Should More People with Type 2 Diabetes Use a CGM?

The continuous glucose monitor (CGM) has been hailed as vital technology for good blood sugar management in type 1 diabetes. But although it could provide similar benefits to people with type 2 diabetes, the expensive technology is not yet widely available for type 2 patients. 

Enthusiasm is growing for the use of CGMs for patients with type 2 diabetes, but some experts remain skeptical. And some of the critical decision-makers still need to be convinced before access will really expand.

Patients with type 2 diabetes typically experience fewer intense and unpredictable blood sugar swings than those with type 1. Only a minority of patients with type 2 diabetes have been prescribed insulin, and only a minority of them use rapid-acting insulin multiple times a day, the way that patients with type 1 require. 

Many experts are eager to give patients with type 2 a new tool to help manage their condition. And nothing would make CGM manufacturers happier than to sell their products to the type 2 market; for every patient with type 1 diabetes, there are about 20 potential customers with type 2. But scientists have yet to make the case that the CGM is so helpful to patients with type 2 diabetes that it justifies its high price.

Current Guidelines

So far, the American Diabetes Association has only recommended CGMs for patients with type 2 diabetes that are on “intensive” insulin regimens – patients that are using insulin pumps or multiple daily injections to control blood sugar levels aggressively.

It certainly makes sense for patients on intensive regimens to get the earliest access to the tech. Frequent blood sugar readings allow these patients to dose insulin for meals, exercise, and corrections far more precisely. The alarm function can be a literal lifesaver in the event of low blood sugars.

However, millions of patients with type 2 diabetes use only basal insulin, and millions more do not require insulin at all. They may not need to make multiple insulin dosing decisions every day, and may have a less critical need for low blood sugar alarms, but the device could still play a huge role in improving their glucose management.

Many people with type 2 diabetes are eager to use a CGM but cannot pay for it out-of-pocket. Some find themselves in the disheartening circumstance of knowing that they can only access this valuable technology if their control gets worse.

But a new study may help change this situation.

The MOBILE Study

Dexcom, the manufacturer of the popular G6 CGM system, recently unveiled the results of a randomized clinical trial pitting its continuous glucose monitors against traditional blood sugar meters. The studies were published in the medical journal JAMA and presented at the recent Advanced Technologies & Treatments For Diabetes (ATTD 2021) conference.

The MOBILE study looked at 175 adults with “poorly controlled” type 2 diabetes who used basal insulin but had not been prescribed multiple injections of mealtime insulin. The participants began the trial with an A1c between 7.8% and 11.5%. They were randomized into two groups: those given CGMs, and those given blood sugar meters.

After eight months, both groups had improved A1c’s, but the group using CGMs improved much more: −1.1% vs. −0.6%. On average, the CGM users spent about four more hours in range and four fewer with very high glucose (>250 mg/dL).

Those improvements appeared to apply across the board. When researchers split the study group into different subsections based on age, education level, or “diabetes numeracy,” the group using the CGM always had significantly better results than the group using fingersticks.

second study was published in the same edition of JAMA; this one observed the outcomes of patients that began using Dexcom CGMs in real life (without any intervention by the researchers). Patients with type 2 who initiated CGM use were overwhelmingly likely (97%) to be using intensive insulin regimens, just as the guidelines recommend.

The results? Type 2 CGM users improved from an average 8.2% A1c to 7.64%, an even larger improvement than patients with type 1 enjoyed in the same study. They also experienced significantly less hypoglycemia than they had previously.

Dexcom, unsurprisingly, was ebullient, describing the publication of the two studies as “a pivotal moment in diabetes care innovation.”

Skeptical Experts

Not everyone agrees that CGMs should be prescribed to more patients with type 2 diabetes. In March, Kaiser Health News argued that there is actually very little evidence that the technology does much good for most patients in the type 2 community.

The writer noted that the small number of studies of the CGM’s efficacy in type 2 diabetes have so far come up with conflicting results; several find little benefit. And while the data from the two new Dexcom studies wasn’t yet available, it might be wise not to take the results of industry-sponsored science at face value. Several of the older studies that found good results for continuous glucose monitoring were similarly organized by CGM manufacturers, including Dexcom.

Dr. Katrina Donahue, director of research at the University of North Carolina Department of Family Medicine, was one skeptical expert quoted in the article: “I don’t see the extra value with CGM in this population with current evidence we have… I’m not sure if more technology is the right answer for most patients.”

Money Talks

Price is going to be a big issue. Dexcom, Abbott, and any other competitors not only have to convince patients and doctors that the CGM is can help type 2 diabetes. They also have to convince insurance companies that it’s worth paying for.

That might be a tough job. Many CGMs users are already acutely aware of how expensive the product can be. If the benefits to patients with Type 2 that do not require intensive insulin treatment are less dramatic, insurance companies will be less enthusiastic about covering the system.

Some doctors agree. Dr. Silvio Inzucchi, director of the Yale Diabetes Center, was quoted by Kaiser Health News: “The price point for these devices is not justifiable for routine use for the average person with Type 2 diabetes.”

Short-Term CGM Use

Interestingly, the results of the two studies suggest that the improvements in glycemic control were not the result of increased insulin use but improved patient engagement. The CGM can serve as a constant gentle reminder of the importance of glucose management. Hopefully, the thinking goes, CGM users are more likely to make good eating or exercise decisions.

That finding might help support the advance of temporary CGM use for patients with diabetes. If the CGM works primarily by informing its user about the glycemic impact of different lifestyle decisions, maybe people could benefit from only a week or two of CGM use. They might learn lessons that they could put use to improve their glucose management even after ceasing to use the device.

The temporary CGM has long been rumored as the next big step for patients with type 2. Some healthcare providers already have CGMs that they will loan to patients for short-term rentals, and Dexcom has recently made its CGM available on a trial basis through its Hello Dexcom initiative.

Moving Forward

JAMA simultaneously published an editorial arguing for expanding the use of CGMs for patients with Type 2 diabetes. Authored by doctors Monica Peek and Celeste Thomas of the University of Chicago, the letter calls for “important policy changes in Medicare eligibility to CGM for type 2 diabetes and institutional changes that promote its use in primary care.”

The writers also noted that patients “from racial and ethnic minority populations, those in low-income groups, and other socially marginalized groups are disproportionately affected by type 2 diabetes,” and that improved access to CGMs could especially help the most vulnerable diabetes patients.

The MOBILE Study is just one step, but perhaps a significant one, in widening access to the CGM for the type 2 community. Advocates will hope that such data will convince the diabetes authorities, especially the American Diabetes Association, to expand their recommendations.

Source: diabetesdaily.com

Olympian Laurie Hernandez, Her Dad, and Diabetes

Laurie Hernandez is an elite athlete. To keep up her Olympics-quality form, she needs to take her lifestyle decisions, like diet and exercise, very seriously.

Anthony Hernandez is similarly mindful. He’s not an elite athlete – he’s Laurie’s dad. He takes care of his health because he has type 2 diabetes.

“I’ve always watched him take care of himself. It was just something he did because he had to do it. For me and gymnastics, going to physical therapy, and doing preventative bodywork, and eating the right things … all of those are key things that I’ve watched him do.”

Photo by Harry How/Getty Images

Laurie, a gymnast, won both individual silver and team gold in the 2016 Summer Olympics in Rio. 

I spoke to Laurie only days after she had sustained an unfortunate injury that put her Olympic return in doubt. A hyperextended knee forced Laurie to withdraw from the U.S. Gymnastics Championships, a critical competition that helps determine which athletes can make the team for the upcoming Tokyo games. In the days after our talk, Laurie decided not to petition for a spot on the Tokyo team – potentially ending her career as a competitive gymnast.

We talked about gymnastics and the Olympics, but we mostly talked about her dad. Anthony’s had diabetes for as long as Laurie can remember, but he never made a big deal about it.

“He wanted things to appear as normal as possible, so it wasn’t a big topic. It was just something that he did. He would prick his finger, and he would take his medication.”

Laurie’s grandmother also had diabetes – little Laurie would watch her take insulin shots. As her grandmother got older and more unsteady, Laurie would help her with her injections. Everyone helped out like that.

“I didn’t see it like an odd thing. ‘Oh, here are two people taking care of themselves. That’s my family!’”

I was struck by the contrast, but similarity, between Laurie and her dad. They’re in very different stages of life, but each is similarly motivated to take their health seriously, and each inspires good decisions in the other. Growing up in a household where diabetes was an everyday fact of life gave Laurie early models of self-care.

“I had that representation of somebody taking care of themselves.

“This gymnastics training is crazy, but let me show you how I learned all the in-betweens, how I learned to take care of myself. A big part of that comes from my dad. Watching him do that and set that example for me and my siblings.”

