Should More People with Type 2 Diabetes Use a CGM?

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

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

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

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

Current Guidelines

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

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

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

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

But a new study may help change this situation.

The MOBILE Study

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

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

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

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

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

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

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

Skeptical Experts

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

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

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

Money Talks

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

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

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

Short-Term CGM Use

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

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

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

Moving Forward

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

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

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

Source: diabetesdaily.com

Olympian Laurie Hernandez, Her Dad, and Diabetes

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

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

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

Photo by Harry How/Getty Images

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Diabetes care can be a team effort for the Hernandezes.

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

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

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

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

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

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

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

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

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

 

Source: diabetesdaily.com

Bethany’s Story: My Eye Started Bleeding the Day My First Child Was Born

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

By Ginger Vieira

“My first bleed was almost 12 years ago — the day my first baby was born,” explains Bethany, who’s lived with type 1 diabetes for nearly 40 years, since she was 3 years old.

Despite receiving preventative laser treatments to the concerning blood vessels in this area of her eye prior to and throughout her pregnancy, the stress of pregnancy and pre-eclampsia (high blood pressure during pregnancy) were enough to cause them to bleed.

“There was a bunch of trauma around that, because the bleed was the catalyst for me to have an emergency c-section. That was the biggest bleed I’ve had and it took a long time to clear up.”

Since then, Bethany has experienced minor bleeds off and on, but has also gone long stretches of time without any new bleeds.

Ginger Vieira

Image Source: Beyond Type 1

“Last October I had another bad one,” says Bethany. “It was so discouraging, because I haven’t had any new abnormal vessel growth, I’m not pregnant, I don’t have blood pressure issues, and my A1C is stellar. It just happened.”

“It’s cleared up since then without traditional treatments like a vitrectomy or steroid shots, but it took quite a while because it leaked more blood and fluid for a few weeks after the initial burst,” she adds. “At this point, I’d say I’m back to where I was pre-October in terms of vision, but maybe it’s a bit messier.”

My Experience With Laser Treatments for Retinopathy

“I’ve only had laser treatments,” says Bethany, who’s been able to manage her retinopathy without more invasive treatments.

“I’m not sure the experience qualifies as ‘pain’ so much as ‘misery’. It’s horribly uncomfortable, and it does begin to be painful as the treatment goes on, but it’s not what I’d describe as particularly painful.”

Eventually, Bethany says she used a low dose of a mild sedative to help take the anxiety out of receiving laser treatments. While it can’t change how it feels physically, it can help make the overall experience a bit less stressful.

“It’s hard to catch your breath, and it feels like being tortured, and my eyes pour with tears, but it’s all more of a dull feeling other than a bit of a sensation that a rubber band is being snapped behind your eye.”

Parenting a Newborn With Low Vision

“Nursing a baby and not being able to see her face clearly when she’s on your left side was heartbreaking,” recalls Bethany.

“Struggling to read a book to a child, wondering if you’ll have another bad bleed when you’re at the store with your child, not being able to lift an older child because it might exacerbate the bleed—it all sucked.”

Fortunately, by the time her second pregnancy began, Bethany’s eyes were ready.

“It was so much easier,” she says. “No pre-eclampsia, no eye issues. It was such a relief after being so terrified to try it all a second time.”

Today, she says she’s careful how much to share with her children about her eye complications.

“After my recent bad bleed, it was my oldest daughter (the one who was born the day of my first bleed) who held me while I sobbed, because she was ready to support me,” recalls Bethany. “That was so bittersweet and beyond meaningful.”

What My Vision Is Like Today

“I wouldn’t say I live with ‘low vision’ today but there is a blobby mess in one eye,” explains Bethany. “My brain has learned to adapt, and I can see around it. I don’t read super fine print very well, but I’m not sure I would even without retinopathy since I’m getting old!”

However, Bethany would say she did have low vision for a period of time — and it wasn’t easy.

“After those two bad bleeds, I did have trouble with the vision in one eye for a while, until the blood cleared. That was hard, but I’m grateful it wasn’t long-term.”

However she says that it’s also affected her life in other ways when there are bleeds.

“My eyes feel strained, I have headaches, and I definitely don’t feel comfortable driving until the bleeding has cleared up.”

The worry and anticipation of a potential new bleed feels like a ticking time bomb.

“I try not to think about what my vision could be like later in life, but I do wonder if I’ll be able to see my grandkids clearly, and if I should retire early so I can make the most of my later years while I still have vision. In day-to-day life it’s pretty minimal, but in terms of mental/emotional load it’s huge and it’s always there.”

