Easy At-Home Gym Hacks

We are nearly a year into the pandemic, which has all but frozen life as we used to know it. It has required a shift in thinking, and a transition to doing most everything at home: work, school, and even exercise. Most gyms across the country are either still closed or operating at extremely limited capacity, and many people feel more comfortable working out from the comfort of their own homes until herd immunity is achieved in the United States.

But how can you get a good, full-body workout at home, when time, space, and equipment is limited? These are our top tips.

Keep a Routine

The best workout is the one you’ll do consistently, and that means making your exercise time routine. It should be no different than when you would typically go to a physical gym: exercise should happen during the same time and in the same place every day.

This also helps create boundaries with work and family. If you go to the garage every morning at 6 a.m. for dedicated “gym” time, the kids will soon learn that you’re not available to play then. Alternatively, if you block out 20 minutes at noon every day for a run on your Outlook calendar, your boss is much less likely to schedule impromptu meetings during that time.

Also, it’s important to know yourself. If you’re a morning person and start to fade around dinnertime, don’t wait to get your exercise in after the kids go to sleep. By prioritizing your exercise time and making it routine, you’re guaranteed to make it a habit that will stick.

Set Yourself Up for Success

Adjusting to home workouts does not need to be complicated. You can start small with Youtube yoga and dance videos, high-intensity interval training (HIIT) workouts, and even meditation to deal with stress. Listening to Spotify or Pandora while working out can help bring fresh music to your routine, too.

Accumulating some at-home gym equipment can also keep you stimulated and less likely to become bored.

Michelle, from Madison, Wisconsin, says that she uses the Nike training app religiously, as it helps prevent ennui and always mixes up workouts. The app comes with multi-week programs, including a prescribed series of workouts, nutrition tips, and wellness guidance to help users build healthy habits. Each flexible program is led by a Nike Master Trainer and is created to cater to those working out at home.

Additionally, Michelle recommends Bowflex adjustable dumbbells, which replace 15 sets of weights! The weights adjust from 5 up to 52.5 lbs each. By easily turning the dial you can change the resistance, enabling you to gradually increase your strength.

Ryan, from Albany, New York, uses the Bowflex C6 bike in combination with the Peloton app (which is just $15 per month!). The bike has 100 levels of resistance, just like the Peloton bike, but is half the cost, so you can follow along to Peloton workouts while saving a ton of money.

If you’re not into collecting a ton of equipment but want to build strength and get your heart rate up, simply investing in a kettlebell and a jump rope can be all you need to take squats and lunges to the next level.

If you don’t want to buy all new equipment for your home, see if you can crowdsource some from friends and family. Pool resources together, and share weights, a rack, a bicycle, treadmill, or other equipment, to make assembling an at-home gym more affordable.

Jennifer, from Des Moines, Iowa, says, “My sister lives across town and has a great treadmill in her garage. She works the night shift and I work during the day, so will pop on over to her house to get a run in on cold mornings while she’s still at work. It works perfectly.”

Some people have even had luck renting equipment or even borrowing equipment from their gyms while they are closed due to COVID-19 restrictions. Jessica, from Boulder, Colorado, says. “I emailed my local rec center, and they’ve let me borrow some heavier kettlebells that would have been prohibitively expensive to buy. They let members borrow equipment for 72 hours, which works perfectly to spice up my workout routines.”

exercise accountability buddy

Photo credit: iStock

Find an Accountability Buddy

No one is inspired to exercise all the time. Having a friend or family member checking in with you to make sure you’re meeting your fitness goals can be a crucial nudge to help you stick to your routine. Perhaps you have a weekly check-in call with a friend every Friday to review what you did to get your heart pumping, or you email different workout plans to each other every week to stay motivated.

If you feel safe enough to do so, maybe you meet someone for a walk each weekend, to get fresh air and a change of scenery. Whatever you do, it should help you stay motivated, not hinder your progress.

Even if your accountability buddy isn’t actively trying to improve their fitness or lose weight, they could benefit too: a recent study showed that when 130 couples were tracked over six months, the accountability buddy not actively trying to lose weight had success in some weight loss too, if their partner was on an exercise plan.

Make It Fun!

In this strange time, it’s important to make exercise fun. Have goals and work hard to meet them, but make sure to celebrate your progress, too. Maybe you’re trying to deadlift 150 lbs, lower your HbA1c, do twenty weighted lunges in a row, or run a faster mile.

If and when you meet those goals, celebrate them! This may look different in 2021, but ordering takeaway coffee from a favorite coffee shop, ordering your favorite candle online, or buying a new swimsuit are all well-deserved awards for hard work put in at home.

Working out at home does not need to be boring or uninspired. With these tips, you can keep your fitness levels high, stay motivated, save money, and get healthier, even during the quarantine. Remember to always check with your doctor before starting a new exercise routine.

Have you been working out at home during the pandemic? How is it going for you? What strategies or advice would you give others? Share this post and comment below!

Source: diabetesdaily.com

Study Compares MiniMed 780G and MiniMed 670G Algorithms

This content originally appeared on diaTribe. Republished with permission.

By Albert Cai

A new study in adolescents and young adults with type 1 diabetes directly compared two automated insulin delivery algorithms. Medtronic’s newer Advanced Hybrid Closed Loop (built into the MiniMed 780G system) improved glucose management more than the MiniMed 670G, though both systems showed impressive increases in Time in Range for this population. Ultimately, the 670G gave users over an hour and a half more time in range each day, while the 780G gave wearers over two hours every day in range!

Two Medtronic automated insulin delivery algorithms, the Advanced Hybrid Closed Loop and the MiniMed 670G, were recently compared in a cross-over study, allowing 113 participants to use both algorithms. Results from the study were published in the medical journal The Lancet. Notably, the study tested this technology in adolescents and young adults with type 1 diabetes ­– a group for which diabetes management is notoriously challenging. View our resources for adolescents with diabetes here.

For an introduction to automated insulin delivery (AID), check out our piece on current and coming-soon AID systems in 2021.

What is the MiniMed 670G?

The MiniMed 670G is an AID system that has been available since spring 2017 – it was the first system ever to “close the loop.” The system includes the MiniMed 670G pump, the Guardian Sensor 3 continuous glucose monitor (CGM), and an automated insulin adjustment algorithm. The algorithm adjusts basal insulin delivery every five minutes based on CGM readings, and a target of 120 mg/dl.

What is Advanced Hybrid Closed Loop?

