How to Handle Halloween for Children with Diabetes

It’s that time of year again: the leaves are falling, the temperatures are dropping, and all things scary and spooky are on store shelves. While pumpkin picking and catching a hay ride are (for all intents and purposes) “low carbohydrate” activities, trick-or-treating can be anything but. So, how do you handle Halloween with a young child with diabetes? Do you allow them to “be a kid” for an evening, and go all out on the chocolate and sugar spike? Or do you limit them to a few, portion-controlled treats, with a food scale nearby? While there’s no one right answer to this question, here are some helpful tips to make your Halloween a little less spooky this year.

Take the Focus Away from Food

This is helpful for all children, for all holidays. No holiday needs to be 100% about the food, especially for a child with diabetes. For Halloween specifically, focus on carving pumpkins, watching scary movies, dressing up in really elaborate Halloween costumes, and yes, if you and your child wish, some candy, too.

Noelle from California says, “Our kiddo is three so our main focus is on creating traditions that will be helpful for her later on with type 1. For parties, I create treats that aren’t food-related.”

Lila from New York City says, “We completely avoid the candy thing. Trick or treating isn’t a huge deal in our neighborhood, so this hasn’t been an issue yet.”

Kate, from Pennsylvania, says, “We go out a little, but limit the number of stops. After we get home, we go through our candy, keeping only what we really, really like. The rest, we give to the Switch Witch, and she brings the girls a little present in the morning as an exchange for giving her their candy.” There’s even a book you can buy that helps explain the magic of the Switch Witch.

Create Unique Traditions

Perhaps you have a spooky, scary dance party or movie night on Halloween, or the whole family dresses up in matching costumes to go walking around the neighborhood. Maybe you bob for apples or roast pumpkin seeds after carving, or let your child have a few friends sleepover. Creating unique family traditions that are inclusive will be beneficial not only for your child now, but will be helpful as they grow up with type 1 diabetes.

Be Wary About Restrictions

Be cognizant about putting too many restrictions on candy for your child. Children with diabetes are much more likely to develop an unhealthy relationship with food. If your child really wants to indulge, just make sure they’re carbohydrate counting appropriately, and let them enjoy themselves (within moderation, of course). Most of the time children intuitively eat anyway, and don’t actually end up eating that much candy.

Melissa, from Iowa, says, “We bring any candy home and carb count it ahead of time, and then put a post-it note on each piece, so our daughter can dose appropriately whenever she’s hungry or wants a treat.”

Plan Ahead

Like all things diabetes-related, it helps to plan ahead. Make sure your child eats dinner with some protein and fat before going trick-or-treating, so they’re not just eating sugar on an empty stomach, which can cause the roller coaster effect. Make sure you know where and how far they’ll be walking, or better yet, walk along with them. Have your child carry low snacks (they shouldn’t solely rely on candy that won’t have any nutrition facts or carbohydrate information on it), and make sure they’re drinking plenty of water. It’s helpful if your child also has fresh continuous glucose monitor (CGM) and insulin pump sites on, but not absolutely necessary.

Hannah says, “Planning ahead a learning to navigate holidays with type 1 diabetes is critical and so empowering once you find what works for you and your family.”

Don’t Stress the Small Stuff!

It’s important to remember that Halloween is only one night, and you shouldn’t stress the small stuff. Some parents of children with diabetes shy away from candy, while others let them indulge, and there is no one right answer. Do what works for you and your family, but don’t let the stress of one holiday ruin the evening for you and your child. Relax and let them have fun! They’ll be doing so much running around anyway that you’ll be glad they had the extra “low snacks” on them anyway.

Lija, from Minnesota, says, “We don’t do anything different for my type 1 and non-type 1, and it works out fine. We find that she tends to go low while out trick or treating, so she just eats and boluses a little while out; it isn’t actually a difficult holiday for us!”

The key is finding what works for you. There are no right or wrong answers. Here’s to a happy, spooky Halloween! Hopefully the candy (and subsequent blood sugars) are the least scary part.

How do you and your family handle Halloween in a household affected by diabetes? What tactics and strategies have helped you manage appropriately? Share your experience in the comment section below; we love hearing from our readers!

Source: diabetesdaily.com

What I Wish People Knew About Type 3C Diabetes

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

By Jen M.

What do you think of when you think of a diabetes diagnosis story? It could be a type 1 diagnosis story when someone experiences diabetic ketoacidosis (DKA) symptoms and gets admitted to the hospital. It could be a type 2 diagnosis story of someone diagnosed through blood work at a routine doctor’s appointment. My story is a little bit different.

I am a type 3c diabetic. Most people I converse with have never heard of my type, and that’s okay. Since my diagnosis, I have found a passion for educating the general public and the diabetes community about type 3c and what life is like living without a pancreas.

You read that right, I don’t have a pancreas at all!

In December 2015, I woke up with severe abdominal pain. At first I thought it may have been a stomach ache and tried to rest. As the day went on, the pain continued to get more severe. And when I say severe, I mean the worst pain I have ever felt. It is difficult to even put the experience into words. I was visiting my parents for Christmas and my mom drove me to the local emergency room. What I thought would be a quick trip turned into a 4 week stay. I was diagnosed with pancreatitis and they spent those weeks trying to get the pain under control and figure out why this was happening.

The journey to figure out why I, a 25 year old with no family history and no alcohol use, was having repeated episodes of pancreatitis took about 7 months. I was in and out of the hospital every few weeks with recurring flares. I’ll spare all of the details, but it was finally determined that I had two genetic mutations in the SPINK gene and the CFTR gene. The combination of these gene mutations explained why I had chronic pancreatitis. I consulted with several doctors at different hospitals and they all agreed that the best plan of action to improve my quality of life would be to perform a total pancreatectomy.

