my diabetes management has been the key to my success during this time.

I am also using this time to connect with my family as we adjust to life as a family of four. I’m especially grateful for my wife and mid-morning naps for keeping the Kimball household happy and healthy during this time!

Thank you so much for taking the time to talk to me, Charlie. Congrats on your success as an IndyCar driver and as well as on becoming a family of four!

Source: diabetesdaily.com

Why Glucagon Is a Must for Sick Days

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

By Jordan Dakin

Common Knowledge

Becoming sick when you have type 1 diabetes can easily complicate things. When you have the flu or a serious bacterial infection, your blood sugar levels can quickly become harder to manage, as they typically trend higher because of your body’s automatic, hormonal response to being sick. Because of this, you might find yourself needing more insulin than usual and needing to check for ketones more often to prevent diabetic ketoacidosis (DKA). Having a plan for sick day management when you have type 1 diabetes is crucial.

It’s important to be mindful of the possibility of high blood sugar when you’re sick. But it is also important to realize that sick day lows are a definite possibility as well! Especially if you’re taking more insulin than normal to combat highs when sick, you have to be mindful of resulting lows. You also run the risk of encountering a severe low if you are either unable to keep food down or lack an appetite when you’re sick, which are common realities when you have a cold or flu.

Enter Glucagon

Whatever the reason for a low, keeping glucagon handy to combat severe bouts of hypoglycemia on a sick day is definitely a must. Severe hypoglycemia is a dangerous complication of type 1 that can result in seizure, loss of consciousness, or death, and there is peace of mind in having a safety net to prevent any one of those outcomes. Glucagon is the first line treatment for severe hypoglycemia because it is the main counter-regulatory hormone to insulin. Parents and caretakers of those with type 1 can especially benefit by having an immediate safeguard against the dangers realities of a severe low.

The standard of care has been to keep a glucagon emergency kit handy. Historically, these emergency kits came equipped with an injectable form of glucagon, that requires mixing powder and liquid with a syringe by whoever is administering the shot. While this can definitely be an effective form of glucagon, having to mix the shot prior has made the procedure complicated and intimidating for some.

Next Level Options

Luckily for those of us affected by type 1 diabetes (T1D), glucagon has been approved in two new forms over the last year: nasal glucagon and pre-mixed steady state.

Baqsimi is the first and only nasal, non-injectable form of glucagon, offering a slight variation on what most people with diabetes are used to. It is administered like a nasal spray, but does not require inhalation, so even if a patient is unconscious (a frequent cause of severe hypoglycemia), anyone can administer Baqsimi and it will work.

Gvoke is the first liquid stable form of glucagon, meaning though it is an injection, it comes ready to use and requires no mixing on the part of whoever is administering the shot. Gvoke also comes in two forms: a pre-filled syringe (called Gvoke PFS) that is available to patients now and an auto-injector pen (the Gvoke HypoPen) that has yet to become officially available.

Neither Gvoke nor Baqsimi require refrigeration, and both have an impressive shelf life of up to two years if kept at room temperature. Another added benefit of these next generation iterations of glucagon is that these tools can likely prevent an ambulance trip to the hospital, saving time and resources. (Editor’s Note: This is especially important during the current COVID-19 pandemic, as it is not advised to visit hospitals unless absolutely necessary.)

How to Get Glucagon

Lilly currently offers a Baqsimi coupon patients can use to get up to two devices for as little as $25.

Through the end of April 2020, Xeris is offering a Gvoke co-pay card with which some patients can pay as little as $0 with eligible insurance to get their Gvoke PFS. Patients can also opt to request their prescription through the website and have Gvoke PFS delivered by PillPack at no additional cost.

Keeping glucagon handy is the best defense against unexpected lows when you’re not feeling well. Being sick might come with some uncertainties and cause some worry, but you can rest easier knowing you’re prepared and equipped with the necessary tools to take on whatever comes your way.

For step by step instructions on how to use each type of emergency glucagon, click here.

Source: diabetesdaily.com

Parenting, Working, and Diabetes During the Coronavirus Pandemic

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

For some, school cancelations and working from home have added stress that can make diabetes management even more difficult. Here are the perspectives and strategies of several parents who are navigating this environment

With COVID-19 spreading through the United States, every state in the country has closed public and private elementary, middle and high schools. As a result, many of us are living and working at home full time with our kids.