Advanced Hybrid Closed Loop (AHCL) is Medtronic’s next-generation AID algorithm. The AHCL algorithm is used in Medtronic’s MiniMed 780G system, which is currently available in at least twelve countries in Europe. While it is not yet available in the US, Medtronic hopes to launch the 780G in the US this spring. In addition to automatic basal rate adjustments, the AHCL algorithm can also deliver automatic correction boluses and has an adjustable glucose target that goes down to 100 mg/dl. This is big news because many people using closed loop do not want to target the higher 120 mg/dl, even as a safety measure. The 780G algorithm is designed to have fewer alarms and even simpler operation than the MiniMed 670G system.

What was the study?

The newly published FLAIR (Fuzzy Logic Automated Insulin Regulation) study was conducted over six months across seven diabetes centers (four in the US, two in Europe, and one in Israel). The study enrolled 113 adolescents and young adults (ages 14-29) with type 1 diabetes. The study sample is notable, because teens and young adults with type 1 diabetes have the highest average A1C levels of any age group.

At the beginning of the study, participants performed their usual diabetes management routine for two weeks to establish their baseline glucose levels. Half of the group was then randomly assigned to use the MiniMed 670G system, while the other half of the group used the same pump and CGM, but with the new AHCL algorithm. After three months – the halfway point of the study – the two groups “crossed over,” switching to the opposite technology.

What were the results?

Nearly every measure of glucose management favored the AHCL period over the MiniMed 670G:

  • Compared to baseline, participants reduced time spent above 180 mg/dl by 1.2 hours per day when using MiniMed 670G and 1.9 hours per day when using AHCL.
  • Time in Range (TIR, time between 70-180 mg/dl) improved from a baseline of 57% to 63% using Minimed 670G and to 67% using AHCL.
  • Time spent below 70 mg/dl fell 0.2% of the time. While those 28 minutes a day may not be statistically significant – and time in severe hypoglycemia, or below 54 mg/dl, did not increase from baseline when using either algorithm – many people with diabetes would benefit from that additional half hour in range.

The graph below shows the time spent in glucose ranges during baseline, MiniMed 670G, and AHCL periods. For both algorithms, the Time in Range increase from baseline was significant – use of either AID system led to at least 14 hours more each week spent in range. Nevertheless, we also point out, of course, that the group (again, the group that has the most challenges of any age group managing diabetes) still experienced a fair amount of time above 250 mg/dl. This is  another reason for healthcare professionals and people with diabetes to think about the “whole person” when considering diabetes management, and another reason why we always recommend Adam Brown’s Bright Spots and Landmines for ways to improve diabetes management in terms of food, exercise, mindset, and sleep – it includes many strategies for people, especially teens and young adults, to use each day.

AID comparison

Image source: diaTribe

  • The biggest Time in Range improvement came overnight (between midnight to 6am). During this six-hour overnight period, AHCL users spent an average of 4.4 hours in range (74% TIR), compared to 4.2 hours (70% TIR) for 670G, and 3.5 hours (58% TIR) during baseline. While the overnight Time in Range difference between AHCL and 670G may not seem large, it added up to nearly a 22-hour difference over the three-month the AHCL period.
  • With daytime numbers, the average AHCL user spent 63 more hours (about 2.6 days) in range than the average 670G user in each three-month study period.

The graph below shows daytime and nighttime differences in time spent in range (70-180 mg/dl), and the data is included in a table at the end of this article. Better sleep the night before can also make diabetes management more effective during the day.

Comparison

Image source: diaTribe

  • Using MiniMed 670G drove an average A1C improvement from 7.9% to 7.6%, while AHCL use improved A1C from 7.9% to 7.4%.

Both systems showed extremely positive results and were found to be safe for use in young people with type 1 diabetes. The AID algorithms led to dramatic increases in Time in Range in a population that stands to benefit – over the course of a year, adolescents and young adults could spend more than ten additional days in range. The direct comparison between these two AID algorithms is highly informative – we hope to see similar trials in the future.

Comparison

Image source: diaTribe

Source: diabetesdaily.com

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

This content originally appeared on diaTribe. Republished with permission.

By Julia Kenney, Matthew Garza, and Eliza Skoler

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

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

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

Defining Key Terms

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

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

A Look at Racial Health Disparities in Diabetes

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

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

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

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

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

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

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

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

How Genetics and Biology Are Involved

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

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

Main Causes of Racial Health Disparities in Diabetes Prevalence

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

Income 

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

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

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

Unemployment and Health Insurance

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

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

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

Stat

Image source: diaTribe

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

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

Food and Exercise

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

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

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

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

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

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

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

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

The Importance of Addressing Health Inequity in Communities of Color

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

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

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

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

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

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

Source: diabetesdaily.com

CGMs to “Hack” Your Blood Sugar? People with Diabetes Speak Up

It’s becoming more and more common: whether in a coffee shop in Silicon Valley or in a weightlifting gym in Boulder, Colorado, people without diabetes are using continuous glucose monitors (CGMs) to “hack” their blood sugars, lose weight, and hone their diets accordingly. This article will explore the use of CGMs in the non-diabetic population, what the backlash from the diabetes community has been, and what the call to action should be.

CGMs for More Than Just Diabetes Management?

According to one website that promotes the use of CGMs in a non-diabetic population,

“ Wearing a CGM can facilitate the effort for someone who wants to hack their diet, blood sugar control, and overall health. This technology can go beyond a single blood sugar reading that a blood glucose meter provides. A CGM can provide real-time insight on whether blood sugar is trending up or down.”

What may seem like an innocuous accessory for the upper-class elite has many people with diabetes enraged. CGMs are crucial in providing regular, near-constant blood glucose readings to track time spent in range (TIR), identifying patterns in blood sugars, and anticipating both low and high levels.

The Original Purpose of a Continuous Glucose Monitor

For people with diabetes, they are life-saving, and more and more often are being coupled with insulin pumps that will then increase or suspend insulin according to the blood sugar that a CGM reads. It almost entirely eliminates the need for manual finger testing and has proven to help lower HbA1c levels, reduce dangerous low blood sugars, increase time in range, prevent unnecessary emergency room (ER) visits, and save the health care system money and save many lives. It has quickly become a necessity for tight diabetes management in recent years for many people.

For something so seemingly necessary for most people with diabetes, it clearly isn’t seen that way by industry: 16 states, including California (the most populous), do not have Medicaid coverage for continuous glucose monitors at all. And while most private health insurance plans (and even Medicare) now cover CGMs, affording one without health insurance is nearly impossible: the most popular CGM and the one that most commonly connects with insulin pumps, the Dexcom CGM, costs thousands of dollars out of pocket per month without insurance.

