Big Changes! Centers for Medicare & Medicaid Services (CMS) Loosen Requirements for Obtaining a Continuous Glucose Monitor (CGM) During COVID-19

This content originally appeared on diaTribe. Republished with permission.

By Karena Yan and Kelly Close

In-person visits, lab tests, and finger stick documentation are no longer required at present to get a CGM

Editor’s note: This article was updated on May 21, 2020 to reflect that lab testing is still required for an insulin pump and pump supplies.

High blood sugar levels leave the body vulnerable to infections, meaning those individuals with poorly controlled diabetes are at greater risk of contracting COVID-19. To properly monitor and respond to glucose levels and to strengthen the immune system to fight off infections, a continuous glucose monitor (CGM) can be very helpful.

If you are on Medicare, obtaining a CGM through your healthcare professional is a relatively involved process, requiring an in-person clinic visit, lab tests, documentation of frequent finger sticks (four or more times a day), and a lot of paperwork. At present, only those on insulin have an opportunity for approval. However, due to COVID-19 and the increased risks it poses for people with diabetes, the Centers for Medicare & Medicaid Services (CMS) announced that it will not enforce the following criteria for receiving a CGM:

  • In-person clinic visits
  • “Clinical criteria,” including lab tests for C-peptide or auto-antibodies, or demonstration of frequent finger sticks

This means that people with diabetes do not have to go to the doctor’s office or undergo lab tests to receive a CGM. Importantly, these loosened restrictions also reduce the amount of paperwork and bureaucracy for healthcare providers and give them greater flexibility in providing CGMs. Lab testing is still required for insulin pumps and pump supplies.

This increased access to CGMs is a huge win for the many people with diabetes on insulin who would not otherwise be able to get a CGM. Because CGMs provide real-time data for blood sugar levels, users are able to monitor their glucose and proactively adjust their insulin doses. Not only do CGMs help increase time in range, and thus have the opportunity to increase productivity and quality of life, but they can also improve overall diabetes management and can help keep patients out of the hospital.

We hope that in the future, at least those on SFUs will be able to get CGM, as SFUs can prompt hypoglycemia, which is especially dangerous right now, given the importance of staying out of the hospital.

Every person with diabetes can benefit from either a professional CGM used regularly (at least yearly) or a 24/7 CGM. While these new CMS guidelines are temporary in response to COVID-19, we are hoping and advocating for making the changes permanent. With the rise of the Beyond A1C movement and increased awareness of time in range, CGM (24/7 or professional) is an essential tool for people with diabetes to live happy and healthy lives, both during and after COVID-19.

This article is part of a series on time in range maybe possible by support from the Time in Range Coalition. The diaTribe Foundation retains strict editorial independence for all content.

Source: diabetesdaily.com

A D-Mom’s Changed Perspective Using Basal IQ

Technology continues to make managing our diabetes easier. Continuous glucose monitors, apps for carb counting and insulin pumps have all alleviated some of the stress of managing our condition. Tandem Diabetes created Basal IQ technology, which allows us to spend less time worrying about going low and let our devices do the work. For a person living with diabetes, this means less stress and more sleep.

Basal IQ technology helps reduce the frequency and duration of lows by predicting glucose levels and suspending insulin if the blood sugar level is thought to go below 80 mg/dL or the Dexcom reading goes below 70 mg/dL. Insulin delivery will start automatically once the blood glucose starts to rise again.

Basal IQ is different than the newly released Control IQ, in that Control IQ can adjust insulin delivery, including the delivery of automatic correction boluses as needed, therefore helping patients avoid episodes of hyperglycemia. Using either one of these systems also means fewer fingerpricks, as you will no longer have to get manually take your blood glucose reading.

Basal IQ technology has given many people living with diabetes, and those who love them, a little more rest and some peace of mind. A pivotal study showed the use of Basal-IQ Technology on the t:slim X2 Insulin Pump demonstrated a 31% relative reduction in time spent below 70 mg/dL when compared with a CGM-enabled pump without Basal-IQ Technology. Important to note, the less amount of time spent at lower glucose levels did not mean more time spent at higher glucose levels. Maintaining your target range has become a lot easier thanks to Basal IQ technology.

Photo credit: Allison Hoffman

One woman, Allison Hoffman, who helps manage her 10-year-old daughter, Becca’s diabetes, raved about the changes to her overall well-being since switching over to Basal IQ technology after relying on Omnipod for the past few years.

Here is her story:

For 7 years my mornings were absolute hell. While I would see others sleeping in, meditating, going to the gym, etc, I was a slave to Becca’s whackadoodle blood sugar swings, which would often start around 5:00 AM. My body learned to wake up at this time, and that I doubt I’ll ever be able to change.

My mornings would include me running up and down the stairs entering the bedroom, praying I wouldn’t wake her and deny her the right to sleep in, suspending insulin (audible beep I couldn’t silence), sticking glucose tabs in her mouth, often with the pay-off of a horrible blood sugar spike. I would start 95% of my days this way.