How are you overseeing your diabetes during this time? Several parents with diabetes shared what they’re doing, how they’re managing, and their best advice.

Go Easy on Yourself

Ellen Sheng, of New Jersey, pulled her 11- and 6-year old sons out of their schools three days before the schools closed on March 13 for at least a month. While the fifth grader had online instruction the day after the schools shut, the younger child had a week off from any school-based learning. Sheng’s husband is also working from home during this period.

“I’ve been trying to come up with lessons and activities while also juggling work deadlines,” says Sheng, a financial journalist. “Between the lack of exercise (I usually go to the gym), and all the stress, my numbers have been trending high. I activated my ‘stress’ basal setting on my insulin pump, which is usually reserved for that time of the month or visits from my mom. I’ve still had to do a lot of corrections. I guess I need a special ‘pandemic’ basal setting.”

Sheng suggests focusing on what you can to help ease into what is admittedly a historical and unprecedented period in time. “It’s only been a few days with everyone home, so we are still figuring things out,” she says. “I’ve been focused on getting enough sleep, meditating, carving out time for exercise such as walks with the kids and doing a short high-intensity interval training workout outdoors with my husband, and watching some comedy. I’m also trying to keep to my usual diet instead of stress eating, which I’m prone to do. It’s starting to help: I went back to my usual basal setting today [after about a week of kids being home].”

Take It One Day at a Time, and Be Realistic

Focus on what you can control, advises Theresa Hastings in Denver, Colorado. Her kids are 9 and 6 and have been home since March 13. Overseeing the stress of the pandemic, unexpected homeschooling for her kids with learning differences (autism and ADHD), stocking the pantry, cancelled vacations, and ensuring she has enough diabetes medications on hand, “has taken me from great diabetes management to less than optimal management,” she said. “The entire thing is stressful from top to bottom.”

For supervising her kids’ online learning, Hastings broke the process down into manageable steps. She took the school’s lessons and divided them into daily checklists. That way, her kids can see exactly what they need to do, and once they finish, “know they can play as if it were the weekend,” she says. To work around her son’s hatred of journal writing, which is expected in school but causes a battle and tears at home (and makes Hastings’ blood sugars skyrocket), “I adapted that into something my son would enjoy, which is writing letters to friends and family on a topic with three things about that topic. I communicated with the teacher to make sure my change met her expectations.” The adaptation has worked both for her son and his teacher, and has helped Hastings keep her glucose levels stable.

Making things reasonable helps lower stress levels and contributes to more manageable blood sugars. “While I’d love to do so many amazing Pinterest learning projects and experiments with them, I know my limitations in this current situation,” she says. “I recognize I don’t have the bandwidth to put the activities together and execute them. I’d rather use my creativity to break their lessons into something they won’t fight me on. I also recognize that letting them watch Bill Nye the Science Guy for their science lesson is OK. We don’t have to build papier-maché volcanoes.”

Develop and Maintain Routines

Melissa Lee lives in the San Francisco Bay Area, where California’s governor said on March 17 that all schools would likely remain closed through fall of 2020. While Lee works from home for a remote/distributed company and while her diabetes management is already part of her routine, her 10- and 8-year old have been home since March 16, “and their rather robust independent study coursework that our schools sent home has been our biggest challenge,” she says. “I find that keeping to our routine has been key: mealtimes, food types, snacking behavior and bedtime. The more we can feel like business as usual, the more predictable my diabetes will be.”

Leaning into the familiar is a way to foster normalcy when things are very much not normal now, says Lee. “Accept that there will be some things that can be controlled, like your routine and behaviors, and some things that can’t, like your stress level and how that may impact your glucose levels.” While having family in close quarters may make it harder to spend time on yourself, she says, “consider how you might use this time to nurture some new habits without the pressures of having to be somewhere.”

We’re All in This Together

Know that everyone is doing the same as you—living with the same pandemic situation, working from home, parenting kids—and even if everyone you know doesn’t have diabetes, just about everyone has something they are concerned about, whether that is another health condition, concern for family or friends with health issues, economic worries, and so on. Do what you can to manage stress.

“Stress is the main contributor to fluctuating glucose levels,” said Shannon Brumley in Boston. At work, she directly oversees a staff of two and indirectly oversees a staff of ten. “To manage stress, I ensure my staff and I are comfortable taking breaks—some to tend to children,” she said. Exercise, particularly for those in sedentary jobs, is also important. “Not getting outside, especially when the weather is crummy, will compound stress levels. Today, when the weather was nicer, I took advantage of the day and my kids and I jumped on our trampoline and took our dogs out for a much-needed walk.”