So when someone with diabetes, who is already struggling to afford their insulin, goes to the local coffee shop and overhears two dudes from Crossfit comparing their (perfect) blood sugar readings on their respective CGMs over their non-fat decaf lattes, the inequity of the situation can be enough to make your skin crawl.

Clair from Illinois says,

“The general population using CGM devices trivializes them.”

Cate from Nebraska adds,

“It absolutely incenses me [when non-diabetics use CGMs]. There’s a local doctor in my area who treats patients for weight loss and gives everyone a free CGM; meanwhile, it’s an arm and a leg to refill my own.”

Bonnie from Minneapolis says,

“It drives me absolutely bananas.”

We Are All Just Products of the System

Managing diabetes with a continuous glucose monitor is life-changing, but it is expensive, and living with diabetes in America is anything but easy. We have the most expensive insulin prices in the world, health insurance isn’t compulsory or cheap, and even when you do have a job that has health insurance, necessary diabetes technology is sometimes not even covered or affordable under your plan.

Seeing people use technology that we need can be seen as a slap in the face, but we’re directing our anger at the wrong place. The problem with accessibility in the United States is not a supply issue. The problem with accessibility in the United States is that we use health care as a commodity when it is not. We put health care into a capitalist box when it’s something that should be treated as the human right it is. We’ve priced people out of their lives. We treat things like insulin and insulin pumps and continuous glucose monitors as if they’re elastic goods when they’re 100% inelastic. We cannot negotiate our own pricing for insulin. We can’t haggle down the price or walk away. We need the drug or we die.

People without diabetes see products like continuous glucose monitors as the valuable goods they are and are willing to pay for them. No person who uses a CGM recreationally has it covered by their insurance, and it’s important to remember that.

It’s not a zero-sum game where someone’s CGM that’s paid for out of pocket in San Francisco precludes another person on Maine’s Medicaid program from accessing one of their own, but it feels like it does. Instead of taking our anger out on the gym-rat in Colorado who’s paying thousands of dollars out of pocket for their Dexcom each month (which is stupid, but why question their motives?), we should be angry at the government and systems that created this situation to begin with.

If the United States had a single-payer health care system where everyone who lives here had health coverage, we wouldn’t care what people buy on the free market. If all plans (including Medicaid!) covered CGM use for people with diabetes at 100% of the cost, it wouldn’t bother us what anyone else was doing with their blood sugar levels (diabetic or not). It’s a symptom of a system that denies people with diabetes the proper care and regular, reliable access to proper durable medical equipment that makes them covet these devices as much as we do. There’s nothing inherently wrong with people without diabetes using CGMs, but it does sure feel like there should be. 

CGM for non-diabetic population

Photo credit: iStock

Some People Support Wider Use of CGMs

In speaking with others for this story, I found several people who encourage non-diabetics to use CGMs, like Mindy, a registered dietician from Colorado,

“I am pleased that there is adequate supply for people without diabetes who can view the real-time movements and fluctuations of blood glucose. The more understanding there is in groups of non-DMs, maybe we can finally change the direction of people diagnosed with (type 2) in the future.”

Christie, from California, added,

“being mad about someone having a CGM that they bought on the free-market is similar to someone with hypertension being angry over another person having an at-home blood pressure monitor. It just doesn’t compute.”

In a country with nearly 100 million people living with prediabetes, learning to respond to blood sugar trends and figuring out which foods work best for your body can only be a good thing. And although it hasn’t happened yet, the more “mainstream” these devices become, the more affordable they’re bound to become, which would be great for everyone. Additionally, for shy diabetics, CGMs becoming more mainstream can also take away the stigma of having a visible device on your body 24/7. It’s suddenly “cool”.

Benefits for Everyone

Whether or not you have diabetes, a continuous glucose monitor can help with several things:

  • Learning how your body responds to certain foods (grapes versus crackers, for instance)
  • Identifying blood sugar patterns around mealtime and exercise
  • Diagnosing diabetes before the onset of ketoacidosis (DKA) in people at high risk (people who are overweight, obese, live with prediabetes, or who have the antibodies for type 1 diabetes)
  • Improving blood sugar to help maximize energy for a workouts
  • Helping people lose weight by managing their hunger (which is the result of fewer blood sugar fluctuations throughout the day)

In a country where over 70 million adults are obese and another 99 million are overweight, having more data regarding how our bodies respond to the foods we eat is vital. We have a type 2 diabetes epidemic on our hands that is only getting worse, and wider CGM usage may help curb that, but people need to be careful.

Using them as “wellness gimmicks” may bombard those who truly do not understand the relationship between glucose and blood sugars, leaving users overwhelmed with data and confused, while not making any dietary changes at all. In a true market economy, the greater the demand, the more competition will spring up, the more prices will fall (for both people with and without diabetes).

The real issue that people need to focus on is making sure that everyone with diabetes who wants a CGM can get one, but people without diabetes accessing CGMs on the open market will not prevent that from happening. We need to push for greater coverage for CGMs on the private and public health insurance market with our elected officials and make sure that we inch ever closer to the illustrious universal health care system that other industrialized countries enjoy. We need to make sure that everyone with diabetes has access to affordable insulin, pumps, and supplies (including CGMs), with strong grassroots advocacy to equip people with all the tools they need to thrive. If we achieve universal health care maybe someday everyone who truly needs a CGM can get one, but until then, let the Crossfit bro with his Dexcom sensor alone. Although you can let him know that the caffeine in his latte will raise his blood sugar a few points in the meantime.

Source: diabetesdaily.com

Diabetes and Hangovers: What You Need to Know

Anyone who lives with diabetes knows that a hangover can wreak havoc not only on productivity and sense of well-being but also on your blood sugars, leaving them unpredictable for hours and even days. When you’ve had too much to drink and you’re feeling hungover, what can you do?

This article will touch upon the best course of action to take to help your diabetes management when you are hungover, the best food and beverages to help treat a hangover, and how you can prevent a hangover in the future.

What Exactly Is a Hangover?

A hangover, quite simply, is the culmination of unpleasant symptoms that develop several hours after drinking too much alcohol. Common signs of a hangover include:

  • Headache
  • Nausea, vomiting, or stomach pain
  • Light and sound sensitivity
  • Fatigue
  • Thirst
  • Dizziness
  • Poor sleep quality
  • Decreased ability to concentrate

More severe symptoms of a hangover include:

  • Shallow breathing
  • Low body temperature
  • Excessive vomiting (not able to hold down water)
  • Confusion
  • Seizures
  • Blue-tinged skin
  • Loss of consciousness

If someone you know is experiencing severe symptoms of a hangover, seek emergency medical treatment immediately, or call 911.

