Getting the Most Out of Your Remote Healthcare Visits

This content originally appeared on Integrated Diabetes Services. Republished with permission.

By Gary Scheiner MS, CDCES

A long, long time ago, before the days of coronavirus, there was a little diabetes care practice called Integrated Diabetes Services (we’ll just call it IDS for short). IDS taught people with diabetes all the wonderful things they can do to manage their diabetes. Word got out, and people who lived far from IDS’s local hamlet (better known as Philadelphia) wanted to work with IDS. Even people IN the hamlet wanted to work with IDS but were often too busy to make the trip to the office. So IDS had an idea: “Let’s offer our services via phone and the internet so that everybody who wants to work with us can work with us!” The idea took off, and IDS grew and grew.

And virtual diabetes care was born.

Today, in response to the COVID-19 pandemic, virtual healthcare has become a virtual norm. Often referred to as “telehealth” or “telemedicine,” people with diabetes are connecting with their healthcare providers for everything from medical appointments to self-management education to coaching sessions. Some consults are conducted via phone calls, while others utilize web-based video programs (like Zoom) or simple email or text messages. Regardless of the form, virtual care can be highly effective. But it can also have its limitations. Whether you’ve been receiving virtual healthcare for months or have yet to give it a try, it pays to learn how to use it effectively. Because virtual care will certainly outlive the pandemic.

What Can… and Can’t… Be Accomplished Virtually

Most diabetes care services, including medical treatment and self-management education, can be provided effectively on a remote basis. We have managed to teach our clients everything from advanced carb counting techniques to strength training routines to self-analysis of glucose monitoring data, all while helping them fine-tune their insulin program, on a 100% virtual basis.

Some clinics and private healthcare providers have gone 100% virtual since the pandemic began, while others are using a “hybrid” approach – periodic in-person appointments with virtual care in-between. Depending on the reason you’re seeking care, a hybrid approach makes a lot of sense. While virtual visits are generally more efficient and economical (and in many cases safer) than in-person appointments, there are some things that are challenging to accomplish on a remote basis. From a diabetes standpoint, this includes:

  • Checking the skin for overused injection sites
  • Learning how to use medical devices (especially for the first time)
  • Examining the thyroid gland and lymph nodes
  • Evaluating glucose data (unless you can download and transmit data to your provider)
  • Performing a professional foot exam
  • Listening to the heart rhythm and feeling peripheral pulses
  • Checking for signs of neuropathy and retinopathy
  • Measuring vital signs (unless you have equipment for doing so at home)

The Logistics

Virtual care can be provided in a variety of ways, ranging from a phone call to an email, text message or video conference. Video can add a great deal to the quality of a consultation, as it allows you and your healthcare provider to pick up on body language and other visual cues. It also permits demonstrations (such as how to estimate a 1-cup portion of food), evaluation of your techniques (such as how to insert a pump infusion set), and use of a marker board for demonstrating complex subjects (such as injection site rotation or how certain medications work).

When using video, it is important to have access to high-speed internet. A computer is almost always better than a phone for video appointments, as the screen is larger and has better resolution. If you have the ability to download your diabetes data, do so and share access with your healthcare provider a day or two prior to the appointment. It may also be helpful to share some of your “vital” signs at the time of the appointment – a thermometer, scale, and blood pressure cuff are good to have at home.

In many cases, care provided on a remote/virtual basis is covered by health insurance at the same level as an in-person appointment. This applies to public as well as private health insurance. However, some plans require your provider to perform specific functions during the consultation (such as reviewing glucose data) in order for the appointment to qualify for coverage. Best to check with your healthcare provider when scheduling the appointment to make sure the virtual service will be covered. At our practice (which is 100% private-pay), virtual and in-person services are charged at the same rates.

If security is of the utmost importance to you, virtual care may not be your best option. Although there are web-based programs and apps that meet HIPPA guidelines, there really is no way to guarantee who has access to your information at the other end. My advice is to weigh the many benefits of virtual care against the (minuscule) security risk that virtual care poses.

Optimizing the Virtual Experience

Just like in-person appointments, virtual care can be HIGHLY productive if you do a little bit of preparation.

