How Telemedicine Improves Diabetes Care

How Telemedicine Improves Diabetes Care

By Heather Nelson

Rapid advances in telehealth have provided doctors a level of convenience (1) that lends itself to well-rounded patient care. In this article, we will highlight some benefits of telemedicine relating to diabetes management.

Rise of Diabetes Distance Care

Telemedicine is the use of technology in delivering medical care to patients from a distance (2). Once considered necessary for rural or underserved communities, telemedicine has transformed over the past 50 years into a vibrant, integrated service utilized by hospitals and physicians around the globe (3).

Diabetes telemedicine has combined the wonders of technology and the necessity of recurring specialty care to enable providers to be more proactive. One effect of telemedicine on the management of diabetes is that providers are able to help their patients see improved HbA1c levels (4).

As always, in the grand scheme of diabetes therapy solutions, the measuring stick has always been the almighty HbA1c. As technology improves, doctors are seeing the added benefits of reading telehealth data from sensors to measure Time-In-Range as well (TIR) (5).With both of these in mind, a new treatment option can succeed or fail based on the ability to improve HbA1c ranges consistently or provide greater time in optimal blood glucose range. This seems to be no struggle for telemedicine.

The benefits of telemedicine in diabetes distance care are so promising that the CDC (Centers for Disease Control and Prevention) ran a 2-year study in rural Alabama and Georgia (6). The outcome showed decreased hemoglobin A1c as well as average reduced travel time of over 78 minutes per visit. Based on their findings, the CDC declared that “diabetes care delivered via telemedicine was safe and was associated with time savings, cost savings, high appointment adherence rates, and high patient satisfaction.”

Additionally, another study found lower HbA1c levels as well as improved blood pressure and cholesterol levels after just one year of telemedicine (7).

These studies might seem great on paper, but you might be asking yourself…

“How can telemedicine help me manage my diabetes?”

Well, I’m so glad you asked. Welcome to “Telediabetes”!

We all know that diabetes is a chronic disease that requires regular and constant monitoring. Some providers wish to see their patients bi-annually, while others request quarterly or even monthly check-ups. The practical challenges of regular office visits can sometimes prove challenging, and in the gap of in-office care and at-home management, the person with diabetes flounders. This gap is precisely where telemedicine shines.

4 Reasons Why Real-time Feedback No Longer Requires Face-Time Appointments

  • Is the driving distance to your endocrinologist office making those quarterly visits hard to squeeze into your lunch hour? Transmit your health records and let telemedicine connect you for guidance in basal rates adjustments or dosing tweaks with less time off work.
  • Is prohibitive weather keeping you from talking with your mental health practitioner about diabetes challenges? Log into a portal and send a message detailing your snow-day concerns straight away. They can respond via email or video conference to provide real-time support and encouragement.
  • Are school absences piling-up making it hard for your child to miss another half-day for their monthly appointment? Simply log-in, upload the latest chart data you’ve been keeping, and let their doctor analyze the trends and suggest small changes. These tweaks can make a big impact in keeping them at optimal health while keeping them in school and learning (8).
  • Have travel challenges made your food dosing questionable? Send a message to your certified diabetic educator (CDE) and let them guide you to healthier solutions and safer swagging.

Whatever reason you have to miss out on those essential office visits, telemedicine doesn’t judge. Telemedicine understands.

With Great Tech, Comes Great Responsibility

The rapid advances of tracking devices and sensors mean we can readily gather reliable glucose data in a fairly simple manner. But that’s not the full picture your healthcare team will need. We all know that taming the diabetes monster requires a multi-faceted approach. The rise of newer and better diabetes management technology has perfectly poised the diabetic community to benefit from telemedicine and all it has to offer including lifestyle modifications, mental health checks, and more. But we must have solid data to reap those benefits.