So You’re Hungover; What Should You Do?

A hangover’s nemesis is time and hydration. Most hangovers disappear within 24 hours, although some can last for days. It can be excruciating, but sometimes you simply must wait it out.

While you’re waiting, the next best thing you can do is hydrate with water (about 15.5 cups, or 3.7 liters, of fluids a day for men and about 11.5 cups, or 2.7 liters, of fluids a day for women), and make sure to get plenty of electrolytes from sources such as coconut water and sports drinks (although make sure to count carbohydrates and dose insulin appropriately, if needed).

The caffeine in coffee can also energize you and can be beneficial for headaches and sleepiness after a night of drinking. Staying adequately hydrated will also make blood sugar management easier.

It is also extremely important to keep a close watch on your blood sugars and watch for any signs or symptoms of developing diabetic ketoacidosis (DKA), which can be life-threatening. Check your blood sugar every few hours or wear a continuous glucose monitor (CGM) to make sure you’re staying in range, as recommended by your doctor.

If you notice your blood sugar remaining stubbornly high (at or above 250 mg/dL) for several hours or more and you have moderate to high ketones, contact your doctor right away and seek medical attention to prevent developing DKA. You may need IV fluids administered at a hospital to hydrate and an intravenous insulin drip, which can bring blood sugars down more aggressively than subcutaneous injections at home.

Some people experience low blood sugars after a night of drinking because the liver is busy processing the alcohol content from drinks consumed, leaving one to fend for themselves because glycogen (glucose) will not be released if one’s blood sugar starts to drop. The more one drinks, the greater the likelihood of low blood sugar, which can be dangerous.

glucose tabs

Tip: Carry glucose tabs when you’re drinking with friends. | Photo credit: iStock

People with diabetes should always carry glucose tabs or gel with them in case of an emergency low and should check their blood sugar regularly both during and after drinking. It’s also important to remember that some diabetes medications may not work as well if too much alcohol is consumed, especially type 2 diabetes medications.

If your blood sugars are staying within range and you don’t feel too nauseous, make sure to eat a good meal, which helps combat hangovers and stabilizes blood sugar. Aim for a balance of carbohydrates, fat, and protein. Some recommended foods include:

  • Bananas
  • Oranges
  • Eggs
  • Avocados
  • Rice
  • Oatmeal
  • Toast
  • Crackers
  • Clear broth soup

Getting plenty of sleep also helps remedy a hangover; alcohol notoriously disturbs sleep patterns, so if you didn’t get a good night’s rest after drinking, taking a nap the next day can help you bounce back quicker.

Some people take over-the-counter pain relievers, such as aspirin or ibuprofen, to manage symptoms. If you’re unsure what to take or are worried about the side effects of any over-the-counter medication, talk with your doctor about what will work best for you.

Finally, even though you may not feel well, getting outside for a quick, 20-minute walk can help revitalize you, get some fresh air into your lungs, and help you feel better faster. While vigorous exercise is not recommended while hungover, some light exercise can boost not only your mental health but will charge the cardiovascular system and speed up recovery.

How to Prevent a Hangover

The surest way to prevent a hangover is by abstaining from alcohol or only drinking in moderation. Some other tactics to help prevent hangovers include:

  • Drink alcohol only with food and never on an empty stomach
  • Drink slowly
  • Make sure you stay hydrated with water while drinking (a good rule of thumb is drinking one glass of water for every alcoholic beverage)
  • Keep a close watch on your blood sugar (sugary alcoholic beverages can make your blood sugars spike, while the alcohol itself can make you crash. Be wary of both consequences and check your blood sugar often).
  • Avoid sugary mixed drinks and sweet wines, which are not only bad for blood sugars but may also make hangovers much worse. Instead, mix liquor with water, seltzer water, or diet drinks.
  • Know your limits, and stick to them
  • Stick with friends or family who will watch (and potentially limit) your alcohol intake
  • Avoid alcohol that contains higher amounts of congeners: congeners give many types of alcoholic beverages their flavor. They are found in larger amounts primarily in dark liquors (like brandy and bourbon) and contribute to worse hangovers. Instead, choose lighter beverages such as vodka, white wine, or gin
  • Eat something (like a banana) and drink water before going to bed after a night of drinking

Hangovers are an unpleasant side-effect of drinking alcohol, and having a hangover with diabetes makes them all the more complicated. But with these strategies, you can help prevent hangovers in the future, while still imbibing from time to time.

If you think you have a problem with drinking or develop signs of alcohol addiction, get help immediately.

Source: diabetesdaily.com

My Decision to Get Screened for Type 1 Diabetes

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

By Jorge A. Aguilar

My mom lives with type 1 diabetes. Do you wonder what that is? Well, type 1 diabetes is a life condition in which you have to be careful in what you eat, your exercise, and you have to have good control of your blood sugar levels and make a balance with the insulin you need. This is because your body destroys the cells that make insulin and then stops making it.

When I Was Little

Since I was born my mom taught me how to help her change her insulin pump and refill it, I would pass her the things she needed and we pretended that I was a health professional. I learned quickly how to inject insulin and she also taught me how to help her in an emergency.

I remember one morning I wanted to show her something in a video game, to which she said, “Yes, I’m coming.” That’s completely normal except for the fact that she sounded weird in some way. I called my dad and it turned out that my mom had hypoglycemia and I had to help her. Fortunately, I acted in time and she sure doesn’t even remember.

Type 1 Diabetes Is Interesting and Sometimes Worrisome

I find it interesting that it is normal for people with diabetes to inject insulin and endure pain from time to time. Even vaccines scare me, they scare the hell out of me.

It is sometimes scary to think that she could have hypoglycemia while sleeping and might not wake up. It’s also scary to be extra careful with what you eat and to avoid eating certain types of food if you want to have everything under a perfect balance. It seems that living with type 1 diabetes is a lot of work.

Know My Risks

I know there is some genetic risk. I understand that this means that at some point in my life I could develop type 1 diabetes although I also understand, from what I read and my mother has told me, that this risk is small. I think whatever it is I would like to know if I have that risk or not to be prepared later in my life.

I think that if I knew if I had antibodies that would one day attack the cells in my body that produce insulin, I could be calm but also very prepared because I would let my parents know if I had any symptoms like the ones my mother usually talks about at work: thirst, really wanting to go to the bathroom, feeling very hungry, and feeling very tired, among others.