Overall, know you are likely doing your best. “Everyone is in the same boat and employers should be adjusting expectations and ensuring family comes first,” Brumley said. “I am very fortunate to be able to work from home and still be available to my kids during these trying times.”

About Cheryl

Cheryl Alkon is a seasoned writer and the author of the book Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby. The book has been called “Hands down, the best book on type 1 diabetes and pregnancy, covering all the major issues that women with type 1 face. It provides excellent tips and secrets for achieving the best management” by Gary Scheiner, the author of Think Like A Pancreas. Since 2010, the book has helped countless women around the world conceive, grow and deliver healthy babies while also dealing with diabetes.

Cheryl covers diabetes and other health and medical topics for various print and online clients. She lives in Massachusetts with her family and holds an undergraduate degree from Brandeis University and a graduate degree from the Columbia University Graduate School of Journalism.

She has lived with type 1 diabetes for more than four decades, since being diagnosed in 1977 at age seven.

Source: diabetesdaily.com

Tracey Brown’s Success as First ADA CEO with Diabetes

Tracey D. Brown is the Chief Executive Office (CEO) of the American Diabetes Association (ADA), a powerhouse organization in diabetes advocacy and research into prevention and treatment. She also lives with type 2 diabetes. Today, on her birthday, we reflect on her hard work, leadership and accomplishments in striving to improve the lives of people living with diabetes.

Tracey Brown holds degrees in Chemical Engineering and Business and has decades of leadership experience in various arenas. Tracey stepped into her role as the ADA CEO in the summer of 2018, following a long and impressive career in upper management roles at many large organizations, including Sam’s Club.

Notably, she is the first CEO of the ADA, who also lives with diabetes themselves. Originally diagnosed with gestational diabetes, she was later confirmed to have type 2 diabetes, which she has been managing for over fifteen years now.

Tracey first-hand understands the struggles that people with diabetes face and has described in various interviews that she wasn’t always on top of her management. However, motivated largely by her daughter, Tracey began to learn more about diabetes management and advocacy, later becoming empowered in optimizing her diabetes management and formally getting involved with the ADA.

Tracey Brown is passionate about many issues, in particular, continuously improving patient access (including affordable insulin) and education (including on low-carbohydrate diets, which she herself implements for her own management), as well as pushing forward towards a cure.

Last year, Tracey described the steps she had to take to achieve the results she wanted in her diabetes management, and how her experiences motivated her to help others living with diabetes:

“I became mindful of the foods I ate. I now eat fewer carbs and watch my sugar intake. I took it a step further and purchased a Continuous Glucose Monitor (CGM), which keeps me informed in real time on where my sugars are throughout the day, and which allows me to make better choices.

I am dedicating my life to helping as many people as possible thrive while living with diabetes, driving prevention of diabetes and continuing to fight for a cure to eradicate this disease! This is about serving a purpose bigger than myself: helping people and saving lives.

As the first chief executive officer of the ADA living with diabetes, I truly feel this is a role where my purpose meets my passion and position. I am where I am supposed to be during this season of my life. Our mission is to prevent and cure diabetes, and to improve the lives of all those affected by it. I work every day to meet that mission because, as someone living with diabetes myself, I feel an intense drive to help educate the world on diabetes, how to prevent it, and just as important, how to thrive with it.”

Today, on her birthday, we thank Tracey D. Brown for all she is doing to help the diabetes community.

Happy and healthy birthday, Tracey, and we look forward to seeing your efforts continue to reflect positively on patients living with diabetes for many years to come!

Source: diabetesdaily.com

Are People with Diabetes Immunocompromised?

What does it mean to be immunocompromised?

Simply put, the term “immunocompromised” means that the person’s immune system is not functioning properly to fight off infections. This could be due to a number of reasons, including underlying health conditions, or specific medications that the person is taking.

For example, patients who are HIV-positive are considered immunocompromised. This is because HIV invades the T cells (a type of white blood cell), which are a major component of our immune system. When functioning normally, T cells help to effectively clear various infections. Because HIV affects the T cells, the immune system of these patients may not respond as effectively, and they may struggle with complications from infections that most healthy people would easily recover from.

