How I Crushed Type 2 Diabetes in Only Weeks and Completely Changed My Outlook on Life

Editor’s note: We found Rey’s remarkable story in the diabetes online community, and asked him if he would share it with us. Rey experienced extraordinary rapid success by following a precise diet and medication regimen immediately after diagnosis with type 2 diabetes. His improvement was incredible, but others making the same changes may not experience the same success. Please speak to your doctor or caregiver before enacting any major health changes of your own.

I’m Rey, and I’m a 44-year old male with a history of high blood pressure and being overweight, but until recently I had no major health issues. Only this past summer I learned that I had dangerously uncontrolled diabetes. Within the span of just a couple of months, I completely changed my diet, started and then stopped glucose-lowering medications, and got my blood sugar back into the normal, healthy range. Here’s my story.

My First Health Scare

My story is ultimately a diabetes story, but there were some bumps along the way that I think are worth including before I jump into the diabetes.

My adventure really began in the summer of 2020. After some stressful life events, I developed a rather constant state of anxiety, which seemed to be preventing me from getting good sleep. Even while using a sedative, I was up at least 4-5 times during the night, every night. I didn’t have a previous history of mental health problems, so this was all new to me. The especially challenging part was that as time passed, lying in bed became a trigger for the anxiety, which made the sleep even harder to come by. I felt like I was just going through the motions to get through life.

Fortunately, after months of stubbornness and sucking it up the best I could, I finally got to the bottom of things. I discovered it was sleep apnea, and started CPAP treatment. The result was truly life-changing, sleep returned to normal, and my anxiety went away 100%.

Life was great and I’d survived and handled my major mid-life health crisis…. or so I thought! Little did I know, but that relief would prove to be short-lived as in the coming months I started to experience a new set of symptoms.

I was at my highest weight yet and my BMI was creeping towards 30. Some reading this will scoff and think “30 is nothing, I’m well above that,” but everyone’s body is a little different and apparently 30 was my personal breaking point.

My fasting blood sugar was over 100 mg/dL, and my doctor said something about pre-diabetes, but she didn’t sound too concerned about it.

The Symptoms

I was again experiencing sleeplessness. Now I was finding that instead of sleep apnea waking me up during the night, my bladder was sure filling up and I was getting up to pee several times a night. Also, I was quite thirsty when this would happen. I did notice it was nights that I’d eat pizza or pasta for dinner that were the worst. Some combination of stubbornness and perhaps denial kept me from taking this too seriously, so I just kept on with things. Besides, this was March 2021 and you didn’t dare go into a medical clinic unless you were on your covid deathbed. Surely, this was no big deal, and getting checked out could wait.

Still, I sensed something was wrong and I reduced the amount of pizza and pasta I was eating for dinner (maybe twice a week instead of five nights a week), eating beans with rice and veggies for dinner instead. In hindsight, not great, but a minor improvement.

The next major symptom arrived in April: blurry vision. At first, I wasn’t worried. I’d gotten LASIK eye surgery done 12 years earlier, and this change seemed like a mild return of my nearsightedness. I was also in my mid-40s, which I’m told is a time where focusing becomes harder and your vision changes.

Then it got really bad: I was on a trip to Florida when I couldn’t read a menu board that was 8 feet in front of me. I had to resort to taking a picture of it with my phone and then looking at that picture to read the menu. Something was majorly wrong!

When I got back from Florida (after some real nerve-wracking and likely dangerous driving), I went in to get my vision checked and received a -2.0 diopters prescription. The optometrist was shocked that I had let my vision get that bad before getting glasses and made a comment about diabetes, but was also of the impression that my vision would change throughout the day as my blood sugar changed. That clearly wasn’t happening to me (turns out it’s more complicated than that).

The last major symptom was that I had been losing weight at a pretty decent clip (5-10 pounds a month). Obviously, this must have been due to cutting back on pizza and pasta, right? Curiously, past attempts at eating better had never been quite this effective, but why question such great progress when you’re on a roll! At this point, it was late April and the earliest I could get in for a check-up was mid-June, so why not ride out another month of weight loss and see how great my labs come back then?

My Diagnosis

A little over a week before the appointment I started researching diabetes online, since I was starting to wonder about what my doctor and optometrist had said. But surely that takes years to develop, right?

Obviously, my “diet” was working since I had now lost 25 pounds this year and weighed less than I did in my 30s. Who knew eating healthy was so easy!

After a little light reading, I quickly realized how wrong I was, that everything that had happened in the last few months was explained perfectly by diabetes, and that the weight loss might have been diabetes rather than my new diet. This was hard to process.

I picked up a blood sugar meter, and on a Friday night fumbled with the thing enough to figure out how to get a reading. I was shocked when the meter read 567 mg/dL. That can’t possibly be right! My girlfriend tried the meter and her result came in at 77 mg/dL. I tested mine again and this time it registered 596 mg/dL!

At this point, it was 11 PM on a Friday night, and my safest course of action would have been to go to the ER, but I figured if high blood sugar hadn’t killed me in the last 3-4 months, it probably wasn’t going to kill me that weekend. I decided to read more about diabetes, give myself a couple of days to get my wits about me, and go into urgent care on Monday. I also continued to test my blood sugar and it seemed to stay in the 300 to 450 mg/dL range that weekend, regardless of what I ate or whether I was eating.

At urgent care my A1c came in at 13.7%, and my fasting blood sugar was 449 mg/dL. Based on my history, I was more likely to have type 2 diabetes (and additional testing would later confirm that). I was prescribed metformin, and advised to take insulin, advice that I wasn’t ready to take.

Rey kept track of his blood sugar measurements from the moment he began testing, before he was diagnosed with diabetes. You can see his girlfriend’s healthy reading, 77 mg/dL, on the first day.

A New Diet

I now understood that the reason I had lost so much weight so quickly was my uncontrolled diabetes, at least 3 months of it!

I immediately cut most high-carb foods out of my diet and subsisted largely on a diet of full-fat cottage cheese, full-fat plain Greek yogurt, hard cheese, nuts, avocadoes, and canned beans with olive oil. I also kept some fruit and berries in my diet initially. Throughout the day I ate random combinations of these foods. I didn’t really prepare them or fancy them up at all with cooking (other than heating the beans in the microwave so they’d be warm).

I knew I had screwed things up, and if there was going to be any hope of reversing the damage I feared I had done to my body I needed to focus. Maybe I would be able to go back to eating pizza, pasta, and all those delicious carb-filled foods that I loved someday, but it was clear now wasn’t the time for that.

I’d certainly thrown in the towel on diets plenty of times before and gone back to eating like crap, but this time it felt like there was a gun held to my head, and quitting wasn’t an option. Perhaps I’m being overly dramatic about this, and perhaps it wasn’t the healthiest outlook, but it’s how I saw things and it got me through the first weeks where I was at my highest level of motivation.

I wasn’t using a particular diet system I had found on the internet or in a book, it was just me trying to think of all the foods (as a vegetarian) that I normally ate that were lower on the glycemic index, and sticking to those. Frustratingly, there seemed to be a lot of disagreement online in regards to what the “best” diet was for a diabetic, but I’ll come back to that later.

The Right Medications

With this diet and metformin, my blood sugar still ranged from about 250 to 400 mg/dL that first week. My blood sugar really needed to come down since the longer it remained elevated, the greater my risk for diabetes-related complications. Clearly, a week of my new diet and metformin wasn’t enough, and I was more open to exploring what else could be done.

When I saw my primary doctor after that week, she wanted to put me on insulin too, in order to stabilize my blood sugar. Although I knew that insulin would have rapidly brought my blood sugar down to normal levels, using it would have made it difficult for me to gauge if my dietary changes were getting the job done.

Through my research, I had become convinced that SGLT2 inhibitors were the only class of drugs that made any sense for a person with new uncontrolled type 2 diabetes to take (in addition to metformin). Normally in uncontrolled diabetes, your kidneys excrete sugar to your urine as a means of keeping your blood sugar from getting dangerously high, but that effect doesn’t really kick in until your blood sugar levels are way up there. With an SGLT2 inhibitor, your kidneys are just doing that all the time, keeping your blood sugar down in the process. The real beauty of this is instead of insulin, which causes your body to store that excess sugar (only delaying the problem), once you pee out the excess sugar, it’s gone forever.

I asked my doctor for a referral to an endocrinologist and a prescription for an SGLT2 inhibitor instead. She didn’t have much experience with SGLT2s and started talking about other drugs, but she could see I had a pile of notes with me on different drug classes, the research I had done on them. I think she also realized that although she was the one to write the prescription, that I was ready to argue my case.

As soon as I started taking the SGLT2 inhibitor my blood sugar came down almost immediately.