Know Your Risks

My mom helped me ask Indigo for his opinion. Indigo’s mother also lives with type 1 diabetes and he told us that he would definitely have this test done because “knowing the risk, he could take action.” He told us that getting tested would help him get ready by asking his mother lots of questions. He confessed that he would pay more attention to the things his mom does and says and that it would definitely not cause him stress because he has seen her taking good care of herself and succeeding. He does not consider this as something complicated as he spends a lot of time watching his mother do all this and other stuff in life.

I think that if it were possible for everyone to take the test they should do it because, on the one hand, it does not affect you at all to take a test, on the other you contribute to science and finally, it is a good way to prepare yourself mentally for what comes in your lifetime. If it comes.

You should take a diabetes antibody test because you may learn that you are likely to develop type 1 diabetes and you may learn to take better care of yourself with or without risk.

Source: diabetesdaily.com

The Importance of Sleep Health for Diabetes

Everyone who lives with diabetes knows that the cornerstones of successful management include insulin therapy, strict monitoring of one’s diet, exercise, and managing stress. But another, lesser-known key element to good diabetes management is sleep health.

According to the Centers for Disease Control and Prevention (CDC), nearly 1 in 3 Americans don’t get enough sleep. The National Sleep Foundation recommends that adults between 18 and 60 sleep at least 7 hours every night. Sleeping less than that is associated with an increased risk of developing chronic conditions such as obesity, type 2 diabetes, hypertension, heart disease, and even stroke.

Sleep health is especially important for people with diabetes. This article will outline the reasons why sleep health is so important and how you can improve your sleep health to improve your diabetes management.

Why Is Sleep Important?

Sleep is important for everyone. Sleep plays an important role not only in physical health but in mental health maintenance as well. During sleep, the body heals and repairs cells damaged during the day (like muscles worked and stretched during exercise), and even restores and clears out both heart and blood vessels, reducing inflammation throughout the body.

Sleep brings much-needed balance back to hormone levels, such as cortisol, serotonin, leptin, ghrelin, melatonin, and adrenaline, working to restore mental and emotional health. Restoration of these key hormones helps the body control stress, combat depression, achieve satiety, and manage hunger levels throughout the day.

Most importantly, sleep helps protect immune function. One study monitored the development of the common cold after giving people nasal drops with the virus to a group of people. The researchers discovered that those who sleep fewer than 7 hours for two weeks were nearly 3 times more likely to develop a cold than those in the study who slept 8 or more hours each night for the duration of the study.

Americans Are Not Getting Enough Sleep

This is all great, except Americans are simply not getting enough sleep. City-dwellers are more likely than those living in rural areas to suffer from sleep deprivation, and the CDC shows that the northeastern and Appalachian mountain parts of the country are the most affected. Nearly 11 percent of Americans are only getting 6 or fewer hours of sleep per night!

There are many reasons why people aren’t getting enough sleep: 24/7 technology, ever-increasing workloads, light and noise pollution in cities, the but most stunning reason, from the National Sleep Foundation, is that Americans simply don’t prioritize sleep.

In a survey, when Americans were asked which of five activities were most important to them, just 10% of people said sleep, the lowest by far out of exercise, nutrition, work, and other hobbies.

As a nation we are not getting enough sleep,” said Dr. Wayne Giles, director of CDC’s Division of Population Health. “Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, mobile devices from the bedroom, can help people get the healthy sleep they need.”

People With Diabetes Need to Prioritize Sleep!

Even though sleep is often disrupted because of diabetes due to CGM alarms, insulin pumps beeping, low and high blood sugars, and the 24/7 nature of the disease, sleep is crucial for good diabetes management.

“Getting inadequate amounts of sleep can negatively impact blood sugar levels short and long term,” says Dr. Gregg Faiman, an endocrinologist at University Hospitals Cleveland Medical Center. “In fact, sleep is as essential to your health as nutrition and exercise,” he says.

Not having enough of it can cause insulin resistance and insatiable hunger due to out of balance hormones, fatigue that makes exercising more difficult, and brain fog that makes carbohydrate counting and the self-control to properly manage food and diet harder.

Sleep affects all other elements of diabetes management: when you don’t have enough sleep, you need more insulin (due to insulin resistance from spiked cortisol levels) to control blood sugars, your body is hungrier when your hormonal leptin levels are off balance, which makes eating and balancing carbohydrates more complex, you’re more tired which makes exercise all the more difficult, and your body is naturally stressed out, wreaking havoc on diabetes management.

Plus, if you nap during the day to try and make up for a bad night’s rest, you may not be tired at bedtime, and one sleepless night can lead to two, which can then turn into a chronic problem, which sets the stage for harder to control blood sugars, higher HbA1c, and possibly even complications later on in life.

how to get enough sleep

Photo credit: iStock

Strategies to Improve Sleep Health

Creating good sleep habits can take time, but the following recommendations can help you improve your sleep, which will positively affect not only your diabetes management but your overall health as well:

  • Exercise daily so you are tired at bedtime
  • Avoid all caffeine after 12 p.m.
  • Go to sleep and wake up at the same time every day
  • Do not nap during the day
  • Use the bathroom right before bed, so you don’t wake up in the middle of the night to go
  • Limit fluids before bed
  • Make sure your blood sugar isn’t too high or low at bedtime
  • Turn your thermostat down at bedtime for more peaceful sleep
  • Take a relaxing bath before bed
  • Eat foods that contain natural melatonin at night: cherries, pomegranate, grapes, walnuts, peanuts, or sunflower seeds work well
  • Do some gentle yoga, meditation, or breathing exercises to calm you down before bed
  • Do not allow screens in the bedroom; opt for journaling or reading in bed instead (except, of course, your continuous glucose monitor and insulin pump)
  • Close all curtains and make your room as dark as possible
  • Keep pets outside of the bedroom, and especially off the bed (except diabetes alert dogs, of course).

Managing sleep can be complex and challenging, but making sure to get at least 7 hours of quality sleep per night will make diabetes management easier and better blood sugars more achievable.

Try out these tactics for several weeks, and see if any make a meaningful difference in the amount of quality sleep you’re getting each night, and if it has any positive effects on blood sugar levels the next day.

While an underrated component of diabetes health, sleep is crucial for better blood sugar management, one night at a time. Do you struggle with getting an adequate amount of quality sleep each night? What tactics have helped you improve your sleep health? Share this post and comment below!