Similarly, some classes of medications can directly inhibit immune system responses. For instance, patients who are taking anti-rejection medications following an organ or tissue transplant are considered immunocompromised. This is also the case for patients who take immunosuppressive agents for other reasons, including for the treatment of certain autoimmune conditions and cancers.

Also, because immune system function is underdeveloped in very young children and declining in the very elderly, one may consider that the very young and the very old might be considered immunocompromised to a degree (because the immune system is not functioning quite as efficiently as it does in a healthy adult).

So, what about diabetes? Could diabetes, on its own, affect our immune system function to such a degree that would be considered “immunocompromised”? Are people with diabetes, by definition of just having the condition, immunocompromised?

It is known that high blood glucose levels can negatively affect immune system function, likely doing so through several mechanisms. High blood glucose levels are linked to negative clinical outcomes in the context of infections. The importance of maintaining optimal blood glucose management, and especially during infection and in the hospital setting, has been described in the scientific literature.

It is also well-established that patients with diabetes who achieve the recommended A1c levels have a markedly lowered risk for developing infections or complications from infections as compared to those with higher A1cs. You can read more about the connection between blood glucose levels and health complications here.

One expert commentary published in the Canadian Medical Association Journal explains,

“The evidence indicates that an immunocompromised state occurs only in the context of poor glycemic control with severe complications such as diabetic ketoacidosis or in adults with vasculopathy and peripheral neuropathy.”

There is some debate concerning the pathophysiology of both type 1 and type 2 diabetes as related to aberrant inflammatory responses and what this could mean for responses to certain infections. However, this is a complex and multifactorial topic, of which much remains to be elucidated at this time, and we cannot generalize based on theoretical and/or poorly characterized physiological processes in this patient population.

What is well-established, is that for patients who are able to maintain optimal glycemic management, and in the absence of other factors (such as related complications, a medication that may suppress immune system function), diabetes, on its own, does not make the patient automatically immunocompromised. However, for patients who frequently experience very high blood glucose levels and certain associated complications, immune system function can be negatively affected. This subset of patients might be considered “immunocompromised” due to the frequency and severity of hyperglycemia as compared to those with more optimal glycemic management and/or other complicating factors.

Also, it’s important to remember that when talking about an entire population of people with diabetes, on average, these patients are more likely to be immunocompromised. In addition to (generally) having higher than normal blood glucose levels for a considerable proportion of time, many people with diabetes are more likely to also have other health conditions that may negatively affect their immune system function. One example, in particular for patients with type 2 diabetes, is obesity, which is known to negatively impact immune function.

In summary, to accurately determine whether a patient with diabetes is “immunocompromised”, we must consider their overall health, including other health conditions, the medications that they use, as well as their age and glycemic management. Simply having diabetes does not, on its own, necessarily mean that the patient is immunocompromised, although as a group, this patient population is more likely to have immune system function issues.

Source: diabetesdaily.com

Type 1 Therapist’s Tips for Coping and Grieving During Hard Times

The COVID-19 pandemic has left us all in fear, especially for those who are elderly or have pre-existing conditions. Knowing that we fit this demographic adds an extra layer to this challenging time. It is more important than ever to take care of our mental, emotional, and physical well-being. We spoke to a licensed associate marriage and family therapist, Allison Nimlos, about managing during this difficult period.

Hi Allison, thank you so much for taking the time to talk to me.  I know you are a licensed associate marriage and family therapist and very active within the diabetes online community and do your part to advocate, educate, and support others dealing with this disease.

I follow you on Instagram and have appreciated some of your COVID-19 related posts helping people to deal with our new normal. I thought it would be nice for our readers to hear the perspective of a mental health professional and get some ideas on how we can cope with the situation and keep ourselves sane!

How long have you been living with type 1 diabetes?

97 years. Oh, wait. It just feels that way. I’ve had type 1 diabetes for 26 years.

Photo credit: Allison Nimlos

Did your diagnosis play into your choice of becoming a marriage and family therapist?

Absolutely! Originally, I thought about becoming a nurse or dietitian because I want to become a diabetes educator, but I decided to pursue counseling because I wanted to have the education to help with the mental health toll that I and many others have experienced. I also love the systemic view MFTs [marriage family therapists] take because diabetes affects more than the person with the broken pancreas.

Now I work as both a therapist serving residents of Minnesota with mental health and relational issues, and as a diabetes coach, where I merge my counseling skills with my passion and experience in diabetes education to focus on the three S’s: self-talk, self-care, and sustainable strategies for diabetes management.