I had my surgery on February 2, 2017, a little over 1 year after my first diagnosed pancreatitis flare. The surgery is called a total pancreatectomy with autologous islet cell transplant (TPAIT). The surgeon removed my pancreas, spleen, gall bladder, duodenum, and lower portion of my stomach. As people with diabetes know, insulin is incredibly important, so in an ideal case, the surgeon would remove the pancreas and isolate the islet cells from the pancreas and transplant them into my liver. According to my surgeon, 36.9% of patients in his research studies became independent from insulin after islet transplant. Hearing this before surgery made me optimistic, however there was extensive damage and calcification to my pancreas when they removed it and the islet cell yield made my transplant unsuccessful. I have been fully insulin-dependent since the second my pancreas was removed from my body.

So I want to explain briefly exactly what type 3c diabetes is. It is referred to as “pancreatogenic” diabetes, which means diabetes that results from a pancreatic condition. Examples of pancreatic conditions could be exocrine insufficiency, pancreatitis, cystic fibrosis, pancreatic cancer, or partial or total pancreatectomy. As you can imagine, it is a complex condition that is not widely researched or even recognized by many medical professionals. After asking my close TPAIT friends, most of us don’t even have the diagnosis of type 3c in our charts, because insurance won’t cover devices and supplies under that diagnosis code. Most of us have type 1 diabetes as our chart diagnosis, an entirely different autoimmune condition.

Type 3c may have similarities to type 1 due to the fact that both conditions require insulin, but that’s the only similarity. There are a few big differences to note. With TPAIT related type 3c specifically, since our pancreases are completely removed we have no alpha cells. In the most simplified definition, alpha cells secrete glucagon, which works opposite to insulin by increasing the amount of glucose in the blood. Without these alpha cells we are at risk for “brittle” diabetes and large swings in our blood sugar. Another big difference between TPAIT type 3c and other types is the malabsorption issues that we can face after surgery. Since we have large portions of our digestive systems removed, including the lower stomach and duodenum, the way our food and nutrients are digested may impact our insulin needs.

The pancreas has both endocrine and exocrine function. The endocrine function is secreting hormones, such as insulin, into the blood and the exocrine function is secreting digestive enzymes, bicarbonate, and water into the duodenum to begin the digestion of food. Most type 3c diabetics require prescription digestive enzymes when eating. Pancreatic conditions typically affect the exocrine function of the pancreas so we have to supplement these enzymes to aid with digestion. Without the proper dosage and timing when taking the capsules, we cannot properly digest food and can face serious gastrointestinal complications and malabsorption of nutrients.

When it comes to the diabetes community, there is not a large representation of people with type 3c. Type 3c is rare and often misdiagnosed. When someone is suffering from a pancreatic condition and they develop diabetes as a result, doctors often just call it type 2. I imagine this is due to a lack of information, research on type 3c, and insurance coverage.

There are a few things that I wish people knew when it comes to type 3c. The most important to me is that, when you have diabetes alone, your pancreas isn’t “dead”. The pancreas is often referred to as dead or useless in the diabetes community. Using these terms is false and misleading.

Endocrine cells make up 5% of the overall pancreas. Diabetes is an endocrine disease, and diabetes doesn’t necessarily mean you have zero pancreatic endocrine function. Many people with type 1 diabetes may have functioning alpha cells (producing glucagon) because the initial autoimmune attack is limited to the beta cells of the pancreas. Exocrine cells make up the other 95% of the pancreas, and for people with type 1 diabetes and no other pancreatic condition, this function is still working smoothly. Both endocrine and exocrine functions are vital in their own way to the body. Your pancreas could be considered “useless” if you are missing both of those functions. In any other context, it spreads misinformation.

I feel that most people with diabetes, of any type, want the general public to better understand our condition. We want them to understand the differences between the types. We want them to understand what causes or doesn’t cause diabetes. If that’s the case, why would we want to give them misinformation in the process? It’s not helping society understand diabetes. It’s not helping people with diabetes to understand diabetes. I honestly think that some people who say their pancreas is useless believe it to be true, because it’s what they’ve heard others say. And I know the diabetes community can do better to help educate within our community and also to the general public. I know the type 3c community would appreciate being recognized and validated. We haven’t had many opportunities to have our voices heard from large diabetes organizations or within the community. I know I will never stop using my voice to advocate for us. I can only hope to have the support of the diabetes community behind us.

Source: diabetesdaily.com

FreeStyle Libre 3 Cleared in Europe – Smaller, Thinner, and No More Scanning!

This content originally appeared on diaTribe. Republished with permission.

By Matthew Garza and Katie Mahoney

The FreeStyle Libre 3 has been cleared in Europe for anyone ages four and older. The new continuous glucose monitor is as small as two stacked US pennies, provides real-time readings directly to the mobile app via Bluetooth, and has the same low list price

Abbott announced that the new FreeStyle Libre 3 has been cleared in Europe – see 40-second video here. This third-generation continuous glucose monitor (CGM) has many of the same features that make the FreeStyle Libre 2 so popular, including optional alarms, 14-day wear, and high accuracy. The FreeStyle Libre 3 also adds several new features:

  • Real-time, minute-by-minute readings are sent directly to the FreeStyle Libre 3 app via Bluetooth – moving this CGM from “on-demand” to “always-on,” so there is no need to scan the sensor every eight hours.
  • It is 70% smaller than previous models, making it the “smallest and thinnest” CGM sensor yet – it’s said to be about the size of two stacked pennies. Importantly, this new model will reduce the amount of plastic and carbon paper used, improving the production of the device significantly from an environmental perspective.
  • It is cleared for people with diabetes as young as four years old.
  • It is cleared for use in gestational diabetes and pregnant women with type 1 diabetes. We suggest that everyone who is pregnant and has type 1 diabetes try to get CGM, and that everyone else who is pregnant be tested for gestational diabetes as early on as possible.
  • It is cleared as an iCGM, meaning it can be used for automated insulin delivery (AID) development in Europe.
  • The new FreeStyle Libre 3 app, available for both iOS and Android devices, will contain many of the same features as the FreeStyle Libre 2 app (Libre View) including the all-important time in range graphs and ambulatory glucose profile (AGP). You can learn all about the AGP here.