Source: diabetesdaily.com

5 Ways to Make Time for Exercise

Prioritizing yourself isn’t easy. Whether your busy taking care of kids, an elderly parent, hustling at your job, or just life in general, it is sometimes hard to remember to take of yourself. This means getting adequate sleep, checking your blood sugar regularly, eating a proper diet and getting in physical activity. All of which can also help you better manage your diabetes and overall health. But finding the time is not an easy feat.

Here are 5 ways you can make the time for exercise:

Make an Appointment

Just like you schedule meetings, lunch dates, and family functions, your hour of exercise deserves a daily slot too. Once it is on your schedule, you can plan other commitments accordingly, and prioritize your health.

Meal Prep

Many people spend a great deal of time preparing meals for themselves and their families. This can really eat up a good chunk of your free time. Think ahead and meal prep. You can easily prepare an entire week’s worth of meals in just a few hours, freeing up enough time each day to get yourself moving!

Work Within Your Confinements

Making time is easier said than done. And many people work long hours, two jobs, and have other responsibilities that do not afford a lot of free time. Get creative. There are things you can do, some like calisthenics throughout the day to keep your blood flowing. You can also look to invest in a desk bike or an under the desk elliptical. These gems are a worthy investment if you are unable to find time to go to a gym. It will allow you to work and work out at the same time!

Find a Workout Buddy

Staying accountable is a key to success, so having someone there to push you can only help you to achieve your goals. You would be more likely to take a long stroll at 6 am with some good conversation rather than go at it alone. Reach out to friends and see if they’d be interested, I bet you’d be surprised at the response!

Think Big Picture

We are often thinking of others before ourselves, which shows we care. We mustn’t forget the importance of making our health a priority, so we can be around for our loved ones for a long time to come. If you are bogged down with work or consumed with other things, remember health is wealth, and that must come first!

Putting ourselves first isn’t something we easily do, but it is important for our long-term health. A little bit of physical activity can go a long way in managing your diabetes and your overall health!

Have you found time for exercise despite being too busy? What motivates you on a day-to-day basis?

Source: diabetesdaily.com

Tech on the Horizon: Where Will Automated Insulin Delivery (AID) be in 2021?

This content originally appeared on diaTribe. Republished with permission.

By Albert Cai

What AID systems are currently available, what can we expect in the next year, and where is AID technology headed?

Want more information just like this?

As we enter 2021, we’re taking a look at what’s ahead for automated insulin delivery (AID) systems. Because the COVID-19 pandemic delayed many clinical trials and FDA reviews in 2020, several companies are expecting to launch new AID systems in 2021. This list covers many of the most notable upcoming products, but there are likely others on the horizon – if you know of a system you think we should track, please let us know.

Click to jump to a product, organized by expected launch date. You’ll find detailed descriptions and possible launch timelines for each, reflecting US availability.

What is automated insulin delivery (AID)?

Automated insulin delivery has many names – artificial pancreas, hybrid closed loop, bionic pancreas, predictive low-glucose suspend – but all share the same goal: combining continuous glucose monitors (CGMs) with smart algorithms to automatically adjust insulin delivery via an insulin pump. AID systems aim to reduce or eliminate hypoglycemia, improve Time in Range, and reduce hyperglycemia – especially postmeal and overnight.

When thinking about the development of AID technology, it’s often helpful to think in stages.

  • Stage 1: The most basic AID system might shut off the insulin pump whenever the user’s CGM readings drop below a certain number, such as 70 mg/dl, to reduce time spent in hypoglycemia and help prevent severe hypoglycemia.
  • Stage 2: The AID system could predict when glucose is going to go low and automatically reduce or stop insulin delivery to further help prevent hypoglycemia.
  • Stage 3: The AID system may be able to automatically adjust basal insulin delivery depending on whether the user’s glucose is trending up or down, and taking into account other factors, such as insulin on board. This adjustment of basal insulin would aim to increase Time in Range (TIR), and help prevent both high and low glucose levels. At this stage, the user would still have to manually give meal boluses and correction boluses.
  • Stage 4: The AID system will be able to deliver correction boluses when glucose values are high. These small adjustment boluses would be a further step in improving TIR, with less time with hyperglycemia.
  • Stage 5: The systems will be able to detect meals and automatically deliver a system-calculated meal bolus to reduce postmeal high blood glucose levels. With the elimination of manual meal bolusing, the system is considered to be a “fully closed loop” System.

Currently available products are in stages 3-4. By the end of 2021, we may have multiple stage 4 systems available.

Medtronic MiniMed 670G and 770G – already available 

AID

Image source: diaTribe

Now available for people over the age of two.

What is it? Medtronic’s MiniMed 670G has been available since spring 2017 and was the first stage 3 AID system to be cleared by the FDA. Prior to the 670G, Medtronic released stage 1 and stage 2 systems (Medtronic MiniMed 530Gand 630G, respectively). More recently, the MiniMed 770G system was cleared in the US in September 2020. Both the MiniMed 670G and 770G systems use the same insulin adjustment algorithm, which adjusts basal insulin delivery every five minutes based on CGM readings, targeting 120 mg/dl. The target glucose level can be temporarily raised to 150 mg/dl when low blood sugar (is a concern, such as during exercise or sleepovers for children. Both systems come with Medtronic’s Guardian Sensor 3 CGM, which has seven-day wear and requires two fingerstick calibrations per day (although four are recommended). See our article from 2016 for a full breakdown on the MiniMed 670G and from September for more on the 770G.

What’s the difference between the MiniMed 670G and 770G? As mentioned, both the MiniMed 670G and 770G systems use the same insulin adjustment algorithm and the same CGM. However, the newer MiniMed 770G has an improved pump: the 770G pump includes Bluetooth connectivity and can be paired to the MiniMed Mobile smartphone app (available for the iOS and Android) for users to view their CGM and pump information without pulling out their pumps. The app also allows users to share their data with others in real-time. Note: users can only view information but cannot control the pump (e.g., deliver a bolus, adjust basal rates) from the app. Bluetooth connectivity also means the system’s insulin adjustment algorithm can be updated. Medtronic has promised current MiniMed 770G users a free upgrade to the MiniMed 780G when that system becomes available (more below). Finally, the MiniMed 670G is only cleared in the US for people over the age of seven, while the MiniMed 770G is cleared for people over the age of two.

Medtronic management recently shared that algorithms will become an increasingly important part of the diabetes ecosystem, and presumably, a key differentiator for companies – lots of exciting times ahead with AID, that is for certain.