And the frustration! No adjustments to her settings were right. If I reduced her insulin she’d go high; .35 too low, .4 too high. I would wake up at 3:00 am to set a temp basal to get the amount she needed that Omnipod didn’t have as a preset-still wouldn’t work. Nothing I did was right.

Since starting on t:slim pump with basal IQ, I finally have my mornings back. It allows more fine-tuned insulin delivery and suspends when it predicts her to go low. As long as her sensor is good, and her insulin settings aren’t way off (I will always need to determine her insulin needs, it isn’t automatic), I can have a pretty peaceful morning now.

I can watch the news, or another show, or read, and my coffee doesn’t go cold. I can sit with my dog on my lap and not have to jump up every ten minutes to go deal with diabetes. I can breathe. And Becca can sleep peacefully.

I’ve made four seesaw activities for my students this morning and she’s still sleeping.

7 years of hell. I finally have my mornings back.

If you are living with type 1 diabetes and are considering a pump, you may want to look into t:slim X2 pump along with the Dexcom G6 so you can make use of the new Basal IQ or Control IQ technology. Their slogan is “live more and worry less” and I am so glad this seems to be the case for so many.

Have you tried out this technology? How has your experience been?

Source: diabetesdaily.com

Embracing Community in Times of Crisis

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

By Erin McShay

Sometimes in life, it takes something bad to happen for us to pause and appreciate how good things once were. I used to think of our lives as before and after our Sam was diagnosed with type 1 diabetes. Fast forward twelve years: he’s a senior in high school and the Corona virus is sweeping the country. The cacophony of chaos in the world is now pulling our attention into dark territory, channeling voices of fear and uncertainty. It’s almost as if time has slowed down to a crawling pace; giving us the chance to inhale and catch our second wind.

Community

Image source: Beyond Type 1

Always a Battle

Dealing with any chronic illness is an arduous job packed with hundreds of additional decisions to make a day. Ordering supplies, planning and packing become essential, life-saving chores. We take the burden in stride, but then become our harshest critic when thing go wrong. From personal experiences, I’ve learned that dwelling on our missteps serves no one. Remember that Billy Joel song? “We’re only human, we’re supposed to make mistakes.”

Just last year I made a doozy when we sent our two teenagers to Houston to visit family – I forgot to pack additional insulin pump cartridges for our son. Halfway into the trip, Sam called to say he ran out of cartridges. We’ve taken dozens of trips throughout the years, driven and flown across the country, camped in remote areas, and I’ve never forgotten anything. I told him to check again. We went over the list together; extra insulin, needles, blood sugar meter, back up meters, test strips, infusion sets, ketone strips but no cartridges. In a cupboard, I found the sandwich baggie of them that somehow got left behind. Anyone who’s ordered these types of supplies knows that you can’t just walk into a pharmacy to get more; in fact, you only have a few options and they all take twenty-four hours to ship. It didn’t matter how many times my son and husband told me it was okay: two thousand miles away, I spent the entire night consumed with guilt and worry, crying on my husband’s shoulder. Sam spent the night waking up every two hours to do blood sugar checks and give himself shots. He learned a hard lesson and so did I, but meanwhile we still had to find cartridges.

Community

Image source: Beyond Type 1

Somehow, on a hunch and a prayer I managed to look up a Facebook/Beyond Type 1 friend whom I’ve never met – and asked for help. It was a miracle really. I was a complete stranger to her, she could have said, ‘Sorry,’ but instead this angel went to extraordinary measures for us by reaching out to her community to find me the specific cartridges I needed for Sam’s pump. Her son had a different pump, but a friend of her’s (another angel) met Sam and my sister-in-law to give them an exceeding amount, beyond what he needed. I paid her back when I got her address, but at the time I don’t think they knew the depth of my gratitude. Not to mention the many thanks to my sister-in-law for driving Sam to another county, and our family in Houston for taking such good care of him.

When You Need Help, Ask

The chances are in your favor in the type 1 community with a million out-stretched hands, and general well-wishers ready and willing to offer not only advice, but whatever you need to help you get by.

I’m embarrassed to say I ran out of supplies once before the Houston trip. Not long after Sam was diagnosed, we depleted our infusion sets before our new order arrived. Luckily a neighbor, whom I met through a friend, had the same insulin pump as Sam, and gave us a few loaners. Another neighbor, a type 1 diabetes (T1D) dad who lived around the corner from us, went out of his way to offer advice and help us when Sam was first diagnosed. We were so scared in those early years and his helpful words still bring me comfort years later.

Get to Know Your Neighbors

Once, I bonded with a fellow writer at a conference, where I divulged that I had a son with type 1 diabetes. We became fast friends after she told me she had developed late adult onset T1D. One night, when my son’s pump stopped working, I called her in tears. My husband was out of town and I couldn’t get Sam’s pump to prime. She drove over to my house at ten at night – because these problems never happen in the middle of the day – and got the pump working again.

I wouldn’t have known these angels to receive help from them, had I not been as forthcoming about Sam’s disease. Nor would I have met them if I wasn’t on Facebook or involved with my community. You don’t realize these tiny miracles for what they are, until after the fact. If not for their help, I would probably be in a strait-jacket staring at a cement wall somewhere. Instead, I am now willing and able to pay it forward anyway I can.