Currently the FreeStyle Libre 3 is cleared for upper-arm wear, though we imagine people may try to use it “off-label” on their abdomen or other spots. There is no separate reader for collecting and monitoring sensor data, so people will use smartphones with the FreeStyle Libre 3 app in order to connect to the sensor.

The FreeStyle Libre 3 will be available at the same price as previous versions of the CGM ($109 for a one-month’s supply, without insurance); Abbott will continue to offer the FreeStyle Libre 2 at the same price for people who prefer the to scan their CGM. The FreeStyle Libre 3 is expected to launch in the coming months in Europe, and though we don’t yet know where it will first launch, we expect it may be Germany, like Abbott’s other CGM launches. In the US, Abbott has not announced any potential timeline for FDA submission or clearance. With the recent Libre Sense clearance in Europe, there is lots happening with this brand – stay tuned for more. Readers in European countries, we’d love to hear your early thoughts once you try the FreeStyle Libre 3!

Source: diabetesdaily.com

Semglee, A Low-Cost Basal Insulin, Comes to the US

This content originally appeared on diaTribe. Republished with permission.

By Karena Yan and Joseph Bell

A more affordable alternative to Lantus (insulin glargine) will cost $148 for five pre-filled insulin pens

Mylan and Biocon Biologics announced last month the long-awaited US launch of Semglee, a new insulin aiming to be deemed “biosimilar” to insulin glargine (basal insulin) by the FDA. A biosimilar drug is a biological product that is highly similar in structure and function to a product already approved by the FDA, known as the reference product. Semglee is said to be similar to Sanofi’s basal insulin Lantus; it has the same protein sequence and has a similar glucose-lowering effect. The FDA has yet to classify Semglee as “biosimilar” or “interchangeable” to Lantus due to the need for additional review – so for now, Semglee should be considered a new basal insulin option for people with diabetes. Semglee was previously approved in 45 countries, including Australia, Europe, Japan, and South Korea. We aren’t positive how “interchangeable” will go – would someone using Tresiba or Toujeo “next-generation basal” insulin want to go with Semglee instead? This is unlikely in our view.

Semglee is currently available by prescription in either a pen or a vial and can be used by people with type 1 or type 2 diabetes. It costs $147.98 for five 3 mL pre-filled pens or $98.65 for one 10 mL vial. Semglee is reported to be the cheapest available insulin glargine-equivalent on the market, with a 65% discount from the list price of Lantus. That calculation is a bit misleading as does not take into account discounts and rebates available with a variety of insulin brands; actual out-of-pocket costs can differ dramatically for individuals.

Happily for people who don’t qualify for patient assistance programs, Semglee represents a far more affordable option for people with type 1 and type 2 diabetes who take basal insulin. While biosimilars are usually not as inexpensive as “generic” versions of drugs, because biosimilars are more expensive to manufacture, they do provide cheaper alternatives to brand name drugs, in this case, Lantus (and Levemir, Tresiba, and Toujeo). Further, because Semglee is thought to be essentially equivalent to Lantus, it should provide an important and practical option for basal insulin users who are concerned about insulin costs and do not have a route to pay less – this is far more people than often considered.

It’s also key to note that Semglee is not technically considered a “biosimilar” drug – it is currently under FDA review to gain approval of this designation. The biosimilar designation would mean that Semglee officially has bioactivity and clinical efficacy that are not different from Lantus, but are not necessarily exactly the same. If it earns an “interchangeability” designation, pharmacists would be able to substitute Semglee for Lantus without consulting the prescribing healthcare professional. Semglee might also be substituted for Tresiba or Toujeo, two “next generation” more stable basal insulins.

Two biosimilar insulins are currently approved in the US: Basaglar, a basal insulin glargine approved in 2016, and Admelog, a rapid-acting insulin lispro approved in 2018. If Semglee gains an FDA biosimilar designation, it will become the third biosimilar insulin available in the US.

Mylan is offering a co-pay discount card and a patient assistance program to help people afford Semglee. The co-pay card is available to people with commercial health insurance – you may be able to receive up to $75 off each 30-day prescription. Learn more here. For people without prescription insurance coverage, you may be able to get Semglee for free – access the patient assistance program by calling Mylan customer service at (800)796-9526.

Source: diabetesdaily.com

Diabetes Can Be Controlled But It Is a Constant Struggle!

Philipp was diagnosed with type 2 diabetes right after knee surgery in 2005 and his diagnosis was like a little odyssey. Before jumping into the interview with Philipp, here is what he shared about his diagnosis journey.

mySugr loves to show the many different faces and stories of people with diabetes in the real world. They do their own photoshoots and feature real people living with diabetes instead of using stock photos.

“I was diagnosed with diabetes in 2005, during the evaluation and testing to discover anything that would delay the total left knee replacement surgery.

Nobody mentioned anything about diabetes when I had blood work done the week before surgery.

