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

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

Drink to That: How to Safely Consume Alcohol with Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

We’re already thinking about carbs and calories all the time, and adding alcohol into the mix makes things more complex. ­Experts share their best advice on how to safely drink when living with diabetes.

People who choose to drink alcohol typically do so for a few main reasons: to cope with challenges, to be sociable, or just because they enjoy having a drink. But while alcohol may make some people feel more comfortable, drinking can be especially complicated for people with diabetes. If you’re choosing to drink with friends or loved ones, let’s talk about how you can do so safely with diabetes.

First, alcohol is a drug, and it can be highly addictive. If you don’t drink now, there’s no reason to start. In fact, avoiding alcohol is the healthiest choice for people with or without diabetes. Drinking more than is healthy for the body has been linked to issues in the brain, heart, liver, pancreas, and immune system and is associated with several kinds of cancer, according to the National Institute on Alcohol Abuse and Alcoholism. Drinking is also connected to other health problems, such as unintentional injuries (car accidents, falls, drownings), domestic violence, alcohol use disorders, and fetal alcohol spectrum disorders, per the Centers for Disease Control and Prevention.

So, with all that said, how can you best manage your diabetes if you choose to drink?

What happens in the body when you drink?

Your liver works to create glucose when your blood sugar levels are low, but it also processes any alcohol present in your body, says Sandra Arevalo, a certified diabetes care and education specialist and spokesperson for the Academy of Nutrition and Dietetics. More specifically, “Alcohol gets broken down by your liver. The liver is also in charge of making sugar when your blood sugar levels are low, by converting stored glycogen into glucose, and releasing that glucose into your bloodstream. When you drink, your liver is busy processing the alcohol and has a hard time producing glucose,” she said.

This process “puts people with diabetes at high risk of low blood sugar when they drink,” Arevalo said. “If you are on basal insulin, you may not make enough glucose for the amount of basal insulin you have taken, and you may suffer a hypoglycemic episode.” This applies primarily to people with type 1 diabetes, but people with type 2 diabetes are still at risk for low blood glucose levels when they drink.

What’s in a drink?

That’s a tricky question. What you are drinking and how much of it you choose to drink can make a big difference. Like most things with diabetes, there aren’t simple answers.

According to the CDC, moderate drinking is defined as two drinks or less per day for men, or one drink or less per day for women. The US Dietary Guidelines Advisory Committee recommends one drink or fewer per day for people of any gender. It is illegal for people under 21 to drink alcohol in the United States.

Drinking

Image source: diaTribe

What does the CDC classify as “a drink?” One drink contains 14 grams, or 0.6 ounces, of pure alcohol, which normally equates to 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of hard liquor or spirits such as gin, rum, vodka or whiskey.

What influences your intoxication?

Several factors – including diabetes medications, food, and exercise – can all make things even more complicated, said Carrie S. Swift, a dietician and spokesperson with the Association of Diabetes Care & Education Specialists. “Overall, alcohol intake leads to less predictable blood glucose whether you have type 1 or type 2 diabetes,” she said. But “the impact of alcohol on blood glucose isn’t always the same.”

This can be caused by:

  • Carbohydrate content of drinks: Beer and sweet wines contain a lot of carbohydrates, and can increase your blood sugar level despite the alcohol content. On the other hand, quickly cutting down your intake of these drinks, or quickly making the switch to dry wine or spirits, can carry a high risk of hypoglycemia.
  • Diabetes drugs: Insulin and sulfonylurea medications such as glipizide, glyburide, and glimepiride – all of which help to lower blood glucose levels – “are more likely to cause low blood glucose when alcohol is consumed,” said Swift. Insulin and alcohol work similarly whether you have type 1 or type 2 diabetes. If you take metformin, pay attention to these specific symptoms when you are drinking: weakness, fatigue, slow heart rate, muscle pain, shortness of breath, or dark urine. “Excessive alcohol intake while taking metformin may increase the risk of a rare, but dangerous condition, called lactic acidosis. If you have these symptoms – get medical help right away,” she said. There are no specific or predictable ways that blood glucose levels react when taking other oral diabetes medications or GLP-1 medications, Swift added.
  • Food: “If you drink on an empty stomach, you are more likely to experience hypoglycemia,” said Swift. Yet, eating while drinking “may also increase your blood glucose, especially if you eat more than usual or make less healthy food choices when you drink.”
  • Exercise: If you are physically active either before or after drinking alcohol, it can cause your blood sugars to drop and lead to hypoglycemia.

What and how are you drinking?

If you have diabetes and choose to drink, what should you keep in mind?

  • Alcoholic drinks can have as much added sugar as some desserts, so think about what kinds of drinks you are having. “It’s best not to choose alcohol mixed with punches or soft drink mixers, such as Pepsi, Sprite, or Coke, daiquiris, margaritas, or sweetened liquors like Kahlua or Bailey’s Irish Cream,” said Swift. Regular beer and sweet wines are also higher in carbohydrates. “These drinks not only add carbohydrate, but excess calories from the added sugars,” she said.
  • If you have a continuous glucose monitor (CGM), use it. While you are drinking, you can see where your glucose is at all times and if it drops quickly. If you don’t have a CGM, “test your blood sugar more often,” said Arevalo. “Mainly if you are not feeling well, you want to know if your sugar is dropping, or if you are getting drunk. Even though both feel equally bad, you will want to know if your sugars are low so you can correct them quickly.”
  • Never drink on an empty stomach. Instead, “Have a good meal before or during drinking,” said Arevalo. But know the carb count of what you are eating and work with your healthcare professional to determine how to take medication for that meal along with the alcohol you are consuming.
  • Exercise and alcohol can make your numbers plummet. “Avoid drinking while dancing or exercising,” said Arevalo. “Physical activity helps to reduce blood sugar levels, and if the liver is not able to keep up with the production of glucose, the risk of hypoglycemia is even higher.”
  • Have your supplies handy, such as a hypoglycemia preparedness kit. Always bring your blood glucose testing kit and enough supplies for you to test frequently. It’s a good idea to have extra test strips, alcohol swabs, lancets, as well as fast-acting forms of glucose, including emergency glucagon in case your blood sugar level doesn’t come up with food or glucose.
  •  If you take basal insulin in the evening, it’s not an easy answer on what to do if you plan to consume alcohol that evening, said Swift. “Depending on what type of diabetes the person has, and other factors, the results of drinking and taking a long-acting insulin before going out, may contribute to a different result,” she said. If you have type 1 and you take your usual amount of long-acting insulin and then you drink alcohol, “It may contribute to delayed hypoglycemia when drinking too much alcohol,” she said. If you have type 2 diabetes and are overweight or have significant insulin resistance, “Taking your usual amount of long-acting insulin may be a good strategy to avoid high blood glucose numbers,” she said. “No matter what your type of diabetes, frequent blood glucose checking will help you take the right action to avoid high or low blood glucose when choosing to drink alcohol.”
  • If you use an insulin pump or a CGM, make sure you check that they are working properly before you leave the house, without any low-power indicators. If you need to fill your pump with insulin or change out either your infusion set or CGM sensor, do it before you begin drinking or get drunk. As Dr. Jeremy Pettus and Dr. Steve Edelman say in this video, “Protect yourself from drunk you as much as you possibly can.”

It’s important for everyone to avoid getting drunk to the point of not being able to protect yourself. For people with diabetes, this includes protecting yourself from hypoglycemia.

Navigating social situations

If you find yourself in situations where people around you are drinking, or your friends like to party, there are ways to fit in without feeling left out:

  • “It’s okay to choose sparkling water with lemon or a diet soda instead of an alcoholic drink in a social setting,” said Swift. “If you do choose to drink alcohol, have a glass of water, or another no-calorie beverage between alcohol-containing drinks.” It’s also okay to hold a drink and not consume it, if that makes you more comfortable.
  • Tell a trusted friend ahead of time where you keep your supplies, such as your blood glucose monitor or CGM reader, how to get glucose tabs or juice if you need it, and, if necessary, how to give emergency glucagon, either by injection or by nasal inhalation, said Arevalo. It’s also good to have a designated non-drinker in your group, who can watch out for everyone’s safety. And be sure the group you are with knows that the signs of a low blood sugar and the signs of being drunk are the same, said Swift: slurred speech, blurry vision, dizziness, confusion, lack of coordination, irritability, and potentially, loss of consciousness.
  • Make sure you’re hanging out with people you want to be with, and consider where drinking fits in to your health goals and your life. “Friends are only friends if they accept you the way you are and help to take care of you,” said Arevalo. “If you feel peer-pressured to drink, let them know that you have to take care of yourself because of your diabetes. Good friends will respond in a positive way, and will understand and help you. If you want to have a good time and don’t want to keep an eye on how much you are drinking, alert your friends about your diabetes. Let them know where you have your supplies, how to use them, and who to call and what to do in case of an emergency.” Remember, never drive if you (or your driver) have been drinking.