The best way to take advantage of all the rewards of telemedicine is to provide good and useful data. The more data you can afford, in a succinct and readable format, the better distance care your provider can give. Utilizing technology means you should be able to provide food records, insulin doses, basal and bolus rates (for our pump-loving friends) as well as activity, health events, and other biometrics like Ketones, HbA1c readings, weight and body measurements.

Beyond the tracking of data itself, presentation also matters. Clearly you can’t courier-pigeon over a stack of origami-worthy paper logs and in this day and age, you shouldn’t have to. Organize your logs into a format that is easily accessible for your healthcare provider. If they need CSV, Excel sheets, or PDFs, provide what they can read.

How mySugr PDF Reports Makes Data Sharing Easy

If you are reading this and genuinely shocked to learn that you need to log things like insulin dosing and food intake, allow us to usher you out from under your rock and into the age of technology by introducing the reporting feature in the mySugr app! Indeed we believe you are the captain of your pancreas. As such, the ability to harness all your well-tracked data into usable information for you and your doctor is a key focus of our app. Using the reports feature you can quickly:

  • View your own data at a glance, anytime, to see trends.
  • Select your own time period to see only the data you wish to discuss. No more information overload or sifting through months of records needlessly.
  • Send preferred data to your doctor via email for quick communication about necessary formula changes. Even select from one of our three output formats for optimal communication.
  • Stay in constant communication and more!

Using the data in these reports, you can truly be the master of your own fate. The reports are meant to empower you as you discuss your treatment decisions with your provider, making the conversation more constructive and putting you back in the driver’s seat of your care.


And for our US friends in the diabetic online community (DOC), we still have our fabulous bundle! mySugr has over 2 million registered users to-date and a 4.6+ rating on the App Store and Google Play. The mySugr Coaching service is second-to-none and utilizing our monthly subscription gets you:

  • Blood glucose meter
  • Lancing device (with a box of refills…so that’ll last you basically forever, amiright)
  • Unlimited test strips (new shipments arrive before you even run out!)
  • The mySugr Pro App (that includes the ability to estimate the HbA1c!)
  • Diabetes coaching (with a pretty top-notch team)
  • Free shipping

And all the tech-support a person could need!

Indeed, we believe telemedicine is here to stay (9) and with good reason!

People living with diabetes can find more freedom and a better quality of life with the rising accessibility of a healthcare team armed and ready to interpret and predetermine the many responses to all the data we track.

As always, mySugr stands on the edge of change ready to help usher in this new age with open arms and glucometers for all Rise up mighty warriors and embrace the freedom of “telediabetes”!


(1) Wicklund E. Leveraging Primary Care Telehealth for Convenience and Quality. https://mhealthintelligence.com/features/leveraging-primary-care-telehealth-for-convenience-and-quality(2) White LA, Krousel-Wood MA, Mather F. Technology meets healthcare: distance learning and telehealth. Jan. 2001. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116779/

(3) eVisit: The Ultimate Telemedicine Guide | What Is Telemedicine? 2018. https://evisit.com/resources/what-is-telemedicine/

(4) Hompesch M, Kalcher K, Debong F, Morrow L. Significant improvement of blood sugar control in a high risk population of type 1 diabetes using a mobile health app – A retrospective observational study. Poster presentation at ATTD 2017, Paris, France.

(5) Beck R, Bergenstal R, Riddlesworth T, Kollman C, Li Z, Brown A, Close K. Validation of Time in Range as an Outcome Measure for Diabetes Clinical Trials. March 2019.

(6) Xu T, Pujara S, Sutton S, Rhee M. Telemedicine in the Management of Type 1 Diabetes. 2018. http://dx.doi.org/10.5888/pcd15.170168

(7) Steven Shea, MD, Ruth S. Weinstock, MD, PhD, Justin Starren, MD, PhD, Jeanne Teresi, EdD, PhD, Walter Palmas, MD, Lesley Field, RN, MSN, Philip Morin, MS, Robin Goland, MD, Roberto E. Izquierdo, MD, L. Thomas Wolff, MD, Mohammed Ashraf, BA, Charlyn Hilliman, MPA, Stephanie Silver, MPH, Suzanne Meyer, RN, Douglas Holmes, PhD, Eva Petkova, PhD, Linnea Capps, MD, Rafael A. Lantigua, MD, PhD, for the IDEATel Consortium. A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus. Jan-Feb. 2006. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380195/

(8) Please note that all mySugr products have a minimum age limit of 16 years for the mySugr Logbook and 18 years for the mySugr Bolus Calculator (for more details please read mySugr’s General Terms & Conditions).