But upon being admitted hours before my 8am surgery, I was told I was a borderline diabetic. I anxiously asked what does that mean? The technicians at the attending nurse stated that I had a predisposition to having diabetes.

As far as I was concerned, I either had diabetes or I didn’t. I couldn’t grasp the concept of borderline.

After surgery, and in the recovery room when I woke up, I didn’t think anymore about it.

However, once I was delivered to the ward and further tested that evening, I was told that I was now a full-blown person with diabetes. That was a shock, and I began gathering information from the staff. How could I go from borderline diabetes to having diabetes overnight? I wasn’t told what kind of diabetes I had until hours into the second day of my hospital stay. That is when I was diagnosed as type 2.

Upon my third day prior to my release, I was told that I was being prescribed oral diabetes meds and not insulin.

Several weeks later, I was dehydrated and became extremely thirsty and began drinking 32 oz. “slushy” drinks from the 7-11. One every hour.

It became so intense the next day. While my wife was at work, I became so concerned that I drove myself to the VA emergency room. After waiting more than 1 hour I was seen in the ER and after testing my blood sugar level, it was well over 300.

I was blessed for driving to the ER because my vision was super blurry and traffic was almost non-existent. What guided me mostly were the lane dividers that I could hear to guide me, muscle memory for guiding the vehicle and knowing how far away the VA was from our home.

The experiences that are key here are extreme thirst, extreme body temp rise, the extreme need to urinate multiple times in an hour, visual impairment, and potential for bad decision making that can wind up in a very serious situation.

 

1. What was your biggest fears/concerns when you were diagnosed with diabetes?

That it was a mistake. I wasn’t overweight, I exercised regularly and watched what I was eating.

2. What’s the hardest part/biggest struggle for you in living with diabetes day-to-day?

First was the prescription for diabetes medication that the result was not managing my sugar level. Second, not believing this disease couldn’t be eliminated. Third, monitoring my sugar regularly and the levels did not fall below 200.

3. What piece of advice would you give to a person who is newly diagnosed with diabetes?

My advice would be to research as much as possible to get accurate and reliable information regarding diabetes. Do not believe that diabetes can be eliminated. Diabetes can be controlled but it is a constant struggle.

4. Is there a phrase/statement about diabetes that drives you crazy?

Yes! The statement that diabetes can be eliminated by a regulated diet of certain meds drives me crazy.

5. When you think of the word “freedom” in terms of diabetes, what does that mean to you? What would make you feel more free?

Freedom for me would mean that diabetes can be cured in a certain amount of time.

Source: diabetesdaily.com

The Keto Diet Isn’t for Everyone: A Type 1 Diabetes Perspective

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

By Christel Oerum

I’m a firm believer that there is no such thing as a “Diabetic Diet,” but that we each need to find the best diet for our bodies and mental happiness.

In the search for the diet that’s right for me, I tried the keto diet, and this is what happened.

Why I Decided to Try the Keto Diet

I’ve been living with type 1 diabetes since 1997 and didn’t pay much attention to my diet or followed any specific nutrition regime for the first 17 years. I just ate and adjusted my insulin to my food. And you know what, that worked pretty well for me.

Then in 2014, I started preparing for my first bodybuilding competition and I really had to focus on my diet in a way I never had before. Back then, my coach had me on a high protein, medium/low-carb, and very low-fat diet.

After that experience, I became fascinated with different nutrition approaches and I’ve tried out quite a few diets in the name of research and just plain curiosity.

What is so fascinating about nutrition is that every approach has its die-hard followers and I’m always curious to see if I’ll love it as much as they do.

So, in the name of research, I set out to try the keto diet on my own body.

How I Implemented the Keto Diet

The keto diet restricts the amount of carbohydrates and protein consumed, which means that you primarily rely on fats for your daily energy. The goal is to consume very few carbohydrates (~5% of your daily calorie consumption, or 20-50 grams max), thereby forcing your body to burn fat for fuel.

Fans of the keto diet usually like the approach because it supposedly helps with blood sugar management as well as weight management. And let’s face it, if you’re into bacon and cheese, it sounds very alluring.

Many say that they’ve seen weight loss even though they don’t pay attention to calories, simply because a diet high in fat is very satiating, making them feel full quickly so they eat less.

Based on all of this, I decided to eat less than 50 grams of carbs a day (including veggie carbs/fibers), about 80 grams of protein, and as much fat I needed to feel full without keeping a track of my calorie intake.

My Experience Following the Keto Diet

Christel

Image source: Beyond Type 1

At first, my experience was great. I enjoyed the cheese, nuts, seeds, and avocado that my diet predominantly consisted of.

When it came to my diabetes management, I saw a flatter blood sugar profile with fewer spikes on my Continuous Glucose Monitor (CGM) that I often see when I eat a more carb-heavy diet (which is not surprising since carb are what gets converted into glucose the fastest in the bloodstream).

But my experiment quickly went south. I started to become increasingly insulin resistant after only about a week, which meant that I needed more and more insulin to manage my blood sugars, even though I was eating very few carbs.

I still wasn’t seeing any major spikes in my blood sugars, but since fat slows down the release of glucose into the bloodstream, my blood sugar would continue to slowly creep up. To keep my blood sugars in-range, I had to increase my long-acting insulin significantly while micro-dosing my rapid-acting insulin more often.

The reason for the micro-doses rather than doing larger doses was to adjust my blood sugar without ending up with low blood sugar.

Not only did I become more insulin resistant and had a harder time managing my blood sugars, I also started to have a lot of digestive issues and was gaining weight at an alarming rate.

None of the last two issues are really a surprise.