Sibling

Image source: Beyond Type 1

As a writer and avid reader, I peruse tons of articles and social media sites a day, and if there is one thing I’ve learned, it’s to think before you say or post something. Negativity helps no one. I’ve found that depressing, bleak posts can linger in your psyche long after you’ve read them. Your views can really impact others. On the other hand, knowing how meaningful certain tweets can be, spreading love and encouragement, cannot only change a person’s day but has the power to alter their lives.

One kind word can mean the world to someone. Life is hard, especially with a chronic illness and there is no question diabetes stinks, but what a wonderful support system we have in place within the T1D community! People can be quite beautiful, and they have a wealth of knowledge on a much deeper level sometimes than our medical professionals.

Pay It Forward

I heard once that Jackie Kennedy Onassis said that motherhood was the most important job on earth and if you mess that up, whatever else you do doesn’t matter very much. My son and daughter are edging their way to adulthood now, and I hope that they’ve learned from my mistakes and watched how I forgive myself. I hope they’ve learned from the tiny mercies shown to us, and that when someone’s in need, you offer a helping hand or an encouraging word without blinking. I hope they stand up to injustice when they see it, and become advocates for the less fortunate, like those struggling to afford insulin.

As I reflect in this trying time, I see that through Sam’s diagnosis, we’ve learned and grown so much because of it. It’s made us who we are – all of us. And though this is a flawed, imperfect world, we truly have a family beyond our own. No amount of social distancing can diminish how interconnected we truly are. The silver lining through this all is that we have each other.

Source: diabetesdaily.com

Parenting, Working, and Diabetes During the Coronavirus Pandemic

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

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

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

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

Go Easy on Yourself

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

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

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

Take It One Day at a Time, and Be Realistic

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

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

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

Develop and Maintain Routines

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

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

We’re All in This Together

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

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

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

About Cheryl

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

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

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

Source: diabetesdaily.com

How to Extend the Dexcom G6 Sensor Beyond the Ten Day Hard Stop

Some clever technologists have discovered how to restart a Dexcom sensor to extend its life beyond ten days. The process works by exploiting a bug in the sensor pairing process.

Katie DiSimone walked us through the process. Katie is involved in the community of people who are building homemade automated insulin delivery systems using current insulin pumps and continuous glucose meters. Since the original article was written, Katie has joined the Tidepool organization which is dedicated to making diabetes data more accessible, actionable, and meaningful for people with diabetes, their caretakers and for researchers as well.

Since our last update, new transmitters have been released. These newer models are more stubborn and are more challenging to “hack”. The specific transmitter ID  will dictate which restart sensor method you should use.

Please see Katie’s instructions to determine which is the preferred method for your transmitter ID.

The method that seems to be working amongst the diabetes online community (and myself; I currently have the transmitter starting with “8G”) is the “pop-out method.” This means you need to physically pop out the transmitter, which can be a little tricky but doable. Here is a video on how to do it, I have had luck with an old credit card.

For this method you will need to:

  • Stop session (it does not matter if the sensor expires on its own first or not)
  • Pop out the transmitter (Some people cover the site during the 30 min period or even insert an old transmitter to prevent stuff from getting in there/ also the wire moving, as the transmitter holds it in place)
  • Set a timer for 30 minutes (I’ve heard that 15-20 minutes works, but have not tried this)
  • Pop the transmitter back in
  • Restart the sensor (make sure to save the previously used code; I snap a picture of it so this way you will not have to calibrate)

There are instructions on how to restart the sensor using the receiver so that you continue to receive current glucose values throughout the 2-hour wait. Here are the instructions on how to do so.

Caveats

The Dexcom G6 has not been tested or approved by the FDA for restarting sensors. There is no guarantee of sensor accuracy. Extend the sensor life only at your own risk.

A previous version of this post has been updated.

Source: diabetesdaily.com

New COVID-19 Medicare Funding for Telehealth in Australia

By Rachael Baker

COVID-19 is proving to be an extreme and unparalleled time for healthcare services across the globe. Credentialled Diabetes Educators (CDEs) are not exempt from this rapidly changing landscape and multiple shifts are occurring in the way we now provide care. Changes to funding models are being welcomed by CDEs with open arms.

Telehealth is by no means a new concept for patients living with diabetes in Australia, and CDEs have been advocating to endorse telehealth to be an equitable means of service delivery for quite some time. Telehealth is often an integral component of care for a person’s diabetes management; however, never before have patients been able to claim Medicare rebates on these services, until now.

Easier Access, More Convenience

Prior to the COVID-19 funding, telehealth already enabled many Australian

s living with diabetes, especially in rural and remote areas, to have access to up-to-date, specialist education and diabetes technology provided by CDEs. Diabetes is a chronic condition that necessitates a person to attend frequent appointments to a range of healthcare professionals across the multidisciplinary team, including: General Practitioner (GP), CDE, Endocrinologist, Dietician, Podiatrist, Psychologist, Optometrist, along with other specialist clinicians. Juggling life, and diabetes and attending these appointments can prove difficult at the best of times.