On Farxiga, within days my blood sugar dropped to the 100 to 150 mg/dL range. I had to pee a little more at first too, which suggested the drug was doing exactly what it was supposed to. After a few days, I found I wasn’t peeing any more than normal, which was probably due to my fairly low-carb diet.

[Editor’s note: Rey had an incredibly positive experience with SGLT2 inhibitors, but they are not for everyone, and do carry side effects and risks, especially when combined with low-carbohydrate diets. Please speak to your doctor about changing your medication.]

This was a great improvement over where I was before, but like every newly-minted diabetic I had dreams of reversing my diabetes and getting my blood sugar back to “normal.” I obviously wasn’t there yet and just because you want something doesn’t mean it’s possible or realistic, but I was holding onto that dream.

Remission is a very controversial topic. Most ADA and official-looking literature I found said that diabetes was a progressive disease. As time passes, more drugs are required to maintain the same degree of control, and some pretty awful complications occur as it gets worse and worse. That was a rather depressing outlook. If it all falls apart in the end, why not just go back to enjoying all those carb-rich foods that I love and enjoy whatever time I’ve got left? Fortunately, I didn’t fall into that trap, but I have to imagine many do.

Intermittent Fasting

I was aware of internet doctors out there on the fringes saying type 2 diabetes can be reversed and people can manage through diet alone, without drugs. Are they selling false hope, similar to new-age healers selling energy crystals to cure cancer? Most of them are talking about low-carb and “keto,” which I’d previously assumed to be just another random fad diet. “They’re obviously quacks,” I thought. I figured that American Diabetes Association was most certainly correct about diabetes being progressive, just giving me the cold hard truth. But just for the sake of argument, I decided to hear the quacks out first.

Of the doctors on Youtube, the first to really suck me in was Dr. Jason Fung, a Canadian nephrologist. He had a very intuitive model for explaining type 2 diabetes, and used research on treating the condition with gastric bypass surgery (which has been highly successful) as a starting point. He suggested a low-carb diet combined with fasting in various forms. Hey, I’m already doing the low-carb thing and it seems to be helping. Maybe fasting would be the next nudge I needed.

I started with 3 set meals a day (eating between 7:30 AM and 7:30 PM, and then fasting from 7:30 PM until 7:30 AM the next morning). Around the time I started Farxiga, I moved into the next phase of fasting, which was to skip breakfast and then eat only lunch and dinner (eat at 12 PM and then 8 PM). To my surprise, I no longer felt hunger when I wasn’t eating. I now know that’s a common benefit to the keto diet, but if someone had tried to tell me about that a year earlier, I would have thought they were crazy. Also, I didn’t really know I was doing keto. I was just doing a tighter version of the diet I’d explained earlier, with less fruit and no beans.

I completed my first full-day fast the weekend after starting Farxiga. I didn’t eat anything at all starting Friday after dinner until around 1 PM on Sunday, for a 40+ hour fast. Again, Farxiga had gotten my blood sugar down to under 150 mg/dL on a regular basis, but this was the kick that finally got me back under 100 mg/dL. Throughout Friday it was testing 130 to 150 mg/dL, Saturday morning I was at 144 mg/dL, but as Saturday dragged on and my fast continued I started getting multiple readings under 100 mg/dL. My Sunday morning fasting result was 96 mg/dL and, it got as low as 79 mg/dL on Sunday afternoon before I finally broke my fast. To my surprise, breaking my fast only bumped me to 119 mg/dL and 5 hours later my blood sugar was back down to 82 mg/dL. Seeing this progress felt truly amazing and it was only 16 days after finding out I had diabetes!

Maintenance

Rey’s blood sugars improved rapidly and remarkably with the right combination of diet and medication.

Of course, you don’t eat your way to diabetes in two weeks and you don’t undo your diabetes in two weeks either. I was taking 2,000 mg of metformin a day as well as the SGLT2 inhibitor. The week after my big fast, my fasting blood sugar readings would go back over 100 mg/dL, but I kept plugging away, only eating two larger meals a day during a narrow set of eating hours. I also tested the high-carb waters with a 6-inch Subway sandwich – it spiked my blood sugar to 190 mg/dL, which is much higher than a non-diabetic would likely hit from that meal. That helped knock me back down a peg and remind me that I still had diabetes, after all.

The next weekend I noticed that my blood sugar numbers were starting to come down to under 100 mg/dL without extended fasting. I also noticed that foods that previously spiked my blood sugar a great deal were now spiking it much less. On June 28th (day 24 of knowing I had diabetes and 13 days after starting my SGLT2) I decided to stop taking Farxiga and see what effect it would have. This was not a responsible decision, as you should always consult with your doctor before discontinuing medication, but with my improved blood sugar levels, I questioned if Farxiga was still doing anything for me. It turned out my guess was correct. There was no significant change in fasting or post-meal blood sugar readings in the days that followed, and my type 2 diabetes was now well-controlled via just diet and metformin!

About a week later I started wearing a Freestyle Libre 2 to get a broader picture of my blood sugar trends, and for convenience. My readings were still in the 80-90 mg/dL range throughout the day, with small bumps up over 100 mg/dL after a meal. When I finally was due for my appointment with an endocrinologist to discuss my diabetes treatment, the feel of the visit could best be summed up as “why are you here?” My data showed that my average blood sugar in the previous 10 days had been 95 mg/dL, which would extrapolate to a 4.9% A1C (compared to the 13.7% result when first tested). This is, of course, only an estimate. And my blood sugar had only been well controlled for 2-3 weeks at this point.

Blood sugar wasn’t the only improvement either over last year’s numbers: total cholesterol dropped from 238 mg/dL to 172 mg/dL, with HDL (“good cholesterol”) fairly steady from 64 to 62 mg/dL. LDL (calculated) dropped from 141 to 90 mg/dL. Triglycerides dropped from 165 to 102 mg/dL. The endocrinologist agreed that I no longer needed Farxiga and indicated there really wasn’t a reason for me to see her again, but that I was free to set up another appointment if things changed.

My Best Path Forward

Since then, I’ve done more reading on the keto diet and feel that’s my best path forward to continue to maintain my health, both in terms of diabetes and beyond. I’ve improved enough that I no longer wear a CGM or perform finger sticks to check blood sugar on a regular basis, only checking maybe once a week “just to be sure.” Although I’ve tested out eating some of my old high-carb favorites and been impressed by how much less they spike my blood sugar now, I’m no longer interested in eating them on a regular basis, which is surprising to me. I’ve also found I can sleep through the night just fine without my CPAP machine due to the 35 pounds of weight I have lost from my peak of 215 lbs. The sleep apnea isn’t completely gone, so I still wear the mask most nights, but it appears to be dialed back from severe to mild.

It’s a very weird feeling: when I first found out I had diabetes I wanted nothing more than to continue eating the foods I loved and found comfort in. I felt like something had been stolen from me and feared that my body was permanently broken. Why should other people be able to eat what they want to, and I can’t? It felt very unfair and I really wanted there to be a drug or a treatment that would let me eat how I wanted to. Now that I’ve immersed myself in a better understanding of just how bad those foods were for me, I view things very differently.

I share my story not to lord my results over you if you’ve been less successful with your diabetes. I got really lucky, finding good dietary advice quickly after my diagnosis. Sadly, much of the official guidance out there seems sure to fail. I was also lucky with my uncontrolled diabetes “helping” with the first 25-30 pounds of weight loss.

I no longer have aches and pains when I get up out of bed or have to roll a certain way to avoid them, my memory has improved quite a bit and I’m no longer struggling to recall things I was just told, as I did with high blood sugar levels. I have so much more energy and stamina rather than feeling lethargic or struggling to complete physical activities. It’s like I’m in my 20s all over again (except for a little gray hair)! The downside is I now know if I go back to a lifestyle of enjoying carbohydrate-rich foods, things will go poorly for me, but as long as I don’t, I get to enjoy life so much more than I had before. And there are plenty of delicious foods that aren’t packed with carbs that I’m free to enjoy.

I think diabetes has been a net positive for me, as strange as that sounds. The me of today is very different than the me of a year ago.

Source: diabetesdaily.com

Overcoming Obstacles to Treat T1D in Ecuador

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

By Beyond Type 1 Editorial Team

Araceli Basurto is a certified diabetes educator and pharmaceutical chemist who runs an education center accredited by the International Diabetes Federation in Ecuador. She is also the president and founder of FUVIDA, a nonprofit supported by Life for a Child that provides children and young people with access to diabetes education, motivation, and support. The organization started with Arcaeli’s daughter, who was diagnosed with T1D at 2 years old, but now serves over 300 children.

Araceli recently sat down with Beyond Type 1 to discuss her organization’s mission, living with diabetes in Ecuador, and how you can help FUVIDA’s mission. This interview has been translated from Spanish, and edited for length and clarity.

Beyond Type 1What is FUVIDA’s mission?