Tandem Control-IQ – already available in US

AID

Image source: diaTribe

Now available for people six years and older.

What is it? The Control-IQ system from Tandem was cleared by the FDA at the end of 2019 and launched to customers in January 2020. It’s precursor – Basal-IQ – was cleared in 2018. The Control-IQ system uses Tandem’s t:slim X2 pump, Dexcom’s G6 CGM which requires no fingerstick calibrations, and the Control-IQ insulin adjustment algorithm. In addition to automatic basal rate adjustments and predictive insulin suspension, the Control-IQ system is the only AID system with automatic correction boluses: when it predicts glucose to be above 180 mg/dL in 30 minutes, the system will deliver 60% of the correction bolus needed to reach a target of 110 mg/dL. Control-IQ targets glucose values between 112.5 and 160 mg/dL, though users can turn on or schedule “Sleep Activity” mode to achieve 112.5-120 mg/dL by the morning. This past summer, Tandem launched the t:connect smartphone app (for iOS and Android), which allows users to check their pump and CGM data on their phones.

What’s next? With the current t:connect smartphone app, users can view information but cannot control the pump (e.g., deliver a bolus, adjust basal rates). Tandem has already submitted an updated app with pump control to the FDA and expects to launch that functionality in 2021. Tandem has also mentioned enhancements to the Control-IQ algorithm that are expected in 2021. While we haven’t heard many specifics, we believe it’s likely that these enhancements will focus on improving glycemic outcomes, personalization, and usability of the system.

Insulet Omnipod 5 – expected early-to-mid-2021 

AID

Image source: diaTribe

FDA submission is likely coming soon (if it hasn’t occurred already), and Insulet aims for a “limited” launch in early-to-mid 2021. Insulet has completed the clinical trial for Omnipod 5 but has not shared the results.

What’s new? Omnipod 5 is Insulet’s AID for its popular Omnipod disposable pumps, also called patch pumps. If you’ve been following the field, you’ll know that Insulet previously called the new system Horizon – same system, new name. Omnipod 5 uses Dexcom’s G6 CGM, and Insulet expects to launch the system with smartphone control capability; users can still opt for a dedicated controller device, since smartphone control will be available for Android users first. Insulet is working on an iPhone version for Omnipod 5, though that will not be available at launch. Insulet is also working with Tidepool (more below) on an iPhone-based AID system. Omnipod 5 will have adjustable targets between 100 to 150 mg/dl. Because the Omnipod pump will store the algorithm and communicate directly with Dexcom G6, the system will work even without the smartphone or pump controller nearby.

Medtronic MiniMed 780G – expected mid-2021

AID

Image source: diaTribe

Pivotal trial completed for 780G and presented at ADA 2020. Medtronic aims to submit the system to the FDA by January 2021 with launch coming around mid-2021 for adults (either ages 14+ or 18+).

What’s new? The MiniMed 780G will be Medtronic’s second AID algorithm and a significant upgrade over the MiniMed 670G and 770G systems. In addition to automatic basal rate adjustments, the MiniMed 780G will include automatic correction boluses and an adjustable glucose target down to 100 mg/dl. The system will also have fewer alarms and simpler operation with the goal of further increasing Time in Range. The MiniMed 770G and MiniMed 780G pumps are identical, meaning MiniMed 780G users will also be able to use the MiniMed Mobile smartphone app for viewing pump data, uploading pump data wirelessly, and updating their pump wirelessly. As the pumps are identical, Medtronic has promised that those who purchase the MiniMed 770G now will be able to wirelessly upgrade to the MiniMed 780G for free when 780G does become available. Finally, the MiniMed 780G will use the same Guardian Sensor 3 CGM as the 670G and 770G, which requires two fingerstick calibrations per day and has a seven-day wear time. As a sidenote, an improved CGM sensor is in development by Medtronic, but isn’t expected to be available when MiniMed 780G launches.

The MiniMed 780G is already available in many countries in Europe, and data from a clinical trial was presented at the ADA 2020 conference. On average, the 157 participants in the study (ages 14-75) saw their Time in Range improve by 1.4 hours per day (69% to 75%) while using the system – that’s particularly notable given the low baseline of the A1C. Speaking of A1C, the A1C improved by 0.5% (7.5% to 7%) after using the system.

Beta Bionics insulin-only iLet – expected mid-to-late-2021

AID

Image source: diaTribe

Pivotal trial underway with completion expected in the first half of 2021. Launch expected mid-to-late-2021, though this is subject to change.

What’s new? Beta Bionics is a Massachusetts-based startup developing an AID pump and algorithm called iLet. iLet will work with Dexcom and Senseonics’ CGMs (and possibly others in the future) and is designed to be especially user-friendly. diaTribe founder Kelly Close participated in an early Beta Bionics trial (2013!) and raved about the system and how easy the pump seems. At set up, users only need to enter body weight (no insulin-to-carb ratio, sensitivity factor, basal rates, etc.), and the system will learn more over time. To bolus, users will use icons to describe meals as containing more, less, or the same amount of carbs as usual (no carb counting). The insulin-only clinical trial for iLet began in the summer of 2020 and is expected to wrap up in the first half of 2021. Beta Bionics aims to launch iLet mid-to-late-2021, though this could be delayed as the FDA continues to prioritize COVID-19-related devices.

What’s next? Beta Bionics’ iLet is unique from the other pumps on this list, because it is designed to work in either insulin-only or insulin-and-glucagon configurations. With glucagon, Beta Bionics believes the system can reduce hypoglycemia while maintaining stable glucose levels and potentially even better-than-average, lower glucose levels due to availability of glucagon. Currently, there are different views on using glucagon in an AID system – in addition to the potential for improved glycemic management, there are uncertainties around glucagon pricing and availability. Regardless, the insulin-and-glucagon version of iLet is still a few years away.

Tidepool Loop – launch timing unclear

AID

Image source: diaTribe

Online observational study completed, and launch timeline depends on FDA progress.

What’s new? Unlike the others in this list, Tidepool is a non-profit and is working on the AID algorithm only; Tidepool does not have its own insulin pump or its own pump and CGM combination (like Medtronic). About two years ago, Tidepool announced plans to submit the do-it-yourself (DIY) Loop app to the FDA to become an officially supported app available on the Apple App Store, compatible with in-warranty, commercially available pumps and CGMs. For now, DIY Loop is a free, publicly available, open-source, non-FDA-approved AID system that works with Dexcom and Medtronic CGMs and old Medtronic and Insulet pumps. Read about Adam Brown’s experience using DIY Loop here. For those who are very interested in the project, there is a great deal to learn from notes that Tidepool shares about its communications with FDA – the latest notes are from a mid-2020 meeting.