Telehealth consults eradicate time spent on the sometimes long journeys traveling to a CDE appointment, time taken off work (especially if telehealth consults are provided outside of business hours), along with the difficulty of finding someone to mind the kids and the common struggle of parking. While face to face consults are still imperative, especially for new diagnosis and starting on insulin pump therapy, telehealth services have anecdotally proven to have high attendance rates and result in patients feeling well supported, leading to greater health outcomes, both short and long term.

Rebatable Telehealth Appointments

As we see ourselves voyaging through the uncharted waters of this pandemic, abiding by Australian Government guidelines in line with social distancing and essential interactions only, it is a relief that patients will be able to have critical access to CDEs via Medicare rebatable telehealth appointments. While we are navigating the finer details (see link for legislation), it looks like this will be equivalent to current face to face Medicare rebates, equating to $53.80 per consult for patients who have a shared care plan, or a GP Management Plan and Team Care Arrangements, or if they are a resident of an RACF and have a multidisciplinary care plan.

CDEs are the front line when it comes to providing education to patients with diabetes to safely and effectively manage their blood glucose levels (BGLs), optimize their health and wellbeing, but also assisting people with diabetes to safely navigate their blood glucose levels and ketones during sick days. Now more than ever, as our acute healthcare services become overwhelmed, it is vital that we support people living with diabetes to stay safe and well, avoiding preventable Emergency Department presentations and hospital admissions. We also need to come together to support tertiary diabetes services, as they redirect medical and nursing staff to emergency and acute inpatient areas to meet the demand of COVID-19 patients.

Telehealth: A Service Innovation

Living with type 1 diabetes myself, I strongly stand by the notion that patients find this innovative means of service delivery extremely beneficial. It focuses on the needs of an individual and discovers a way to make diabetes management fit into people’s lives with greater ease. With today’s technology, telehealth platforms are incredibly easy to use and patients are able to attend their telehealth appointment using their smart mobile phone.

Given the current climate, telehealth is quickly becoming the standard or the ‘norm’ for a lot of outpatient services. As I have already mentioned, face to face consultations with CDEs will always be essential, nevertheless, telehealth appointments certainly have a broad and practical range of opportunities for use. During this time, telehealth consults are not merely an option, but in fact, the only option to stay engaged with their regular CDE appointments and receive the imperative support and guidance they require.

This is a milestone worth celebrating, and as we are being forced to reflect upon what is really necessary in our individual lives, for those living with diabetes, CDEs certainly fit the bill, and the Australian Government thinks so too. CDEs have a significant impact on people living with diabetes; as a patient and a clinician, I have experienced this from both sides.

I would like to thank Diabetes Australia, the Juvenile Diabetes Research Foundation (JDRF), the Australia Diabetes Educators Association (ADEA), Diabetes QLD and NSW ACT, and most importantly our diabetes community whom are themselves, their loved ones or family members, living with diabetes. I am incredibly passionate about telehealth, and with this funding set to kick in on March 30, 2020, my next question will be whether the cease date on September 30, 2020 will be negotiable, as inevitably people with diabetes adapt to a new way of seeing their CDE.

Stay home and stay safe.

About the Author

Rachael Baker is Credentialled Diabetes Educator (CDE, BN) and Clinical Nurse Specialist at Macintyre Health. You can follow her or her company on Instagram for tips.

Source: diabetesdaily.com

Pump Peelz Does Their Part and Creates Intubation Boxes

We spoke to the founders of Pump Peelz, about the COVID-19 pandemic and important work they’re doing to help.

Hi Scott, thank you so much for taking the time to talk to me. The COVID-19 pandemic has left us all in fear, especially for those who are elderly or have pre-existing conditions. Knowing that we, or someone we love, fits this demographic adds an extra layer to this difficult time.  It is more important than ever to come together and help each other through these uncertain times.

I know you and your wife Emily started Pump Peelz in 2011 with the goal of creating adhesives to help empower people living with diabetes to express themselves and to feel confident in their ability to manage their disease. I know the diabetes community thanks you, and I now wear my Dexcom loud and proud!

How long has your wife Emily been living with type 1 diabetes?

She just celebrated her 10th diaversary in January!

What prompted you to start on this venture of creating adhesives for our community?

Emily was diagnosed while we were both in college. We were taking a few graphic design courses and noticed that at that time there were no graphics, skins, or adhesives for insulin pumps or CGM’s. We took it on as a class project really… and slowly built the business at night for the first few years before taking on Peelz full time and purchasing our own equipment at a specialized facility.

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

Emily read to our son, Oliver’s, preschool class for their “Reading Month’ on March 12 and almost immediately after class, the virus started making headlines in our area. We actually had discussed possibly keeping him home for a little while and talking to the teachers to keep us healthy at home. But later that day, his school became canceled indefinitely anyway. I think we have the same fears and concerns as everyone… Our initial fear was for Emily being immunocompromised but we decided to self-quarantine for the past month to keep her and our family safe. We have groceries delivered, we have only one person at the office at a time, and are really keeping busy at home with our 3 year old.

Being that Emily falls under high risk, what extra precautions have you taken? 