Finally, if you’re going to drink, be smart about it. Always start with a blood glucose level that’s at a healthy, in-range level, sip—don’t chug—your alcohol, and avoid drinking to excess. Your body, your brain, and your diabetes will all be easier to manage once you’re done drinking, either for the evening, the event, or for good.

About Cheryl

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

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

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

Source: diabetesdaily.com

Community Table: Nutrition, Health + Wellness in the Black Diabetes Community

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

By JDRF-Beyond Type 1 Alliance

During our second Community Table discussion, Beyond Type 1 sat down with a group of experts and community members to discuss nutrition, health, and wellness in the Black diabetes community, and share helpful resources and perspectives. Watch the discussion in full!



Speakers included:

  • T’ara Smith, who served as the moderator for this event, was originally diagnosed with type 2 diabetes in 2017 but was re-diagnosed with LADA diabetes in 2019 and is Senior Manager of Beyond Type 2.
  • Keith Crear, who has lived with type 2 diabetes since 2017, is a sports photographer and multimedia specialist.
  • Alexis Newman, who has had type 1 diabetes for 37 years and is a registered dietician.
  • Dex Geralds, who has had type 2 diabetes since 2016 and works as a personal trainer and CrossFit coach.
  • Joy Ashby Cornthwaite, a dietitian and a certifies diabetes care and education specialist.

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

What does wellness mean or look like for you, and has your diagnosis changed the way that you live?

Dex: It’s balance. I know a lot of times when I’m with people who don’t typically know about diabetes, there’s a lot of things surrounding food that they believe I cannot have at all. Once you find the balance, you’re able to still eat some of the things that you’re eating before your diagnosis, maybe not at the same amount that you were eating before. Just finding balance with the way you eat, balance in the way you exercise. Whether it’s like myself who exercise maybe two hours a day or just going out for a 15-minute brisk walk. Just finding balance in what comes with that. The last thing in balance is just your mental health and making sure you check in with yourself and your feelings and your emotions and figure out what brings you happiness and joy.

Keith: It is a balance. It’s knowing what to eat, what not to eat, what to consume, when to consume it. Exercise is very, very important.

Alexis: For me, what it looks like is making sure that I am well, not only with how I’m eating, but also exercise. Making sure I’m honest and checking in with my friends and family, my support system, too. Also, the spiritual aspect of it. I’m a Christian, so making sure I’m connected in the sources that I feel encouraged in. When one of those are kind of out of whack, I don’t feel well.

Joy: I think of health on a continuum, and I encourage that in every day. In my family life, in my personal life, but also for those who I help to balance their journey with diabetes because everyone has their own journey and their whole complete individual. When someone comes to a session with me, I find out where on the continuum you are and what can we work on today? It has to come from you. It has to be what you want and not necessarily what I want. But I’m going to use my skills to get you to where you need to be.

What misconceptions have you encountered pertaining specifically to Black people with diabetes when it comes to fitness? What is some of the ways that you’ve helped your Black clients move past those stigmas and misconceptions?

Dex: The biggest thing is support in our community and in the world in general. If you’re overweight you get looked down upon and that can add to depression and lead to worse things. I know a big term going on right now is “unlearning” and taking everything, looking at it through a different scope, and then figuring out what brought you to this point and then what can I do to change this. It’s not just a one-stop shop kind of thing. It’s going to take a while for you to start to see changes for the most part. You have to create these better habits and getting through that way.

Learning to love yourself is vital, and when you learn to love yourself you want to do the things that’s right for you and you’re going to quiet that outside noise and put your blinders on and work for yourself and not think about the negative things that you might be getting from someone else. My family has a history of diabetes and obesity. My oldest sister, she’s lost 150 pounds now, but still just over 400 pounds. I remember things people would say to her growing up. Now that I support her and my family’s supporting her, she’s been on this incredible journey and losing weight because now she feels confident enough to do the things that once scared her or felt ashamed about. Being able to conversate and talk to my sister, or just clients in general, I’ve been able to learn what’s going on and been able to apply that to them in their journey in fitness.

Alexis: The kind of things that I’ve seen is that they believe that people think they’re lazy so they don’t want to push through that because they’re afraid of what people are going to think. I’ve also seen the fear of not knowing what to do overtake them in my discussions with my patients. Another idea is that they have this perceived idea of what exercise looks like, so really breaking it down into bite-sized pieces of like, “Look, as long as you’re like being consistent with the movement, whatever you choose to do, you can add on time, you can add on intensity. But, as long as you’re out there trying to move.” Those are the things that I have conversations with my patients about in terms of fitness.

Another thing too, is that an ideal weight of someone who’s African American may not be similar to another culture or race. We need to keep that in mind as we are discussing food, nutrition, health, and weight that the ideal weight that a doctor may have for you may not be appropriate. I think that needs to be said and also needs to be addressed when we’re talking to these patients about weight and health and glucose numbers and things like that.

Joy: When it comes to fitness, one of the great disservices, especially for the Black community, is to tell people that they need to lose weight if they’re moving. For many people who are living with diabetes, movement doesn’t always equate to weight loss. It also doesn’t always equate to better blood glucose values.

There’s a lot of things that go into thinking about exercise. When you’re telling someone that it’s going to make them better to exercise and they’re saying that their blood glucose is either crashing or going up way too high with exercise there’s a disconnect. You haven’t heard what they’re saying to you. You need to find out what people are experiencing in their exercise journey and then address those things and say, “Look, you may not lose weight, but let’s check your blood glucose before and after.” Celebrate the win over either the hyperglycemia that you have been feeling or the hypoglycemia that you were feeling if you didn’t pre-exercise meal or whatever reason. Celebrate the win that is more than weight.

How can we celebrate our culture or different types of Black cultures throughout the year, not just during Black History Month?

Joy: Support each other. I know for years I felt like I was the sole person saying, “Black people aren’t making ourselves sick with diabetes.” We need help. We need medications. We need diabetes health care and management. We need to know how to take care of ourselves and we don’t have to do that alone. Whatever we need to do we need to support each other and do it together and then we’re louder.

Dex: Our culture is so vast and rich, and it needs to be shared every day and whatever way possible. Whether it’s through social media or just through conversation or the way you dress, the way you wear your hair. It just needs to be expressed and be out there for people to see and enjoy and learn. I love my culture so much.

Alexis: Buy Black. There are so many amazing Black companies, I’ve been focusing on and amplifying those businesses on social media and telling my friends. I’m in a friend group and we’re talking about face care. I’m like, “All right, I’m using this” and they’re using this Black company. We’re just sharing information of these amazing Black companies that are out there. If we can’t do that, then no one else is going to. It’s really important to invest in Black businesses because they’re everywhere.

T’ara: Yes, please support Black businesses that you see, especially in the diabetes community. There’s so many Black people in the diabetes community who have businesses and organizations who could use amplifying on your social platforms. That social sharing could do a whole lot because you never know who can see their products, so please amplify it.

Keith: Constant delivery of content from Black creators. Constantly delivering things from Black history that could be done every day. The way you wear your hair, the clothes. Just something that constantly keeps it in the public eye so it’s not condensed down to just one month. There are a lot of people out there that are doing it and it’s always great to see that. If more of us continue to do that it’ll shift the narrative and it will shift the visual aspect of how we’re seen in society as a whole.