How My Diabetes Management Has Changed

“I smartened up with my diabetes management big time since the first time the doc saw something in my eye,” explains Bethany. “Since that day I’ve been highly motivated to do this well.”

Having lived with type 1 diabetes since age 3 in the 1980s with early glucose meter technology and insulin options were severely limited, Bethany feels quite sure the first 25 years of her life with diabetes led to the complications in her eyes.

“My A1c was usually in the low double digits when I was a child, because avoiding low blood sugars was considered the safest way to manage diabetes in a young child back then,” says Bethany.

By the time she was in her 20s, technology and advancements in insulin helped her manage an A1c in the 7s and 8s. Once she started using an insulin pump, she was able to maintain an A1c below 7.0 during both pregnancies.

“I’ve always, always, tried really hard with my diabetes,” adds Bethany, “but it was like I spent 25 years trying to solve a puzzle that finally started to come together in the last 15 with a pump, a continuous glucose monitor (CGM), and eating low-carb.”

While Bethany used an insulin pump for 5 years, she’s managed her diabetes with MDI (multiple daily injections) for the last 8 years, and maintained an A1c below 7 percent, and around 5.8 percent for the last year.

“Using a pump, two pregnancies, and eating mostly low-carb definitely taught me so much more than I knew before I used an insulin pump,” explains Bethany. “But I was having a lot of issues with scar tissue which made infusion sites for pumping complicated. And I hated being tethered to my pump.”

The mental game of diabetes, she adds, is a huge part of it.

“There’s always a fear lurking that it could happen again at any time. More so since this last one,” says Bethany. “You never really escape it because you never know that you’re safe. You can do everything right from a certain point on, but the damage is already done.”

Source: diabetesdaily.com

Remember, Your Time in Range Isn’t a Grade Either

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler

Time in Range (TIR) is another number for people with diabetes to pay attention to and use to improve their daily diabetes management. We talked with three women in the diabetes community about how they use TIR as a helpful number to keep them on track and inform their care.

Time in Range (TIR) is a helpful tool that captures the highs, lows, and in-range glucose values that characterize life with diabetes. TIR can help people understand how their daily habits and behaviors affect glucose levels, so they can use this information to feel better and reduce glucose swings. But it’s also another measurement to keep track of – and the goal is to look at it as a number and not have it loaded with emotion or negativity if it falls short of your goal.

For many people, it can be challenging to get past seeing glucose levels as “tests” and A1C checks as “grades.” But as Adam Brown explains, blood sugars are just numbers – they are neither good nor bad, but rather they are information that will help you make a decision about your diabetes. Click here to read about how Adam transformed how he views diabetes data. Seeing your A1C level as a grade can actually cause harm – some people are demotivated to take care of their diabetes when they feel they are frequently failing. Renza Scibilia and Chris Aldred write more about this in “What’s Your Grade?

Enter Time in Range (TIR), the percentage of time that a person spends with their glucose levels in their target range. TIR is a powerful tool to assess patterns in glucose levels throughout the day and over time, and this can help inform lifestyle changes and treatment decisions in a way that A1C cannot. People with diabetes should aim to spend as much time in their target range as possible.

With the TIR number comes the risk that people may see it as yet another test of their diabetes management. It might be another mark that tells them they are not measuring up.

“When I read about Time in Range, it was a bit scary at first, simply because it seemed like it was a ‘grade,’ like you would get in school, so I didn’t want to think of it too much because my own fear of failure is high,” said Sarah Knotts who has lived with type 1 diabetes for 32 years. She has two young children and works with mySugr as the US Head of Customer Support.

Stacey

Image source: diaTribe

Stacey Simms agreed. Simms is the host of Diabetes Connections and author of The World’s Worst Diabetes Mom: Real Life Stories of Parenting a Child with Type 1 Diabetes. Her son Benny was diagnosed with type 1 diabetes in 2006, right before he turned two.

“It’s easy to look at TIR and other diabetes markers as a judgment on your value as a person. I think there’s a bit of a danger in looking at these markers as anything but math and management tools” she told us. “Less TIR doesn’t mean you’re a bad person or worth less than a person with more TIR. I don’t know how we can keep these tools from weighing on the mental burden of diabetes, but I do think being aware they can have this effect is a good first step.”