She really hasn’t gone anywhere since March 12. We take drives and will go for walks in the park and our neighborhood. We mostly have groceries delivered or I will go by myself with my facemask and gloves… I also keep sanitizer in the car. Our office is stocked with Lysol and cleaning supplies to keep all surfaces clean.

Being that you are a small business, how has COVID-19 affected your business so far?

We’ve tried to find different uses for our machinery to try and help a local medical facility. It has given us an opportunity to be more creative and experiment for the better good. Our main business struggle at the moment is simply keeping up while maintaining social distancing and keep our priority on everyone staying healthy. We’re being open and upfront on our website to let people know that during this time, it’s taking us a little longer to produce products.

An intubation box allows doctors and nurses to safely intubate COVID-19 patients | Photo credit: Pump Peelz

How did your local hospital find you? Did they know that you would have the equipment necessary to create intubation boxes?

I knew right away that our facility has capabilities beyond what we normally manufacture. I started early on reaching out to our friends in the medical field to let them know that we have the capability of making masks, cutting materials for face shields, or anything else that might come up. It just so happened that our local hospital system heard this and asked us to make an intubation box for their ICU which they currently have in place.

I am sure you have been extremely stressed about the pandemic, what were your initial thoughts about taking on this task?

I try not to stress too much about things I can’t control. This was one thing that was asked of us that I knew we had the capability to produce and something that we could control to help.

It is so amazing that you quickly learned how to create such a necessary and urgently needed product. How exactly were you able to design and produce it?

We launched our Patch+ product late last year which was the most challenging product for us to produce. We had to purchase new equipment, have software designed, and create processes to rapidly prototype and get products out quickly and efficiently. Because we just made it through this project I felt that I understood our machinery enough to know that this task was possible. I quickly found a website called intubationbox.com that had the assembly instructions… I simply modified their steps so that our laser cutter could easily cut out the pieces like a puzzle. Once I figured it out, I saved those files because I thought someone else could also use them.

It looks like you have been sharing this information on social media and hoping that others follow suit and do their part. Where can people find information on how to create intubation boxes?

Go to intubationbox.com and there is a material list sheet of things you can pick up at Home Depot or Lowe’s. You can email me directly at scott@pumppeelz.com and I can send our vector files to anyone that wants them. They can also follow the instructions and use normal hand tools to produce these. I also recommend talking to your local print shop or sign show to see if they could use our files to cut the acrylic sheets.

Ear relief straps for healthcare workers. These go behind your head and hook onto the straps of a mask rather than the straps rubbing the back of your ears. | Photo credit: Pump Peelz

I must say seeing your post about how you are helping out during this time of need was such a ray of sunshine on what seems to be the longest gloomiest day in a long time. How does it feel knowing that you are helping save lives?

That was really nice of you to say that. We can all pitch in just a little to do something bigger than ourselves. That can be simply staying at home to ‘slow the spread’ or it can be offering your sewing services to make masks, offering a 3D printer at a school to make face shields, or building a box. We all have little talents or things that we can do to help each other… this just happened to be ours.

Going forward we are taking the remaining materials from our boxes to make Mask Relief Straps to take the pressure off of the ears of nurses and doctors who are wearing them all day long. You can look up photos on Google to see what I’m talking about!

Thank you so much for taking the time to talk to me. I know personally, I thank you guys every time I can get more life out of my Dexcom thanks to your adhesives, but now you are truly heroes!

Source: diabetesdaily.com

How to Navigate Blood Sugars During a Pandemic

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

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

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

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

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

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

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

Check Your Basal Insulin Dose

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

Jennifer Smith RD, LD, CDCES, explains:

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

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

Photo by iStock

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

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

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

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

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

Reduce Stress

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

Mindfulness and Meditation Apps

Staying Active at Home

Taking Care of Your Mental Health

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

Create (and Stick to) a Routine

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

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

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

Make Use of Technology

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

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

Photo credit: geralt (Pixabay)

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

Lean On Others

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

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

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

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

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

***

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

Source: diabetesdaily.com

Front Line Nurse with Type 1 Contracts COVID-19

Sarah Hannigan is a fellow member of the diabetes online community. When I saw she was also a fellow New Yorker, who was putting her own life at risk for us, I just had to reach out and thank her. Sarah tells us about her recent experiences with becoming infected with COVID-19 during the ongoing pandemic. Thank you, Sarah, for everything you do and for taking the time to share your experiences with us!

How long have you been type 1?

I am Sarah, a nurse practitioner in a New York City hospital. I have practiced in a hospital for over 14 years as a nurse, ICU nurse and now nurse practitioner for the last five years. I am married, live in NJ and have two young boys. Some of my hobbies include traveling, weightlifting, Zumba, and yoga.

I have had type 1 diabetes for 20 years now. I have been on an insulin pump for 16+ years and have been using a continuous glucose sensor for about nine years. When I was pregnant, I kept my A1cs in the 5.3-5.7% range, but my normal control is typically 6.4-6.7% for the past decade. Prior to that, I spent some years in the low to mid 7s.

Did that play into your decision to become a nurse practitioner? 