Source: diabetesdaily.com

How to Treat Lows Without Sabotaging Your Diet (or Your Blood Sugar)

Diabetes is basically a never-ending test of willpower, and there are few tests more frustrating than properly correcting a hypo. Your challenge: consume just the right amount of sugar, enough to pull your blood glucose into a safe range, but not too much to send it high. This exercise will be performed under immense stress and in an impaired mental state, and may require advanced math skills and superhuman self-restraint.

We’ve all been there—hypoglycemia hits you like a ton of bricks and leaves you weak-kneed and trembling, and your body is screaming at you for the one thing it needs: sugar! It can feel like every bone in your body is pushing you towards the snacks, and before you know it you’re shoving food into your mouth, blowing way past the modest amount of carbs you actually needed.

Binge eating during a hypo admittedly feels great for a few minutes, but it almost always ends in regret. That blood sugar is about to skyrocket back up to the stratosphere, and might require an insulin correction to bring it back down again, triggering the dreaded rollercoaster. Not to mention what your emergency indulgence might have done to your diet—people with diabetes are not generally known to reach for the healthiest treats when fixing a hypo.

The standard advice, the so-called “15-15 Rule,” is a fine starting point, but advanced diabetes management can benefit from a more subtle approach.

Here are some strategies that might help you treat blood sugar lows without sabotaging your blood sugar or your diet:

Go Boring

The yummier your hypo solution is, the more likely you are to overeat. As fun as it is to use a mild hypo as an opportunity to indulge, this is exactly the wrong time to dig into that box of cookies you’ve got squirreled away. Save those treats for a time that your blood sugar is acting predictably and you can bolus responsibly.

It’s much better practice to view the food or drink you consume to correct a hypo as medicine. Because that’s exactly what it is, a medically vital intervention to be dosed precisely. Hypoglycemia is a serious business.

So, go boring with your hypo rescue solution, the more boring, the better. One reason that experts recommend glucose tabs is that they don’t really taste all that good. That’s a feature, not a bug: medicine isn’t supposed to taste good.

Listen to Your Body – But Not Too Much

The classic symptoms of hypoglycemia—shakiness, hunger, and so on—constitute a critical warning system that you should heed seriously and quickly. (The unlucky minority of patients with diabetes that can no longer feel these symptoms are at a greatly enhanced risk of severe hypoglycemia.)

But as soon as you’ve ingested the proper amount of carbohydrates, it’s time to start ignoring those body cues. You may still feel awful, but you need to let the sugars in the food you’ve eaten get into the bloodstream. The standard advice from medical authorities is to wait 15 minutes before checking your blood sugar, and only then think about applying another dose of carbohydrates.

An early study of this topic showed that people with diabetes that treated their hypos by eating “until they felt better” had A1c’s 0.5% higher than those that scrupulously avoided overeating. That’s a huge difference.

Know your Carb Count

Individual candies and glucose tabs are great because the portions are controlled and identical. A single Skittle is always about 1gram of sucrose, every time. Cereal or orange juice? Not so easy to be precise, unless you have the rare presence of mind to break out the measuring cups or kitchen scale during hypoglycemia.

Understand Your Glucose Trends

The standard recommendation of 15 grams of carbs to treat a low may be more or less than you need, depending on how quickly your blood sugar is moving.

If you have a load of fast-acting insulin on board, or if you’re in the middle of an exercise, you might already know that you need more than just 15 grams. A continuous glucose monitor and its trend arrows can make this decision even easier to make.

Alternatively, if your blood glucose level is fairly steady and there’s no reason to suspect that it will drop precipitously, just a few grams of sugar may be all you need to bump it back up into a safe area.

Avoid Fats

When you opt for more complex snacks than simple sugar candies—say chocolates, cookies, or potato chips—you’re usually letting a lot of fat come along for the ride. Those fats might taste good, but they’ll probably just slow down the absorption of the carbohydrates. The longer it takes for your blood sugar to rise, the longer it leaves you in uncomfortable, ravenous limbo, making it more and more likely that you’ll overeat.

And it should go without saying that those added fats are not doing much good for your diet. There’s not a dietary authority on earth that wants you to reach for that sweet, starchy junk food.

Avoid Fructose

The juice box has been a mainstay of hypoglycemia treatment for decades, especially for kids, but it’s not actually the best option for speedy corrections. Why not? Fruit and fruit juices have more fructose than glucose, and fructose, which first has to undergo fructolysis in the liver, is metabolized more slowly. Several studies have found that fructose’s treatment effectiveness is “significantly lower” than that of sucrose or glucose.

It’s also an unfortunate fact that the healthier a fruit product is, the less appropriate it probably is for hypoglycemia treatment. For one thing, less-processed fruits, juices, and snacks are more likely to contain fiber. That’s certainly healthy in other circumstances—fiber slows the absorption of sugar—but in a hypo emergency it’s exactly what you don’t want.

Fructose is found primarily in fruits; manufacturers also use it as an additive in many mass-produced food products, often in the form of high-fructose corn syrup.

Binge Healthy Food

Sometimes it seems impossible to restrain from eating. In those moments, you can opt to “binge” on food that you know won’t sabotage your diet or your glycemic management. Take the appropriate dose of sugar or carbohydrates first, and then stuff your face with a lower-carb food that you won’t feel guilty about overeating: try crunchy veggies, almonds, or a source of lean protein like smoked turkey. Sometimes I reach for cheese, which is probably not ideal, but at least I know that it won’t spike my blood sugar.

Conclusion

Hypoglycemia too often compels people with diabetes to overeat, which is almost always bad for blood sugar management, diet, and overall health. You should look at your hypo correction snack as a type of medicine, to be dosed quickly and precisely.

Source: diabetesdaily.com

Getting Started with Insulin if You Have Type 2 Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Frida Velcani

New to insulin? Learn about insulin dosing and timing and how often to test your blood sugar levels if you have type 2 diabetes.

If you have type 2 diabetes, it is likely that your treatment regimen will change over time as your needs change, and at some point, your healthcare professional may suggest that you start taking insulin. While this might feel scary, there are millions of others living with type 2 diabetes and taking insulin, so it’s definitely manageable.

Click to jump down:

Why do some people with type 2 diabetes need to take insulin?

Type 2 diabetes can progress with time, which means that it gets more difficult for a person’s body to regulate glucose levels. The body’s many cells become less responsive to insulin (called increased insulin resistance), and the specific cells in the pancreas that produce insulin make less of it (called beta cell insufficiency). This is not necessarily related to a person’s diabetes management, and it is likely not possible to prevent.

For many people, adjusting lifestyle factors such as a reduced calorie diet and increased physical activity are key to keeping blood glucose levels stable and in a target range. Healthcare professionals may also recommend that people with type 2 diabetes take additional medications like metforminDPP-4 inhibitorsSGLT-2 inhibitors, or GLP-1 agonists to their treatment plan to improve glucose management, reduce A1C, lose weight, or support heart and kidney health.

When do people with type 2 diabetes start insulin?

After 10 to 20 years, many people with type 2 diabetes will begin insulin therapy, although every person’s journey with type 2 diabetes is different. This happens when lifestyle changes and medications aren’t keeping your glucose levels in your target range. It is important that you start treatment as early as possible to avoid persistent hyperglycemia (high blood sugar), which can lead to long-term health complications affecting your heart, kidneys, eyes, and other organs.

What are the different types of insulin?

The key to transitioning to insulin is knowing your options. Some people taking insulin need to use both a basal (long-acting) and a prandial (rapid-acting or “mealtime”) insulin each day, while others may only need to use basal insulin. Learn about your options here.

  • Basal (long-acting) insulins are designed to be injected once or twice daily to provide a constant background level of insulin throughout the day. Basal insulins help keep blood sugars at a consistent level when you are not eating and through the night but cannot cover carbohydrates (carbs) eaten for meals or snacks or glucose spikes after meals.
    • Some people use other medications, like GLP-1 agonists, to help cover mealtimes. GLP-1/basal combination treatments for people with type 2 diabetes combine basal insulin with GLP-1 agonist medication in one daily injection. This combination can effectively lower glucose levels while reducing weight gain and risk of hypoglycemia (low blood sugar). Learn more here.
  • Prandial (rapid-acting or “mealtime”) insulins are taken before mealtime and act quickly to cover carbohydrates eaten and bring down high sugar levels following meals. Ultra-rapid-acting prandial insulins can act even more rapidly in the body to bring down glucose levels. Rapid and ultra-rapid insulins are also taken to correct high glucose levels when they occur or are still persistent a few hours after a meal.
  • Basal and prandial insulins are both analog insulins, meaning they are slightly different in structure from the insulin naturally produced in the body. Analog insulins have certain characteristics that can be helpful for people with diabetes. Human insulins, on the other hand, were developed first and are identical to those produced by the human body. Human insulins are classified as regular (short-acting insulin) or NPH (intermediate-acting). These are generally cheaper than analog insulins and can be bought without a prescription at some pharmacies.