  1. My digestive issue was most likely related to my diet being low in fibers and volume
  2. And when it comes to my weight gain, fats are very calorie-dense compared to protein and carbs and since I wasn’t monitoring my calorie intake, I was eating too many calories for my needs. I have a healthy appetite and fats alone were just not satiating enough to make me feel full quickly.

After about a month of sticking to the keto diet, I switched back to my moderate/low-carb way of eating. At that point I didn’t feel good, I was constantly bloated, couldn’t fit in my clothes, and my endo was not impressed with how negatively it was impacting my diabetes management.

If you only take one thing away from this post, I hope that it will be this: that you can (and should) try things out, and if they don’t work for you, then “cut your losses.”

It’s Not a Failure, It’s Just an Approach That Doesn’t Work for You

So maybe the keto diet intrigues you, or the Paleo or Vegan diet sounds more appealing. My recommendation would be to research the diet, talk to others who have tried it, assess if it might trigger any unwanted eating patterns, and then try it out if you like.

There are thousands of people with diabetes who follow any of the three diets I mention above with great results so they clearly work for a lot of people – they just don’t work for all people. It may take some experimentation to find the diet that works for you.

If you’re interested in trying the keto diet, you can find a keto meal plan with recipes on Diabetes Strong.

Source: diabetesdaily.com

Moving Abroad for Better Diabetes Care

Anyone who lives with diabetes in the United States knows that affording care, and specifically insulin, is becoming more and more difficult as prices on insulin and essential medications continue to rise. A recent Yale study even showed that 1 in 4 people with diabetes have rationed their insulin due to cost, which can quickly lead to serious complications and even premature death. In our recent study , an overwhelming 44% of respondents reported struggling to afford insulin.

Our lack of a strong social safety net is leaving some patients feeling as though they have no other options for affordable care, and some patients have even resorted to crossing the border into Canada and Mexico to buy cheaper insulin, where federal price caps prevent runaway pricing on essential medications and prescription drugs. In light of all this, some people with diabetes have even daydreamed of completely relocating to another country for better care, where health coverage is centralized, universal for all people, and where medications are more affordable. The United States is the only rich country in the world that doesn’t guarantee healthcare for all its citizens.

Meet Liz Donehue, a comedian, writer, and American expat who has lived with type 1 diabetes for the past ten years. She moved abroad a few years ago to find better diabetes coverage, and I chatted with her about her experience moving to the Czech Republic.

What made you want to leave the United States? 

I left the United States for many reasons, but one of them was that the motion to repeal Obamacare passed in the House in 2017. Most of my employers didn’t provide health insurance, so the enactment of Obamacare in 2013 was a life-saving situation. Healthcare and insulin had never been unaffordable to me, but then again I was fortunate enough to have my parents support me in times of need, especially after I aged out of their insurance at age 26. I have never rationed insulin due to cost, only at times when the pharmacy or my endocrinologist made an error during insulin refills.

Why did you choose the Czech Republic? 

Part of the reason I chose the Czech Republic was that their visa process was relatively easy compared to other countries. I also chose the city I’m in, Brno, because of the cost of living. Having moved from Seattle, my cost of living went down by 66%. Other candidates included Poland, Vietnam, and Cambodia, but I had previously been to CZ and they had the most advanced healthcare system out of the four.

What was the deciding factor that made you move?

I had recently been laid off from my job, and I had just gotten out of a relationship. Essentially there was no true reason that kept me in Seattle, so I started to look at other options, especially where there was available socialized healthcare. I did research for about four months before moving, and I was able to secure an apartment online for myself and my cat who I brought with me. I’m living here permanently and my visa is through my current employer.

Will you become a citizen? 

I’m not a Czech citizen and as a “third country national” (non-EU), I will need to have lived in the country for ten years before I can apply. When I first arrived and waited for my freelance visa to process, I had to get private insurance through an international company for my application.

Typically, how expensive is diabetes care and insulin in your new country? 

During this wait, about five months, I was paying out of pocket for appointments and medications. But because it’s CZ, the costs pale in comparison to what they are in the US. A pack of five Humalog pens costs $18 here as opposed to $556 back home without coverage. When I got hired by my current employer, they took over paying for my healthcare costs, about $98 a month. I paid this for myself while I was self-employed, but everything was covered. There are no prior authorizations and the notion of pre-existing conditions doesn’t exist here.

Additionally, monthly insulin supply costs me nothing. I take Humalog and Tresiba daily and my test strips are also free of charge and included with my health insurance costs paid for by my employer. I get new prescriptions every 90 days whether I ask for them or not, so I now have a surplus of insulin and I don’t need to worry about refills.

Do you miss anything about the US healthcare system? 

I think the major thing I miss about the US healthcare system is the access to current technology. The system in CZ, while affordable and readily accessible, doesn’t have the technology to download glucometer readings, for instance. I also need to provide my own samples of urine for quarterly testing instead of having it done in the office. The medical equipment and tools are often metal and sterilized as opposed to plastic and designed for one-time use, which I’ve heard is a practice left over from the communist era.

Are you ever planning on moving back to the US? 

My move to CZ was an act of self-preservation. In the US, for some reason, health insurance is tied to a person’s employment. As long as that system is in place or there is no enactment of a system like Medicare for All, I can’t move back to the US. The pandemic has increased my concerns, and right now, I could go back to the US to visit, but I would not be let back into the Czech Republic just on the basis that I was IN the United States as the situation is worsening by the day. I feel healthier [living here] but I’ve also been taking extreme precautions due to the pandemic since I’m immunocompromised.

Thank you for your time, Liz. We really appreciate you sharing your story with us!