When you heard the virus was picking up speed, what were your first thoughts? Fears? How did you prepare for staying at home?

When I received confirmation that supply lines were not going to be disrupted, it definitely quelled a lot of nerves (although I was very happy I could order a 3-month supply of insulin and pump supplies right at the start — it was just lucky timing!). I think my concern was actually with the misinformation around PWDs [people with diabetes] being immunocompromised — we’re not.

A lot of the adjustments have come with evaluating and navigating what changes need to be made, and making decisions around the process of how things get done. I think it’s important to strive for as much normalcy as we can (regular sleep, healthy eating, work/life balance, etc.) because our basic needs need to be met, while remembering that this is not normal, and it’s not going to feel that way.

Photo credit: Allison Nimlos

I know a lot of us are stressed…very stressed. How do you suggest people cope with these emotions? 

I think stress often comes from wanting to control things that are out of our control, so recognizing our power can help. Making a list of things that you are in charge of deciding (how do I want to protect myself when I go out), vs. things that you aren’t in your control (how other people dress) can keep you focused where your attention is most useful.

Many of us try to anticipate what’s going to happen next, and that’s also something that is out of our control. I could spend a lot of time thinking and planning, and then be worried about whether or not I was right, and then spending more time worried that I’m wrong… Or I could just focus on today and this week and making only the decisions that need to be made right now.

Many people have found their blood sugars all over the place amidst the crisis. What do you do to stay on top of your management during this challenging time? 

This is where the mindset and management overlap comes into play! We have to recognize that things are different, and pretending they aren’t is a recipe for disaster. Observe your blood sugar patterns and your lifestyle patterns. What sorts of things are your blood sugars, your energy levels, your mood asking for? What changes can you make to your management to see improvement? When we don’t adapt to our changing needs, it raises our anxiety and stress because we end up battling diabetes using strategies that are no longer sufficient.

For me, I have noticed that my blood sugars are trending much higher lately. It could be less activity, it could be our meals, it could be the low-level but constant stress that I have. Some things I’m working on are changing my insulin settings on my pump, and also making a plan to get some more regular exercise. I’m also making a point to review my Dexcom Clarity regularly to see how those adjustments go.

Many people are staying home. Some are lucky enough to be with family and/or friends; others are doing this all alone. What is your advice to those people who may be feeling very lonely and in despair?

Connection is key. Loneliness, scientifically, really is unhealthy for people. But social distancing does not mean socializing at a distance. People do need to stay home and away from people! Make plans to do things virtually, like attending online meet-ups, calling parents and friends regularly. You’re right, it isn’t the same, and that sucks, but it’s what we have and better than complete cut-off. I encouraged my clients to do an activity with friends and family virtually, such as watching a TV show together or eating a meal together. Making shared memories is a big part of how we feel connected.

Photo credit: Allison Nimlos

On the other hand, many are stuck home with spouses and children for weeks on end and are starting to get a little cranky. What is the best way for families to enjoy this time while respecting each other’s space?

Designated time for solo activities and hobbies, such as reading quietly, putting a movie on for the kids, taking a long shower or bath, or even going outside to a deck or balcony.

I live in New York and haven’t left my house in over three weeks besides to a park to exercise. What are you doing to keep busy, stay active, and keep your spirits lifted?

My 2.5-year old loves to go on walks but hasn’t seemed to notice that we don’t go farther than 2 blocks. We keep a fairly regular schedule with online games, arts and crafts, baking, his toys, reading, watching TV, and thankfully, naptime. I also stay connected with regular virtual meet-ups, including one that I host on Wednesday nights at 8 pm EST.

These are difficult times. Even after the COVID-10 virus dies down, come the warm weather, we will feel the effect of it for years. Many people are losing their jobs and wondering how they will stay afloat. What is your advice on how to stay positive?

Before we can move into positivity and meaning-making, we first have to grieve. It IS okay to be sad and angry and any other emotions you’re feeling. It’s a really big deal that has happened to people, and I don’t think we should feel pressured to feel anything we don’t. They are powerful messengers and need to be listened to, but we also need to make sure they aren’t driving the car the whole time. I try to remember that I have gone through hard times before, and I can get through another. And again, to not try to overpredict how bad or good something is going to be. It’s easy to think “worst-case scenario” — but what if everything works out for the best? We spend very little time sitting in hope.