Although many people use both basal and prandial insulin – which is called multiple daily injections of insulin (MDI) and consists of one or two injections of basal insulin each day as well as prandial insulin at meals – people with type 2 diabetes who are beginning insulin therapy may only need basal insulin to manage their glucose levels. Basal insulin requires fewer injections and generally causes less hypoglycemia. For these reasons, many healthcare professionals recommend basal insulin when you first start insulin therapy.

How do I take and adjust my insulin doses?

It is important to learn the different methods of taking insulin and what kinds of insulin can be delivered through each method. There are several ways to take insulin – syringe, pen, pump, or inhalation – though injection with a syringe is currently the most common for people with type 2 diabetes. There are many apps that can help you calculate your insulin doses.

  • Insulin pens are considered easier and more convenient to use than a vial and syringe. There are different brands and models of insulin pens available. Smart pens are becoming increasingly common and can help people manage insulin dosing and tracking. They connect to your smartphone and help you remember when you took your last dose, how much insulin you took, and when to take your next one.
  • Insulin pumps are attached to your body and can be programmed to administer rapid-acting insulin throughout the day, to cover both basal and prandial insulin needs. When you need to take insulin for meals or to correct high glucose, calculators inside the pump can help determine the correct dosage after you’ve programmed them with your personal insulin pump settings.
  • Inhaled insulin is ultra-rapid acting insulin and can replace insulin used for mealtime and corrections of high glucose. It is taken through an inhaler and works similarly to injected prandial insulin. People with diabetes who do not want to inject prandial insulin might use this, but it’s not for people who only use basal insulin. The only approved inhaled insulin on the market is the ultra-rapid-acting mealtime insulin Afrezza.

Your insulin regimen should be tailored to fit your needs and lifestyle. Adjusting your basal insulin dosage and timing will require conversations and frequent follow-up with your healthcare team. When initiating insulin therapy, you may be advised to start with a low dose and increase the dose in small amounts once or twice a week, based on your fasting glucose levels. People with diabetes should aim to spend as much time as possible with glucose levels between 70-180 mg/dl. Insulin may be used alone or in combination with oral glucose-lowering medications, such as metformin, SGLT-2 inhibitors, or GLP-1 agonists.

One of the most important things to consider is the characteristics of different insulin types. To learn more, read “Introducing the Many Types of Insulin – Is There a Better Option for You?” and discuss with your healthcare team.

In order to dose insulin to cover meals or snacks, you have to take a few factors into consideration. Your healthcare team should help you determine what to consider when calculating an insulin dose. Prandial insulin doses will usually be adjusted based on:

  • Current blood sugar levels. You’ll aim for a “target” blood sugar, and you should know your “sensitivity” per unit of insulin to correct high blood sugar levels.
    • Insulin sensitivity factor (ISF) or correction factor:  how much one unit of insulin is expected to lower blood sugar. For example, if 1 unit of insulin will drop your blood sugar by 25 mg/dl, then your insulin sensitivity factor is 1:25. Your ISF may change throughout the day – for example, many people are more insulin resistant in the morning, which requires a stronger correction factor.
  • Carbohydrate intake. Insulin to carb ratios represent how many grams of carbohydrates are covered by one unit of insulin. You should calculate your carbohydrate consumptions for each meal.
    • Insulin to carbohydrate ratio:  the number of grams of carbs “covered” by one unit of insulin. For example, a 1:10 insulin to carbohydrate ratio means one unit of insulin will cover every 10 grams of carbohydrates that you eat. For a meal with 30 grams of carbohydrates, a bolus calculator will recommend three units of insulin.
  • Physical activity. Adjust insulin doses before, and possibly after, exercise – learn more about managing glucose levels during exercise here.

Learning to adjust your own insulin doses may be overwhelming at first, especially given the many factors that affect your glucose levels. Identifying patterns in your glucose levels throughout the day may help you optimize the timing and dosing of your insulin. Your healthcare professional, a certified diabetes care and education specialist, or insulin pump trainer (if you use a pump), can help guide you through this process. Do not adjust your insulin doses without first talking to your healthcare team.

How often should I test my blood sugar?

The frequency of testing will depend on your health status and activities during the day. Initially, you may be advised to check your blood glucose three to four times a day. As a starting point, check in with your healthcare team about how often to check your blood sugar. Many people test before meals, exercise, bedtime, and one to two hours after meals to ensure that they bolused their insulin correctly. Over time, your fasting, pre-meal, and post-meal blood glucose levels will help you figure out how to adjust your insulin doses.

Continuous glucose monitors (CGM) are particularly useful for tracking changes in glucose levels throughout the day. Some CGM devices also connect with an insulin pump to automatically adjust insulin delivery. After you start a treatment plan, the goal for most people is to spend as much time as possible in their target range. Talk with your healthcare professional about starting CGM and developing glucose targets.

What else do I need to know about taking insulin?

It’s common to experience minimal discomfort from needle injections or skin changes at the insulin injection site. You may also experience side effects of insulin therapy, which can include some weight gain and hypoglycemia. In some people, insulin increases appetite and stops the loss of glucose (and calories) in the urine, which can lead to weight gain. Hypoglycemia can occur if you are not taking the right amount of insulin to cover your carb intake, over-correcting high glucose levels, exercising, or consuming alcohol. Treating hypoglycemia also adds more calories to your daily intake and can further contribute to weight gain. Contact your healthcare professional to adjust your insulin dose if you are experiencing hypoglycemia, or call 911 if you experience more serious side effects, such as severe low blood sugar levels, serious allergic reactions, swelling, or shortness of breath.

Staying in contact with your healthcare team is the best way to make the transition to insulin therapy. Though the first few days or weeks will be challenging, with the right support, you’ll find a diabetes care plan that works for you.

If you were recently diagnosed with type 2 diabetes, check out more resources here.

Source: diabetesdaily.com

Rush for COVID Vaccine Hinders Diabetes Tech Advancements

Modern science is amazing. The COVID-19 pandemic, which is still shaking the world as we know it, is quickly getting controlled due to fast scientific progress and the vaccine rollout (in the United States, at least).

Having an effective vaccine come to market within a year of the appearance of a novel disease is unheard of; most medicines take decades for adequate approval processes within the Food and Drug Administration (FDA) to be completed. This feat is incredible.

That being said, with all of the rush to get a vaccine to the masses, the FDA pushed the Pfizer, Moderna, and Johnson & Johnson vaccines literally to the front of the approval line, delaying other important medical and technological advancements, including those related to diabetes.

While the vaccine did (and should!) take precedent here, the delays have been tough for people with diabetes in many ways. 

The head of the FDA’s device center, Jeff Shuren, described a “tsunami” of product applications from companies hoping to join the fight against the COVID-19 pandemic.

Those applications include over 1,200 submissions for products like diagnostic tests, ventilators, and digital technology, all of which have slowed their work in other diseases, including diabetes.

Shuren went on to say that review times had begun to increase amid growing backlogs due to the high volume. 

The agency is trying to make as much space as possible to approve COVID-19 related vaccines, medicine, and technology quickly to end the pandemic, which has taken precedence over almost everything else. Experts suspect that the FDA may not be able to meet its own timelines going forward.

In addition, lockdowns and social distancing regulations halted clinical trials and product releases. It’s been a tough year for diabetes tech firms to get much done.

The following products, and their release dates, have been most affected by the pandemic:

Senseonics’ 180-Day Eversense Glucose Monitor

The Eversense continuous glucose monitor (CGM) is a device implanted under the skin that lasts for 90 days. The newest version of their CGM system aims to double its lifespan to 180 days without changing a sensor.