Headshot

Image source: diaTribe

Knotts now uses TIR regularly. “My biggest hurdle to get past was that I equated TIR to being a grade – as if I was turning in a term paper or project and those percentages related to a letter grade,” she said. “Just as your A1C is not an accurate picture of your control, a TIR is also not a complete picture either. Yes, I have a range that I want my TIR to be, but I’m not focusing on one average number, or one A1C target. I’ve been able to learn that if I can keep my numbers close to the target range, everything else (A1C, standard deviation) tends to also be better, and I feel better overall.”

Christel Oerum, who was diagnosed with type 1 diabetes at the age of 19 and created Diabetes Strong with her husband in 2015, thinks about TIR both every day and in a long-term sense.

Christel

Image source: diaTribe

“I use TIR daily in the sense that I aim for glucose levels in my target range (70-160 mg/dL, but I don’t focus on always meeting a daily TIR goal, as I think that’s too stressful and not realistic,” she said. “There are going to be days where I’m in range most of the day and days where I’m not, and for me, that’s okay. I do have a monthly TIR goal that I’d like to see myself hit, but that’s more of a retrospective analysis.”

Oerum acknowledged how easy it is to get obsessed with making TIR goals. “For me, that’s not healthy, which is why I try to not use TIR as a daily goal but rather as an overall indicator of whether I should make changes to my care,” she said. “TIR is not a grade or score. It’s a tool to help you manage your diabetes to the best of your ability.”

Simms’ family focuses less on the actual numbers (like TIR and A1C) and more on helping Benny thrive with diabetes: “I spend a lot less time working on TIR than on things like fostering independence, teaching Benny to trouble shoot and helping him advocate for himself. TIR is a great tool to check on for trends and adjustments, but we don’t use it very often. I wouldn’t want Benny checking TIR every day or even more than once a week unless he was really tweaking settings or trying something new.”

We don’t want TIR to be scary or intimidating. At diaTribe, our hope is that more and more people will be able to use TIR in a non-judgmental and informative way, helping themselves and their families lead healthier lives. Oerum summed it up well. “TIR for me means more details on how my management is going and can help me hone in on what to change and what to leave alone. Diabetes can’t be about perfection, and just as my A1C isn’t a grade of my effort, neither is my TIR.”

This article is part of a series on time in range.

The diaTribe Foundation, in concert with the Time in Range Coalition, is committed to helping people with diabetes and their caregivers understand time in range to maximize patients’ health. Learn more about the Time in Range Coalition here.

Source: diabetesdaily.com

Review: Twisted Healthy Treats Keto Ice Cream Bars

Low-carb ice cream is hard to come by, and finding one that tastes good and is affordable isn’t an easy feat. I was thrilled to come across Twisted Healthy Treats Lick Keto Bars, which are both low-carb and sugar-free, perfect for me and my blood sugar management.

This Australian company was kind enough to send me their Lick Keto Bars to try out at no cost, so that I could try this low-carb treat (as a person living with type 1 diabetes) and share my experience with our community. I did not receive additional compensation for this review and all opinions are my own.

Who They Are

Twisted Healthy Treats is a company that was started by a mother looking for treats that didn’t come loaded with artificial flavors and sugar. Since her background was in Food Science and Technology, it only made sense that she took her expertise and put it to good use. Today Twisted Healthy Treats is all female-run company, manufacturing in a state of the art facility. All of their products contain:

  • All-natural ingredients
  • No sugar or low-sugar
  • Natural based sweeteners

Products

Here’s what the company is offering today:

  • Twisted low-calorie frozen yogurt in a variety of flavors, including Watermelon & Mango, Chocolate & Coconut, Strawberry & Vanilla Bean, and Chocolate & Vanilla Bean. These products are not recommended for those aiming for keto or perfect blood sugar lines, but they can be a nice treat, with around 20 grams of carbs!
  • Licks Frozen Juice Bars have no sugar added and only contain about 7.5g of carbs. They come in Pink Lemon Twist, Mango Delish Twist, and Berry Buzz, and all are made with 99% real fruit juice.
  • Licks Frozen Ice Cream Bars in Rich Chocolate and Vanilla Latte, which contain only 2 grams of net carbs.

My Review

It has been such a wonderful feeling to know I can open up my freezer and have a quick healthy choice that can satiate my sweet tooth without impacting my blood sugars or my weight loss efforts. The Lick Keto Bars are dense, unlike many other low-carb frozen treats that leave me wanting more. They have a great creamy consistency, and each bite is packed with flavor. Each pack comes with 4 bars, and prices vary according to retailers – at Costco you can buy a large pack of mini-cups for less than $1 per cup. Check their website for locations in both Australia and the United States.