I might be biased, but I highly recommend finding a therapist to work through the grief, loss, and trauma that comes with an experience like this. We are still available! You can find a therapist in your state (because we can’t practice outside of where we are licensed) by visiting a therapist directory like PsychologyToday.com.

Unfortunately many are dealing with the loss of a loved one due to COVID-19. Dealing with death is hard enough, but during a time like this when you can’t be with your loved one for support how do you recommend people going about mourning? It is a unique time for sure.

How to properly mourn is a question a lot of people in grief ask and it’s one thing most therapists shy away from. There isn’t a process or a procedure, but there are themes and commonalities (hence the 5 stages of grief — which is more of a description for common elements than anything). Anger is going to be a really common emotion right, and that makes sense. Bargaining too. And a bunch of other ones the stages don’t include (because it’s not all-encompassing!). There are no shoulds for grief, no timelines.
But I will say that it is absolutely okay – necessary maybe – to name and feel all the emotions, even the ones we don’t understand and don’t feel we have a right to. People who have lost someone, it’s going to be clear and understood they are grieving. But we have all lost something, our old way of life, and that can also bring up the same feelings of grief, even if not tangibly connected to an individual. However it makes sense to care for your grief is going to be okay right now.

Thank you, Allison, for taking the time to talk to me and for all you do for our community! I hope you and your family stay safe and healthy!

Source: diabetesdaily.com

Registered Dietitian Shares How to Stay Healthy at Home

The COVID-19 pandemic has left us all in fear, especially for those who are elderly or have pre-existing conditions. Knowing that we fit this demographic adds an extra layer to this difficult time. We’ve all been staying at home and trying our best to keep our minds and body active and healthy. I reached out to my diabuddy, Ben Tzeel, MPH, RD, and CSCCS to get his advice on how to get through this time at home.

Hi Ben, thank you so much for taking the time to talk to me. I know you are a registered dietitian (RD) and strength coach and you are very active within the diabetes online community and doing your part to advocate, educate and support others dealing with this disease. You spend your time sharing your expertise on nutrition and exercise, even offering one-on-one coaching, helping people living with diabetes achieve better glucose and weight management. Both of these are even more trying during this crisis. I thought it would be nice for our readers to hear a perspective of a type 1 RD on how to remain healthy while at home!

How long have you been living with type 1 diabetes?

Almost 21 years!

Did your diagnosis play into your choice of becoming a registered dietitian and strength coach?

Yes! Absolutely. Growing up, I’d go to the endo every three months as I was supposed to, and as an athlete, I’d have a ton of questions about blood sugar management during practices, games, and more. I played baseball and volleyball and began lifting weights when I was fifteen. Still, no matter who I would talk to – endo, dietitians at the clinic, etc. – no one seemed to have any definitive answers, and it became a “figure it out for yourself” type deal, which got frustrating.  I started to take training more seriously in college, and learned nutrition was the X factor that could level up my training and my diabetes, so I ultimately became an RD.

How has your overall health and blood sugar management been leading up to the COVID-19 pandemic?

For me, it was pretty status quo – I was training as I usually do, five days per week with a combo of strength and interval cardio, and my blood sugars were pretty solid.  Life for me was normal, as it was for most of us.

When you heard the virus was picking up speed, what were your first thoughts? Fears? How did you prepare for staying at home?

I first heard about it in the end of January and didn’t pay it much attention, but once large events started getting canceled, including the Arnold, where I was supposed to meet up with some other members of the T1D tribe, I started to take it a little more seriously.  I actually went to Costco to stock up on food in case there was a lockdown, which for me in Florida didn’t happen for another four weeks. I wouldn’t say I was scared, but I definitely knew it was something serious and contemplated how I would adapt to stay at home life and minimal leaving.

Right now, people want to get in and out of the grocery store quickly. What are your staples foods that help keep you on track with your goals?

Great question. For me, before anything else, I’m planning out my meals ahead of time, so I have a plan going into the grocery store and don’t have to go up or down aisles unnecessarily. I’m thinking of my proteins (chicken, turkey, pork, canned tuna, salmon, cheese, greek yogurt, eggs), my vegetables (greens, peppers, zucchini, cauliflower, and more), and my fiber sources (chickpea or black bean pasta, whole grain bread/tortillas) and making sure each meal has them, and then getting food according to the recipes.