Araceli: FUVIDA’s main objective is to provide education to families who have been affected by type 1 diabetes, whether they are children or adolescents, providing the necessary tools so that they are able to manage their condition at home. My personal mission is to ensure the health system provides the supplies and the necessary treatment so that these children and families have everything they need.

We are keeping an eye on [the health system] because 2 or 3 years ago the government issued a resolution that has not yet been executed. So, our mission this year is to promote that and follow up with the government so that this law is executed, and the children can get insulin, test strips, glucose meters, everything necessary for daily life with type 1 diabetes.

How many people does FUVIDA help today and what services do you offer or provide for the people who reach out to you?

We currently have more than 300 families living with diabetes. Many of them have 2 or 3 children with diabetes in the same family. We help them with workshops, camps, talks, and we provide supplies to children with limited economic resources so that they can have treatment because the health system does not provide them, or if it is provided, it is done very inconsistently. For example, in the middle of this pandemic, it was impossible for children to attend hospitals and they did not have insulin available. We make sure that they have the treatment they need so that they can survive.

We know that, in Ecuador, as in other parts of Latin America and around the world, people have trouble accessing treatment, especially in a timely manner, and it may not be available to everyone. What happens in your country?

The main problem is that we do not have enough trained professionals, that people do not speak the same language within the same hospital. It can be a very serious problem. As an example, about 5 years ago the government began to provide analog insulin, glargine, but after it came, a lot of the glargine insulin was returned because healthcare workers did not know how to use it.

That is one of the most serious problems we have, that despite having all the logistics and being able to get analog insulins, access to treatment, and diabetes technology, not all the personnel are trained.

So, I think that having access to the medications that the government provides and having sufficient resources to buy them go hand in hand, and it is a different issue for health professionals to actually be able to use it and know how to dose it, know how to deliver it correctly so that parents, with proper education, may be able to make use of these treatments.

Tell me about your partnership with Life for a Child

Life for a Child has a very common phrase that says, “No child should die of diabetes.” This started when María de Alba was president of the International Diabetes Federation and saw that many children were dying from lack of access to insulin. She then asked the Federation to create a program to provide insulins.

We partnered with Life for a Child in 2003; With their donation, we are able to deliver test strips and insulin along with diabetes education. The parents receive a monthly education talk and can take their supplies. They are well aware that the correct use of insulin is what really ensures a good quality of life. Through a group of professionals, we help these young people and their parents so that they can dose correctly, have appropriate treatment, and also use the test strips.

What has been the most significant success story you have had within the Life for a Child program?

The success story does not end, it continues writing itself because the story really is watching the children grow up and knowing that they can enjoy going to school. There used to be families whose children did not go to school because they had diabetes, but that mentality has started changing.

The children have now graduated because we have practically been working for 26 years. We have been following their story and that is what gives us the satisfaction, knowing that there are children who are already university students, who have jobs. Families who had abandoned their jobs to dedicate their lives to taking care of a child at home, to take care of their diet.

Some mothers have taken steps back, and when we give them that freedom based on diabetes education, we instruct the children so they start taking responsibility depending on their age, they are already capable of managing their diabetes with their parents’ support and with professional medical visits, but now their mothers can leave their homes, they can function as women, as professionals. They can also help and contribute to the family and that, for me, I think is the most beautiful story, being able to give this diabetes community that freedom so the children can get an education, to empower mothers as professionals, as women. This has been the greatest triumph, seeing families smile with diabetes now.

What are the plans for FUVIDA?

In the middle of the pandemic we were able to build a camp house. The first stage is now done, there is a social area and there is a large kitchen, because the mothers themselves do the cooking. I have great hopes that by 2021 everything will be more normalized, and we can take some of the children to enjoy Machalilla beach, which is a beach only for FUVIDA children. In other words, they cannot get lost there, you can see them from afar and you know that only the FUVIDA family is there.

We also plan to put more pressure on the government. We cannot depend on international organizations alone; it is actually the government’s responsibility. Let’s hope that there is someone at the top who has a child with diabetes. I do not truly wish for that, but if they are affected by diabetes perhaps they would actually listen to us. Maybe diabetes has to be personal to them.

Is there anything else you would like people to know about FUVIDA?

We really always need medical supplies to expand the program, so that not only 100 children can get this type of treatment; We need pharmaceutical companies to provide more analog insulin. Also, know that FUVIDA is a source of inspiration for many mothers, because there are many mothers in the world who are directly affected and we are all capable of starting an organization, it does not matter if there are only 2 or 3 of us.

To find out how you can support young people living with type 1 in under-resourced countries visit Life for a Child

Source: diabetesdaily.com

Why Allulose is My Favorite Zero-Carb Sweetener

I have always despised the flavor of alternative sugars. This article is about the first zero-carb sugar that I ever really liked.

“Despise” may sound exaggerated, but I use that word carefully: it’s a flavor that I really, really hate. I find it astonishing, for example, that anyone cannot tell the difference between diet soda and regular soda. The diet version seems to sear my tongue at the very first sip, and even the tiniest amount fills my mouth with a nasty flavor that lingers for minutes.

When I was diagnosed with type 1 diabetes, as an adult, I immediately knew that I would reduce my sugar intake. And with my aversion to fake sugars, I figured that I just wouldn’t get to enjoy sweet flavors very often.

As I dove into the diabetes online community – a totally incredible resource, by the way, worth far more to me than anything I ever learned from my doctor or endocrinologist – I noticed with trepidation how enthusiastic everyone else was about alternative sugars. It seemed like everyone’s favorite hobby was baking low-carbohydrate sweets at home, something that I had no interest in doing.

I wasn’t enthusiastic, but I figured that I might as well give alternative sugars a shot. I already knew that I hated Sweet’n Low, Equal, Splenda, and the like. And so I started ordering and tasting ones I’d never tried, newer and trendier alternatives. I gave stevia and erythritol and others a fair shake, but they all had nasty chemical flavors, or strange aftertastes, or both. No thank you. Around this time I figured that if homemade stevia cookies and cake was the best I could look forward to, you could count me out. I’d splurge on real sugar treats from time to time, and otherwise just pass on dessert.

The first alternative sweetener that I found more than halfway tolerable was monkfruit powder. Monkfruit has a powerful sweet flavor. It is subtly but identifiably distinct from sugar, and it still has a hint of a weird aftertaste. This was a partial success, the first sweetener I tried that I thought was actually good enough to use. But I didn’t love it.

Finally, I tried a winner.

Allulose is my favorite zero-carb sweetener. My reasons are incredibly simple: of every alternative sweetener I’ve tried, it tastes the best, which is to say that it tastes the most like true sugar. There is no aftertaste, no chemical flavor, no strange mouthfeel issues. I have dumped huge amounts of allulose into my tea, in the name of science, and have never noticed an off-flavor of any kind.

Allulose is not quite as sweet as sugar, and even if you add in extra to a recipe, it never will be as sweet. It’s also not quite as delicious as sugar. It tastes like actual sugar that has been somehow dulled or muted. It’s not perfect, but it’s good enough for me. Anyway, ever since reducing my carb intake, it definitely takes less sweetness than it used to in order to satisfy my sweet tooth.

When I’ve cooked with allulose I’ve been extremely pleased with the results. The texture is not different enough from granulated sugar to make much of a difference, as far as I can tell. You could easily fool an unsuspecting guest, especially in recipes like pudding that don’t require any starch or starch replacements. It’s also available as a liquid sweetener – an instant simple syrup replacement for cocktails.

The blood sugar effect is, from what I can tell, nonexistent. My CGM line doesn’t budge. Your mileage may vary, of course – there’s no telling how any one person might react to a new ingredient – but I couldn’t be more pleased about its blood glucose impact.

And guess what? Allulose might be kind of healthy, too. I admit that didn’t know or care about any secondary health impacts when I fell in love with allulose – it doesn’t spike my blood sugar, and that’s good enough for me. But it turns out that allulose may have a host of other metabolic health benefits. Dr. Peter Attia has written a long and exceedingly detailed essay on the subject. While most of the encouraging study of allulose has been in rodents, one meta-analysis of human trials found that allulose may actually reduce post-prandial glucose levels.

I’ve tried several brands of allulose, some with fancy brand names and packaging, some without. I haven’t discerned a difference from one brand to the other, so now I buy in bulk, usually whichever vendor happens to have lower prices at the time.

Maybe in the future we’ll have an even better option, an alternative zero-carb sweetener that is exactly as sweet and delicious as sugar. But in the meantime, allulose is a pretty great replacement, good enough to have turned me into an alternative sugars believer.

Source: diabetesdaily.com

Walking a Tightrope – Dealing with the Highs and Lows

This content originally appeared on diaTribe. Republished with permission.

By Julie Heverly

Julie Heverly joined The diaTribe Foundation in 2021 as the Director of Institutional Giving. Heverly was diagnosed with type 1 diabetes after her junior year at Washington & Jefferson College and she is a guest writer for diaTribe Learn.