As a person living with type 1 diabetes, I wanted to see how the Keto bars affected my blood sugar. I decided not to take any insulin beforehand and watch what happened. I started the experiment at a blood sugar level of 115 mg/dL and watched carefully to see if there was a spike or even just a slow rise. 2 hours later, my blood sugar was stable and coasting at 102. It really is rare to find something enjoyable that I don’t even have to take insulin for. I am sold! I highly recommend this product to anyone looking for a delicious dessert that is nutritious and blood sugar-friendly!

Have you tried any of these? What are your favorites?

Source: diabetesdaily.com

Why You May Be Experiencing High Blood Sugar

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

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

What Exactly Happens When Blood Sugar Is High?

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

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

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

You’re Stressed

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

Dawn Phenomenon

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

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

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

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

You’re Sick

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

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

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

You’re Eating Too Many Carbs

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

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

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

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

You’re Eating Hidden Carbs

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

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

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

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

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

Your Insulin Pump May Be Kinked

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

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

You’ve Injected Into Scar Tissue

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

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

Your Medications Need Adjusting

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

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

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

Your Medications Are Expired

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

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

What to Do When Your Blood Sugar Is High

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

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

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

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

Source: diabetesdaily.com

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

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

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



Speakers included:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: diabetesdaily.com

How to Explain Insulin Price Insanity in Just One Image. Or Several Images.

Insulin prices in the United States are insane. This isn’t exactly news—if you have insulin-treated diabetes, you surely already know it. And even those without a connection to diabetes should recognize that insulin affordability is one of the most talked-about healthcare topics in politics. It’s also the rare issue that finds widespread agreement across the political spectrum, at least with regard to the existence of the problem, if not the solution.

What’s less well-understood is exactly why insulin prices are so outrageously high. This one image may help you understand:

source: Drug Channels

Oh, what’s that? It didn’t explain everything?

Maybe one image wasn’t enough. Try this one. It’s a bit simpler:

Source: diabetespac.org

If you’re confused, well, that’s the point. It’s a total mess! But don’t worry, we’ll walk you through it.

These two images were bravely prepared by Dr. Adam Fein of Drug Channels and the Diabetes Patient Advocacy Coalition (DPAC), an influential nonprofit diabetes advocacy group. There are many other versions of this chart, and none of them is easy to understand.

The “insulin-payment journey” is a bizarre and complex path that is poorly understood by outsiders. A recent congressional investigation took two years to conclude, and relied on an immense volume of internal documents to tease out what the heck is going on.

The relationships are messy, but a couple of things are clear:

  • The amount of money that you fork over the pharmacy counter has essentially nothing to do with supply and demand.
  • The higher the price, the more everyone benefits. Everyone except for you.

The images above identify the many different players shoving their fingers into the pie. Here’s a look at who some of these different forces are, and how they conspire to push your insulin costs into the stratosphere.

The Drug Company

It’s probably safe to say that most people in the diabetes community tend to blame high insulin prices on the greed of the insulin manufacturers.

Just three companies—Lilly, Novo Nordisk, and Sanofi, each a multinational pharmaceutical giant—make 90% of the world’s insulin and 100% of the insulin approved for sale in the United States. It sure seems like the Big Three have locked down the market and can charge whatever the heck they want. Patients, especially those with type 1 diabetes, have little or no ability to shop around or reduce their reliance on the life-giving medication, and get stuck paying the price whatever it is.

Make no mistake—the insulin manufacturers have plenty to answer for. The Big Three engage in a variety of hijinks, such as “evergreening” patents and paying off (or suing) would-be makers of affordable biosimilars, to help keep their iron grip on the insulin market. The insulin makers tend to raise prices almost in lockstep. This image from Business Insider should cause outrage:

source: Business Insider

But it turns out that insulin manufacturers are by no means the only organizations pushing prices up. If you look at the first two images, you’ll see multiple other participants in the insulin-payment journey—insurance companies, pharmacies, pharmacy benefit managers and drug wholesalers—all of whom profit when insulin prices increase.

In a nutshell, everyone makes more money when prices go up, and patients have hardly anything that they can do about it.

The Pharmacy Benefit Manager

If there’s a second major villain in this story, it’s the pharmacy benefit managers (PBMs), perhaps the one source pushing insulin prices up even more forcefully than the insulin manufacturers.