Have you ever considered moving abroad for better health coverage and diabetes care? Why or why would you not move abroad? Share your thoughts below; we would love to hear from you!

Source: diabetesdaily.com

Zoning in on Sick Day Management: Practical Tips, Strategies, and Advice

By Dr. Francine Kaufman

Pediatric endocrinologist Dr. Fran Kaufman shares tips for managing illness and diabetes: make a sick day plan, have supplies on hand, log your data, modify your insulin doses, and call your healthcare team. 

Everyone with diabetes who takes insulin needs to have a sick day plan. This is something you develop with your healthcare professional to help you manage the high and low sugar levels that can be associated with an illness. The following advice applies to people with type 1 diabetes and people with type 2 diabetes who take insulin – the advice may be different if you have type 2 diabetes and do not take insulin.

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When you get sick, you are at risk of becoming dehydrated from poor intake or from excessive loss of fluids due to nausea, vomiting, diarrhea, and fever (your body may lose more water when you have a high temperature). In addition, dehydration is common in diabetes because high glucose levels (above 180-200 mg/dL) cause sugar to enter your urine, dragging an excess amount of fluid with it. Illness also puts you at risk of developing ketones, which when coupled with high glucose levels can lead to diabetic ketoacidosis (DKA), a very serious condition. How do you know if you have ketones? Good question, click here!

The purpose of your sick day plan is to try to keep your glucose levels in a safe range – to avoid dehydration and to prevent ketones from rising to a dangerous level. When you get sick, you should contact your healthcare team to describe your symptoms, determine if they want to evaluate you or send you to a lab (for testing), and most important, to share the numbers that you will collect as you fill in your sick day log (more on this below). It is possible that no matter what you do, you might need to go to an emergency department or be hospitalized – but acting quickly, obtaining the right data, and doing your best to manage your glucose and hydration will minimize risks.

So what illnesses are we talking about? It turns out just about any common bacterial or viral infection – such as the flu (influenza), a cold (upper respiratory virus), tonsillitis, strep throat, an ear infection, stomach flu (gastroenteritis), a bladder infection, and even a skin infection, such as an abscess – can interfere with your diabetes management. However, right now, the greatest concern is COVID-19. An infection with COVID-19 can lead to very high glucose and ketone levels, putting someone at risk for DKA. Acting quickly to start your sick day plan, even if you end up needing to be hospitalized, is important.

When you get sick, your body needs energy to fight the infection and repair damaged tissue. The infections listed above, particularly those that lead to vomiting, diarrhea, fever, and dehydration, cause your body to release certain hormones (called stress or counterregulatory hormones) that tell your liver to release stored glucose and tell your fat cells to release free fatty acids that form ketones. In someone without diabetes, the body releases more insulin to control the rise in glucose and ketones; because you have diabetes, you have to take additional insulin to manage the high glucose and ketone levels. You want to get your sugar levels between 100-180 mg/dL. Blood sugars below 180 mg/dL will prevent excess urination that can dehydrate your body. Staying above 100 mg/dL helps keep you from dipping too low and risking severe hypoglycemia.

If your glucose level is above 180 mg/dL, you need to consider increasing basal insulin doses, using an increase in basal insulin with the temp basal feature on your insulin pump, or giving repeated corrections of bolus insulin with a syringe, pen or pump. Usually, correction doses should not be given more often than every two to three hours to avoid “stacking” insulin, which could lead to low blood sugars. By having a plan for illnesses that starts your modified care early and by keeping in touch with your healthcare team, you are more likely to keep your glucose values in the 100-180 mg/dL range.

But you also have to be concerned about hypoglycemia. Low sugar occurs, particularly in children and the elderly, if the illness affects calorie and carbohydrate intake by decreasing appetite or by causing vomiting or diarrhea. Although low glucose is usually considered to be less than 70 mg/dL, during illness there is concern if glucose levels are below 100 mg/dL. If your infection or illness leads to low glucose levels, reducing basal insulin and not taking bolus insulin doses should be considered. If suspension of insulin is required, you should not suspend or delay taking the next dose of basal insulin for more than 60 minutes, because this increases your risk of developing ketones. Start sipping a sugar-containing drink, one tablespoon at a time. If hypoglycemia continues and you cannot make it better by ingesting sugar, consider the administration of low-dose glucagon. Low-dose glucagon can increase glucose level by 50-200 mg/dL in 30 minutes. To learn about whether low-dose glucagon is right for you, and at what dose, talk with your healthcare team.

To follow what is happening in your body, it helps to start a log of your glucose levels, ketones, fluid intake, and insulin doses. This sick log can be shared with your health care team. It should show improvement from one time period to the next (see below). Note: the biggest concern is vomiting; if you vomit more than twice in a time period or across two time periods, call your healthcare team.

The log shows only two days, because you should be better after 24 hours and completely on the mend after 48 hours. If you are not getting better, call your healthcare team.

Table

Image source: diaTribe

Here’s how to keep track (and why to keep track!) of these important numbers:

1. Glucose Levels: Check glucose levels every 1-2 hours. You may have to change this and check your glucose every 30 minutes if your levels are changing quickly. CGM trend data should be looked at every 10-15 minutes. Watch for rapid changes by looking at numbers and arrows. The goal is to keep your glucose between 100-180 mg/dL and without wide swings in values.