Anthony still manages his diabetes in a subtle way, and isn’t one to draw much attention to himself. But over the years, he’s gotten more in tune with his body and addressed his condition in a little bit more depth.

He’s also been more open about how his children helped inspire him to improve his control. He didn’t want his disease to force him to miss out on their lives, especially Laurie’s superlative athletic career.

“He would say, ‘I wanna be there for those things.’”

I spoke to Laurie because she’s the newest spokesperson for Trulicity, a GLP-1 agonist approved for type 2 diabetes. Trulicity is a once-weekly injection that studies have shown can confer both improved glucose control and weight loss. It also may help reduce the likelihood of major cardiovascular events.

Laurie told me that representing a diabetes medication “resonated” with her.

“I get to talk about my dad and show all the hard work that he’s done in quiet. It’s life, it’s something that he takes care of every single day. He doesn’t really have a choice! So to give him grace and kudos for that, I do think it’s important.”

If anyone’s curious why Laurie, who doesn’t have diabetes, decided to represent Trulicity, she has a simple answer: “It’s my dad. That’s my family, that’s my core, he’s a big part of who I am.

“I’m so proud of him. He talks about how proud he is of me, all the time, but now I have an opportunity to tell everyone how proud I am of him.”

Diabetes care can be a team effort for the Hernandezes.

“My mom would always carry snacks with her, you know, just in case he ever got low. It didn’t click for me, up until the last few years, that she was doing that to take care of him. I thought, you know, that’s just mom being mom, but it was always for him. It was a way to keep an eye out.”

Even when she’s on the other coast, she makes an effort to keep up with her dad as much as possible:

“I make sure to check in and see that he’s doing ok. Just give him an encouraging word or call. Me and my siblings, we have a big family group chat, and we’ll let him know that we’re so proud of him. If he does have an off day, not reprimanding him for it, but letting him know, hey, everybody’s got an off day. Lots of love and support.”

In a remarkable coincidence, Laurie’s roommate Charlotte Drury, also an Olympic hopeful, was recently diagnosed with Type 1 diabetes. Performing at an elite athletic level while dealing with newly diagnosed type 1 diabetes can’t be easy, but Laurie reports that Charlotte “is kicking major butt.” She certainly lucked out in having Laurie as a roommate. Laurie has accompanied her to the doctor’s office, and is happy to run and grab a juice box when Charlotte’s blood sugar goes low.

It’s been a strange year for Laurie, as it has for everyone, but the pandemic did bring some benefits. Laurie usually trains in California, far away from her hometown in New Jersey, but after her gym closed down she switched for about six months.

“I got to spend a lot of time with my family, got to watch my nephew grow, which was awesome. There was a lot of family time that I should not have gotten but did, so that was a huge silver lining.”

What advice does the high achiever and devoted daughter have for other people with diabetes?

“The biggest thing is just to do your best, to not let it stop you from doing things you really want to do. From watching my dad be a good dad and do his best to show up for all my different meets, diabetes did not get in the way of that. I’m sure it was a challenge for him, but he constantly showed up.”

“I’m really proud of all of you. You’re strong because you have to be, but you are strong.”

 

Source: diabetesdaily.com

Why You May Be Experiencing High Blood Sugar

High blood sugar is part of a life with diabetes, whether it’s type 1type 2LADA, gestational diabetes, even the more rare forms of the disease. But sometimes, hyperglycemia can seem unexplainable, persistent, and stubborn.

This article will outline the reasons why you may be experiencing high blood sugar, and what you can do about it.

What Exactly Happens When Blood Sugar Is High?

High blood sugar, by definition, is when there’s too much glucose in the blood and not enough insulin to help the cells digest it. That extra glucose floating around in the bloodstream is what brings about symptoms of frequent urination, fatigue, brain fog, headache, body ache. In severe cases, it can lead to diabetic ketoacidosis (DKA).

People with diabetes manage their blood sugars by taking either oral medications or insulin, and monitoring both their food intake and exercise on a daily basis.

But even when you’ve done everything “right,” like counting carbohydrates and taking your medications, your blood sugar may rise and stay annoyingly (or dangerously) high. These are the top reasons why you may be experiencing unexplainable hyperglycemia.

You’re Stressed

Ever wonder why when you’re stressed about work or school your blood stays high? That’s because the release of natural hormones in your body, like adrenaline and cortisol, spike when you’re stressed, leading to insulin resistance, and in people with existing diabetes, high blood sugars. Whether you’re prepping for a big test, selling your home, hustling for that promotion at work, or fighting with your spouse, stress can send your blood sugars skyrocketing.

Dawn Phenomenon

Dawn Phenomenon describes the high blood sugars and insulin resistance people experience in the morning, usually between 2 a.m. and 8 a.m. 

The phenomenon is natural: late overnight, the body releases a surge of hormones in preparation for the new day. These hormones can trigger the liver to dump glucose into the bloodstream. In people with diabetes, the body cannot produce a healthy insulin response, and therefore blood glucose levels spike up.

Many people with diabetes require more insulin during those hours, maybe even twice as much, to counteract this age-old hormonal effect.

A different, less common (but more dangerous) phenomenon may also explain morning blood sugar highs: Somogyi effect.

You’re Sick

When people with diabetes are under the weather (or fighting off an infection), their blood sugars tend to be much higher than normal, and they become much more insulin-resistant.

This can sometimes result in needing 75% (or more!) of your average daily insulin requirements. Make sure you’re staying hydrated, monitoring for ketones, and taking as much insulin as you need to keep your blood sugars in range.

If you cannot control your blood sugars during illness – especially if you’re having trouble eating or drinking – it’s very important to get in touch with your doctor.

You’re Eating Too Many Carbs

Let’s face it: carbohydrates spike blood sugar. It’s something that people with diabetes need to think about nearly every time they eat.

Test your blood sugar frequently to see how your own body responds to different foods. Some people may find that they can comfortably eat fresh fruit, but not added sugars or white rice. Some may find something completely different.

And if you use insulin before meals, you probably already know that carbohydrate counting can be an inexact science. The more carbs you eat, the more insulin you need to take, and the more difficult it is to deliver that perfectly dosed and perfectly timed pre-bolus.

Even a little carbohydrate restriction is likely to help reduce the frequency and intensity of blood sugar highs.

You’re Eating Hidden Carbs

Ever order a salad at a restaurant, thinking it will be a nice, low-carbohydrate option, only to experience debilitating high blood sugars for hours on end afterward? There are many deceiving foods that we think are low-carb, but are anything but.

Sugar and starches hide in many foods where you wouldn’t expect to find them, especially at restaurants and among the processed foods in the grocery store. Some examples of foods that seem “healthy” but can cause a blood sugar nightmare include:

  • Salads with sweet dressings and croutons or other toppings (or salad in a bread bowl)
  • Soups
  • Smoothies (especially fruit smoothies)
  • Fruit juice
  • Foods labeled “gluten-free”
  • Granola
  • Flavored yogurts
  • Fat-free ice cream
  • Restaurant foods (especially due to extreme portion sizes)

“Healthy” does not necessarily mean “diabetes-friendly.” Fat-free products are often fortified with sugars and starches. And many gluten-free products have even more carbohydrates than their standard gluten counterparts.

If you’ve chosen a restaurant that can provide nutritional information, ask for it, so you’ll know exactly how many carbohydrates you’ll be consuming. Consider asking for salad dressings and sauces on the side. 

Your Insulin Pump May Be Kinked

If you’re insulin-dependent, the first thing you should do at the sign of stubborn high blood sugar is to check to see if you have a kink in your insulin pump cannula. This can block the delivery of insulin, leading to a very frustrating day.

If you’re unsure, change your pump site! Make sure to call your insulin pump manufacturer to let them know of the issue, and they will usually mail you a replacement for free.

You’ve Injected Into Scar Tissue

If there’s no kink in the cannula, or if you’re using syringes to deliver multiple daily injections (MDI), you may have also just picked a “bad” site. When insulin is injected (either manually or with an insulin pump infusion set) into scar tissue, absorption suffers, resulting in unpredictable and high blood sugars.

Make sure to always rotate your sites as much as possible to avoid developing scar tissue and the inevitable high blood sugars they bring.

Your Medications Need Adjusting

Our bodies are constantly changing. It would be silly to expect the same insulin to carbohydrate ratio or insulin sensitivity factors or even the same number of milligrams of our oral diabetes medications for our entire lives.

Make sure you’re seeing your endocrinologist or diabetes doctor regularly; they can help refine your medication regimen.