What was supposed to be released in early 2021 now faces delays of up to two months for its application to the FDA while the agency tasks its staff with emergency reviews of coronavirus tests and other medical devices. The new release date of the model is scheduled for mid-2021.

The Omnipod 5 (Originally “Horizon”)

Insulet’s Omnipod 5 system, which utilizes CGM data to make automated adjustments to basal insulin throughout the day, will be the company’s first hybrid-closed loop system.

Similar to the T-slim Control IQ system, this insulin pump will provide mobile app control and insulin dosing from a smartphone, eliminating the need to carry their hallmark Personal Diabetes Manager (PDM) around to control the release of insulin.

While significantly delayed due to the COVID-19 pandemic, Insulet said during its Nov. 4, 2020 investor update call that it had recently finished its clinical trial and was finalizing its FDA submission.

They hope to launch their product by June of 2021.

Medtronic 780G

Also known as the Advanced Hybrid-Closed Loop (AHCL) system, this system will improve upon its first iterations of the hybrid-closed loop system, the 670g and 770g. Hoping to seek approval for adults and children as young as two, this system includes:

  • A CGM sensor that will require just one calibration on the first day of wear and no further calibrations after that
  • Automatic correction bolus delivery every 5 minutes, in conjunction with CGM readings, that can automatically bolus for missed meal doses.
  • A lower glucose target range, adjustable between 100-120 mg/dL
  • Different insulin duration times, to adjust for the “tail” of your insulin (eg, Fiasp vs. Humalog)
  • Built-in Bluetooth to share data and provide remote software updates

Due to the pandemic, the approval for this device has been delayed, but Medtronic confirmed that it had submitted its application for review to the FDA in February, 2021.

They hope to have a commercial launch sometime in 2021.

Dexcom G7

The much-anticipated Dexcom G7 continuous glucose monitor (CGM) was also delayed due to the pandemic, but it should be worth the wait. You’ll no longer need to buy separate transmitters; each sensor is a complete and disposable transmitter/sensor integrated system. Some other great features include:

  • No calibrations, much like the G6
  • At the start, wear time will be 10 days, but eventual use will include a 14-15 day feature, also without any calibrations
  • Smaller and thinner: the newest CGM will be 60% smaller than the G6
  • One hour warm-up period

Dexcom CEO Kevin Sayer said that the company eventually plans to have different versions of the G7 for different people.

For example, people with type 2 diabetes who don’t use insulin (or even the general public) might opt for a much simpler interface than people with type 1 diabetes, who will want all of the alarms and settings.

Abbott Freestyle Libre 3

For years, the FreeStyle Libre from Abbott Diabetes was a considered Flash Glucose Monitor (FGM), because it only reported blood sugar levels whenever a user scanned their sensor with a receiver or smartphone.

That will change with the new edition: The Freestyle Libre 3 will function as a real-time CGM, because it won’t require sensor scanning to get a “flash” of blood glucose data. It will instead provide trends and graphs to track blood sugars throughout the day.

The Libre 3 generates real-time blood sugar readings every minute (as opposed to Dexcom’s every 5 minutes), displaying the result on a mobile app on your smartphone. This version also has optional high and low blood sugar alarms, a feature introduced with the Libre 2 in 2020.

Additionally, the sensor is much smaller and thinner (a 70% size reduction), and is kinder to the earth, using 41% less plastic overall.

The Libre 3 received global approval in September 2020. The timeline in the US has been pushed backwards, but with clinical trials now complete, we’ll likely see the Libre 3 applications submitted to the FDA mid-2021.

While the hustle for an effective COVID-19 vaccine has been nothing short of miraculous, people with diabetes don’t want to wait any longer!

Hopefully, with the hastened release of the vaccine, we can see more diabetes technology hit the market in 2021. 

Source: diabetesdaily.com

So You Got a CGM – Now What?

This content originally appeared on diaTribe. Republished with permission.

By Katie Mahoney, Hanna Gutow, and Diana Isaacs

If you just got a continuous glucose monitoring system, you may be wondering how to use it most effectively and how to understand your glucose data. Read our tips, tricks, and things to consider.

Congratulations – you got a continuous glucose monitor (CGM), an excellent tool to support diabetes management. Hopefully you’re feeling optimistic and excited that you have the opportunity to use this technology.

It’s most likely that you and your healthcare team decided that using a CGM is the optimal way for you to manage your diabetes. Perhaps you were given a prescription for a personal CGM. Or maybe you’re trying CGM as part of Dexcom’s Hello Dexcom program (a free ten-day trial), through Abbott’s MyFreestyle program (a free 14-day trial), or as part of Medtronic’s CGM Discount Access program. You might also be trying professional CGM, which is owned by your healthcare clinic and worn on a short-term basis.

If you haven’t yet been able to get CGM, ask your healthcare team if you can get a trial device or get a prescription. CGM is recommended for anyone with diabetes who takes mealtime insulin. While many people with diabetes currently don’t have access to CGM, we’re hopeful that more and more individuals will be able to use this technology in the future. Regardless of what brings you to using a CGM, we’ve created a three-part guide to help you get started, including tips, tricks, and considerations.

Click to jump down to a section:

Part 1: Before you apply your CGM

Learn the basics.

Before you start using your CGM, it can be helpful to understand its basic features. Continuous glucose monitors (CGM) measure the body’s glucose (or sugar) levels by sensing the glucose present in tissue fluid (also called interstitial fluid). While a blood glucose meter (BGM) provides a measurement of the blood glucose level at a specific moment in time (when you prick your finger), CGMs provide a new glucose level every one to five minutes – depending on the device, that’s 288 to 1,440 times per day. A CGM provides a constant stream of information on glucose levels, trends, and patterns.

A CGM can either be transcutaneous (it goes through your skin) or implanted (it lies under your skin). CGMs require three basic parts:

  1. A sensor that monitors real-time glucose levels under your skin.
  2. A transmitter that sits on top of the sensor and sends glucose information to a smartphone app, reader, or receiver. In transcutaneous systems, the sensor and transmitter are connected as one small on-body device. Some transmitters are disposable with the sensor while others require an additional step to attach. In implanted systems, the transmitter is attached to the skin and can be removed without harming the sensor below the skin.
  3. A smartphone app, reader, or receiver to collect and display your data.

CGMs have a variety of features that differ by brand and model, including the amount of time the CGM needs to “warm up” before glucose readings are available, how long you can wear a CGM sensor before needing to replace it, and alarms that alert you to highs and lows. You can learn more about CGM devices here. For brand-specific resources and information, click here to jump down.

Personal CGM vs. Professional CGM

The CGMs that we just described are called personal CGMs – they are owned by the person with diabetes and used for a long period of time. They are available as real-time CGMs, where the data can be continuously viewed, or as intermittently-scanned CGMs, where information is recorded all of the time, but you need to scan the sensor to view the data.

Another type of CGM is called “professional CGM.” Professional CGMs are given to someone with diabetes for a short session (usually one to two weeks) to better understand that person’s glucose levels. After the wear period, the person will review the data with their healthcare professional. This can provide insights that inform the person’s diabetes treatment, and it can help healthcare professionals recommend therapy and lifestyle recommendations that lead to better glucose management.

Some professional CGMs have a real-time mode, meaning that the user can see their glucose levels while wearing the device. Other professional CGMs have a “blinded” mode. Blinded CGM means that you cannot look at their glucose values on-demand; instead, all of your glucose data is stored and shared with your healthcare professional. This can help your healthcare team identify hypoglycemia (or low blood sugar levels). If you get a blinded professional CGM, your healthcare team will analyze the data and discuss it with you once your wear period is complete.

While long-term, real-time CGM is most effective for day-to-day diabetes management, especially for insulin users, professional CGM can be an important tool for people who are not using personal CGM. Periodic use of CGM can help people learn the effects of food and physical activity on glucose levels, even for those not taking any diabetes medications.

Reflect on your goals, know your targets, and make a plan to respond to highs and lows.