2. Ketone Levels: Urine ketones are often detected using a urine ketone strip. A small patch on the strip changes color depending on your level of ketones, representing negative, small, moderate, large and very large levels of ketones. Moderate, large, and very large levels are of concern. Ketones can also be measured with a fingerstick and a special ketone meter. The readings for blood ketones are more accurate and range from 0.0 to 3.0 mmol/L or greater. Blood ketone levels below 0.6 mmol/L are considered normal. Between 0.6 and 1.5 mmol/L ketones are high and show that your fat has broken down to form excess ketones. This puts you at risk of DKA if glucose levels are also elevated. Ketone levels above 1.5 mmol/L are serious, and you should contact your healthcare professional. Signs of elevated ketones:

  • Nausea and vomiting (which may also be present because of the infection)
  • Shortness of breath and labored breathing (your body is trying to eliminate the ketones through your breath so you can also smell them, they make your breath smell fruity)
  • Weakness
  • Altered level of consciousness and trouble staying awake (this is most concerning; call your healthcare professional immediately if this is happening)

Ketones should be tested at the onset of an illness and then every four hours.  If ketone and glucose levels are both elevated, your healthcare team might advise you to increase correction insulin doses further, by an additional 10-15%. If ketone levels are high and glucose levels are not high (less than 150 mg/dL), oral glucose and some insulin – reduced by about 50% – will help clear your ketones. Drinking water will also help reduce ketones as they are removed in the urine. To learn more about ketones, including what they are and how to measure them, click here.

3. Temperature: High fever can help show the severity of your illness, particularly if it is persistent.  We have learned that COVID-19 is associated with persistent high fever. Use the log sheet to document any medications you take to lower fever so that you can report this to your healthcare team.

4. Fluid Intake, with and without Sugar: Consuming liquids is critical if there is risk of dehydration. Fluids with sugar should be taken if glucose levels are between 100-150 mg/dL, and fluids without sugar should be taken if glucose levels are between 150-180 mg/dL. If you have vomited, wait 30-60 minutes before trying to drink, and then start with teaspoons of water or ice chips, progressing to tablespoons and ounces. The goal is to retain 4-6 ounces of fluids (or 2-4 ounces for young children) every 30-60 minutes until you can drink without risk of vomiting and as your thirst dictates. Food is much less important after vomiting; don’t try to eat food until you are on the mend.

5. Urination: Noting frequency and amount (small, medium, or large) is important to understand the ongoing risk of dehydration. As glucose levels reach the target of 100-180 mg/dL, you should see a decrease in both frequency and amount of urination, as well as less dehydration.

6. Vomiting, Diarrhea and Dehydration:  Vomiting and diarrhea can lead to dehydration. The signs of dehydration include dry mouth, sunken eyes, weakness, loose skin, rapid heart rate, and low blood pressure. Vomiting is also of great concern because it occurs not only from the illness, but as a result of DKA. That’s why vomiting that occurs throughout one time period or spans two time periods in your log means it is time to call your healthcare professional.  However, if you feel weak after vomiting only once or twice, it is always better to call earlier than later.

7.  Insulin, Amount and Time: One of the most important things to remember is that during an illness, you still need to take insulin. Even if you are not eating or drinking at the beginning, you need to have insulin in your body. Insulin allows sugar to enter your body’s cells to be used for energy, and you need more energy to fight off an illness. Insulin also reduces ketone formation and stops excess urination by lowering glucose levels. If you have high glucose, you might need 25-50% more insulin than you usually take, due to insulin resistance created by the extra stress or counterregulatory hormones in your body. If you have low glucose, you might need to take 25-50% less insulin than you usually take, but you still need some basal or background insulin on board.

8. Medications: At the beginning of an illness, you should consider calling your healthcare team to determine if you should avoid taking any of your routine medications while sick. This includes glucose-lowering pills or injections, such as SGLT-2 and GLP-1 drugs, or medications for blood pressure and cholesterol. In addition, it is important to write down any medications you take (name, dosage, time) to treat fever, vomiting, diarrhea, or other symptoms of your illness. Anti-vomiting medications may be helpful but should only be taken after discussing with your healthcare professional.

Key Messages:  

  • Know your sick day plan before you become sick.
  • Have supplies on hand. These include supplies to measure glucose, a way to measure ketones, a thermometer, sugar-containing fluids, glucagon, extra-rapid (or short) acting insulin, and medication to treat fever. Discuss with your healthcare team whether you should have medication for diarrhea and vomiting on hand.
  • Have all the contact information for your healthcare team available, and call them sooner rather than later.
  • Before you call your healthcare team, have the data listed on your log sheet written down, plus your symptoms.
  • Take insulin at modified doses to address both high and low glucose levels. You still need to have some insulin in your body, even if you are not eating.
  • Let someone help you while you are ill. It is too big a job to be done alone.

About Fran

Dr. Fran Kaufman is the Chief Medical Officer of Senseonics, Inc. She is a Distinguished Professor Emerita of Pediatrics and Communications at the Keck School of Medicine and the Annenberg School of Communications at the University of Southern California.

Source: diabetesdaily.com

Mammoth Creameries: The Keto Ice Cream That Tastes Like the Real Deal

If you eat low-carb, you probably know that there is no shortage of alternative products when it comes to our favorite treats, like ice cream. However, far from all are able to deliver a wholesome list of ingredients in a product that is blood sugar-friendly and tastes great!

I received samples of several flavors of ice cream from Mammoth Creameries at no charge. I was not additionally compensated for this review and all opinions are my own.