You may be especially likely to require adjustments if you’ve recently lost or gained weight, have increased or decreased your activity levels, are going through a stressful life change, are pregnant, or planning on becoming pregnant, or haven’t been to the doctor for a while.

Your Medications Are Expired

Always check to make sure your medications aren’t expired! At room temperature, insulin will lose potency

Oral medications can last much longer, but you still need to be cognizant of expiration dates and make sure you’re refilling your prescriptions regularly to avoid taking an expired (and potentially useless) dose.

What to Do When Your Blood Sugar Is High

High blood sugars can range from not-a-big-deal to a life-or-death emergency. Make sure to check your blood sugar often and monitor for any signs of diabetic ketoacidosis (DKA). If you have blood sugars that are over 250 md/dL for more than a few hours and you have moderate to high ketones, you will need to seek emergency medical care immediately. If you don’t have ketones, but want to feel better as soon as possible, try some of these tactics:

  • Exercise – cardio (a walk, jog or even jumping jacks) can bring blood sugar down quickly
  • Take a correction bolus of insulin
  • Change your pump site
  • Chug water
  • Take a hot shower or bath 
  • Manage stress with a quick yoga sequence or meditation
  • Test for ketones (if you have moderate or high ketones and your blood sugar has been high for several hours, call your doctor or go to the emergency room right away)

Understanding why you’re experiencing high blood sugars is one more way to improve your life with diabetes! Always work with your doctor before changing your oral medication and/or insulin therapy.

Have you ever experienced a mystery, stubborn high blood sugar? What helped you to get it down quickly? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

Community Table: Women’s Health and Living Empowered with Diabetes

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

During our third Community Table discussion, Beyond Type 1 sat down with a group of experts and community members to discuss women’s health and living an empowered life with diabetes within both the type 1 and type 2 communities, and share helpful resources and personal perspectives. Watch the discussion in full!



Speakers included:

Partial transcript of conversation below, edited for content + clarity.

What’s the one thing you wish someone had told you about women’s health and diabetes?

Dr. Gomber: It’s okay to not strike that perfection of 100%. It’s absolutely all right if you can’t figure out how to deal with everything, including your hormones. As a person living with type 1 diabetes and as a trained physician, I realized it by trial and error by realizing that hormones are something which I need to adjust, make a balance myself.

Lexie: There are so many things that can affect your body in so many different ways. Nobody ever really explained to me what insulin resistance was, and everything that can come from insulin resistance. I recently got diagnosed with PCOS (polycystic ovarian syndrome) at the beginning of 2020 and it’s been a crazy journey. My husband and I have been trying to get pregnant and for the past 3 or 4 years, I’ve had irregular menstrual cycles. I just thought it was normal.

Doctors never put two and two together for me that PCOS and insulin resistance are linked in a lot of cases. Years ago, when I was in college, I had an endo tell me, “Hey, you’re showing signs of insulin resistance.” But he never said anything else. I thought, “Okay. Well, my A1C isn’t that bad so I’m good.” I never made any changes because I didn’t know what that actually meant.

Whenever I was going to see my OBGYNs they never really connected the dots for me either. When I said I was having irregular cycles it was just, “Okay, well let’s put you on birth control.” It wasn’t, “Maybe this is linked to your diabetes.” I never had any idea until I went and did my own research.

Jessica: How many people actually have diabetes, and I wish I would have told myself to reach out to other people with diabetes sooner. When quarantine hit, I made an Instagram just so I could talk to other people because I’m the only one with type 1 and no one in my family has type 2. It seemed like I was an outsider sometimes and I really needed to know that I am not alone in this.

Marina: Diabetes management is much more than counting carbs, then giving insulin, and having a blood sugar of 110. It is so much more than that. It is emotional health, it is wellbeing, it’s so much more. Sometimes we want to have a feeling of control, and we control the food or we control whatever thing we can. That’s really the beauty of what I do is ask how we can have a positive relationship, and a holistic view in how we eat.

What should people know if they’re heading into the age of menopause that might help them out a little bit with that?

Dr. Porter: It is important to understand everyone’s body is going to react very differently to menopause, and you need to be your own advocate with your OBGYN to tell her that things are not going right. They might need to adjust your blood sugar management routine because it’s counterproductive.

When it comes to menopause, there is this one massive hormone called progesterone which acts as a complete monster when it comes to blood sugars. Progesterone actually increases your blood sugars. You need to adjust your insulin regimen to understand how your body is going to react to progesterone. Also, during menopause, there are other additional things that you can incorporate into your regimen like incorporating exercise or yoga. Which will improve your insulin sensitivity and help incorporate that resistance that is coming up with progesterone in your body.

What’s a challenge that you’ve faced that taught you how strong you are as a woman living with diabetes?

Marina: I just bring it back to pregnancy. I think that’s been my most challenging moment because again, I’ve studied. It wasn’t necessarily new to me, but these are new human beings. Once they were born, it was like, “Wow, you’re healthy.” That is all that matters, nothing else. That really proved to me how resilient people with type 1 diabetes are. We really have an extra skill, like we have two brains. We’re able to not just manage our blood sugar, but also be a mom, be a doctor, be a wife, be all of these different things on top of all of the demands of diabetes.

Lexie: There have been different phases years of my life that always reminds me how strong I am. So, the first thing was looking back at the time I didn’t realize it, but Aussie kids, little young kids on Instagram, like giving themselves an injection or changing their pump site. And I’m like, “Oh my gosh, they’re so young.” And then I’m like, “Let’s see. You were doing this same thing.” Then I’ve given myself insulin while driving. I inject it, and in my mind, before I would go somewhere, I’m already calculating, “Okay, I’m going to be gone for this long. Let me go ahead and get this number of snacks.”

Growing up with a chronic illness, it forces you to have compassion for any and everybody which has helped me be able to support others. I don’t think I’ve ever really felt more accepted and loved by a community like the diabetes community. It just teaches you to love people.

A question from a community member: “I was diagnosed at age 41. I’m now 44. I also live with Hashimoto’s. I’ve been using Dexcom for a year and the Tandem pumps in september. Will I ever learn my body?”

Jessica: Yes, you will! Obviously my experience is different than yours, but you just got to take it day by day. Again, find someone who is just like you. There’s someone else out there dealing with the same thing.

Lexie: I agree that you will learn your body, but also know that your body is going to change all throughout your life and diabetes is literally a journey. You’re never going to get to like a destination where it’s like, “Okay, I’ve got it. I’m good for the rest of my life.” That’s why it’s definitely important to connect with other people who are going to be with you on this journey literally for the rest of your life. Because your body is always changing. Like everybody has said, it makes such a huge difference to feel like you’re not alone.

Lala: You’ve only had diabetes for three years, you’re a baby. There are things that you’re going to keep learning for a very long time. I’ve had type one for 23 years. As you know, I just learned new things from this conversation. There’s always a learning curve and the learning curve is long. Have patience with yourself.

Marina: Sometimes it just takes either a visit to somebody that knows to say, “Hey, have you noticed this, this and that?” And it might take somebody that might have that experience or that education or that has gone through the same thing to say, “I did not know that.”

So just know that there are people that are educators, doctors, or people that have diabetes that could just help you out in a professional way as well to say, “Hey, look at your Dexcom. This is what’s happening. Have you noticed this?”

Source: diabetesdaily.com

Heart Failure – The Overlooked Diabetes Complication, Part 1: What and Why?

This content originally appeared on diaTribe. Republished with permission.

By Ben Pallant

Learn what heart failure is, what it has to do with diabetes, and how to identify and talk about this complication that’s often less discussed.

Healthcare professionals often discuss diabetes complications such as vision loss (retinopathy), chronic kidney disease (nephropathy), and cardiovascular disease (referred to as atherosclerotic cardiovascular disease by healthcare professionals). However, there is a less talked about heart complication, heart failure. Heart failure refers to a condition where the heart’s ability to pump blood is less than normal, often meaning not enough blood is effectively circulating to the rest of the body.

This is part one of a two-part series on heart failure and diabetes.

What is heart failure?

First, it’s important to differentiate heart failure from other conditions such as cardiovascular disease, a heart attack, or cardiac arrest. There is also the broad term “heart disease,” which can encompass any heart issue. Because the names can get confusing, here are some brief explanations:

  • Cardiovascular disease, or atherosclerotic cardiovascular disease, is related to the process called atherosclerosis, which occurs when a substance called plaque builds up in your arteries making it difficult for blood to flow normally. The plaque buildup can be caused by high blood pressure, high cholesterol or triglycerides, smoking, or a number of other reasons. When it builds up in the arteries that supply blood to heart muscles or the brain, a heart attack or stroke can occur. Read our article on diabetes and heart disease here.
  • In a heart attack, the blood flow (and the oxygen supply, since blood carries oxygen throughout the body) to the heart muscle is blocked, causing damage to the heart muscle.
  • Heart failure happens when the heart isn’t able to pump enough blood to the rest of the body.
  • Cardiac arrest is the sudden loss of heart function. Usually due to an issue with the heart’s electrical system that disrupts a regular heartbeat, cardiac arrest causes the heart to stop pumping blood to the rest of the body.