Julie Heverly describes one harrowing day when her glucose levels teetered between way too high and way too low and how she navigated this challenge.

For me, life with diabetes is like walking on a tightrope. Sometimes my course is set, and I can navigate to the ledge on the other side gracefully. Yes, it’s difficult, and yes, it requires skills, knowledge, the right equipment, and bravery (and even some luck), but it’s doable. But other days, a big wind blows through, and that delicate tightrope act is put in jeopardy.

I recently experienced one of those really bad windstorms, and it knocked me right off the tightrope.

To help me stay in range, I wear a continuous glucose monitor (CGM) and a closed-loop insulin pump that can give me small doses of insulin (micro doses) when my glucose levels are high and that can halt insulin delivery when my glucose levels are dropping or anticipated to become below my desired range. It’s a helpful system that assists my daily management quite well overall. It is not, however, a fool-proof system or a cure.

On this particular day, I woke up determined to stay in range (as is my daily mindset). At 5:30 am my alarm clock went off. I exercised for an hour on the elliptical, showered, and got myself and my family ready for the day. I chose the same breakfast I’ve been eating for the past six months – low fat cottage cheese and fresh berries. Shortly after breakfast though, my glucose started creeping into the 300s, where it stayed, despite my best efforts, until 9:30 p.m.

That entire day, my stomach was nauseous, my head was foggy, and my mood resembled Oscar the Grouch. I tried my best to bring my glucose down just as I have been taught:

  • I calculated correction boluses through my pump.
  • I selected low carb meals for lunch and dinner, and I pre-bolused 15 minutes in advance for both meals.
  • I changed my pump site in case the canula had kinked.
  • I used a new vial of insulin in case the old one had turned bad.
  • I took a walk after dinner.
  • I hydrated myself throughout the day (I personally aim to drink half my body weight in ounces each day).
  • And finally, I even resorted to a manual injection correction.

It didn’t help, at least not at first. But as we all know, what goes up, must come down.

Snacks

Image source: diaTribe

By 10:30 pm, my stomach started to growl, and my CGM showed that my glucose levels were finally coming down, but rapidly. I dropped from that 300 mg/dL range to below 80 in less than 60 minutes, and my CGM warned that I would continue to drop without urgent treatment. I treated myself with my standard juice and peanut butter crackers and went to bed relieved that the unbudgeable high was gone. But 45 minutes into my sleep, I was awoken by another CGM alert. I was below target again. My CGM and pump began beeping once every 15 minutes for the next two and a half hours. Once again, I attempted everything I have been taught, but this time it was to raise my glucose levels:

  • I consumed 8 oz of juice and waited 15 minutes.
  • Then I ate some peanut butter crackers and waited 15 minutes.
  • Then I consumed 8 oz of milk and waited 15 minutes.
  • And finally, I ate approximately 50 grams of carbs in small doses (approximately 15 grams of carbs at a time over the course of two hours). I felt like I was eating everything in sight.

Throughout all of this, I checked my glucose with my CGM and blood glucose meter regularly, but no matter what I seemed to try, my glucose sat between 60-70 mg/dL with downward facing arrows on my CGM. Thankfully, because I never fell to level 3 hypoglycemia (below 54 mg/dL, when mental or physical functioning is impaired), I did not need additional assistance or glucagon.

This is the point in the textbook story where a person should have their family on standby with a glucagon kit and their phone ready to call 911. But I don’t live in a textbook. I live in the real world where people are employed and need sleep to function properly. I had left my bedroom after the first six alarms so my husband could try and salvage some sleep. I had my phone at the ready, but I’ll admit to trying to fall back asleep after each course of treatment, making each alarm more upsetting and frustrating than the last.

Throughout the course of the night, I dealt with soaking sweats and shakes. My legs were able to carry me to find more carbs, but they felt like they would give out at any time. I knew I needed more glucose in my system, but I lacked the resolve to search for the best options and ended up eating whatever was closest to me.

My lack of control and inability to quickly resolve this situation left me with significant anxiety, feelings of helplessness, and guilt for potentially disrupting my family in the middle of the night. But perhaps the worst side effect of this hypoglycemic episode was the fear it provoked.

I’ve been living with type 1 diabetes for 23 years; I know the risks of hypoglycemia. In 2016, I was serving as the executive director for the American Diabetes Association in Western Pennsylvania, and while setting up for our annual diabetes camp, one of our best volunteers never arrived with our inflatable arch. This was incredibly unlike him, and we left message after message trying to reach him. A few days later, I learned that Gregg, who also had type 1 diabetes and who dealt with hypoglycemia unawareness, had died from hypoglycemia. Two years later, a 9-year-old girl named Sophia who had participated in the same diabetes camp the summer before, died at a sleepover, also from hypoglycemia.

Most of the time, diabetes is manageable thanks to new and evolving tools, therapy options, and tons of education. But every so often, there are days that are completely outside of the normal day-to-day. These days are difficult to manage and can only be explained by ambiguous culprits like stress or hormones. Those days are frustrating and sometimes scary. They remind me of Gregg and Sophia. I see their faces and I recall the heartbreak I shared with their families and loved ones when diabetes took them too soon. They also remind me to push through and to keep fighting.

At some point, during this particularly difficult glucose rollercoaster day, I remember falling asleep and thinking, “I’m exhausted, and I really hope that it’s my alarm clock that wakes me next and not my diabetes devices or a paramedic.”

Three hours later my alarm clock went off.

Thank you, Lord!

I felt like I had been hit by a truck, but it was a new day and I was given another chance to get it right.

I am so grateful to be dealing with diabetes in the age of CGMs, closed-loop insulin pumps, and helpful metrics like Time in Range that give me more information about my diabetes management. My life is better, easier, and healthier because of them. But there are still days when the best laid plans don’t always work.

After this incident, I contacted my endocrinologist. We decided to complete some basal rate testing to ensure my pump settings were currently correct. I also got a prescription for one of the new next-generation glucagon options. I’ve talked to my husband and daughter about learning how to use the new glucagon if I hit level 3 hypoglycemia. Finally, I resolved to work on balancing patience and vigilance with my diabetes management. That will be the toughest challenge.

Sometimes I wonder if Nick Jonas makes having diabetes look too cool. Or that maybe we have all done such a great job of thriving with this condition that the public, our families, and even those of us living with diabetes sometimes forget how dangerous diabetes can be when something in our world changes the wind near the tightrope that we walk 24 hours a day, 7 days a week, 365 days a year.

If you want to learn more about managing hyperglycemia or hypoglycemia, check out some of diaTribe’s helpful resources:

Source: diabetesdaily.com

“Our Trials are Totally Different.” The Denise Faustman Interview

There’s no question that Dr. Denise Faustman does things differently.

Dr. Faustman’s research has won her avid fans and raised millions from donors, but it has also provoked significant pushback from major diabetes organizations. Dr. Faustman wears that repudiation like a badge of honor, proof that her work is disruptive and important.

A Maverick Approach

Dr. Faustman takes an unconventional approach. Her work, which is focused on the underlying immune response responsible for type 1 diabetes, has led her to a very old and inexpensive drug, a tuberculosis vaccine used widely in the developing world. It’s a treatment that may have been hiding in plain sight for generations.

Dr. Faustman’s immune intervention trials also concentrate on adults with long-standing type 1 diabetes. By contrast, virtually all of her peers have targetted patients with new-onset diabetes, or even patients that have yet to develop diabetes. This approach is generally considered more likely to succeed, because the targets of the interventions have not yet entirely lost their ability to secrete insulin. But in Dr. Faustman’s telling, it hasn’t accomplished much yet:

“Over the last 30 years, immune intervention trials in type 1 diabetes haven’t had very good outcomes. The important diabetes advances have been different versions of insulin and new forms of blood testing, but the immune intervention trials have been a very sad point. Nothing’s worked very well, no new treatments have been approved.”

“Our trials are totally different. They’re all in people that have had diabetes for decades.”

Dr. Faustman told me that a who’s who of diabetes experts has told that her approach is crazy, a response that has clearly tickled her contrarian side.

“We thought the need is to treat the people that actually have the disease. It sounds like a no-brainer, but keep in mind that nobody else is doing it!”

The decision to study patients with long-established diabetes, which was originally made well over a decade ago, was inspired in part by financial constraints: “we could not afford to do new-onset diabetic trials.” And focusing on an incredibly inexpensive generic drug meant that Dr. Faustman had no way of interesting large pharmaceutical companies and their very large R&D budgets.

“It’s a terrible drug to make money off of.”

BCG

The drug is BCG, the Bacillus Calmette–Guérin vaccine, which was first used a century ago in order to protect patients from tuberculosis. It is considered extremely safe, and is still administered to millions of infants annually, most prominently in the developing world.