Initially, Tidepool plans to launch with Insulet Omnipod and Dexcom G6 compatibility. To set it apart from the DIY-version, Tidepool Loop will have different colors, guardrails around certain settings, and a built-in tutorial for new users. A 12-month, completely virtual study was performed with Loop users and will support Tidepool’s submission of Loop to the FDA. The six-month data was presented at ATTD 2020 showing a Time in Range increase of about 1.4 hours per day (67% to 73%) with Loop. Tidepool also announced in November, 2020 that its human factors study had also been completed – this is another required step of the FDA submission. Much of what Tidepool is doing is unprecedented, so the launch timing is unclear.  In an update on January 8th, Tidepool shared that it has now completed FDA submission of Loop.

Source: diabetesdaily.com

How to Have a Healthy Relationship With Food

People with diabetes have a notoriously complex relationship with food. Food and nutrition are a cornerstone of a healthy life with diabetes, and balancing it with insulin intake, exercise, sleep, and stress management can be a lot to handle. This article will outline strategies that you can implement to cultivate a healthier relationship with food. Warning: this article may contain triggers for people who struggle with disordered eating and/or body dysmorphia.

Having a healthy relationship with food takes time and is sometimes difficult to achieve for some people, especially if you live with diabetes. Studies show that people with diabetes are more than twice as likely to have an eating disorder.

The most common eating disorders are anorexia nervosa, bulimia, and binge-eating disorder, but people with diabetes may also suffer a unique disorder to their condition: diabulimia, where one withholds insulin (and eats as per usual), letting blood sugar levels skyrocket in order to lose weight rapidly.

Combine diabetes with any of these eating disorders is a recipe for disaster, and can quickly lead to serious complications and even death. So, how can you develop a healthy relationship with food, when so much of diabetes involves counting, tracking, measuring, and constantly thinking about everything we put into our mouths?

Learn to Follow Hunger Cues

Diabetes can warp one’s thinking about food. Often, people with diabetes respond more to their blood sugar levels than their hunger pangs. One will always eat when they’re low, for example, but if their blood sugar is high but they’re hungry, they will often wait until glucose reaches more normal levels before eating. This can be healthy from a blood sugar and HbA1c point of view but does not help establish a healthy relationship with food.

If your blood sugars are well-managed, learn to follow hunger cues in addition to blood sugar needs. Eat when you’re hungry and stop when you’re nearly full. It can be helpful to eat lower carbohydrate foods if you’re hungry but your blood sugar is high, but don’t punish yourself by skipping meals altogether.

Photo credit: iStock

Practice Mindful Eating

People tend to multitask and do a million things at once, and in our fast-paced world, that can come to be expected. One thing that you should never multitask, however, is eating. Take the time to put your phone down, close your laptop, step away from the television, and really enjoy a meal without distraction. Take the time to smell your food, feel the texture, chew thoroughly, and really taste the flavors.

Practicing mindful eating helps prevent overeating, and the experience will leave you more sated. Slow down and really enjoy your meal. Practicing being in the moment and savoring your food, being thankful, and appreciating all of the work that went into growing, cultivating, and cooking a meal can help form a healthier relationship with food.

There Are No “Good” or “Bad” Foods

Understand that there are no “good” or “bad” foods. No food should be forbidden (unless, of course, you have a serious allergy or celiac disease). Labeling foods as “off-limits” puts them on a pedestal and makes people more likely to binge eat them later on.

At least one study confirmed this; a group of dieters and non-dieters were given a milkshake to drink and then were ushered into private rooms where they could eat an unlimited amount of cookies. Shockingly, non-dieters were much better at regulating their cookie intake and stopped eating when they felt satisfied, while the dieters ate significantly more cookies. Labeling the milkshake “bad”, the dieters felt that since the milkshake already “broke” the rules of their diet, they might as well overeat the cookies.

This is counterproductive, as having a treat every now and again will do nothing to “ruin” a diet, HbA1c, or your diabetes control. Treats and incorporating foods that you enjoy just for the sake of enjoying them are crucial to sound mental health and is a key to a healthy relationship with food.

Make space in your diet to incorporate treats, so you never feel deprived, and never label foods as “good” and “bad”. If you’re recovering from disordered eating, do not forbid entire food groups. For example saying, “I’ll never eat grains again” will make you much more likely to binge eat it and can cause your mental health to go into a tailspin.

Think in Terms of How You Can Nourish Your Body

People caught up in disordered eating often fixate on calories (and sometimes if you live with diabetes, severely restricting carbohydrates). Shift your thinking. Instead, ask yourself, “how can I best nourish my body today?” Make sure to include healthy fats, protein, and carbohydrates into your diet to fuel your activity and life.

Instead of exercising to “burn off” whatever it was that you ate that day, flip the narrative and ask yourself how can you best nourish yourself for the activity and day ahead? It can be helpful to look at specific vitamins and minerals as well.

This can also help incorporate new foods into your diet that you may have traditionally been hesitant to try. For example, if you have some ice cream after dinner, note the fact that it has both calcium and vitamin D in it. Bread, too, often has lots of fiber and thiamine (vitamin B1). See the good in all foods, and focus on the nutrients they provide. This will help heal your relationship with foods and incorporate new foods into your diet.

Photo credit: iStock

Seek Professional Help

Managing a chronic disease that requires constant vigilance in your diet and the foods you consume can be exhausting, but you don’t have to go it alone. Ask your doctor for a referral and enlist help from a registered dietitian or nutritionist, who can help you craft a meal plan that will work for both your diabetes and non-diabetes related goals, and will also be specific to your activity level and lifestyle.

If you’re struggling with disordered eating and think you are developing an eating disorder, get help right away. Seeing a psychologist or diabetes therapist can also be beneficial for those struggling to heal their relationship with food.

Relationships with food, especially while living with diabetes, are personal, complex, and require regular work to keep healthy. By following these strategies, it’s possible to get to a place in which food no longer controls your thoughts, and instead, fuels your overall physical and emotional well-being.

A healthy relationship with food means balancing nutrition with your diabetes needs, not labeling foods as either “good” or “bad”, seeing the value in nutrition beyond calories and carbohydrates, and remembering that food doesn’t have power over you.

Taking the first steps to fix a bad relationship with food can be complicated, but is well worth the effort.

Source: diabetesdaily.com

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