There are a number of reasons why heart failure can occur, including coronary artery disease, high blood pressure, previous heart attacks, or other conditions and structural issues that damage the heart muscle (like cardiomyopathy or heart valve problems). Your chances of developing heart failure also increase as you get older. The heart’s inability to pump enough blood usually happens in one of two ways:

  1. When the heart muscle becomes stiff, the chambers in the heart cannot relax. This decreases the fill capacity of your heart chambers. Nevertheless, the heart is still able to release more than 50% of the blood in the heart chamber to the rest of the body. This type of heart failure is called “heart failure with preserved ejection fraction,” or HFpEF.
  2. When the heart muscle becomes weaker, not enough blood goes out to the body with each heartbeat. Thus, the percentage of blood that is released to the body is less than 50% of the amount in the heart chamber. This type of heart failure is called “heart failure with reduced ejection fraction,” or HFrEF.

Diabetes and prediabetes have been associated with both types of heart failure. Heart failure overall is a widespread health challenge – over 6 million Americans live with heart failure, and it leads to about 1 million hospitalizations per year in the US.

Heart failure is usually a chronic condition that progresses over time. At first, people may not experience any physical symptoms at all because the body has ways of trying to compensate – the heart may become bigger, it could develop more muscle mass, or it could try to pump faster. Over time though, heart failure worsens leading to shortness of breath, fatigue, inability to exercise, and more. Eventually the heart’s decreased ability to pump blood causes fluid to build up in other parts of the body, including the legs and lungs, which makes ordinary things like breathing and walking difficult. This is called congestive heart failure (CHF).

To learn more about heart failure, check out the American Heart Association’s heart failure resources.

What does heart failure have to do with diabetes?

Heart failure is unfortunately one of the most common and deadly complications of diabetes, especially for people with type 2 diabetes. They are two to four times more likely to develop heart failure than people without diabetes, and having diabetes increases a person’s risk for repeat hospitalizations for heart failure. This is partly because many of the key risk factors for heart failure are common in people with type 2 diabetes, such as a body mass index (BMI) over 25 (click here for a BMI calculator), high blood pressure, coronary artery disease, or a history of a heart attack. Other risk factors for heart failure include heart valve problems, sleep apnea, lung disease, and smoking.

But the shared risk factors alone don’t explain everything – diabetes itself is an independent risk factor for heart failure. According to several research studies, each percentage point increase in A1C is associated with an increased risk (8-36%) of heart failure. Researchers suspect that over time, high blood sugar levels either damage the cells of the heart muscles or force the heart to work harder due to damage to smaller blood vessels throughout the body and in the heart – this may be why high glucose levels are associated with heart failure.

Signs, symptoms, and screening

The Mayo Clinic and the American Heart Association have identified a number of possible symptoms of heart failure. These include:

  • Shortness of breath during activity or when you lie down
  • Tiredness and weakness
  • Swelling in your legs, ankles and feet, and very rapid weight gain (due to fluid retention)
  • Rapid or irregular heartbeat
  • Persistent coughing or wheezing (or coughing that produces pink, foamy mucus)
  • Chest pain if the heart failure is caused by a heart attack
  • Lack of appetite or nausea
  • Confusion or impaired thinking

It is especially important to seek immediate medical attention if you experience chest pain, severe fatigue or weakness, rapid or irregular heartbeats with shortness of breath or fainting, or sudden, severe shortness of breath especially if it is associated with coughing up pink, foamy mucus. For CHF especially, seeking timely medical attention is essential.

Talking to your healthcare team is key to making sure you are staying healthy, and it can help identify an early diagnosis. If you are experiencing any of the above symptoms, ask your healthcare professional if you can be tested for heart failure. Even if you aren’t exhibiting symptoms, start a conversation about what you can do to stay healthy and prevent future complications.

How do healthcare professionals test for heart failure?

Heart failure is most commonly assessed using medical imaging techniques that allow healthcare professionals to “see” the heart and assess its function. The most common test associated with heart failure is echocardiography (often called an “echo”) which is a non-invasive, painless ultrasound image of the heart. The echocardiogram can show how thick the heart muscle is and how much blood is pumped out of the left ventricle (one of the heart’s four chambers) with each beat. This information can be used to determine whether heart failure involves preserved or reduced ejection fraction.

Other imaging tests include an x-ray, an MRI, and a myocardial perfusion scan. An x-ray can see if the heart is enlarged or if there is fluid in the lungs, two signs of CHF. If your healthcare professional is concerned that there may be damage to the heart muscle or blockages of major blood vessels to the heart muscle, they may recommend an MRI. A myocardial perfusion scan uses a tiny amount of a radioactive substance that allows the heart to be imaged. It can show how well the heart muscle is pumping and areas with poor blood flow. This scan is often done with an exercise stress test (explained below).

In addition to these different imaging techniques, healthcare professionals use exercise stress tests (which measure how a person responds to increasingly difficult exercise) as a measure of heart function, blood tests to check for heart failure-associated strain on the kidney and liver, or an electrocardiogram (EKG or ECG) test to look at the heart’s electrical activity for signs of a heart attack and to see if the heart rhythm is abnormal.

Before any of these heart tests are ordered, your healthcare team will usually conduct a physical exam to determine what your symptoms are and what tests are needed. It’s important to be honest – your healthcare team needs to know about your lifestyle, including whether you smoke cigarettes, eat a lot of high-fat foods, and are physically active. Be prepared to answer other questions too:

  • When did symptoms begin?
  • How severe are the symptoms?
  • Does anything make the symptoms better or worse?
  • Do you have a family history of heart disease, diabetes, or high blood pressure?
  • Are you taking any medications, including over-the counter-drugs, vitamins, supplements, or prescriptions?

To learn more about heart failure, including prevention, medication options, and management tips, read “Heart Failure – The Overlooked Diabetes Complication, Part 2: Prevention and Management,” which our team will be updating this summer. You can also check out the Know Diabetes By Heart resources on heart failure.

This article was originally published on June 15, 2018. It was updated in May 2021 by Matthew Garza as part of a series to help people with diabetes learn how to support heart health, made possible in part by the American Heart Association and American Diabetes Association’s Know Diabetes by Heart initiative.

Source: diabetesdaily.com

How to Find a Good Mental Health Provider

If you live with any form of diabetes, you’re far more likely to suffer from depression and anxiety. An estimated 40% of people with type 1 diabetes and 35% of people with type 2 diabetes experience significant levels of “diabetes distress,” which can result in negative mental health repercussions, including diabetes burnout.

A mental health provider can be a crucial part of your medical team. Dr. Mark Heyman, the Founder and Director of the Center for Diabetes and Mental Health (CDMH), explains why:

Diabetes is a self-managed condition. This means that it is the person with diabetes, not their doctor, who is responsible for taking care of him or herself on a daily basis. Diabetes involves making frequent, sometimes life or death decisions under sometimes stressful and physically uncomfortable circumstances.

In addition, diabetes management is constant and can feel overwhelming. If you or someone close to you has diabetes, take a minute and think about all of the steps you take in your diabetes management every day. What to eat, how much insulin to take, when (or whether) to exercise, how to interpret a glucose reading, how many carbs to take to treat a low, the list goes on. Decisions, and resulting behaviors (and their consequences) are critical aspects of diabetes management. However, doing everything necessary to manage diabetes can become overwhelming – and feeling overwhelmed is usually no fun.

There are things you can do to help manage the mental distress of diabetes, including finding a good mental health provider that is especially positioned to help people with diabetes. This article will outline how to find the perfect fit!

Consider What You Want in a Mental Health Provider

Think of your mental health provider (or therapist) as someone you’re trying to develop a long-term relationship with. You want to be comfortable sharing all of your thoughts and feelings with this person, and be vulnerable with them as well.

Mental health providers become very close with their clients, so knowing what will make you uncomfortable is very important and crucial to knowing who you want to look for when searching for a provider. Some things you may want to keep in mind:

  • Gender (do you have a preference to work with only men or only women?)
  • Age (you may feel more comfortable working with someone much older or younger than you, or maybe you’d prefer someone closer to your age)
  • Religion (are you looking to connect spiritually with someone? Perhaps your religion is very important to you, or perhaps you’re looking to keep the interactions completely secular)

When you contact a provider’s office or complete an initial questionnaire for therapy, you’ll usually be asked some questions about basic preferences, such as those described above, to help match you with the best therapist.