BCG first piqued Dr. Faustman’s interest because it was “the only drug in animal models that has worked in established diabetic mice.” Exactly why it worked, though, still requires some unraveling. The results of her Phase I trial – results that were both celebrated and questioned – showed that patients receiving the vaccine experienced impressive improvements in glucose control without restoring insulin production or insulin sensitivity.

Most immune intervention drug trials involve the suppression of immune cells that are harming the body – in the case of type 1 diabetes, the T-cells that attack the pancreatic Beta cells. But the BCG vaccine works the opposite way, not by depleting the immune system, but by putting something else back in.

“BCG adds to the microbiome. It’s actually the tuberculosis organism, inactivated. So you’re putting back in, effectively, tuberculosis. When you revaccinate with this vaccine, the reason it takes a little while is that it gets to your bone marrow and actually resets your stem cells in your bone marrow.”

Why would you want tuberculosis in your bone marrow? Dr. Faustman referred to the hygiene hypothesis, the idea that many autoimmune and allergic diseases are caused at least in part by our excessively sanitary modern world. Myobacterium tuberculosis may have co-evolved with humans for thousands of years, and its absence may therefore trigger immune system dysfunction.

“The absence of this organism has allowed these rogue immune systems to take off and create all these autoimmune diseases. We’re just reestablishing this synergistic relationship to get immune tolerance.”

Because of its many possible effects, BCG has lately become “fashionable” in the research community, Dr. Faustman told me. The old vaccine is being evaluated as a treatment for other serious autoimmune diseases, and it has also been theorized to provide protection against the novel coronavirus that causes COVID-19.

But how does all that help with your blood sugar levels? Dr. Faustman believes that when BCG vaccine “retrains” the immune system, it also causes the immune system itself to begin utilizing large amounts of glucose in the bloodstream.

“What really happens is that their white blood cells now become the regulator of sugar, and have restored sugar transport. So there are underlying defects in type 1 diabetes in the use of the lymphoid system as a sugar regulator, and BCG restores that.”

The Effect

“It’s definitely a game-changer. Our hope, based on the early results, is that it will lower your A1c 10-15%, stably. You can use less insulin, and have better blood sugar control.”

It is, however, a slow process:

“It takes a number of years to have its metabolic and immune effects. We know we need to follow these patients for 3-5 years to get the maximal effect. But it’s got good durability. It’s quite permanent.”

The nine patients that originally received the BCG vaccine for the Phase I trial are still checking in with Dr. Faustman’s lab every six months, and she says that they continue to enjoy dramatic improvements in glucose management.

“Everyone wants to know if we have any [trial participants] off insulin. We have one person off insulin. Normally when he’s on a fairly low dose of insulin his A1c is in the normal range. When he goes off insulin, he no longer goes into DKA, but he goes up to around 7.2%.

“Is it gonna last twenty years? Thirty years? We don’t know yet.”

Sample Size

One of the chief concerns that other experts have raised with Dr. Faustman’s work is the tiny sample used in her Phase I trial: a mere nine patients received the BCG vaccine.

Dr. Faustman is completely unphased by this criticism, arguing that the statistical significance of her results speaks for itself.

“A p-value of .05 is as statistically significant in a sample of 10 as it is in a sample of 200,000. The only difference is, in the sample of 10, everybody responded, and the magnitude of the response was large.

“If you have to design big trials, you have small effects and unresponsive groups. And that’s what you’re seeing in the [rest of the] diabetes community.”

The criticism of her work by major diabetes authorities, particularly ADA and JDRF, doesn’t seem to have phased her, although she admits that it has slowed down the pace of her trials. She quoted one of her most significant boosters, the late Lee Iococca, a rockstar among American executives as the CEO of Chrysler during the 1980s. Iacocca told her, “I love it when they’re shooting the cannons at me. It means I’ve got something good.”

Dr. Faustman continued: “If they didn’t think it was competitive, it wouldn’t matter to them. The fact that they shot their cannons, to issue statements that were not truthful, it shows that it mattered to them a lot, that it was threatening to them.” She believes that the criticism set forth by the ADA and JDRF in a remarkable joint letter was not only misguided but dishonest.

Don’t Do It Yourself

Referring to the BCG vaccine’s long history of safety, Dr. Faustman suggested that there was little downside to her proposed intervention.

I felt an uncomfortable comparison to some of the pandemic era’s health controversies, in particular to the arguments advanced by many in favor of poorly investigated COVID-19 treatments such as hydroxychloroquine and ivermectin. I asked her what she would say to readers that are ready to go get the BCG vaccine themselves, before it’s been evaluated by the FDA. It’s a question she deals with constantly.

About once a month, Dr. Faustman gets a call from a physician, asking confidentially where one might acquire BCG of the correct strain. Sometimes it’s pharmacies attempting to fulfill a prescription, sometimes it’s the patients (or parents) themselves.

“Everyone’s trying to do it in the closet because it’s a safe drug, right? People try to do it all the time. But you should really wait until we get the right strain and the dosing. What we try to say is that if you get vaccinated with the wrong strain of BCG, we’re not sure, when we give you the right strain, that it’s gonna work.”

The BCG vaccine may be easy to come by in countries where it is used frequently, but there’s no telling what strain you’d get and what the effects would be.

For patients that are very eager about BCG, Dr. Faustman recommends registering for one of her clinical trials.

Timeline to Treatment

There’s already a phase II trial underway, which will test the BCG vaccine in adults with long-standing type 1 diabetes. This expands the study size from 9 to over 200; Dr. Faustman expects that good results in a much larger cohort will finally resolve the criticism and controversy that has dogged her for years.

Meanwhile, her lab is beginning its first trial of children with type 1 diabetes.

In an ideal world, she told me, the phase II trial for adults would be followed by phase III, an even larger study which she would then present to the FDA for evaluation. In a best-case scenario, the approved drug could be administered to regular patients in “five to eight years.”

“We’re moving as fast as we can.”

Source: diabetesdaily.com

10 Fruits with 10 Net Carbs or Less

Fruits are high in vitamins and minerals and have several health benefits, including reducing the risk of obesity, heart attack, and stroke. However, all fruit contains sugar, and this can be challenging for those of us living with type 1 or type 2 diabetes. The fruit mentioned below all have a carbohydrate count of 10 carbs and are low GI foods which means they won’t spike you as quickly. These fruits are also loaded with fiber, which can help keep you fuller longer, promote good digestion, and help your overall blood sugar management.

Be mindful of the carb count of the fruit you’re eating: it will help you enjoy this healthy and delicious food without spiking your blood sugar. And please note that fresh fruit and frozen fruit are always better choices than fruit that comes in a can or jar. Also, avoid processed fruits and dried fruits that contain extra sugar.

Here are 10 fruits that contain 10 carbs or less per serving:

Tomatoes

Surprise! The tomato is a fruit, and I find it to be one of the most versatile fruits to work with. You can eat tomatoes over a salad, serve them with fresh mozzarella and a drizzle of balsamic vinegar, roast them, or turn them into a sauce and add it to any of your favorite proteins. Tomatoes contain a slew of vitamins, minerals and antioxidants and only contain 4.8 grams of net carbs for an average-sized tomato (about 123 grams/4.3 punches).

avocado

Avocados

Containing only 1.7 grams of net carbs per 3.5 ounces/100 grams of avocados, this is a great choice that is full of healthy fats and antioxidants. It is also high in fiber, contains potassium, Vitamin K, Vitamin C, and folate. Adding some avocado to a salad is a flavorful way to get in some good nutrients without spiking your blood sugar. You can also turn this into guacamole and serve it with your favorite crudite.

Strawberries

This personal favorite of mine contains only 8 net grams of carbs per cup. This fruit is high in vitamins, fiber, and antioxidants, along with many other nutritional benefits. You can do so much with strawberries and don’t have to worry too much about your blood sugars. Make a smoothie, toss on your favorite summer salad, or dice them up and add to greek yogurt. Add a drizzle of sugar-free chocolate syrup for a decadent and healthy snack.

Lemon and Lime

While most people don’t actually eat whole lemons and limes, either is a great addition to water to make it more palatable. It is also great to mix with your favorite alcohol for a low-sugar tasty drink. Lemon and lime both only contain 7 net carbs per serving, so feel free to use them generously in your drinks and to season meals as well.

Blackberries

Out of all the really fruity fruits, berries contain the lowest amount of carbs, only 8 net carbs per cup. (Blueberries, by contrast, contain 17 net carbs per 1 cup serving). They are packed with vitamins and high in fiber, making them a great choice.

kiwi

Photo credit: Pranjall Kumar (Unsplash)

Kiwi

Unbeknownst to many, kiwis are berries, and like most other berries they have minimal sugar, coming in at 8 net carbs per kiwi. The health benefits of kiwis are plentiful, they are packed with vitamins, antioxidants and are high in fiber, which will help aid digestion. When it comes to using kiwi, the options are endless- smoothies, puddings, desserts, even bread. Check out these recipes for more ideas on how to use this super fruit.