It can be helpful to reflect on your CGM goals, set your glucose targets, make plans for responding to your glucose readings, and decide with whom you want to share your data:

  • Reflect on your CGM goals. Perhaps you want to use CGM to prevent hypoglycemia using its alert system, or to prevent hyperglycemia and increase your Time in Range, or to manage glucose during exercise. Or, maybe you and your healthcare team are going to use professional CGM for two weeks to explore how your lifestyle habits affects your glucose levels. Regardless, the ultimate goal of CGM is to improve your diabetes management.
  • Know your personal glucose targets and make a plan with your healthcare team for how you’ll respond to hyperglycemia and hypoglycemia. Knowing your target glucose range is important for responding to your real-time glucose values. For most people with diabetes the target range is 70-180mg/dl – learn more about Time in Range goals here. Make a plan that incorporates glucose trend arrows from your CGM to help you prevent big spikes out of range. Here are some prompts for you to discuss with your healthcare team:
    • What is my glucose target when I wake up and before meals?
    • What should my glucose level be two hours after a meal? If it is above that value, what actions should I take to bring my glucose levels down?
    • What is my glucose target before bed?
    • What high glucose level should I try to avoid? What should I do if my glucose gets that high?
    • What low glucose level should I try to avoid? What should I do if my glucose gets that low? What should I do if my glucose levels are trending down?

Part 2: Applying your CGM

Connect the CGM to the app and set the system up.

Download the mobile app associated with your CGM system if available. If you’re using a receiver (Dexcom device) or reader (Libre device), make sure it’s charged daily. The CGM should come with instructions for applying the sensor (every seven, ten, or 14 days) and pairing the app, reader, or receiver with your sensor and transmitter. If you have an implanted CGM, it will be applied by a healthcare professional and can last up to 90 days. To jump to brand-specific instructions and tutorials, click here. To learn about CGM adhesives and tips for keeping your CGM on, check out Adam Brown’s suggestions on the topic.

Once your system is set up, your CGM will need to “warm up” before you can see your data. Different models have different warm-up periods, but this will generally take one to two hours, after which your data will be accessible either directly (Dexcom, Guardian, Eversense) or by scanning your sensor (FreeStyle Libre). The warm up period for the implantable Eversense system is 24 hours.

For many people starting to use a CGM, video tutorials can be quite helpful. If you have the opportunity, it’s good to meet with a diabetes care and education specialist or your local pharmacist (if picking up your CGM from a pharmacy). Here are set-up and application tips and tutorials for your CGM:

Part 3: Understanding your CGM data

Once you’re set up with your CGM and the warm up period is complete, you can access your data. There are two types of data you’ll want to pay attention to: real-time data and past data.

Interpret your real-time data.

Depending on the CGM brand you’re using, you can either access your glucose data at any time by looking at an app on your phone, your smart watch, or your receiver. For those using an intermittently-scanned CGM, you can view your glucose levels by scanning your sensor with your smart phone or reader. Looking at your data can feel overwhelming at first, so we recommend focusing on two aspects of your real-time data:

  • First, look at your CGM glucose value. Is it in your target range? If your glucose level is out of range, which steps of your plan should you follow?

If you’re experiencing hypoglycemia in particular, make sure you act right away to increase your glucose levels.

  • Second, look at the trend arrow. Your CGM provides a “trend arrow,” to tell you the direction and speed with which your glucose values are changing. The trend arrow is helpful for understanding what’s going on and how you can respond. For example, if your glucose value is 90 mg/dl and your trend arrow shows that your glucose levels are going down, you may need to take action to prevent hypoglycemia; if your glucose value is 90 mg/dl and your trend arrow shows your glucose levels are increasing, you are likely not going to develop hypoglycemia.

Trend arrows can help with premeal insulin dosing, before and after exercise, before bed, and to understand where your glucose will be trending in the next 30 minutes. Trend arrows are particularly beneficial when used with insulin on board (short-acting insulin that was recently taken for food or to correct a high glucose level and is still working in the body). For example, if your trend arrows are going down and you have insulin on board from an insulin dose given two hours previously, your risk of hypoglycemia is even greater.

For those not using insulin, trend arrows can help understand how different foods and activities affect glucose levels. For example, if a person sees that the arrow is rising rapidly after a certain meal or snack, they can go for a walk to try to bring it down. It may also signal that next time you should consider a smaller portion size or try to add protein or fat to prevent glucose levels from rising as quickly.

Each CGM has a slightly different interpretation of the arrows, but here’s a general idea of what the trend arrows can tell you.

data

Image source: diaTribe

We recommend working with your healthcare team to decide how often to check your glucose levels. Many people benefit from checking glucose when waking up, before meals, before physical activity, and at bedtime. Some people benefit from checking one to two hours after meals. A person should also check their CGM any time they feel symptoms of high or low glucose. CGM alarms are especially helpful for monitoring glucose levels as they change – more on this below.

Interpret your past data.

Once you’ve used your CGM for a few days, you can see your recent daily trends and the amount of time you’re spending in the target range (70-180 mg/dl). This is also called retrospective data. It is beneficial to review your glucose data regularly to understand how your lifestyle – like the food you eat, your exercise habits, your stress levels, and medications you use – affects your glucose levels. Look at your glucose levels over the past two weeks, one month, and three months; talk with your healthcare team about trends that you are noticing and how they might be addressed. Learn about the many factors that affect glucose here.

During diabetes care appointments, your healthcare team can view this data in an Ambulatory Glucose Profile (AGP) report and use it to talk with you about how your diabetes management is going and any potential adjustments to your care plan. This should be a collaborative discussion between you and your healthcare team about how your diabetes data compares to your management goals and what changes could be made.

Each CGM system offers a standardized one-page report, called an ambulatory glucose profile (AGP). The AGP includes three important components:

  1. CGM key metrics
  2. 24-hour profile
  3. Daily glucose patterns

Although there are many ways to view your glucose data, the AGP report often has all of the information that you need. We’ll explain the three main pieces below. To learn more, read our in-depth piece on understanding your AGP report: “Making the Most of CGM: Uncover the Magic of Your Ambulatory Glucose Profile.”

CGM key metrics

More green, less red.

The time in range bar shows the percentage of time you spend in five glycemic ranges:

  • data

    Image source: diaTribe

    Time in Range: glucose levels between 70-180 mg/dl

  • Time Below Range: glucose levels below 70 mg/dl
  • Time in severe hypoglycemia: glucose levels below 54 mg/dl
  • Time Above Range: glucose levels above 180 mg/dl
  • Time in severe hyperglycemia: glucose levels above 250 mg/dl

Your goal is to grow the green bar and shrink the red bars – in other words, increase Time in Range and decrease time Below Range and time in severe hypoglycemia. See more on Time in Range goals and standard targets.

24-hour profile, also known as Ambulatory Glucose Profile (AGP).

chart

Image source: diaTribe

How do you figure out how to change your diabetes management to increase your Time in Range and decrease your Time Below and Above Range? That’s where the 24-hour profile is helpful, which shows your daily glucose trends across the full 24-hour day.

  • Understanding what the 24-hour profile shows: The black line represents your median glucose level throughout the day based on data from a set period of your CGM use (e.g., the last two weeks). The blue shaded areas help show how much your glucose levels vary at different points in the day.
  • Using the data: Compare different times of day to see what might be influencing your glucose numbers. For example, while the person shown above has glucose readings that vary greatly at 3pm (indicated by a very wide shaded area), their 8am glucose numbers are much more consistent (the shaded area at 8am is narrower), despite being higher. This person also regularly sees a spike in sensor glucose readings at around 9am. What’s causing that increase? Maybe it’s a higher carbohydrate breakfast choice, forgetting to bolus, not bolusing early enough, or not accounting for all the carbs in breakfast. Reflecting on what is causing a spike or valley can help you make behavior changes to reduce fluctuations and increase your Time in Range.
  • chart

    Image source: diaTribe

    The goal: The overall goal is to keep your glucose levels in your target range without big spikes or valleys, sometimes called “flat, narrow, in range” (FNIR). In the AGP above, the green box represents the user’s target sensor glucose range (70-180 mg/dl). While the user stays in range overnight and in the afternoon, they tend to see spikes in the morning and evening. With the goal of FNIR in mind, you can look at your long-term data and ask, what’s making it possible for me to stay in range? What is making my glucose spike or fall?

  • The good news is the goal for most people is to spend 70% or more Time in Range. However, increasing your Time in Range by even 5% (an extra hour per day in range!) can be helpful. You don’t have to reach perfection to improve clinical outcomes.