The PBMs is a middleman that negotiates deals between the big pharmaceutical companies, health insurance companies, and pharmacies. And because PBMs determine which medications insurers will cover—deciding whether millions of patients will use this insulin or that one—they wield immense power. There’s another Big Three here: CVS Caremark, Express Scripts, and OptumRx combine to dominate the market.

PBMs like high prices because they take a cut out of every transaction, through administrative fees and insulin rebate programs. The higher the price, the higher the rebate, so PBMs are strongly motivated to choose higher-priced medications. The result is that insulin makers find themselves competing with each other to raise prices in order to offer higher rebates to PBMs. PBMs aggressively encourage this competition.

The size of rebates has increased “exponentially” in the last decade. For more detail on this ridiculous situation, check out this summary from Beyond Type 2.

The Insurer and the Wholesaler

Insurance companies also share some of the PBM’s bounty, as the PBM’s usually pass through a percentage of those big rebates. In theory, some of this value should get trickle down to individual patients in the form of reduced insurance premiums. In reality, it is still patients with chronic conditions like diabetes that bear the brunt of the system, especially those that can only afford to choose high-deductible plans.

There’s something similar going on with drug wholesalers, middlemen that purchase insulin directly from manufacturers and then sell it to pharmacies and other medical facilities.

Believe it or not, there’s yet another Big Three here—in 2018, just three businesses held over 95% of the American drug wholesale market—again facilitating the use of monopolistic practices. These powerful drug wholesalers can bully their suppliers and customers; the Senate report mentioned above reports that they use “aggressive disruption techniques” to secure favorable deals and boost their profits.

The Consumer

There’s a reason you come last: the consumer is an afterthought in this system. When insulin manufacturers set the list prices of their medications, they think an awful lot about how that price will impact their relationships with PBMs and drug wholesalers, and insurance companies, and somewhat less about the number that eventually hits the patient. After all, you have virtually no ability to “vote with your wallet”. Whether you had to pay $30 or $300, the manufacturer long ago made its profit.

Bottom Line

There’s a lot of blame to go around. Insulin prices are determined by a closed system of warped incentives, full of greedy middlemen that hike up the price with no discernible benefit to patients. It’s a vicious cycle in which higher prices make more money for everyone except the patient.

The inefficiencies and absurdities that drive up insulin prices are at work in many other ways throughout our byzantine healthcare system. Insulin is particularly plagued by these problems because there are no generic insulins available and because demand is inelastic.

You can help advocate for change, big or small. New laws in several states have capped insulin prices, and many similar grassroots efforts are underway throughout the nation. You can also advocate for yourself, your loved ones, and even your employees on a smaller scale: check out DPAC’s Affordable Insulin Project, which connects people with diabetes to patient assistance programs, and helps those with employer-sponsored insurance get the most out of their plans.

 

Source: diabetesdaily.com

5 Simple and Healthy Summer Swaps

The warm weather is finally here, and the pandemic is subsiding. For me that means a lot of barbeques and entertaining in my backyard. It is very easy to be a people pleaser and get what you think everyone else wants, but that could leave you dealing with a roller coaster of blood sugars. When you are hosting, it can be hard enough to find time to actually enjoy yourself and the last thing you need is to be worrying about your numbers. So, make sure to get plan on some recipes that are blood sugar friendly so that you can be present and enjoy the day.

The warm weather makes me crave light and refreshing foods. Thankfully, these foods are typically lower in carbs than their hearty winter counterparts. It is also so easy to find lower carb options at the grocery stores nowadays, making swaps super simple! Here are five alternatives to some of everyone’s favorite go-to hearty foods:

1. Zucchini Linguini

Put down the pasta! There are so many healthy alternatives available to us that you really don’t have to take a gamble with your weight or your blood sugar! Zucchini linguini is a great go-to that can also be turned into a cold pasta salad which is perfect for summer barbeques (pro tip: edamame pasta is my personal favorite, check it out here).

healthy summer swaps

Photo credit: Adobe Stock

2. Cauliflower

People love comfort foods and meatloaf and mashed potatoes is a fan favorite. However, being hot and humid doesn’t really make me in the mood for such a rich and filling meal. You can lighten it up by replacing the mashed potatoes with mashed cauliflower. You can also create a cold potato salad, hashbrowns and so much more! Add your seasoning of choice to spice it up!

mashed cauliflower

Photo credit: Adobe Stock

3. Meat and Cheese Roll-Ups

I definitely have a weak spot for mozzarella sticks. Anytime my kids order them at a restaurant, I take an extra unit or so of insulin in the hopes there will be one for me. I decided to make a healthier version at home and it turns out to be something my son loves. I bake clumps of shredded cheese on parchment paper in a 400-degree oven until it looks melted and then throw a pepperoni in the center of each one and wait until the cheese is bubbling which means it’s ready to come out. You can broil it for another minute if you like it extra crisp. And if you need a quick lunch or high protein snack, opt for meat and cheese roll-ups. There are so many variations, you are sure to like one!