Plums

This fruit only contains 7.5 net carbs per average-sized plum and is packed with nutrition. Plums have also been found to reduce blood sugar thanks to a hormone, adiponectin, which helps regular blood sugars.  The fiber will also help avoid a quick spike in your blood glucose levels.

Rhubarb

Coming it at only 1 net carb per cup, this fruit is worth the effort. You can eat it on its own (only the stalk; the leaves are poisonous), but most people use it to bake with. This superfruit is packed with vitamins and antioxidants and has numerous health benefits, such as aiding collagen production and fighting inflammation, to name a few.

Watermelon

With only 8 grams of carbs per 100 grams/3.5 ounces of watermelon, this is a delicious refreshing fruit you can enjoy any time of year. Not just high in vitamins and antioxidants, watermelon also contains lycopene, which has has been found to lower blood pressure and cholesterol, reduce inflammation, and benefit brain health.

Cantaloupe

Like watermelon, cantaloupe only contains 8 grams of carbs per 100 grams/3.5 ounces. It is full of vitamin A, C, and potassium. You can get pretty creative with this succulent fruit by turning it into sorbet, cantaloupe chia pudding, or even this refreshing drink

Do you try to stick to low-carb fruits? What are some of your favorites and how do they impact your blood sugar levels? Share and comment below!

Source: diabetesdaily.com

We Asked an Immunologist Your Questions About COVID-19 Vaccine Safety

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

By Lala Jackson

August 2021 is starting to feel like March 2020 – the COVID-19 delta and other emerging variants are more dangerous than the original virus, but what does that mean? Cases are rising rapidly, are we safe? Do we need to wear masks or not? Vaccines work, but do they for everyone?

To get some clarity, we spoke with Bernard Khor, MD, PhD, of the Benaroya Research Institute at Virginia Mason in Seattle, Washington. Dr. Khor’s laboratory is trying to find new ways to treat autoimmune diseases, specifically for people living with Down Syndrome as they are more likely to develop autoimmune diseases like type 1 diabetes. Because he spends so much time researching immune responses, we published his interview on whether type 1 diabetes means a person is immunocompromised and wanted to talk with him more about COVID-19 vaccine safety for people with type 1 diabetes.

Beyond Type 1: Are people with type 1 diabetes more likely to get COVID-19?

Dr. Khor: People who have autoimmune diseases aren’t necessarily immunocompromised; instead we can think of it as having a dysregulated immune system. That’s what causes the immune system to attack its own body. It does not necessarily mean that they don’t respond appropriately against infections.

What we do know is that, if they catch it, people with type 1 diabetes are more susceptible to worse outcomes from COVID. If it were my child or loved one living with type 1 diabetes, I would do everything I could to mitigate that risk.

What about the delta variant? How did we get here?

The delta variant and other variants we’re seeing start to develop are worse for everyone. These mutations happen because the virus has had time to persist and improve itself. If we were able to completely contain it, if everyone got the vaccines right now, we could stop this pattern by giving it nowhere to hide. But if the coronavirus is hiding in 30 to 40 percent of the population, it will come back and come back worse again and again. It’s just a matter of time.

That’s the thing about a virus – it’s not a one time threat. It’s an ongoing, adaptable threat. It’s a virus that mutates. It’s trying to survive. It can change and adapt to circumstances. There’s another variant coming out from Peru that’s getting more powerful – it’s affecting younger people, it’s leading to more rapid hospitalization, it’s a worse disease.

I cannot overstate how much COVID-19 needs to be respected. The writing on the wall was very clear from the beginning. We have seen outbreaks of diseases before and we have seen pandemics before. They are all agents that need to be respected immensely.

Other forms of coronavirus – SARS, MERS – were incredibly bad. In both cases we basically escaped worse outcomes because we got lucky; transmission rates of those viruses weren’t as high as COVID. Now we have COVID. We started off unlucky, and if we don’t respect it, it will get worse. It can cause death, it can cause disability, it can cause horrible outcomes. We’ve seen nursing homes decimated, it’s devastating.

We as scientists can make the best thing we possibly can, but it doesn’t matter if no one uses it. I see this as our generation’s World War event. We’re lucky that many of us are inside, that we have Netflix and ways to work from home. But the societal impact is every bit as serious.

Are people with type 1 diabetes more likely to have a particularly bad reaction to the vaccine?

All the data points to no. You’ll rarely hear a scientist say never—1 in millions is not never—but all the studies to date say no, and we can have confidence in that because there’s been a lot of post-marketing assessment of these vaccines. We have a lot of people who have taken the vaccines already worldwide to see how it’s working.

And that’s what we look at—the remarkably low rate of adverse reactions that are reported and tracked, versus the highly measurable rates of severe illness or death, or of long-term disability from long haul COVID.

What about the fear that vaccines in general can lead to new or more autoimmune issues? Can you explain the risk?

It’s a terrible thing to come down or have your child come down with a severe life-long illness. Type 1 diabetes is so diabolically difficult, and it’ll be different for different people. It’s a slog. So of course we want to know why it happens. Especially when you’re trying to find that important of an answer, our minds are programmed to look for patterns, but when you look from a single case, you’re only able to make the pattern from the single situation. Huge studies have uniformly debunked the idea that vaccinations commonly cause autoimmune issues.

That’s the benefit of our system – it’s very transparent. When there are adverse effects, we know about them. There are rare occurrences that have been seen; an example was a batch of flu vaccines in the 1970s, where several people came down with a rare autoimmune disorder called Guillain-Barré syndrome (GBS). Even in that instance, the risk of getting GBS was ten times less than the risk of death from flu. The cost benefit ratio is not even close.

Editor’s Note: There have been 100 reports of GBS among people who received the Johnson & Johnson vaccine, from approximately 12.5 million doses administered. Each year in the United States, an estimated 3,000 to 6,000 people develop GBS. Most people fully recover from the disorder. Whenever health issues like these do arise from vaccines, the FDA requires revisions to the information provided to vaccine recipients and healthcare providers so that they know about potential risks. No similar pattern has been identified with the Moderna and Pfizer-BioNTech COVID-19 vaccines.

How can we trust vaccines that only have emergency use authorization (EUA) And are not fully approved?

Editor’s Note: Since this interview was published on August 10, 2021, the FDA has granted the Pfizer and BioNTech COVID-19 vaccine full approval for ages 16 and up, with the EUA still in effect for ages 12-15 and booster doses for immunocompromised individuals. 

I think it’s incredible that we have a vaccine ready as quickly as we did – that has been due to immense collaborative work from the entire global scientific community. That work happened because of the immense threat and impact of COVID-19.

In this case, scientists worked hard, building upon decades of existing research to make this thing work. In a sense, we also got lucky. We are so fortunate that these vaccines work as well as they do. We built this nice big shiny thing, now we have to walk on in. Because scientists can build the best possible solution and it means nothing if people don’t use it.

Lack of full approval—which we know is coming soon—is due to the fact that the FDA has a rigid and bureaucratic approval process. It’s not wrong. But it makes it very slow even once the medicine and science has been proven, as is the case with the COVID-19 vaccines we offer in the US.

But no corners have been cut—the data has been reviewed, the process has been transparent. Everyone understands the need for post-marketing surveillance, ongoing data from the vaccines as they are administered. No expense has been spared for that.

How do we know that people who take the COVID-19 vaccine won’t face health issues from it in twenty years?

I cannot think of a scientific mechanism to be worried about that. I do know that COVID is here and is a very real risk, right now. We fear the unknown; the fear of the known has become hard to remind people of. After more than a year, we’ve gotten used to the bear that’s in the house. We can get worried about how we’re dealing with the bear, or we can go ahead and get the bear out of the house.

We heard discussion a few weeks ago about the psychology of choosing to take the COVID-19 vaccine; that to humans, it’s scarier to face making a choice and something bad happening, like taking the vaccine and getting sick from it, and less scary if something bad happens to you passively, like getting COVID-19 when you are going about your daily life trying to be careful. It feels like less responsibility. What are your thoughts on this?

Choosing not to do something is as much a choice as doing something. It’s about the risk of not doing it, not taking the vaccine.

You can always be nervous about some infinitesimal risk of doing something, but there’s a true risk of not doing something in this particular case. And the risk is not just what might happen to you if you get COVID, it’s the risk of all the people you might pass COVID to, including grandparents and children.

Because it’s not a question of if you will be exposed to COVID-19, it’s a question of when.

Source: diabetesdaily.com

Your Brain and Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Brett Goerl and Matthew Garza

Recent studies have shown a link between brain diseases like Alzheimer’s and Parkinson’s and diabetes.  Unfortunately, these conditions are becoming more common as our population grows older. Find out more and ways to improve brain health.