(9) Klonoff David C., M.D. Using Telemedicine to Improve Outcomes in Diabetes—An Emerging Technology. July 2009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769943/

Source: diabetesdaily.com

Homemade Keto Alfredo Sauce Recipe

This content originally appeared on Low Carb Yum. Republished with permission.

If you’ve never made your own white pasta sauce, you’ll be surprised how easy it is. You can make a simple cream sauce with butter, heavy cream, parmesan cheese, and cream cheese. Those are the four basic ingredients I use to make homemade keto Alfredo sauce.

I like to add a few more ingredients to mine to enhance the flavor. For me, garlic is one of the best seasonings ever so I add in a few freshly minced cloves. I also add in a few shakes of fresh ground black pepper.

There’s very little preparation needed to make homemade sauce. And, it’s much better to make it yourself because commercially prepared ones always contain unnecessary ingredients that up the carbs.

Print

Low-Carb Alfredo Sauce

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Cook all the ingredients together in a saucepan until smooth. Then serve this easy low-carb cream cheese sauce over zoodles or keto-friendly fettuccine.
Course Side Dish
Cuisine Italian
Keyword alfredo sauce, zucchini
Prep Time 5 minutes
Cook Time 10 minutes
Total Time 15 minutes
Servings 16 people
Calories 321kcal

Ingredients

  • 1/2 cup butter
  • 2 cloves garlic minced
  • 2 ounces cream cheese
  • 1 1/2 cup parmesan cheese shredded
  • 2 cups heavy whipping cream
  • dash ground black pepper

Instructions

  • Melt butter in a medium saucepan over medium heat. Sauté garlic in hot butter until fragrant.
  • Blend in remaining ingredients and simmer for about 10 minutes or until the sauce has thickened.

Notes

Sauce will thicken as it cools and will become very thick if stored in the refrigerator. Simply heat the sauce up for it to be pourable.

Nutrition

Serving: 0.25cup | Calories: 321kcal | Carbohydrates: 2g | Protein: 15g | Fat: 28g | Saturated Fat: 18g | Polyunsaturated Fat: 1g | Monounsaturated Fat: 7g | Cholesterol: 87mg | Sodium: 706mg | Potassium: 65mg | Sugar: 1g | Vitamin A: 950IU | Calcium: 490mg | Iron: 0.4mg


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

Homemade Keto Alfredo Sauce Recipe

Source: diabetesdaily.com

What Should I Do If I Have Symptoms of COVID-19?

As the global viral outbreak continues, you may be wondering what special considerations there are for people with diabetes to keep in mind. In particular, what should you do if you begin to experience symptoms consistent with the infection? This article reviews the most common COVID-19 symptoms, discusses potential issues specific to people with diabetes, and provides a guideline of how to respond if you become sick.

Symptoms of COVID-19

Be on the lookout for the following most common symptoms of COVID-19:

  • Fever
  • Coughing (especially dry)
  • Shortness of breath

Other symptoms may include fatigue, body aches, and sore throat, among others.

Special Considerations for People with Diabetes

You may have heard that people with certain medical conditions, including those with diabetes, are considered to be in the high-risk group for developing more serious symptoms of the disease, and have been reported to have a significantly higher mortality rate than those without underlying conditions. While these statistics are both relevant and can be scary, it is also important to keep in mind that your individual risk will vary widely depending on your specific health status, regardless of your diabetes diagnosis. Your age, other related and unrelated health conditions, and blood glucose management profile, all play a role in determining your overall risk. So, while as a whole population, people with diabetes are at higher risk for complications, your individual risk could be much lower than that.