Photo credit: Adobe Stock

4. Guacamole

I love cheese and dips but many of them are very fattening and loaded with calories. Avocado, on the other hand, is a fruit full of healthy fats and vitamins. It contains 9 carbs each but 7 of those carbs are fiber leaving it with a total of 2 net carbs. You can prepare guacamole however you like it and I recommend using endive as the “scooper”.

guacamole dip with fresh vegetables

Photo credit: Adobe Stock

5. Make Your Own Low-Carb Pizzas

Pizza is quick and affordable which makes it an easy go-to when you are running around. The only problem is pizza is loaded with carbs and fat making this a food notorious for being hard to bolus for. Why not turn pizza into a fun family activity and make your own using almond flour, egg and mozzarella as the crust? Then everyone can personalize as they see fit. Store them in the freezer and make them on those hectic nights instead of having to make another trip before you head home!

Photo credit: Adobe Stock

It is much easier than you would think to find low-carb alternatives for some of our favorite foods. You just need to take the time and plan ahead. Both your blood sugars and waistline will be glad you did!

Have you found some healthy summer swaps for your heartier winter favorites? Comment and share below!

Source: diabetesdaily.com

The Power of the Diabetes Online Community

By Nate Allman

Daily management of the beast that is type 1 diabetes (T1D) can be challenging, at best, on a good day. I am 29 years old and was diagnosed at age 12. Thankfully, I had a good support system in place. My mom, a nurse, and my dad, who worked as an EMS/Firefighter, helped me start my journey, as did my older sister. I learned as much as I could, as quickly as I could. I memorized the carb counting nutrition guide book my parents bought me, which made calculating my doses a lot easier.
Into my late teens, early twenties, my fear of hypoglycemia and the dangers of my sugar going too low caused me to keep my blood sugar higher than it should have been. I would consistently have readings above 600mg/dL, and my A1c was 12.4%, an average blood sugar of 360mg/dL. I got to the point where I gave up on trying to manage it. Diabetes had taken control of my life. I had let it.
I suppose I had been ashamed in a way of being a diabetic. Which, looking back now, I find ridiculous. Five years ago, a change took place. I was scrolling through Facebook when I came across a fellow T1D. This person was a friend of a recent acquaintance of mine. He replied on a post with a photo comment, in which I saw his insulin pen. That was the first time I really saw someone openly displaying their diabetes. I had felt like it was something I needed to hide away.
I liked the comment and replied to him. I had never really been around many other people with type 1 diabetes, not since I was first diagnosed and in a clinical setting. I was in my mid-twenties at the time and never realized how lonely I was. I still had the support of family and friends, but no one can truly understand this unless they are living it themselves. When I received a Facebook message from this diabetic, my life forever was changed.
I was invited to a couple of different Facebook groups, only for type 1 diabetics. They welcomed with open virtual arms. I found a family of people who struggled with and fought the same battles as I had. I learned more from these people than I ever thought possible. I learned about the Continuous Glucose Monitor, Dexcom, through this group. In fact, when I went to see my endocrinologist at the next office visit, I asked her about getting a Dexcom and she did not even know what it was! I was finding out things my doctor hadn’t even heard of.
After starting my CGM, my A1c started to improve drastically. In one year it lowered from 12.4% to 7.4%. I, as of last month, am now at a 5.7%. Having access to the diabetes online community (DOC) is without a doubt the best thing to have happened in my 17 years of being a diabetic.

Nate meets some of his online diabuddies in real life | Photo credit: Nate Allman

Since 2004, the tools available to assist in treating diabetes have advanced. I now have a connection to others just like me, all around the world, and can share my life with my DiaFamily, through Snapchat, Facebook and Instagram. From receiving Christmas gifts and care packages to meeting up with these amazing people in the real world, I am forever grateful to have found my place in the DOC. It has given me the resources and strength to take control of my life. Diabetes is still hard, but it makes all the difference to have a group of people to share that burden with. The power of the Diabetic Online Community is truly awe-inspiring.

Source: diabetesdaily.com

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