You may also be able to research a mental health provider’s bio online to learn more about their areas of expertise before scheduling a visit.

Consider the Issues You Want to Address

There are many different types of mental health providers out there, and knowing that specific issues you want to address can help steer you in the right direction. Perhaps you’re suffering from substance abuse, or maybe you have developed anxiety around food. Maybe you and your spouse are struggling with your child’s new diabetes diagnosis, or you’ve noticed depressive symptoms that you want to tackle early. Different providers can help you manage different issues, so be cognizant of that. Some of the different types of specialists include:

  • LCSW – Licensed Clinical Social Worker
  • LMFT – Licensed Marriage and Family Therapist
  • NCC – National Certified Counselor
  • LCDC – Licensed Chemical Dependency Counselor
  • LPC – Licensed Professional Counselor
  • LMHC – Licensed Mental Health Counselor
  • PsyD – Doctor of Psychology
  • Ph.D. – Doctor of Philosophy
  • MD – Doctor of Medicine

But no matter what a provider’s background credentials entail, what matters most is their area of expertise. Reading up on a provider’s background information and bio can help you familiarize yourself with the areas of mental health they deal with, and can help you decide if they would ultimately make the best fit for you and your needs.

Consider Asking for a Consultation

Consider this an interview for the mental health provider you’re considering “hiring.” Some practices will offer a free, 30-minute consultation, so that you can get to know the provider before deciding to come on as a client. Some important questions to ask if you’re able to, are:

  • Are you a licensed provider? (while every state varies, a licensed provider has passed the minimum competency standards for training within your state)
  • What’s your educational background?
  • What is your treatment orientation? (this refers to the school of thought that the therapist draws from in understanding and treating mental health issues)
  • What is your area of expertise? (and if they say “chronic disease” or “diabetes,” that would be excellent!)
  • Do you accept my insurance?
  • What is the cost per session?
  • Are you a prescribing physician? (some providers may be able to prescribe medication for things like obsessive-compulsive disorder, anxiety, and depression)
  • What is your communication style?
  • Do you prefer short or longer-term therapy? (some providers are very short-term goal-oriented, while others prefer developing a relationship over a long period of time)

These questions are not a complete list, but it’s a good start to finding the perfect fit for you and your care.

Seek out Diabetes Experts

It can be very difficult to find the right mental health provider for you and your needs, and that’s especially true when living with a chronic disease like diabetes.

The American Diabetes Association (ADA) recently teamed up with the American Psychological Association (APA) and created a directory of mental health providers specifically equipped to meet the needs of people with diabetes. All providers in this directory are:

  • Currently licensed as a mental health provider
  • A professional member of the ADA (Associate, Medicine & Science, Health Care & Education)
  • Have demonstrated competence in treating the mental health needs of people with diabetes

Currently, the directory has about 60 providers, 40 of which provide pediatric services, and the list is rapidly growing. The tool is simple to use: enter your zip code and whether you’re looking for adult or pediatric services. The directory will then pull up diabetes-trained mental health providers near you. The directory also lets you access what types of insurance a chosen provider accepts, their office location, phone number, and more.

Finding an appropriate mental health provider can be a difficult but worthwhile challenge. Investing your time, money, and energy to improving your mental health as someone living with diabetes is absolutely worth it, and it is crucial that you find a mental health provider that is going to work best for you in getting your needs and goals met. Hopefully these tools will make it a little easier to get there!

Source: diabetesdaily.com

Drink to That: How to Safely Consume Alcohol with Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

We’re already thinking about carbs and calories all the time, and adding alcohol into the mix makes things more complex. ­Experts share their best advice on how to safely drink when living with diabetes.

People who choose to drink alcohol typically do so for a few main reasons: to cope with challenges, to be sociable, or just because they enjoy having a drink. But while alcohol may make some people feel more comfortable, drinking can be especially complicated for people with diabetes. If you’re choosing to drink with friends or loved ones, let’s talk about how you can do so safely with diabetes.

First, alcohol is a drug, and it can be highly addictive. If you don’t drink now, there’s no reason to start. In fact, avoiding alcohol is the healthiest choice for people with or without diabetes. Drinking more than is healthy for the body has been linked to issues in the brain, heart, liver, pancreas, and immune system and is associated with several kinds of cancer, according to the National Institute on Alcohol Abuse and Alcoholism. Drinking is also connected to other health problems, such as unintentional injuries (car accidents, falls, drownings), domestic violence, alcohol use disorders, and fetal alcohol spectrum disorders, per the Centers for Disease Control and Prevention.

So, with all that said, how can you best manage your diabetes if you choose to drink?

What happens in the body when you drink?

Your liver works to create glucose when your blood sugar levels are low, but it also processes any alcohol present in your body, says Sandra Arevalo, a certified diabetes care and education specialist and spokesperson for the Academy of Nutrition and Dietetics. More specifically, “Alcohol gets broken down by your liver. The liver is also in charge of making sugar when your blood sugar levels are low, by converting stored glycogen into glucose, and releasing that glucose into your bloodstream. When you drink, your liver is busy processing the alcohol and has a hard time producing glucose,” she said.

This process “puts people with diabetes at high risk of low blood sugar when they drink,” Arevalo said. “If you are on basal insulin, you may not make enough glucose for the amount of basal insulin you have taken, and you may suffer a hypoglycemic episode.” This applies primarily to people with type 1 diabetes, but people with type 2 diabetes are still at risk for low blood glucose levels when they drink.

What’s in a drink?

That’s a tricky question. What you are drinking and how much of it you choose to drink can make a big difference. Like most things with diabetes, there aren’t simple answers.

According to the CDC, moderate drinking is defined as two drinks or less per day for men, or one drink or less per day for women. The US Dietary Guidelines Advisory Committee recommends one drink or fewer per day for people of any gender. It is illegal for people under 21 to drink alcohol in the United States.

Drinking

Image source: diaTribe

What does the CDC classify as “a drink?” One drink contains 14 grams, or 0.6 ounces, of pure alcohol, which normally equates to 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of hard liquor or spirits such as gin, rum, vodka or whiskey.

What influences your intoxication?

Several factors – including diabetes medications, food, and exercise – can all make things even more complicated, said Carrie S. Swift, a dietician and spokesperson with the Association of Diabetes Care & Education Specialists. “Overall, alcohol intake leads to less predictable blood glucose whether you have type 1 or type 2 diabetes,” she said. But “the impact of alcohol on blood glucose isn’t always the same.”

This can be caused by:

  • Carbohydrate content of drinks: Beer and sweet wines contain a lot of carbohydrates, and can increase your blood sugar level despite the alcohol content. On the other hand, quickly cutting down your intake of these drinks, or quickly making the switch to dry wine or spirits, can carry a high risk of hypoglycemia.
  • Diabetes drugs: Insulin and sulfonylurea medications such as glipizide, glyburide, and glimepiride – all of which help to lower blood glucose levels – “are more likely to cause low blood glucose when alcohol is consumed,” said Swift. Insulin and alcohol work similarly whether you have type 1 or type 2 diabetes. If you take metformin, pay attention to these specific symptoms when you are drinking: weakness, fatigue, slow heart rate, muscle pain, shortness of breath, or dark urine. “Excessive alcohol intake while taking metformin may increase the risk of a rare, but dangerous condition, called lactic acidosis. If you have these symptoms – get medical help right away,” she said. There are no specific or predictable ways that blood glucose levels react when taking other oral diabetes medications or GLP-1 medications, Swift added.
  • Food: “If you drink on an empty stomach, you are more likely to experience hypoglycemia,” said Swift. Yet, eating while drinking “may also increase your blood glucose, especially if you eat more than usual or make less healthy food choices when you drink.”
  • Exercise: If you are physically active either before or after drinking alcohol, it can cause your blood sugars to drop and lead to hypoglycemia.

What and how are you drinking?

If you have diabetes and choose to drink, what should you keep in mind?