Yes, I would say that being a person with diabetes played a role in me going into the medical field. Considering various careers, having a chronic disease makes it very important to have stable employment with good health insurance. I also got to see what nurses can do. No one in my family was a nurse and I didn’t really know how autonomous you can be. I also researched being a nurse practitioner and that seemed to be like a great combination of having a nurse background, but being able to diagnose, prescribe medications and radiographic studies, and do important disease prevention education. It seemed like a good way to connect with people and be able to prevent and treat diseases.

Photo credit: Sarah

When you heard about COVID-19 heading our way, were you nervous? For your family? And for your work as a nurse practitioner during this pandemic? Did you feel your hospital was prepared for the outbreak?

At first, like many people, I didn’t know what to think. My hospital, as with many places (in my opinion, because of our country’s poor leadership and lack of proper prevention strategies) kept functioning as usual business until mid-March when we started decreasing visitors significantly, stopping nursing and medical students, decreasing nonessential staff in the hospital. We were still doing elective surgeries. It seemed like it could help, but truthfully the virus was already in NYC; it was just that it was extremely difficult to get tested. This was evident by the skyrocketing numbers we saw when testing was more prevalent. As health care providers, we were actually beginning to wonder who had had it in the previous month.

I didn’t know what to think at that point; I knew my job was going to change, but it was unclear when and how. Since then, we have had to adapt to multiple changes since this is something we have never been exposed to at all. Resources, including doctors and nurses, have been redistributed to better manage the influx and we are constantly adjusting. We have stopped doing elective surgeries and the ways we diagnose and progress patients have drastically changed.

I was the most nervous for me in my house since I am the immunocompromised one who is working in a hospital. Children seem to do well with this disease and my children are very healthy. They don’t have any asthma or other respiratory illnesses. My husband is also healthy. I do know that anyone can get very sick as I have seen many scenarios as a provider for other diseases, but excessive worry is also not good for the immune system, so I have tried not to worry.

Most people were going out and buying hand sanitizer and disinfecting wipes, but I was just trying to prep my immune system as much as possible. I increased my fruit and vegetable consumption, eating smoothies and salads every day, and was more careful with blood sugar control. I did have my husband buy some frozen food and supplies in case we are unable to leave the house for a few weeks, but I didn’t do any excessive buying.

Photo credit: Sarah

At what point did you find out that you have COVID-19? Do you know how you contracted it?

It was either a co-worker or a patient who I contracted it from. I was in the room for the patient for 30 minutes. I worked closely with the co-worker for two shifts and then he left for the day with a high fever. I wasn’t going crazy at this point because I thought he could have something else, but I put it on my radar.

It took five days after I was in close contact with the patient for her to come back positive. It was seven days before I knew the co-worker had it. Testing took a long time to result. Before I knew they had it, I started feeling a little sick. I had a sore throat and felt like I was getting a sinus infection, but I didn’t immediately go to COVID since I didn’t have a cough or fever.

At the same time, my husband was feeling like he had a fever. He tried to get tested, but since he had no known contacts and wasn’t sick enough to require a hospital, they wouldn’t test him. Since my youngest had had a cold for over two weeks, I thought he could have given us something.

Once I heard the patient tested positive, though, I started being suspicious. I talked to my supervisor and she told me to do a telehealth visit to see if they would test me. I didn’t have classic symptoms; I had lost my sense of smell and taste, was very fatigued, and had mild body aches. I didn’t have a cough or fever. Being a person with diabetes, I also had the clue of needing more insulin. My basal was up 20-30% and I need more with mealtime insulin also. This was suspicious to me because normal colds don’t require more insulin.

I did the telehealth visit and the doctor placed an order for me to get the test, but the first appointment was five days away. By the time I was to get tested, I had symptoms for ten days. In the meantime, I took my younger child to the pediatrician since his cough had gotten severe; he was having trouble sleeping at night. Like my husband, they were only willing to test my son if I had tested positive.

It wasn’t good enough for me to say that I had been closely exposed to two people [who have tested positive]. This was frustrating to me because my testing was so delayed and by now I could have given it to my whole family and frankly, no one seemed to care. This, I believe, is how COVID-19 got so widely spread so quickly. It was so rare to get tested, so we, as a society couldn’t know who had it or didn’t. Even though I was social distancing, I still went to the grocery store and drugstore, thinking I was trying to protect myself from other people, not knowing it was the opposite.

Finally, I was tested at work; the test resulted quickly, and was positive. It was quite a turn around to go from having a hard time getting anyone in my house tested to my local public health department calling me and asking every place I had gone for the past two weeks, who I had seen, and the transportation I took to get there.

Photo credit: Sarah

Did anyone else in your family get it? If so, what were their symptoms?

I am pretty sure that everyone in my family had it, but it is unclear. When I called the pediatrician back, they were not interested in testing G since he was doing better. My husband got better much quicker than me and then wasn’t interested in getting tested since I told him how painful the test is.

How long were you (and any family members) sick for?

T, my husband was sick for five days. He had mild shortness of breath, moderate muscle aches, and significant fatigue. He said he felt like he did when he had the flu. (I have never had the flu so I can’t compare it to that). My young son had a bad cough. My older son had cold symptoms including a cough and runny nose. I am assuming they had it, but I won’t be able to know unless they get tested for antibodies.