You’ve also got to have snacks that are delicious but won’t throw you off track – NRG bites are a favorite of mine, quest chips, and enlightened ice cream have all come in handy so far.

We are all trying to come up with quick, easy meals. What are some quick go-to ideas that will keep us on track despite this?

I’m the world’s laziest chef, so I love cooking up a ton of meat and veggies in the Instapot and portioning it out for a few days, but by having the protein on hand along with the foods mentioned previously, you can create things super quick. Tacos, burritos, anything Mexican, tends to be a winner for easy and delicious, any type of salad with chicken is a go-to, and I love peanut butter and jelly on the high fiber tortillas.

Things are getting harder for many financially. Do you have any healthy inexpensive snack or meal suggestions?

If you can buy in bulk, go for it, especially for meats and produce – just cook it up and you can freeze it after portioning it out. It saves a lot of money and also, time.

For snacks, you can’t go wrong with something as simple as veggies and hummus, cheese sticks, or even crackers and tuna.

I know a lot of us are stressed…very stressed. How do you suggest people combat emotional eating? 

Stress will wreak absolute havoc on your blood sugars, so lowering it is going to be key to success. To combat emotional eating, try to situate yourself with some sort of barrier between you and the food, like sit in another room.  When snacking, portion it out, put the container away, and consider moving to a room away from the food so you can’t just get up and go grab some more. But also divert your attention to something else that is hopefully more constructive, like going for a walk or reading a book.

Many people thrive on routine, which is really hard to achieve right now. Do you find you have more success with eating right when you stick to a routine and schedule? 

Routine is key right now – keeping things as normal as possible for eating is going to help you feel your best from both an energy and blood sugar standpoint.  Once you start introducing eating at strange times, eating foods you normally wouldn’t, and eating from sheer boredom, that is where things could become a bit more haywire, and once you fall off the tracks, it can spiral out quickly if you don’t stop it.

Many people want to remain active but aren’t sure exactly how. Besides going for long walks, what are some basic exercises people can do at home?

It’s all about bodyweight workouts to start with! Pushups, squats, lunges, planks, v-ups, side lunges, jumping jacks, burpees, and wall sits can all be combined into a circuit that will definitely make you work hard.  If you have some heavy household objects, you can use those like dumbbells to press or row.

What have you been doing to stay in shape? With being as knowledgeable as you are, are you finding it hard to adapt to our new normal while staying focused on your overall health?

It’s definitely been a little strange having not been in a gym in a month, but I’ve remained consistent at home. I’m fortunate to have a kettlebell and a few resistance bands, which is enough for me to maintain a fairly normal training routine, but again, I’m doing a ton of pushups, lunges, and squats, since those are the types of things I’d be doing anyway in the gym.  To me, the biggest key is to just move. I can say that my overall movement has been difficult, since I don’t really leave where I live, but I’ve still been getting to 5000+ steps per day.

I did create an at-home, 4-week workout program for my clients that I’ve been following as well and that has been super helpful to keeping me on track with different types of training.

Right now, a lot of people are struggling mentally. What are your coping strategies to get through this time?

Biggest thing is to focus on what you can control. None of this is an ideal situation, but dwelling on the negative is going to get you nowhere.  Focus on how you can improve, stay on track, get better, and figure out a way to adapt so when this is over, you can look back at this time and say, “Wow, I could’ve squandered that stay at home time, but instead, I feel like I’ve really used it well and gotten ahead, I’ve gotten better.  Shift your mindset’s frame from “Why me? This sucks” to “What can I do today with the opportunities I have?”

Thank you, Ben for taking the time to talk to me and for all you do for our community! It is more important than ever to take care of our mental, emotional and physical well being so we appreciate these tips!

What have you been doing to keep your mind and body active during this time at home? Share and comment below!

Source: diabetesdaily.com

How to Navigate Blood Sugars During a Pandemic

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

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

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

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

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

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

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

Check Your Basal Insulin Dose

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

Jennifer Smith RD, LD, CDCES, explains:

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

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

Photo by iStock

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

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

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

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

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

Reduce Stress

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

Mindfulness and Meditation Apps

Staying Active at Home

Taking Care of Your Mental Health

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

Create (and Stick to) a Routine

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

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

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

Make Use of Technology

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

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

Photo credit: geralt (Pixabay)

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

Lean On Others

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

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

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

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

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

***

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

Source: diabetesdaily.com

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