For instance, as per the JDRF, those who have type 1 diabetes are  “not necessarily at higher risk of developing serious complications from the disease. Those at greatest risk are those who have another, or second chronic disease (such as a compromised immune system, heart disease or renal failure).

Talk to your healthcare provider to better understand your individual risk level and recommendations.

Have a Plan of Action If Symptoms Arise

Being adequately prepared ahead of time can help you feel calmer and more empowered if you do get sick. Consider taking the following steps today, if you haven’t already:

  • Take preventative measures. Stay home. Practice social distancing (note: if you already have symptoms, self-isolate!)
  • Wash your hands. Avoid touching your face. Disinfect “high-touch” surfaces regularly.
  • Make sure that your medication refills are up-to-date so that you have the supply you need if you will stay in your home for a long period of time (e.g., at least several weeks). Make sure that you consider supplies used for diabetes management as well as any other medications that you use.
  • Check that you have medications on hand that you would typically use to treat a viral infection, such as a fever-reducing agent, like acetaminophen (Tylenol). Consult with your healthcare provider for advice about their specific recommendations.
  • Have enough food and water in your home in case you stay home for a prolonged period of time (e.g., several weeks).
  • Review the “Sick Day Rules” for people with diabetes. COVID-19 causes mild symptoms in most of the people who are infected. This means most likely, you will be treating your symptoms at home. However, any illness can make blood glucose levels more challenging to manage. It is important to be aware of how illness can affect your management plan and make adjustments as needed, with the help of your healthcare provider, to keep yourself safe during the illness. You can find the standard “Sick Day Rules” as described by the Joslin Diabetes Center here, but discuss your specific recommendations with your healthcare provider.

So, what should you actually do (and not do) if you develop symptoms of COVID-19?

  1. Don’t panic.
  2. Self-isolate. Don’t go to urgent care or the emergency room, unless instructed to do so or you experience serious symptoms (see below). Stay home.
  3. Call your doctor and follow their advice closely.
  4. Keep a close eye on blood sugar levels. Work with your healthcare provider to make adjustments to medications, if needed, to help stay in the target glycemic range as much as possible. Keeping blood glucose levels in check as much as possible can go a long way to helping you avoid complications during any illness.
  5. Manage your specific symptoms (e.g., fever). Ask your healthcare provider for specific at-home treatment advice.
  6. Stay hydrated. This can help you keep your blood sugar levels in the target range and avoid complications.
  7. Be on the lookout for serious symptoms, including those of diabetic ketoacidosis (DKA), as well as the following “COVID-19 emergency warning signs”:
  • Difficulty breathing
  • Chest pain
  • Confusion or difficulty waking
  • Blue tint to the skin (on the lips or face, in particular)

If you experience these any of these symptoms, promptly seek medical care. Wear a mask if out in public.

  1. Continue to wash your hands and clean surfaces regularly.
  2. Continue to avoid contact with others (humans and pets).
  3. Do not discontinue isolation until you get the “all clear” from your healthcare provider.

***

For even more detailed information on what to do if you are ill, read these guidelines from the CDC:

What to Do if You’re Sick

Guidelines for At-Risk Populations

Also, learn even more about COVID-19 illness with diabetes from the American Diabetes Association (ADA) here.

Source: diabetesdaily.com

Keto Pecan Pie Cookies

This content originally appeared on Caroline’s Keto Kitchen. Republished with permission.

Legendary Foods Pecan Pie Flavored Almond Butter is one of my favorites, so I knew I had to bake with it quickly before I ate the whole jar. These cookies semi-defeated the purpose since they are equally as addicting (I mean, how can a cookie not be with a giant glob of this nut butter in it!?), but the good news is I had one and the rest are in my freezer. I feel like these would be a great Thanksgiving dessert, but I’m all for pecan pie year-round!