  • Alcoholic drinks can have as much added sugar as some desserts, so think about what kinds of drinks you are having. “It’s best not to choose alcohol mixed with punches or soft drink mixers, such as Pepsi, Sprite, or Coke, daiquiris, margaritas, or sweetened liquors like Kahlua or Bailey’s Irish Cream,” said Swift. Regular beer and sweet wines are also higher in carbohydrates. “These drinks not only add carbohydrate, but excess calories from the added sugars,” she said.
  • If you have a continuous glucose monitor (CGM), use it. While you are drinking, you can see where your glucose is at all times and if it drops quickly. If you don’t have a CGM, “test your blood sugar more often,” said Arevalo. “Mainly if you are not feeling well, you want to know if your sugar is dropping, or if you are getting drunk. Even though both feel equally bad, you will want to know if your sugars are low so you can correct them quickly.”
  • Never drink on an empty stomach. Instead, “Have a good meal before or during drinking,” said Arevalo. But know the carb count of what you are eating and work with your healthcare professional to determine how to take medication for that meal along with the alcohol you are consuming.
  • Exercise and alcohol can make your numbers plummet. “Avoid drinking while dancing or exercising,” said Arevalo. “Physical activity helps to reduce blood sugar levels, and if the liver is not able to keep up with the production of glucose, the risk of hypoglycemia is even higher.”
  • Have your supplies handy, such as a hypoglycemia preparedness kit. Always bring your blood glucose testing kit and enough supplies for you to test frequently. It’s a good idea to have extra test strips, alcohol swabs, lancets, as well as fast-acting forms of glucose, including emergency glucagon in case your blood sugar level doesn’t come up with food or glucose.
  •  If you take basal insulin in the evening, it’s not an easy answer on what to do if you plan to consume alcohol that evening, said Swift. “Depending on what type of diabetes the person has, and other factors, the results of drinking and taking a long-acting insulin before going out, may contribute to a different result,” she said. If you have type 1 and you take your usual amount of long-acting insulin and then you drink alcohol, “It may contribute to delayed hypoglycemia when drinking too much alcohol,” she said. If you have type 2 diabetes and are overweight or have significant insulin resistance, “Taking your usual amount of long-acting insulin may be a good strategy to avoid high blood glucose numbers,” she said. “No matter what your type of diabetes, frequent blood glucose checking will help you take the right action to avoid high or low blood glucose when choosing to drink alcohol.”
  • If you use an insulin pump or a CGM, make sure you check that they are working properly before you leave the house, without any low-power indicators. If you need to fill your pump with insulin or change out either your infusion set or CGM sensor, do it before you begin drinking or get drunk. As Dr. Jeremy Pettus and Dr. Steve Edelman say in this video, “Protect yourself from drunk you as much as you possibly can.”

It’s important for everyone to avoid getting drunk to the point of not being able to protect yourself. For people with diabetes, this includes protecting yourself from hypoglycemia.

Navigating social situations

If you find yourself in situations where people around you are drinking, or your friends like to party, there are ways to fit in without feeling left out:

  • “It’s okay to choose sparkling water with lemon or a diet soda instead of an alcoholic drink in a social setting,” said Swift. “If you do choose to drink alcohol, have a glass of water, or another no-calorie beverage between alcohol-containing drinks.” It’s also okay to hold a drink and not consume it, if that makes you more comfortable.
  • Tell a trusted friend ahead of time where you keep your supplies, such as your blood glucose monitor or CGM reader, how to get glucose tabs or juice if you need it, and, if necessary, how to give emergency glucagon, either by injection or by nasal inhalation, said Arevalo. It’s also good to have a designated non-drinker in your group, who can watch out for everyone’s safety. And be sure the group you are with knows that the signs of a low blood sugar and the signs of being drunk are the same, said Swift: slurred speech, blurry vision, dizziness, confusion, lack of coordination, irritability, and potentially, loss of consciousness.
  • Make sure you’re hanging out with people you want to be with, and consider where drinking fits in to your health goals and your life. “Friends are only friends if they accept you the way you are and help to take care of you,” said Arevalo. “If you feel peer-pressured to drink, let them know that you have to take care of yourself because of your diabetes. Good friends will respond in a positive way, and will understand and help you. If you want to have a good time and don’t want to keep an eye on how much you are drinking, alert your friends about your diabetes. Let them know where you have your supplies, how to use them, and who to call and what to do in case of an emergency.” Remember, never drive if you (or your driver) have been drinking.

Finally, if you’re going to drink, be smart about it. Always start with a blood glucose level that’s at a healthy, in-range level, sip—don’t chug—your alcohol, and avoid drinking to excess. Your body, your brain, and your diabetes will all be easier to manage once you’re done drinking, either for the evening, the event, or for good.

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

Community Table: Nutrition, Health + Wellness in the Black Diabetes Community

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

By JDRF-Beyond Type 1 Alliance

During our second Community Table discussion, Beyond Type 1 sat down with a group of experts and community members to discuss nutrition, health, and wellness in the Black diabetes community, and share helpful resources and perspectives. Watch the discussion in full!



Speakers included:

  • T’ara Smith, who served as the moderator for this event, was originally diagnosed with type 2 diabetes in 2017 but was re-diagnosed with LADA diabetes in 2019 and is Senior Manager of Beyond Type 2.
  • Keith Crear, who has lived with type 2 diabetes since 2017, is a sports photographer and multimedia specialist.
  • Alexis Newman, who has had type 1 diabetes for 37 years and is a registered dietician.
  • Dex Geralds, who has had type 2 diabetes since 2016 and works as a personal trainer and CrossFit coach.
  • Joy Ashby Cornthwaite, a dietitian and a certifies diabetes care and education specialist.

Partial transcript of conversation below, edited for content + clarity.

What does wellness mean or look like for you, and has your diagnosis changed the way that you live?

Dex: It’s balance. I know a lot of times when I’m with people who don’t typically know about diabetes, there’s a lot of things surrounding food that they believe I cannot have at all. Once you find the balance, you’re able to still eat some of the things that you’re eating before your diagnosis, maybe not at the same amount that you were eating before. Just finding balance with the way you eat, balance in the way you exercise. Whether it’s like myself who exercise maybe two hours a day or just going out for a 15-minute brisk walk. Just finding balance in what comes with that. The last thing in balance is just your mental health and making sure you check in with yourself and your feelings and your emotions and figure out what brings you happiness and joy.

Keith: It is a balance. It’s knowing what to eat, what not to eat, what to consume, when to consume it. Exercise is very, very important.

Alexis: For me, what it looks like is making sure that I am well, not only with how I’m eating, but also exercise. Making sure I’m honest and checking in with my friends and family, my support system, too. Also, the spiritual aspect of it. I’m a Christian, so making sure I’m connected in the sources that I feel encouraged in. When one of those are kind of out of whack, I don’t feel well.

Joy: I think of health on a continuum, and I encourage that in every day. In my family life, in my personal life, but also for those who I help to balance their journey with diabetes because everyone has their own journey and their whole complete individual. When someone comes to a session with me, I find out where on the continuum you are and what can we work on today? It has to come from you. It has to be what you want and not necessarily what I want. But I’m going to use my skills to get you to where you need to be.

What misconceptions have you encountered pertaining specifically to Black people with diabetes when it comes to fitness? What is some of the ways that you’ve helped your Black clients move past those stigmas and misconceptions?

Dex: The biggest thing is support in our community and in the world in general. If you’re overweight you get looked down upon and that can add to depression and lead to worse things. I know a big term going on right now is “unlearning” and taking everything, looking at it through a different scope, and then figuring out what brought you to this point and then what can I do to change this. It’s not just a one-stop shop kind of thing. It’s going to take a while for you to start to see changes for the most part. You have to create these better habits and getting through that way.

Learning to love yourself is vital, and when you learn to love yourself you want to do the things that’s right for you and you’re going to quiet that outside noise and put your blinders on and work for yourself and not think about the negative things that you might be getting from someone else. My family has a history of diabetes and obesity. My oldest sister, she’s lost 150 pounds now, but still just over 400 pounds. I remember things people would say to her growing up. Now that I support her and my family’s supporting her, she’s been on this incredible journey and losing weight because now she feels confident enough to do the things that once scared her or felt ashamed about. Being able to conversate and talk to my sister, or just clients in general, I’ve been able to learn what’s going on and been able to apply that to them in their journey in fitness.

Alexis: The kind of things that I’ve seen is that they believe that people think they’re lazy so they don’t want to push through that because they’re afraid of what people are going to think. I’ve also seen the fear of not knowing what to do overtake them in my discussions with my patients. Another idea is that they have this perceived idea of what exercise looks like, so really breaking it down into bite-sized pieces of like, “Look, as long as you’re like being consistent with the movement, whatever you choose to do, you can add on time, you can add on intensity. But, as long as you’re out there trying to move.” Those are the things that I have conversations with my patients about in terms of fitness.

Another thing too, is that an ideal weight of someone who’s African American may not be similar to another culture or race. We need to keep that in mind as we are discussing food, nutrition, health, and weight that the ideal weight that a doctor may have for you may not be appropriate. I think that needs to be said and also needs to be addressed when we’re talking to these patients about weight and health and glucose numbers and things like that.