Everyone was exposed because I really didn’t think I had it well into me being contagious. We are a very cuddly family, so we are always snuggling and hugging. Despite trying, I couldn’t get them tested. I didn’t self-quarantine because I honestly felt like I had exposed them all already and I assumed T and I had it and someone needed to take care of them.

Photo credit: Sarah

What is the main concern you have as a nurse practitioner and someone that has had COVID-19?

The biggest concern after having it myself is that so many people are walking around with it and we have no idea. I didn’t have the classic symptoms and it was so hard to get anyone in my house tested. I feel like it is so widespread and we have no way of knowing how far it extends.

As someone with type 1 who gets diagnosed with COVID-19, what was the first thing you did in order to prepare for your illness?

I just was trying to be extra health focused. A chronic illness makes you more susceptible because no matter how well controlled you are, you are not about to fully mimic your pancreas. I have exercised on some level which helps me keep up my energy. Only on the days of my worst fatigue did I take a break from working out. I think that helps me keep my immune system operating at a higher level.

Is there anything to have on hand that you would recommend to other people living with diabetes?

Keeping a healthy lifestyle! I would try to have other people go to the store for you as much as possible, washing fruits/vegetables well and quarantine other foods for a few days before you bring them into your house (COVID can be on the package).

I can’t imagine how stressful this time has been for you. How have you been able to rest, take care of your family and your patients?

My husband is very good at letting me take naps and workout when I need. I try to get one or two things accomplished before I let myself rest and veg out. When I am at a high energy time, I try to go with it and make dinner if need be. It can be reheated later.

Self-care is so important, how has working on the front lines affected your mental and emotional health right now? What are you doing to make sure you take care of yourself?

My goal for this week is to find a mental health professional to talk to on a video chat. I know there is help out there and I (and I think most medical professionals) could use some help right now. Our jobs are so different and the stress is challenging. I have been trying to listen to my body; I try to take a break from everything COVID every few days because it is making me anxious to be immersed in it all the time. I am working out or doing yoga every day because it makes me feel better.

Photo credit: Sarah

Were you able to take off from work once you find out you were diagnosed? At what point did you go back?

Ironically I was on vacation for the first ten days of my symptoms. NYSDOH and my job recommend healthcare providers stay home for the first seven days after symptoms, so I haven’t had to miss work. I want to take care of the COVID patients since I have had it. I would hate to see any of my coworkers getting very sick from it.

Being on the front lines, what is the most concerning thing you have seen from the COVID-19 patients?

The lack of knowledge and resources has been difficult to deal with. Hospitals are functioning for lack of a better term like war zones. No visitors are allowed. We have to function with what we have. There is no bed. We have to figure out how to manage the patient until they do. There are a lot of different precautions we need to follow to keep staff and patients safe.

What do the symptoms you see range from?

I am in the hospital so patients have to be pretty sick to get admitted. Mild COVID-19 patients, I do not get exposure to. In hospitalized patients, we are watching their oxygenation. They usually require oxygen supplementation in varying degrees. When the oxygenation gets low enough despite non-invasive measures, they have to be intubated and go on a ventilator. Frequently patients have fevers, nausea, and low appetite. It would be unlikely for me to see only mild symptoms because we would have them manage at home since hospital beds are a limited resource.

People are very afraid, being that you have type 1 diabetes and now have survived COVID-19, what would you like to tell our readers? Any words of wisdom on how to feel about this whole terrible situation?

Be vigilant about social isolation, hand hygiene, and good infection control, but try not to be scared. There is only so much you can do and being afraid isn’t good for your immune system. The biggest advice I have is controlling your blood sugars. Good diabetes management when you are sick cannot be overstated. Refilling prescriptions and obtaining your testing/pump supplies as much as you can is good prep as well.

Diabetes doesn’t mean that you are going to be worse off if you get COVID-19. Healthy people are dying from it. Alternately, diabetes doesn’t make COVID-19 a death sentence. I have diabetes and was less sick than my co-worker who is healthy. It is hard to predict, so take care of yourself!

Thanks so much for taking the time to talk to me! I am so glad you are okay and feeling better. And from all of us here at Diabetes Daily, thank you for all you do! 

Source: diabetesdaily.com

Co-Managing His Daughter’s Type 1 Diabetes During COVID-19

Chris is a devoted father and husband and takes care of his daughter Maggie who lives with type 1 diabetes. Chris is very active in the diabetes online community. You can follow Chris’s journey with his daughter Maggie @t1ddad on Instagram.

Chris, thank you so much for taking the time to talk to me. The COVID-19 pandemic has left us all in fear, especially for those who are elderly or have pre-existing conditions. Knowing that you fit this demographic, or have someone you love who does, adds an extra layer to this challenging time. I am sure you are anxious about your daughter, Maggie, who is living with type 1 diabetes. I see you are very active within the diabetes online community and doing your part to advocate, educate, and support others dealing with this disease. I thought it would be helpful for our readers to hear the perspective of such a dedicated dad!