What are neurodegenerative diseases?

The term “neurodegenerative diseases” refers to a range of diseases in which the cells in our brains break down and can no longer perform their designated functions associated with movement or mental ability, according to the EU Joint Programme – Neurodegenerative Disease Research. The most common neurodegenerative diseases that affect people with diabetes are mild cognitive impairment (MCI) and dementia, which includes Alzheimer’s disease.

As we age, it is completely normal for our memory, thinking, and judgment to slightly decline. However, MCI occurs when our mental abilities decline faster than expected and begin to interfere with our daily lives. Age is by far the biggest risk factor for MCI, but diabetes, smoking, high blood pressure and cholesterol, obesity, and depression can further increase a person’s risk of developing MCI.

In around 10-15% of cases each year, the mental decline seen in MCI may progress further, making it difficult for us to carry out a healthy and happy life. When this happens, it is called dementia. The two most common types of dementia that affect people with diabetes are Alzheimer’s disease (AD) and vascular dementia.

While the symptoms of AD and vascular dementia are similar, they are caused by two different processes that occur in our brains. AD is thought to be caused by the abnormal build-up of proteins in the brain. One protein is “amyloid,” which clumps together in spaces around brain cells. The other protein is “tau,” which get tangled up inside brain cells. Vascular dementia, on the other hand, occurs when the blood vessels in our brain become narrow or start to bleed. This reduces the brain’s ability to get the oxygen it needs to keep brain cells healthy and for the brain to function properly. In both cases, brain cells become damaged, leading to a wide range of problems such as memory loss, worsened judgment, and personality changes.

AD is the most common form of dementia in the US, making up 60-70% of dementia cases. In the US, an estimated 5.4 million people of all ages are affected by AD, and one in eight people 65 years and older suffer from it. Considering the 14.3 million adults aged 65 and older in the U.S. who have diabetes, and it is easy to see why Alzheimer’s disease and diabetes are two of the most common diseases of aging. And recent research has suggested that they may be linked in various ways.

How do neurodegenerative diseases like Alzheimer’s and vascular dementia relate to diabetes? 

We often think of diabetes as a problem with our metabolism since the lack of insulin (in type 1 diabetes) or insulin resistance (in type 2 diabetes) affects our body’s ability to maintain normal blood glucose levels. However, our brain consumes the most glucose compared to any other organ in our body. While the brain accounts for roughly 2% of our body weight, it uses almost 20% of the sugars we eat or release from our body’s stores.

An increasing amount of research shows that people with AD and other forms of dementia experience insulin resistance in the CNS (central nervous system, which includes the brain and the spinal cord), similar to what people with type 2 diabetes experience in other areas of the body, such as the muscles, the liver, and the fat. Scientists have yet to determine exactly what the relationship between diabetes and AD or other forms of dementia may be caused by, but there are a few theories that have been proposed.

  • One of these theories focuses on brain insulin resistance, which is when brain cells stop responding normally to insulin, leading to problems related to the ways our brain cells communicate, use energy, and fight infection.
    • Insulin receptors can be found in many areas of the brain, where they are involved with brain cell growth, communication, and survival. While insulin levels are lower in the brain than in the bloodstream, all the insulin that makes its way to the brain comes from the same insulin produced in the pancreas – it crosses over what is known as the blood-brain barrier (or BBB). This barrier prevents unwanted things from the bloodstream from entering the brain. However, injected insulin does not cross the BBB. The reduced transport of insulin across the BBB may be why brain insulin levels are lower when the body experiences insulin resistance (such as in pre-diabetes and type 2 diabetes) and in diseases such as AD.
    • Insulin in the brain is known to help control our metabolism in certain other organs of the body, like the liver and fat tissue. The hypothalamus, the part of our brain that controls hunger, thirst, and emotions, is highly sensitive to levels of insulin in the brain. The association between type 2 diabetes and brain health may be due to problems with insulin’s actions in the hypothalamus, increasing a person’s likelihood of developing whole-body insulin resistance.
  • Diabetes also increases the risk for damaged blood vessels, leading to heart disease and stroke. Damaged blood vessels can starve the brain of oxygen, leading to cognitive decline and vascular dementia.
  • Diabetes disrupts how our bodies produce amylin, a hormone related to insulin that helps our bodies digest food. People with obesity and pre-diabetes often have high amounts of amylin, some of which can circulate and cross into the brain. Studies have shown that amylin can interact with the same protein deposits in the brain known to cause AD.
  • Experiencing hyperglycemia for long periods of time can degrade the myelin sheath (a protective layer that surrounds your neurons). This leads to issues in how your nerves send and receive signals to your body. It can also lead to your brain cells dying.

Type 1 diabetes could be a risk factor for dementia for many of the same reasons as type 2 diabetes. In particular, the cardiovascular complications such as heart disease and stroke that are associated with type 1 diabetes could provide an explanation for its relationship with vascular dementia. Additionally, higher rates of cognitive dysfunction for those with type 1 diabetes could be related to frequent cases of hyperglycemia and hypoglycemia. Indeed, severe hypoglycemic and hypoglycemic events are associated with increased dementia risk for older adults with type 1 diabetes.

Is diabetes a risk factor for developing neurodegenerative disease? 

On average, people with diabetes experience slightly more cognitive difficulties associated with MCI across their lifespan, but experiencing cognitive difficulty does not mean you will eventually get diagnosed with dementia or AD. The prevalence of type 2 diabetes and neurodegenerative diseases, however, both increase with age, meaning it is more common for older people (65+ years) with type 2 diabetes to get diagnosed with vascular dementia or AD.

Data suggests that people with diabetes have a 73% increase in the risk of developing any type of dementia and 56% increase in the risk of developing AD compared to people who do not have diabetes. This makes diabetes one of the strongest risk factors for getting dementia aside from aging. Health measures like A1C, cholesterolhigh blood pressure(or hypertension), and eGFR are negatively impacted by diabetes and may also be associated with cognitive performance and neurodegenerative diseases.

  • In the ACCORD-MIND trial, the largest and most rigorous study on diabetes and the brain to date, higher A1C levels were associated with lower cognitive function in people with diabetes. Similarly, another study found that the risk for dementia increased as a person’s A1C level increased, regardless of whether or not the person had type 2 diabetes.
  • A recent analysis of over 100 studies found that higher levels of LDL cholesterol (known as “bad cholesterol”) was an independent risk factor for the development of AD.
  • High blood pressure in middle-aged people has been linked to future cognitive decline and dementia, and in particular, vascular dementia. This may be due to high blood pressure in the brain causing damage to blood vessels, such as small blockages and bleeding.
  • In a study on kidney health and dementia recently published recently, researchers found that lower rates of kidney filtration (as measured by eGFR) were associated with higher risk of onset of both vascular dementia and AD.

What about Parkinson’s Disease?

Parkinson’s Disease (PD) is another neurodegenerative disease associated with aging. In PD, the cells in your brain deteriorate and begins to affect a person’s ability to perform daily activities associated with movement. Symptoms can include tremors (rhythmic shaking), muscle stiffness and rigidity, and PD can even slow your movement in a process called bradykinesia. It can also lead to other symptoms not associated with movement such as disrupting sleep, constipation, anxiety, depression, and fatigue.

As with other neurodegenerative diseases, research has been conducted to identify if there is a link between diabetes and PD. In particular, one study from 2018 showed an association between the two conditions. The researchers looked at the English National Hospital Episode Statistics and Mortality Data from 1999-2011 and divided the data into two cohorts, those with type 2 diabetes (2,017,115 people) at the time of hospital admission and those without (6,173,208 people). It was found that those with diabetes had a 30% higher chance of developing PD than those without, and the younger a person was with diagnosed type 2 diabetes, the more likely their chance of developing PD.

Though researchers do not yet understand the exact way that diabetes and PD are related, they do have a few hypotheses. Namely, there is the chance that certain genetic abnormalities that lead to diabetes may also lead to PD; even if one of these conditions does not directly cause the other, people who have one may be more likely to also have the other. In addition, when diabetes and PD coexist in a person, they may create a more hostile environment in the brain, leading the neurodegenerative processes underway in PD to speed up and be more severe.

What are strategies to reduce the risk of developing a neurodegenerative disease?

There is evidence that leading a healthy lifestyle can reduce your risk of developing diabetes-related complications like dementia or PD. For example, heart attacks and stroke can increase the risk of developing vascular dementia; therefore, lifestyle modifications that help you maintain an ideal blood pressure and levels of cholesterol for your age and health status are important. This can be accomplished by exercising regularly and consuming a diet low in saturated fat, salt, and sugar.

Below are some other tips for improving brain health, which can go a long way in reducing the risk of neurodegenerative diseases like AD. The good news is that many of these strategies are also recommended for managing diabetes.