Daily glucose profiles.

With your trend data, you also can see your daily 24-hour glucose profiles from the last two weeks. The figures show the target range (70-180 mg/dl) in gray, spikes above 180 mg/dl (hyperglycemia) in yellow, and valleys below 70 mg/dl (hypoglycemia) in red. Viewing the data day by day can help you evaluate how specific factors and behaviors impacted your glucose values on a certain day.

data

Image source: diaTribe

To make the most out of your daily glucose profiles, it can be helpful to log your daily food and exercise to compare with your glucose profile and see which behaviors help you stay in range and which ones tend to make you go out of range.

A helpful tool when reviewing your data with your healthcare team is called DATAA. Which stands for:

  • Data – look at your diabetes data together
  • Assess Safety – Look for and try to solve Time Below Range (hypoglycemia) first
  • Time in Range – Discuss what’s working and how to replicate that by looking for the times of day or the days of the week when Time in Range was the highest
  • Areas to Improve – Note when you spent more Time Above Range (hyperglycemia) and discuss ways to reduce this
  • Action Plan – Develop an action plan together

Other Tips, Tricks, and Considerations

1. Exercise & your CGM

To learn about how to use your CGM before, during, and after exercise, check out our article “Exercise Well with Your CGM – Recommendations, Glucose Trends, and Strategies.”

An important note about exercising with a CGM: There can be a difference between CGM glucose measurements and BGM glucose measurements due to what we call a “lag.” Changes in glucose levels in interstitial fluid are not seen as quickly as they are in the blood. At rest, the interstitial glucose lags about five minutes behind the blood glucose; in situations when glucose changes rapidly, such as during exercise, lag time can increase up to 24 minutes. This means that your CGM readings aren’t always going to be accurate during exercise. This lag can also occur outside of exercise, any time your glucose levels are rising or falling quickly.

2. How to make CGM alarms your friend

Adam Brown has written about how it can be helpful to think about your CGM as a partner in your diabetes management, rather than a nag that points out when you’re not in range. Alarms can be useful tools. By alerting you to current or predicted highs and lows, as well as rate of change, you can increase your Time in Range and see your 24-hour glucose profile become flatter, narrower, and more in range. You can personalize your CGM alarm settings to your preferred thresholds or turn them off completely (though some devices won’t let you turn off an urgent low alarm at 55 mg/dl). It’s helpful to work with your diabetes care team to determine your individualized alarm settings.

3. Sharing data with friends, family, and care-partners

The ability to share your real-time glucose data with your care-partners and loved ones is a huge plus of using CGM – your support network can help you track your glucose levels and keep them in range. At the same time, sharing your data with others makes some people nervous and self-conscious. Decide who you want to share your data with and talk with that person about boundaries and how you want to communicate about your data. For more on how to approach these conversations, check out Kerri Sparling’s “To Share or Not to Share: My Approach to Diabetes Data,” and “How to Coach Your Care-Partner on CGM Data.”

4. How to talk to your healthcare team about your CGM

Now that you’re using a CGM, talking with your healthcare team about your CGM data should become a key part of every visit.

Ahead of the visit: To help visits go smoothly, many healthcare professionals will ask you to upload your CGM data before you come into the office (or before your telehealth appointment) so they can review the data and be prepared to talk with you. Learn about uploading your data here. Note: some CGM systems upload automatically once connected to the clinic’s data portal. It’s also helpful to look over your data – like your AGP report – and come up with questions to ask your healthcare professional ahead of the visit. You may have questions about parts of your daily glucose profile that you don’t understand, areas where you’re having a hard time staying in range, or just general questions to help you navigate your data.

During the visit: To make sure that you and your healthcare professional are on the same page, it can be helpful to take a few minutes at the beginning of your appointment to explain your interpretation of your data in your own words. This may be a good time to start a conversation on any questions you may have prepared ahead of your visit. It is also important to take time with your care team to develop an action plan based on your CGM data with a few straightforward priorities for you to focus on before your next visit.

Brand-Specific Resources

While any CGM can help improve your diabetes management, there are some differences between the currently available systems that you may want to consider or talk about with your healthcare team – see our chart comparing different CGMs here. Specifically, we recommend asking your healthcare professional about how alarms may be able to alert you to times of hyperglycemia or hypoglycemia, what it means if you have to calibrate your CGM, and how to use your CGM with smart insulin pens, mobile apps, or even insulin pumps in an automated insulin delivery (AID) system.

To reach out to CGM companies for product support, contact their customer service departments:

  • Abbott: +1-855-632-8658
  • Dexcom: +1-888-738-3646
  • Medtronic: +1-800-646-4633
  • Senseonics: +1-844-736-7348

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

Will Insulin in a Pill Soon Become a Reality?

Since insulin was first discovered and isolated for therapeutic use nearly 100 years ago, most everyone with insulin-dependent diabetes has had to rely on exogenous insulin, given in the form of injections, whether via an insulin pump or multiple daily shots every single day of their lives (inhalable insulin was approved by the FDA in 2014, but its use is not widespread).

While research and development have come a long way in that time, the reality for millions (and over 7 million people in the United States alone) has been thousands upon thousands of invasive injections, oftentimes causing scarring, bruising, and pain. However, that may be about to change.

Researchers from the New York University in Abu Dhabi have successfully developed a pill using nanomaterial layers that disseminate insulin in rats safely without being destroyed by their stomach acids. This could be life-changing for the millions of people around the world who rely on insulin to live.

“Imagine being able to take insulin in a pill instead of injecting it a couple of times a day,” said first author Farah Benyettou, a research scientist in the Trabolsi Research Group at the New York University in Abu Dhabi. “The insulin was loaded in a system that protects it from the acidic environment of the stomach. Once in the body, the system can sense the blood sugar level and can release the loaded insulin on demand.”

A pill form of insulin has the potential to radically change the daily management of diabetes for the better: It would make treatment easier for children and people with a fear of needles, safer for both patients and clinicians in hospital and clinic settings, more effective, and patient-friendly.

Nearly 30% of people with diabetes rely on insulin injections, and while it might not be for everyone, this revolutionary advancement would be the first of its kind in the world.

Other attempts at orally administering insulin have been made in the past but faced roadblocks in the gastrointestinal tract, where stomach acids and bile quickly destroy insulin and any effectiveness it has.

This is different from common type 2 diabetes drugs like Metformin that aren’t insulin but simply improve the efficacy of insulin that their body already makes.

The research team in Abu Dhabi thinks it has solved the problem of the insulin-destroying stomach bile issue by encapsulating insulin within nCOF nanoparticles in a capsule that is resistant to such acids but responsive to sugar, reacting quickly when it senses blood glucose in the body is rising but survives the dangerous journey down the G.I. tract to reach the bloodstream.

This new advancement also has the potential to reduce or eliminate low blood sugars, as the release of insulin shuts off as soon as it senses blood sugars have fallen. This creates a helpful feedback loop and prevents an overdose of insulin, which for many, is an almost a daily occurrence on injections, where people are constantly walking a balance beam to prevent both high and low blood sugars in a world of stress, meals, exercise, and normal everyday living.

While this is all excellent news, it’s important to remember that the study’s success was only observed in rats, and human bodies are very different. The team will next test different nanomaterials to see what may be appropriate for human trials, and potentially, widespread market availability.

“Our revolutionary technology developed at NYUAD will dramatically improve the well-being of diabetic patients worldwide in a very simple and straightforward way,” says senior author Ali Trabolsi, an associate professor of chemistry at the New York University in Abu Dhabi.

While taking a daily insulin pill may is far from a functional cure, managing diabetes could become easier than ever, especially if the threat of low blood sugars is greatly reduced or eliminated.

The team hopes that diabetes management can soon be a lot less stressful, painful, and dangerous for the millions of people around the world who currently rely on insulin.

Source: diabetesdaily.com

Breakthroughs in Pancreatic Cell Replacement: The ViaCyte Interview

I recently had the opportunity to sit down with Manasi Sinha Jaiman, M.D., M.P.H., Vice President of Clinical Development, and Mark Daniels, Senior Director of Clinical Development, of ViaCyte, “a regenerative medicine company focused on delivering novel stem cell-derived cell replacement therapies as a functional cure for all type 1 diabetes and a next-generation treatment for insulin-requiring type 2 diabetes.”