Who They Are

Mammoth Creameries is a family-owned, low-carb, low-sugar ice cream business based in Austin, TX. It was founded by Tim Krauss and his wife, Sue, shortly after Tim’s diagnosis with type 1 diabetes. Tim explains how the diagnosis changed the course of his and his family’s life, and how the ice cream company was born:

“I committed myself to living a more health-conscious life centered around exercise and eating well, adhering to the paleo diet before making the shift to a low-sugar, low-carb, and high-fat ketogenic diet. Sue, in her typical fashion, went above and beyond in helping guide me through this difficult life transition before eventually going ketogenic herself. She quickly became our household’s go-to keto chef, exploring recipes and dishes of all kinds. However, there was one thing she couldn’t find for our new lifestyle: ice cream.

Born in our kitchen and warmly welcomed by our innovative city, the positive reception and growth we’ve seen since starting this company has reinforced our belief that Mammoth Creameries is the gateway to a dietary independence that diabetic and ketogenic individuals are hard-pressed to find in today’s world. Together, we’re creating dessert that works for your body, not against it!”

The company is committed to using well-sourced, high-quality, real ingredients, including butter from grass-fed cows and egg yolks from cage-free chickens. All products don’t have any added sugar and are sweetened instead with xylitol, a sugar alcohol that does not impact blood glucose levels (Note: Xylitol is very toxic to dogs, so do take extra care if you have a pet!).

The Products

Currently, four flavors of the ice cream are available: Vanilla Bean, Chocolate, Lemon Buttercream, and Chocolate Peanut Butter. A 4-pack of one flavor (pint-size) or a combination 4-pack can be purchased on the company website for $55.00.

Although the ingredients list for each flavor varies slightly, the main ones for each are: cream, butter, sweetener, and egg yolks. They are all very low in carbohydrate (~1 g net per serving), and high in fat (~26 g per serving).

My Review

I have previously tried many low-carb ice creams from different companies and have often made my own, using simple ingredients, like cream, almond milk, sweetener, and vanilla extract. I have to say that out of all the commercially-available products I’ve tried, this one tasted the most like my home-made ice cream!

All the flavors tasted very rich and creamy. Not surprising, as this company uses real cream and butter, delivering a full-fat and satisfying product. The texture perfectly resembled ice cream and wasn’t crumbly, like some other ones I have tried. Caveat: let this product sit out of the freezer for about five minutes to get the perfect ice cream consistency!

Most importantly, the impact on my blood sugar (BG) levels was almost negligible, without even taking any insulin! This is truly a “keto-friendly” and “BG-friendly” ice cream that delivers on its promises and tastes like real ice cream.

As far as the flavors, I enjoyed all of them. My favorites were the classic Vanilla Bean and the subtly citrusy Lemon Buttercream. Meanwhile, my 3-year-old thoroughly enjoyed both of the chocolate flavors! That is perhaps the true test: is it kid-friendly? The answer this time is a resounding “yes!” (which is often not the case for many other low-carb products that I have put to the “toddler test”)!

Also, a little goes a long way! I don’t think I would be tempted to eat a whole pint—due to the caloric load, a ½ cup serving size really does leave you feeling satisfied.

Summary

Overall, Mammoth Creameries delivers a high-quality, blood sugar-friendly line of products that are made with simple and real ingredients. While the price point is on the higher side, if you consider that you can actually eat just one serving and feel satisfied, along with being able to eat delicious ice cream that has no impact on your blood sugar without making it yourself, it is well worth the investment!

***

What’s your favorite low-carb ice cream? Have you tried this product? Please comment below – we love hearing from our readers!

Source: diabetesdaily.com

How Has the Pandemic Affected People with Diabetes?

By Rosalind Lucier and Alia Rizvon

Survey data shows the devastating economic and health effects of COVID-19 on the diabetes community.

The COVID-19 pandemic has affected all of us in different ways – some people have lost their jobs, others have had to navigate being sick or caring for sick family members, and still others have struggled with food insecurity and paying for medications. Sadly, new data released by leading diabetes research company dQ&A and the American Diabetes Association (ADA) found that people living with diabetes have suffered a greater economic impact as a result of the pandemic than the average person in the United States.

According to the survey, the unemployment rate for people with diabetes is much higher at 18% than the national rate at 12%. In addition, one third of people with diabetes have lost some or all of their income. This number is even higher for people with diabetes who need the most support – one in two low-income individuals with diabetes have lost some or all of their income. And finally, for self-employed people with diabetes, the number of individuals who have lost income jumps to a shocking seven out of ten people. These staggering unemployment statistics mean that many people and their families are struggling to afford basic necessities right now.

There is not yet agreement on why we are seeing these extreme economic hardships in communities with diabetes. What we do know, however, is that these economic challenges have prevented many people from being able to afford their life-saving insulin or other diabetes medications. One in four people has turned to rationing their diabetes care. This could mean anything from skipping insulin injections to foregoing blood glucose tests in order to avoid the expense.

These striking data were presented by Richard Wood to the Congressional Diabetes Caucus in Washington. Many people with diabetes work in jobs that cannot be done from home and require them to interact with other people. If you must leave home to work, try to stay as safe as possible; diabetes is one of the top risk factors for severe COVID-19 infections. This data shows that more protection is needed for people with diabetes, many of whom are essential workers.

If you are facing financial difficulty, you should not ration your supplies or medications, as this can have dangerous consequences for your health. Instead, see if you may be eligible for a patient assistance programMany companies – including DexcomSanofi, and Novo Nordisk ­– have responded to the COVID-19 crisis by launching assistance programs that provide diabetes medications and supplies for free or at a lower price to people who are not insured. You can ask your healthcare team to discuss additional options. The CDC recommends that you do not change your medication or your dosage without first talking to your healthcare professional; continuing your regular medication dosing will keep you healthier and put you at lower risk for severe COVID-19 complications.

For more ways to get affordable medication, including insulin, check out our articles.

Source: diabetesdaily.com

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