At what age was Maggie diagnosed, and how old is she now? 

Maggie was diagnosed when she was 3.5 and is now almost 11.

Photo credit: Chris

How did your family and daughter initially handle the diagnosis?

It came as quite a shock for us. I have a first cousin that has type 1 diabetes, but I didn’t know what that meant as he lived further away, and I didn’t even see what that meant for him. Maggie was constantly drinking and urinating, and we noticed that she seemed to be losing weight. We reached out to our doctor, and he was very quick to test, then admit her to the hospital with DKA, which we are extremely grateful for his quick response. Within a month after diagnosis, we also found out we were pregnant with our youngest son as well, so there was so much going on at the same time that we had to take in and figure out as well.

Before this pandemic started, how were things going? How was Maggie’s management? Does she use any technology? Are you still very involved?

In July 2019, we came up to the 5th year of her being on an insulin pump. We had already been using the Dexcom G4 system to monitor and track her blood sugars remotely and, after doing some research, decided to upgrade to the Tandem t:slim X2 pump and upgrade to Dexcom G5. In January, we upgraded to the G6 along with the release of Tandem’s Basal IQ update. I’m so glad that these upgrades and updates all happened, so we had time to get used to them and see their benefits before all this came about.

I provide the primary care for her diabetes as my wife’s health is very poor right now as well, and I’m still quite involved in the overall monitoring and management of her day-to-day care. She can calculate most carbohydrates and give herself insulin for meals, but adjustments, corrections, etc. are all done by me. She has always been afraid of needles as well, so I also still do all the insulin pump, and CGM site changes too.

Photo credit: Chris

Once you heard COVID-19 was picking up speed in your area, what was the first thing you did to prepare? 

So it’s interesting. The timing of everything seemed almost perfect. I was due to refill her insulin prescription right at the beginning of March, and the doctor gave us a prescription for 3 months at a time to reduce filing fees. So before all the panic started to build, and before pharmacies began to limit the amount of insulin they would dispense, I was able to get her normal supply, which I am very grateful for. I also ordered an extra box of infusion sets and reservoirs right around the same time, but I don’t have as long of a supply for that, so I will have to watch carefully and order that a little further ahead to allow for extra time to deliver.

How is your daughter handling what is going on in the world? How did you go about explaining the severity without completely scaring her?

We have been fairly open to all our kids within reason. We try to be clear what’s going on, and there was some talk in school before it was temporarily shut down as well. Once we got word that schools were shut down (right as we were getting ready to start March break here), we had a family meeting and were clear that everyone needed to pitch in and help out so that I can keep working as much as I can to provide for the family and that everyone would need to respect each other’s space since we wouldn’t be able to get away from each other in quite the same way. We try to keep some structure while being flexible and understanding of the situation.

Photo credit: Chris

How has the stress of this affected Maggie’s blood sugars? How about her overall management?

I’m really not sure if stress has affected her blood sugars or not. I know she is not nearly as active currently as she was at school, so we are finding her blood sugars are a bit higher on average, so I’ve made some adjustments to her bolus ratios and basal rates to compensate. It’s finally getting warm enough here that we should be able to have the kids play in the backyard more, so I’m hoping that will help.

One thing we have is time. Do you plan on using this time to tackle anything diabetes-related? For example, some are using the opportunity to do basal testing. Other’s are hoping their kids get more involved with their management, etc. Or are you just taking the time to let Maggie relax and be as stress-free as possible?

The one advantage I have to her being home is having a little more control to monitor and correct compared to when she is at school. So, I’m not letting her blood sugars get quite as high before making adjustments or corrections as she would have at school. Otherwise, I have a lot on my plate, so I haven’t had the time to let her take on any more responsibility for additional things quite yet.

Photo credit: Chris

If there is one piece of advice you would offer to other parents who are going through the same thing, what would you tell them?

I think that maintaining some structure, even if it’s not school work-related is very important to keep things more ‘normal’ for my kids, and for managing diabetes as well. Keeping bedtime at around the same time, meals at fixed times etc. helps to keep the day flowing instead of it just being one long day lying on the couch with one Netflix show after another. Kids feel our stress, so hiding what’s going on isn’t going to help, but allowing them to feel free to express what they are feeling as well so we can all get through this together is very important!

If there is one positive to come out of this crisis, what would it be? I think we could all use a silver lining!

Connection & finding opportunities to love. I know for me personally, my skills, talents, and experience give me tremendous advantages and flexibility to help people. Especially small businesses and nonprofits understand that now, more than ever, they need to get clear on their message and communicate it to their clients, prospects, and those they serve. I have no clue when or if they will be able to pay me, but I continue to do what I can to help.

I have also found that myself, as well as my family, have taken the opportunity to reach out with an email, text or Facebook message, or video chat with many of our friends and family, probably more frequently then we might have even done previously in person because those relationships are so important. I hope that when we come out on the other side of this crisis, we can continue to make relationships an important part of our lives and continue to serve those around us.

Thank you so much for taking the time to talk to me. I hope you and your family continue to remain safe and healthy!

Source: diabetesdaily.com

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