Keto Pecan Pie Cookies

Print

Keto Pecan Pie Cookies

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Pair this low-carb cookie with your afternoon tea or coffee, or have one as a dessert after your meal.
Course Dessert
Cuisine American
Keyword low carb cookies
Prep Time 20 minutes
Cook Time 20 minutes
Total Time 40 minutes
Servings 12
Calories 164kcal

Equipment

  • oven
  • Microwave

Ingredients

  • 10 tbsp Legendary Foods Pecan Pie Flavored Almond Butter
  • 4 tbsp salted butter softened
  • 1/3 cup granulated Swerve
  • 1 tsp liquid monk fruit juice concentrate
  • 1 tsp vanilla
  • 1/8 tsp salt
  • 1 egg large
  • 6 tbsp lupin flour
  • 2/3 cup almond flour
  • 1/4 tsp baking soda
  • 2 tbsp sugar-free chocolate chips
  • 1 tsp coconut oil

Instructions

  • First we'll make the pecan pie centers. I highly recommend having frozen centers before you stuff them into the cookies, or else you might get a bit of a nut butter mess. To get frozen centers, scoop out 12 spoonfuls of refrigerated Legendary Foods Pecan Pie Flavored Almond Butter onto a cutting board covered in wax paper and freeze overnight. (I used 10 tbsp of nut butter total for my 12 centers, so slightly less than 1 tbsp per cookie).
  • Pre-heat oven to 350 degrees.
  • In a large bowl, cream together the butter, vanilla and sweeteners.
  • Mix in the salt, egg, lupin flour, almond flour, and baking soda until a dough forms.
  • On a cookie sheet, form 12 discs of cookie dough and make a "thumbprint" in each center. This is where your filling will go, so it should roughly match the size of your pecan pie centers.
  • Bake the cookies for 5 minutes at 350 and then remove from oven.
  • Remove the frozen pecan pie centers from the freezer and stuff them inside each thumbprint.
  • Return to oven for about 11 minutes or until done.
  • Allow cookies to cool fully before removing from cookie sheet.
  • Melt chocolate chips with coconut oil in the microwave, stir, and use an icing bag to drizzle chocolate over the cookies.

Nutrition

Calories: 164kcal | Carbohydrates: 5g | Protein: 6g | Fat: 15g | Saturated Fat: 4g | Polyunsaturated Fat: 1g | Monounsaturated Fat: 3g | Cholesterol: 26mg | Sodium: 30mg | Potassium: 77mg | Fiber: 3g | Sugar: 1g


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

Keto Pecan Pie Cookies Recipe>

Source: diabetesdaily.com

Type 2 Diabetes Remission: What Is It and How Can It Be Done?

This content originally appeared on diaTribe. Republished with permission.By Emma Ryan and Jimmy McDermott Learn about three ways that may put type 2 diabetes into remission: low-carbohydrate diets, low-calorie diets, and bariatric surgery Type 2 diabetes is traditionally described as a progressive disease – without major lifestyle changes, A1C levels will gradually increase over time, […]
Source: diabetesdaily.com

Taking the Sting Out of Fingersticks: Lancets, Life Hacks and More

This content originally appeared on diaTribe. Republished with permission.By Marcia Kadanoff with Katie Bowles Tips to reduce the pain and hassle of pricking your finger each time you check your blood sugar levels on a meter When I was first diagnosed with type 2 diabetes two years ago, I struggled quite a bit. I had […]
Source: diabetesdaily.com

How to Use FreeStyle Libre Trend Arrows to Adjust Insulin Doses

This content originally appeared on diaTribe. Republished with permission.By Jimmy McDermott, Maeve Serino, and Adam Brown New Endocrine Society guidelines for FreeStyle Libre users to adjust insulin doses based on trend arrows. Plus, additional guidelines on scanning time and frequency The Endocrine Society recently published guidelines on adjusting insulin dosing based on FreeStyle Libre continuous glucose monitor […]
Source: diabetesdaily.com

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