  • Take control of your blood glucose levels by aiming for a greater time-in-range (TIR). To learn more about time-in-range goals, click here.
  • Smoking is associated with higher rates of dementia. In a recent review, smokers were 40% more likely to develop AD than non-smokers. Given that people with diabetes are at an increased risk of developing dementia, smoking is likely to increase this risk further. If you smoke or experience nicotine addiction, talk to your healthcare professional about a plan to quit or cut back.
  • Keep blood pressure at the target discussed with your health care provider (which might be 130/80 mmHg or less, if you are at high risk of cardiovascular disease) by exercising regularly and eating a diet low in salt (aim for less than 2,300 mg of sodium each day)
  • Take your diabetes medications consistently and as directed by your healthcare team. Some early evidence shows that certain diabetes drugs, like GLP-1 receptor agonists, may be beneficial for brain health. In fact, exenatide, a GLP-1 receptor agonist, is currently in clinical trials for treating PD.
  • A very active area of research focuses on the dementia-preventing effects of having an active and stimulating mental life and rich social networks. Working to maintain an active and socially rich lifestyle could help prevent some of the effects of diabetes on dementia risk.

If you are 65 years of age or older and have memory concerns or other cognitive complaints (i.e., brain fog, depression, personality change), talk to your healthcare provider about getting a cognitive assessment. Learn more here.

Source: diabetesdaily.com

Remission, Not Reversal: Experts Agree to Define Ultimate Type 2 Diabetes Success

Type 2 diabetes can be considered “in remission” if patients can maintain non-diabetic blood glucose levels (<6.5% A1c) for 3 months without medication, according to an international panel of experts.

On August 30, the American Diabetes Association joined the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK in co-authoring a consensus statement on “the definition and interpretation of remission in type 2 diabetes.” Here’s a press release, and here’s the full statement.

Remission is Becoming More Common

Type 2 diabetes remission has always been rare – a 2014 survey concluded that fewer than 2% of adults with diabetes experienced any level of remission without bariatric surgery – but in recent years, it has become more common.

The increasing prevalence of diabetes reversal owes partially to the rise in bariatric surgery, but is also likely due to the proliferation of new weight loss and diabetes management techniques. Although diabetes rates continue to rise unabated throughout the world, experience and understanding of the disease have led to superior treatment strategies, allowing a minority of patients to return their blood glucose levels to non-diabetic levels.

Now there are even companies, such as Virta Health, that have based their entire business strategy on the belief that diabetes “reversal” is within the reach of millions of adults with the condition.

With so much attention paid to diabetes remission, the world’s major diabetes authorities decided that the phenomenon of diabetes remission or reversal needed to be properly addressed, named, and described. The consensus statement should help guide study of the phenomenon, and give doctors and patients a framework for understanding just what remission really means.

What’s in a Name?

The experts seem to have given very careful consideration to what word doctors should use to refer to the achievement of regaining non-diabetic blood sugar levels. Many in the diabetes world use words like “reverse” or “correct” or even “cure” to refer to this phenomenon, each of which has its own implications. To speak of a “cure,” for example, is to imply that the disease has left and will never return; in the case of a patient that needs to keep up with dramatic lifestyle adjustments to keep their blood sugar at non-diabetic levels, this is a plainly inaccurate label. “Reversal” and “resolved” likewise suggest similar shades of meaning.

The panel decided,

that diabetes remission is the most appropriate term. It strikes an appropriate balance, noting that diabetes may not always be active and progressive yet implying that a notable improvement may not be permanent.

The term also accounts for the fact that while patients with diabetes may have achieved normal glycemic levels, they may still suffer from insulin resistance and/or deficiency, factors that may mean that they need to continue keeping a careful watch on their blood sugar management.

An earlier statement from the American Diabetes Association on type 2 remission categorized patients into different types of remission – partial, complete, and prolonged. These categories have been discarded as unhelpful.

Diagnosing Remission

Type 2 diabetes remission is now defined “as a return of HbA1c  to < 6.5% (<48 mmol/mol) that occurs spontaneously or following an intervention and that persists for at least 3 months” without the use of insulin or glucose-lowering medications. (The statement also allows for some other manners of diagnosing remission, such as using fasting blood glucose, in cases where HbA1c may be unreliable.)

The 3- month time parameter helps weed out both fluke A1c results and the lingering effect of medication, which can last for months after it’s been discontinued. Lifestyle interventions (changes to diet and exercise) and surgery (especially gastric bypass) can precipitate diabetes remission.

At the moment, the experts advise that patients in remission should have their A1c, as well as any potential diabetic complications, checked annually.

By definition, patients with type 1 diabetes cannot achieve remission (except under perhaps under unique and extraordinary circumstances), given their lifelong reliance on exogenous insulin

How to Achieve Remission

The most reliable way of creating type 2 diabetes remission is through bariatric surgery: nearly half of the patients in a Swedish cohort experienced lasting remission.

Bariatric surgery, however, is a very intense and expensive operation, and it comes with its own risks and complications; most patients with type 2 diabetes will not be considered good candidates. For the rest, weight loss, however it may be achieved, appears to be the best path to remission. Experts additionally debate the efficacy of specialized eating patterns, such as low-carbohydrate diets and therapeutic fasting.

Remission may not be a realistic goal for everyone, and researchers don’t yet have a solid understanding of why some patients are better able to reset their metabolic health than others.

We have an entire article on diabetes remission – originally published using terminology that is now officially out of step with mainstream practice: What You Need to Know About Reversing Type 2 Diabetes.

Going Forward

There’s an awful lot we still don’t know about remission. To date, diabetes remission has not attracted much attention from researchers, possibly because it was considered such a rarity. But with that changing, the diabetes authorities behind the consensus statement recognized a need to guide the questions of researchers.

The statement includes a laundry list of areas where future study is required, including:

  • How often patients in remission need to be re-evaluated
  • Whether or not patients in remission could still benefit from metformin and other drugs
  • Whether other metabolic parameters (such as cholesterol levels) need to be monitored
  • How long remission can be expected to last
  • What impact remission has on longterm health outcomes

Having finally named and described the phenomenon, the panel hopes to spur research into the reality of the condition so that it may be better understood.

 

Source: diabetesdaily.com

Danger Ahead: One-Upmanship in the Type 1 Diabetes Community

We type 1s face danger at every curve: the yummy meal laden with carbs, the pump that suddenly malfunctions, the low that plunges to scary territory, the high that won’t come down, the infusion set that bleeds upon insertion, the CGM that needs constant calibration…the list goes on.

But there is perhaps a larger danger lurking out there, one that can have a devastating effect on our attitude if we let it. It is called one-upsmanship. What do we mean by that?

When speaking with fellow people with diabetes, how often do you hear some of the following lines?

  • I have no problem with control. I have an A1c of 5.1.
  • I’m in range 99% of the time.
  • My pump is great. It keeps my average sugar at 95.
  • I rarely, if ever, go low.
  • My numbers could not be better.
  • My endo tells me I’m doing perfectly.
  • I never go above 150.
  • If I’m at 200, I bring it down in minutes.
  • I have no problem saying no to sugar.
  • Managing diabetes is no big deal.

My reaction to such comments is: Really? I wonder what planet these folks live on. Are they being truthful?  If so, why are my numbers so different? What are they doing that I’m not?

Am I the only type 1 who is not doing that well? Why can’t I be like them?

People with diabetes who brag or boast to others about their ability to handle diabetes are basically sending the message that they can manage better than you. They are putting themselves above you and playing a vicious game of one-upsmanship.

In our constant, ongoing battle with diabetes, our toughest job is to remain optimistic. When we hear others boast of great control, we tend to think less of ourselves. We lose confidence.

Without a strong belief in ourselves and our ability to stay in the diabetes fight, we can get discouraged. Not only do we feel depressed, but worse, we are tempted to say, “The heck with it.” Why should I eat so carefully if I can’t get results like my friend’s?

Some argue that it is human nature to promote ourselves over others or simply want others to know how good we are. Facebook, one might argue, is often a look-at-me activity, where people describe all the wonderful things in their lives. Multi millions around the globe participate in Facebook just to show the world their daily achievements.

How does this make others feel? If, for instance, someone on Facebook shows pictures of a delightful vacation to Paris, France, some readers might say to themselves, “Wish I had that kind of money.” Or: “Wish I had free time.” Or: Wish I had friends to go with.”

The same holds true with diabetes. When others flaunt their abilities to deal with the disease, we can easily start to feel incompetent.

Here’s some advice: Avoid those who would continuously boast about their victories over diabetes. Most of the stories simply are not true. Those that are don’t do us much good.

We need to choose our diabetes support circle as carefully as we choose insulin pumps and carbs at meals. We need to stay positive in the daily struggle and associate with those who provide us honest emotional support.

Source: diabetesdaily.com

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