They have amazing things coming down the pike, so I was super excited to speak with them:

Tell our readers about ViaCyte. What’s the company’s mission and story?

Dr. Jaiman: ViaCyte is at the forefront of regenerative medicine approaches to develop a functional cure for type 1 diabetes (T1D). We have cell replacement therapies for pancreatic islet cells contained in a small retrievable pouch implanted under a patient’s skin.

The therapy is designed to enable insulin and glucagon (the counter-regulatory hormone that treats low blood glucose) production with the implanted cells to effectively control blood glucose levels, decrease the risk of hypoglycemia, and mitigate short-term and long-term diabetes-related complications for patients.

What is exciting is that ViaCyte is the first company to advance human stem cell-derived islet cell replacement therapy capable of producing insulin in the clinic, backed by two decades of research and expertise.

We are further augmenting our therapies by optimizing both the delivery device and the cells through collaborations with industry leaders, including W. L. Gore & Associates (the makers of GORE-TEX) and CRISPR Therapeutics.

Our mission is to develop cell replacement therapies offering long-term treatment to decrease the burden of the constant management needed with T1D.

What led you to your work at ViaCyte?

Dr. Jaiman: A significant focus of my medical career has been the integration of technology and medicine to advance treatments that can change the paradigm of diabetes disease management.

My experiences both in research and actively seeing patients with T1D have given me first-hand experience in seeing the daily work required to achieve any form of glycemic control as well as the burden patients and families face from complications from hypoglycemia or DKA.

I have also been able to see the importance of innovative approaches in addressing their needs. When I looked at the ViaCyte technology, I immediately saw great potential in their regenerative medicine approach to lessen the burden of disease and improve quality of life.

Mr. Daniels: Throughout my time in the industry I have been extremely fortunate to be able to work with innovative companies advancing potential, game-changing therapies for difficult-to-treat diseases. I was attracted to ViaCyte because the bar is set high; ViaCyte is looking to develop functional cures for diseases and is not just treating symptoms.

I also believe in the potential of cell replacement therapies and that these will be a meaningful new chapter in the advancement of medical treatments.

In ViaCyte, I have also found a team of extremely gifted and dedicated scientist-coworkers who are all generous with their knowledge and completely aligned in the mission to deliver a functional cure to the type 1 diabetes community.

It is exciting to be the first company to evaluate human stem cell-derived islet cell replacement therapy for its potential to functionally cure type 1 diabetes in the clinic.

Manasi Sinha Jaiman, M.D., M.P.H., Vice President of Clinical Development and Mark Daniels, Senior Director of Clinical Development

Manasi Sinha Jaiman, M.D., M.P.H., Vice President of Clinical Development and Mark Daniels, Senior Director of Clinical Development

What exciting new developments is ViaCyte currently working on?

Dr. Jaiman: Currently, ViaCyte has two clinical cell replacement therapy candidates. First, VC‑02 PEC-Direct is a treatment comprised of pancreatic islet cells in a pouch designed to allow blood vessels to enter the device and directly interact with the implanted cells to produce insulin and glucagon.

This treatment candidate is targeted for those with high-risk type 1 diabetes (hypoglycemia unawareness) able to tolerate immunosuppression.

In contrast, our groundbreaking VC‑01 PEC-Encap device is an advanced treatment comprised of pancreatic islet cells in a pouch that fully encapsulates the cells preventing immune cells from interacting with the implanted cells, which eliminates the requirement for immunosuppressants.

We are collaborating with W. L. Gore & Associates to optimize their innovative membranes which encapsulate the cells in our implanted devices. We expect to share clinical data in the second half of 2021.

Anything new in the pipeline that people with diabetes should be especially excited about?

Dr. Jaiman: One of the challenges with cell replacement therapies is to protect against adverse reactions and rejection of implants by the body’s immune system, which serves as a defense mechanism against foreign bodies.

In collaboration with CRISPR Therapeutics, we are employing gene-editing technology to engineer cells to avoid recognition by the immune system. Our partnership is focused on advancing gene-edited allogeneic stem cell-derived therapies from discovery through commercialization with the goal of developing a potential next-generation functional cure for all insulin-requiring type 1 and type 2 diabetes.

Mr. Daniels: With our preclinical candidate, VCTX210 PEC-QT, pancreatic islet cells would be in the same pouch as PEC-Direct, allowing the implanted cells to interact directly with blood vessels, an approach intended to enable robust and consistent engraftment.

Yet by designing the cells to be immune-evasive through CRISPR Therapeutics’ gene editing we would expect to eliminate the need for immunosuppressants as are required with PEC-Direct. We look forward to sharing more about this unique program in the future.

Photo credit: ViaCyte

Where do you envision ViaCyte and people’s lives affected by diabetes in five years? Ten years?

Mr. Daniels: This year marks the 100th anniversary of the development of therapeutic insulin to regulate blood glucose, yet dependency on tedious insulin injections are still a common course of treatment for many living with type 1 diabetes.

Within the next five years, we envision delivering significant progress in later clinical-stage studies with increased time in range, reduction in hypoglycemic events, and reduction in (or elimination of) the need for insulin injections in patients following our cell replacement treatments as we move toward making these therapies more widely available.

Dr. Jaiman: Within five years, we expect to be moving through the final phases of our regulatory process for our human stem cell-derived islet cell replacement therapy enabling availability more broadly for patients with type 1 diabetes.

It is our hope that within a decade, cell replacement therapy will offer longer-term treatment, easing the burden of constantly monitoring blood glucose. A functional cure will no longer be a dream, rather, a reality.

Is the ever-elusive cure on the horizon? A functional cure?

Dr. Jaiman: Yes, we believe a functional cure is on the horizon!

ViaCyte is focused on advancing cell replacement therapies toward a functional cure with a combination of implanted cells and device engineering.

This cell replacement therapy could represent insulin production protected from the immune system in a way that totally mitigates the underlying disease. Our technology is designed to safely implant the missing cells that make insulin and glucagon – that’s the breakthrough that gets us to the functional cure.

How can people with diabetes get involved or learn more?

Mr. Daniels: As ViaCyte is advancing novel treatments for type 1 diabetes, our team has been very fortunate to collaborate with multiple incredible research and advocacy organizations, including the Juvenile Diabetes Research Foundation (JDRF), Beyond Type 1, and California Institute for Regenerative Medicine (CIRM).

These organizations are focused on education and support for finding a cure for diabetes with resources for both patients and researchers on their websites. A great resource is the website www.clinicaltrials.gov – by typing “ViaCyte” into the search window, you can find more details regarding our ongoing clinical trials.

This includes details about the entry criteria to participate as well as the geographical locations of the sites (to find the one closest to you) and contact details necessary to reach out and connect with the study site team to learn more about what is involved in the study participation.

Photo credit: ViaCyte

Anything else you’d like to share?

Dr. Jaiman: Insulin treatment has largely transformed type 1 diabetes from a fatal illness to a chronic one, yet it is not a cure. At ViaCyte we recognize the long journey in the evolution of diabetes management, and we are keen to deliver a solution that offers real hope for a functional cure for type 1 diabetes.

Every single member of our team is passionate and dedicated to this endeavor. Managing diabetes can be difficult at any time, however, this past year has highlighted the need for accelerating therapeutic advancements to help reduce COVID-associated morbidity and mortality in the vulnerable population with diabetes.

With the pandemic still ever-present, we believe our mission of realizing a functional cure is even more critical for patients as they navigate living with a chronic disease during this very trying time. Our leadership team is wholly focused on improving patient care with an eye to the future.

Mr. Daniels: I am very appreciative of the Diabetes Daily team for providing this forum to connect to their community. The stories of family member’s and loved one’s experiences (including those of some of our own coworkers) with T1D resonate clearly within us and fuel our motivation behind the work we do.

It is only through the support of the T1D community and especially the valued study participants that we are able to advance this important research.

We are proud to be part of the biotech and biopharma community advancing some of the world’s most promising medical devices and therapeutic treatments. We look forward to sharing more details regarding the value of these treatments in the clinic.

Source: diabetesdaily.com

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