Joy: When it comes to fitness, one of the great disservices, especially for the Black community, is to tell people that they need to lose weight if they’re moving. For many people who are living with diabetes, movement doesn’t always equate to weight loss. It also doesn’t always equate to better blood glucose values.

There’s a lot of things that go into thinking about exercise. When you’re telling someone that it’s going to make them better to exercise and they’re saying that their blood glucose is either crashing or going up way too high with exercise there’s a disconnect. You haven’t heard what they’re saying to you. You need to find out what people are experiencing in their exercise journey and then address those things and say, “Look, you may not lose weight, but let’s check your blood glucose before and after.” Celebrate the win over either the hyperglycemia that you have been feeling or the hypoglycemia that you were feeling if you didn’t pre-exercise meal or whatever reason. Celebrate the win that is more than weight.

How can we celebrate our culture or different types of Black cultures throughout the year, not just during Black History Month?

Joy: Support each other. I know for years I felt like I was the sole person saying, “Black people aren’t making ourselves sick with diabetes.” We need help. We need medications. We need diabetes health care and management. We need to know how to take care of ourselves and we don’t have to do that alone. Whatever we need to do we need to support each other and do it together and then we’re louder.

Dex: Our culture is so vast and rich, and it needs to be shared every day and whatever way possible. Whether it’s through social media or just through conversation or the way you dress, the way you wear your hair. It just needs to be expressed and be out there for people to see and enjoy and learn. I love my culture so much.

Alexis: Buy Black. There are so many amazing Black companies, I’ve been focusing on and amplifying those businesses on social media and telling my friends. I’m in a friend group and we’re talking about face care. I’m like, “All right, I’m using this” and they’re using this Black company. We’re just sharing information of these amazing Black companies that are out there. If we can’t do that, then no one else is going to. It’s really important to invest in Black businesses because they’re everywhere.

T’ara: Yes, please support Black businesses that you see, especially in the diabetes community. There’s so many Black people in the diabetes community who have businesses and organizations who could use amplifying on your social platforms. That social sharing could do a whole lot because you never know who can see their products, so please amplify it.

Keith: Constant delivery of content from Black creators. Constantly delivering things from Black history that could be done every day. The way you wear your hair, the clothes. Just something that constantly keeps it in the public eye so it’s not condensed down to just one month. There are a lot of people out there that are doing it and it’s always great to see that. If more of us continue to do that it’ll shift the narrative and it will shift the visual aspect of how we’re seen in society as a whole.

Source: diabetesdaily.com

How to Treat Lows Without Sabotaging Your Diet (or Your Blood Sugar)

Diabetes is basically a never-ending test of willpower, and there are few tests more frustrating than properly correcting a hypo. Your challenge: consume just the right amount of sugar, enough to pull your blood glucose into a safe range, but not too much to send it high. This exercise will be performed under immense stress and in an impaired mental state, and may require advanced math skills and superhuman self-restraint.

We’ve all been there—hypoglycemia hits you like a ton of bricks and leaves you weak-kneed and trembling, and your body is screaming at you for the one thing it needs: sugar! It can feel like every bone in your body is pushing you towards the snacks, and before you know it you’re shoving food into your mouth, blowing way past the modest amount of carbs you actually needed.

Binge eating during a hypo admittedly feels great for a few minutes, but it almost always ends in regret. That blood sugar is about to skyrocket back up to the stratosphere, and might require an insulin correction to bring it back down again, triggering the dreaded rollercoaster. Not to mention what your emergency indulgence might have done to your diet—people with diabetes are not generally known to reach for the healthiest treats when fixing a hypo.

The standard advice, the so-called “15-15 Rule,” is a fine starting point, but advanced diabetes management can benefit from a more subtle approach.

Here are some strategies that might help you treat blood sugar lows without sabotaging your blood sugar or your diet:

Go Boring

The yummier your hypo solution is, the more likely you are to overeat. As fun as it is to use a mild hypo as an opportunity to indulge, this is exactly the wrong time to dig into that box of cookies you’ve got squirreled away. Save those treats for a time that your blood sugar is acting predictably and you can bolus responsibly.

It’s much better practice to view the food or drink you consume to correct a hypo as medicine. Because that’s exactly what it is, a medically vital intervention to be dosed precisely. Hypoglycemia is a serious business.

So, go boring with your hypo rescue solution, the more boring, the better. One reason that experts recommend glucose tabs is that they don’t really taste all that good. That’s a feature, not a bug: medicine isn’t supposed to taste good.

Listen to Your Body – But Not Too Much

The classic symptoms of hypoglycemia—shakiness, hunger, and so on—constitute a critical warning system that you should heed seriously and quickly. (The unlucky minority of patients with diabetes that can no longer feel these symptoms are at a greatly enhanced risk of severe hypoglycemia.)

But as soon as you’ve ingested the proper amount of carbohydrates, it’s time to start ignoring those body cues. You may still feel awful, but you need to let the sugars in the food you’ve eaten get into the bloodstream. The standard advice from medical authorities is to wait 15 minutes before checking your blood sugar, and only then think about applying another dose of carbohydrates.

An early study of this topic showed that people with diabetes that treated their hypos by eating “until they felt better” had A1c’s 0.5% higher than those that scrupulously avoided overeating. That’s a huge difference.

Know your Carb Count

Individual candies and glucose tabs are great because the portions are controlled and identical. A single Skittle is always about 1gram of sucrose, every time. Cereal or orange juice? Not so easy to be precise, unless you have the rare presence of mind to break out the measuring cups or kitchen scale during hypoglycemia.

Understand Your Glucose Trends

The standard recommendation of 15 grams of carbs to treat a low may be more or less than you need, depending on how quickly your blood sugar is moving.

If you have a load of fast-acting insulin on board, or if you’re in the middle of an exercise, you might already know that you need more than just 15 grams. A continuous glucose monitor and its trend arrows can make this decision even easier to make.

Alternatively, if your blood glucose level is fairly steady and there’s no reason to suspect that it will drop precipitously, just a few grams of sugar may be all you need to bump it back up into a safe area.

Avoid Fats

When you opt for more complex snacks than simple sugar candies—say chocolates, cookies, or potato chips—you’re usually letting a lot of fat come along for the ride. Those fats might taste good, but they’ll probably just slow down the absorption of the carbohydrates. The longer it takes for your blood sugar to rise, the longer it leaves you in uncomfortable, ravenous limbo, making it more and more likely that you’ll overeat.

And it should go without saying that those added fats are not doing much good for your diet. There’s not a dietary authority on earth that wants you to reach for that sweet, starchy junk food.

Avoid Fructose

The juice box has been a mainstay of hypoglycemia treatment for decades, especially for kids, but it’s not actually the best option for speedy corrections. Why not? Fruit and fruit juices have more fructose than glucose, and fructose, which first has to undergo fructolysis in the liver, is metabolized more slowly. Several studies have found that fructose’s treatment effectiveness is “significantly lower” than that of sucrose or glucose.

It’s also an unfortunate fact that the healthier a fruit product is, the less appropriate it probably is for hypoglycemia treatment. For one thing, less-processed fruits, juices, and snacks are more likely to contain fiber. That’s certainly healthy in other circumstances—fiber slows the absorption of sugar—but in a hypo emergency it’s exactly what you don’t want.

Fructose is found primarily in fruits; manufacturers also use it as an additive in many mass-produced food products, often in the form of high-fructose corn syrup.

Binge Healthy Food

Sometimes it seems impossible to restrain from eating. In those moments, you can opt to “binge” on food that you know won’t sabotage your diet or your glycemic management. Take the appropriate dose of sugar or carbohydrates first, and then stuff your face with a lower-carb food that you won’t feel guilty about overeating: try crunchy veggies, almonds, or a source of lean protein like smoked turkey. Sometimes I reach for cheese, which is probably not ideal, but at least I know that it won’t spike my blood sugar.

Conclusion

Hypoglycemia too often compels people with diabetes to overeat, which is almost always bad for blood sugar management, diet, and overall health. You should look at your hypo correction snack as a type of medicine, to be dosed quickly and precisely.

Source: diabetesdaily.com

Getting Started with Insulin if You Have Type 2 Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Frida Velcani

New to insulin? Learn about insulin dosing and timing and how often to test your blood sugar levels if you have type 2 diabetes.

If you have type 2 diabetes, it is likely that your treatment regimen will change over time as your needs change, and at some point, your healthcare professional may suggest that you start taking insulin. While this might feel scary, there are millions of others living with type 2 diabetes and taking insulin, so it’s definitely manageable.

Click to jump down:

Why do some people with type 2 diabetes need to take insulin?

Type 2 diabetes can progress with time, which means that it gets more difficult for a person’s body to regulate glucose levels. The body’s many cells become less responsive to insulin (called increased insulin resistance), and the specific cells in the pancreas that produce insulin make less of it (called beta cell insufficiency). This is not necessarily related to a person’s diabetes management, and it is likely not possible to prevent.

For many people, adjusting lifestyle factors such as a reduced calorie diet and increased physical activity are key to keeping blood glucose levels stable and in a target range. Healthcare professionals may also recommend that people with type 2 diabetes take additional medications like metforminDPP-4 inhibitorsSGLT-2 inhibitors, or GLP-1 agonists to their treatment plan to improve glucose management, reduce A1C, lose weight, or support heart and kidney health.

When do people with type 2 diabetes start insulin?

After 10 to 20 years, many people with type 2 diabetes will begin insulin therapy, although every person’s journey with type 2 diabetes is different. This happens when lifestyle changes and medications aren’t keeping your glucose levels in your target range. It is important that you start treatment as early as possible to avoid persistent hyperglycemia (high blood sugar), which can lead to long-term health complications affecting your heart, kidneys, eyes, and other organs.

What are the different types of insulin?

The key to transitioning to insulin is knowing your options. Some people taking insulin need to use both a basal (long-acting) and a prandial (rapid-acting or “mealtime”) insulin each day, while others may only need to use basal insulin. Learn about your options here.

  • Basal (long-acting) insulins are designed to be injected once or twice daily to provide a constant background level of insulin throughout the day. Basal insulins help keep blood sugars at a consistent level when you are not eating and through the night but cannot cover carbohydrates (carbs) eaten for meals or snacks or glucose spikes after meals.
    • Some people use other medications, like GLP-1 agonists, to help cover mealtimes. GLP-1/basal combination treatments for people with type 2 diabetes combine basal insulin with GLP-1 agonist medication in one daily injection. This combination can effectively lower glucose levels while reducing weight gain and risk of hypoglycemia (low blood sugar). Learn more here.
  • Prandial (rapid-acting or “mealtime”) insulins are taken before mealtime and act quickly to cover carbohydrates eaten and bring down high sugar levels following meals. Ultra-rapid-acting prandial insulins can act even more rapidly in the body to bring down glucose levels. Rapid and ultra-rapid insulins are also taken to correct high glucose levels when they occur or are still persistent a few hours after a meal.
  • Basal and prandial insulins are both analog insulins, meaning they are slightly different in structure from the insulin naturally produced in the body. Analog insulins have certain characteristics that can be helpful for people with diabetes. Human insulins, on the other hand, were developed first and are identical to those produced by the human body. Human insulins are classified as regular (short-acting insulin) or NPH (intermediate-acting). These are generally cheaper than analog insulins and can be bought without a prescription at some pharmacies.

Although many people use both basal and prandial insulin – which is called multiple daily injections of insulin (MDI) and consists of one or two injections of basal insulin each day as well as prandial insulin at meals – people with type 2 diabetes who are beginning insulin therapy may only need basal insulin to manage their glucose levels. Basal insulin requires fewer injections and generally causes less hypoglycemia. For these reasons, many healthcare professionals recommend basal insulin when you first start insulin therapy.

How do I take and adjust my insulin doses?

It is important to learn the different methods of taking insulin and what kinds of insulin can be delivered through each method. There are several ways to take insulin – syringe, pen, pump, or inhalation – though injection with a syringe is currently the most common for people with type 2 diabetes. There are many apps that can help you calculate your insulin doses.

  • Insulin pens are considered easier and more convenient to use than a vial and syringe. There are different brands and models of insulin pens available. Smart pens are becoming increasingly common and can help people manage insulin dosing and tracking. They connect to your smartphone and help you remember when you took your last dose, how much insulin you took, and when to take your next one.
  • Insulin pumps are attached to your body and can be programmed to administer rapid-acting insulin throughout the day, to cover both basal and prandial insulin needs. When you need to take insulin for meals or to correct high glucose, calculators inside the pump can help determine the correct dosage after you’ve programmed them with your personal insulin pump settings.
  • Inhaled insulin is ultra-rapid acting insulin and can replace insulin used for mealtime and corrections of high glucose. It is taken through an inhaler and works similarly to injected prandial insulin. People with diabetes who do not want to inject prandial insulin might use this, but it’s not for people who only use basal insulin. The only approved inhaled insulin on the market is the ultra-rapid-acting mealtime insulin Afrezza.

Your insulin regimen should be tailored to fit your needs and lifestyle. Adjusting your basal insulin dosage and timing will require conversations and frequent follow-up with your healthcare team. When initiating insulin therapy, you may be advised to start with a low dose and increase the dose in small amounts once or twice a week, based on your fasting glucose levels. People with diabetes should aim to spend as much time as possible with glucose levels between 70-180 mg/dl. Insulin may be used alone or in combination with oral glucose-lowering medications, such as metformin, SGLT-2 inhibitors, or GLP-1 agonists.

One of the most important things to consider is the characteristics of different insulin types. To learn more, read “Introducing the Many Types of Insulin – Is There a Better Option for You?” and discuss with your healthcare team.

In order to dose insulin to cover meals or snacks, you have to take a few factors into consideration. Your healthcare team should help you determine what to consider when calculating an insulin dose. Prandial insulin doses will usually be adjusted based on:

  • Current blood sugar levels. You’ll aim for a “target” blood sugar, and you should know your “sensitivity” per unit of insulin to correct high blood sugar levels.
    • Insulin sensitivity factor (ISF) or correction factor:  how much one unit of insulin is expected to lower blood sugar. For example, if 1 unit of insulin will drop your blood sugar by 25 mg/dl, then your insulin sensitivity factor is 1:25. Your ISF may change throughout the day – for example, many people are more insulin resistant in the morning, which requires a stronger correction factor.
  • Carbohydrate intake. Insulin to carb ratios represent how many grams of carbohydrates are covered by one unit of insulin. You should calculate your carbohydrate consumptions for each meal.
    • Insulin to carbohydrate ratio:  the number of grams of carbs “covered” by one unit of insulin. For example, a 1:10 insulin to carbohydrate ratio means one unit of insulin will cover every 10 grams of carbohydrates that you eat. For a meal with 30 grams of carbohydrates, a bolus calculator will recommend three units of insulin.
  • Physical activity. Adjust insulin doses before, and possibly after, exercise – learn more about managing glucose levels during exercise here.

Learning to adjust your own insulin doses may be overwhelming at first, especially given the many factors that affect your glucose levels. Identifying patterns in your glucose levels throughout the day may help you optimize the timing and dosing of your insulin. Your healthcare professional, a certified diabetes care and education specialist, or insulin pump trainer (if you use a pump), can help guide you through this process. Do not adjust your insulin doses without first talking to your healthcare team.

How often should I test my blood sugar?

The frequency of testing will depend on your health status and activities during the day. Initially, you may be advised to check your blood glucose three to four times a day. As a starting point, check in with your healthcare team about how often to check your blood sugar. Many people test before meals, exercise, bedtime, and one to two hours after meals to ensure that they bolused their insulin correctly. Over time, your fasting, pre-meal, and post-meal blood glucose levels will help you figure out how to adjust your insulin doses.

Continuous glucose monitors (CGM) are particularly useful for tracking changes in glucose levels throughout the day. Some CGM devices also connect with an insulin pump to automatically adjust insulin delivery. After you start a treatment plan, the goal for most people is to spend as much time as possible in their target range. Talk with your healthcare professional about starting CGM and developing glucose targets.

What else do I need to know about taking insulin?

It’s common to experience minimal discomfort from needle injections or skin changes at the insulin injection site. You may also experience side effects of insulin therapy, which can include some weight gain and hypoglycemia. In some people, insulin increases appetite and stops the loss of glucose (and calories) in the urine, which can lead to weight gain. Hypoglycemia can occur if you are not taking the right amount of insulin to cover your carb intake, over-correcting high glucose levels, exercising, or consuming alcohol. Treating hypoglycemia also adds more calories to your daily intake and can further contribute to weight gain. Contact your healthcare professional to adjust your insulin dose if you are experiencing hypoglycemia, or call 911 if you experience more serious side effects, such as severe low blood sugar levels, serious allergic reactions, swelling, or shortness of breath.

Staying in contact with your healthcare team is the best way to make the transition to insulin therapy. Though the first few days or weeks will be challenging, with the right support, you’ll find a diabetes care plan that works for you.

If you were recently diagnosed with type 2 diabetes, check out more resources here.

Source: diabetesdaily.com

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