  • Do yourself and your healthcare provider a favor and download your devices, including meters, pumps, CGMs, and any logging apps you may be using, prior to the appointment. If you don’t know how to download, ask your healthcare provider for instructions, or contact our office… we can set up a virtual consultation and show you how. If you have not downloaded your information before, don’t be intimidated. It is easier than you think. People in their 80s and 90s can do it. Oh, and look over the data yourself before the appointment so that you can have a productive discussion with your healthcare provider.
  • Be prepared with a list of your current medications, including doses and when you take them. Check before the appointment to see if you need refills on any of your medications or supplies. If you take insulin, have all the details available: basal doses (and timing), bolus/mealtime doses (and dosing formulas if you use insulin:carb ratios), correction formulas (for fixing highs/lows), and adjustments for physical activity.
  • Try to get your labwork done prior to virtual appointments. This will give your healthcare provider important information about how your current program is working.
  • To enhance the quality of the virtual meeting, do your best to cut down the background noise (TV off, pets in another room, etc…) and distractions (get someone to watch the kids). Use of a headset may be preferable to using the speakers/microphone on your phone or computer, especially if there is background noise or you have limited hearing.
  • Use a large screen/monitor so that it will be easy to see details and do screen-sharing. And use front lighting rather than rear lighting. When the lights or window are behind you, you may look more like a black shadow than your beautiful self. “Ring” lights are popular for providing front-lighting.
  • Provide some of your own vitals if possible – weight, temperature, blood pressure, current blood sugar. This is important information that your healthcare provider can use to enhance your care.
  • Prepare a list of topics/questions that you want to discuss. Ideally, write them on paper so that you can take notes during the appointment. If there is a great deal of detail covered, ask your healthcare provider to send you an appointment summary by mail or email.
  • Be in a private place that allows you to speak openly and show any body parts that might need to be examined – including your feet and injection/infusion sites.
  • Be a patient patient! Technical issues can sometimes happen. It is perfectly fine to switch to a basic phone call or reschedule for another time.
  • Courtesy. Be on-time for your virtual appointment. If you are delayed, call your healthcare provider’s office to let them know. And if you are not sure how to login or use the video conferencing system, call your provider beforehand for detailed instructions. This will help to avoid delays. Have your calendar handy so that a follow-up can be scheduled right away. Oh, one other thing: Try not to be eating during the appointment… it is distracting and a bit rude. However, treating a low blood sugar is always permissible!

If there is one thing we’ve learned during the pandemic, it’s that virtual care is a win-win for just about everybody. Expect it to grow in use long after the pandemic. In-person care will never go away completely, but for treating/managing a condition like diabetes, virtual care has a lot to offer… especially if you use it wisely.

Note: Gary Scheiner is Owner and Clinical Director of Integrated Diabetes Services, a private practice specializing in advanced education and intensive glucose management for insulin users. Consultations are available in-person and worldwide via phone and internet. For more information, visit Integrated Diabetes.com, email sales@integrateddiabetes.com, or call (877) 735-3648; outside North America, call + 1-610-642-6055.

Source: diabetesdaily.com

Study Compares MiniMed 780G and MiniMed 670G Algorithms

This content originally appeared on diaTribe. Republished with permission.

By Albert Cai

A new study in adolescents and young adults with type 1 diabetes directly compared two automated insulin delivery algorithms. Medtronic’s newer Advanced Hybrid Closed Loop (built into the MiniMed 780G system) improved glucose management more than the MiniMed 670G, though both systems showed impressive increases in Time in Range for this population. Ultimately, the 670G gave users over an hour and a half more time in range each day, while the 780G gave wearers over two hours every day in range!

Two Medtronic automated insulin delivery algorithms, the Advanced Hybrid Closed Loop and the MiniMed 670G, were recently compared in a cross-over study, allowing 113 participants to use both algorithms. Results from the study were published in the medical journal The Lancet. Notably, the study tested this technology in adolescents and young adults with type 1 diabetes ­– a group for which diabetes management is notoriously challenging. View our resources for adolescents with diabetes here.

For an introduction to automated insulin delivery (AID), check out our piece on current and coming-soon AID systems in 2021.

What is the MiniMed 670G?

The MiniMed 670G is an AID system that has been available since spring 2017 – it was the first system ever to “close the loop.” The system includes the MiniMed 670G pump, the Guardian Sensor 3 continuous glucose monitor (CGM), and an automated insulin adjustment algorithm. The algorithm adjusts basal insulin delivery every five minutes based on CGM readings, and a target of 120 mg/dl.

What is Advanced Hybrid Closed Loop?

Advanced Hybrid Closed Loop (AHCL) is Medtronic’s next-generation AID algorithm. The AHCL algorithm is used in Medtronic’s MiniMed 780G system, which is currently available in at least twelve countries in Europe. While it is not yet available in the US, Medtronic hopes to launch the 780G in the US this spring. In addition to automatic basal rate adjustments, the AHCL algorithm can also deliver automatic correction boluses and has an adjustable glucose target that goes down to 100 mg/dl. This is big news because many people using closed loop do not want to target the higher 120 mg/dl, even as a safety measure. The 780G algorithm is designed to have fewer alarms and even simpler operation than the MiniMed 670G system.

What was the study?

The newly published FLAIR (Fuzzy Logic Automated Insulin Regulation) study was conducted over six months across seven diabetes centers (four in the US, two in Europe, and one in Israel). The study enrolled 113 adolescents and young adults (ages 14-29) with type 1 diabetes. The study sample is notable, because teens and young adults with type 1 diabetes have the highest average A1C levels of any age group.

At the beginning of the study, participants performed their usual diabetes management routine for two weeks to establish their baseline glucose levels. Half of the group was then randomly assigned to use the MiniMed 670G system, while the other half of the group used the same pump and CGM, but with the new AHCL algorithm. After three months – the halfway point of the study – the two groups “crossed over,” switching to the opposite technology.

What were the results?

Nearly every measure of glucose management favored the AHCL period over the MiniMed 670G:

  • Compared to baseline, participants reduced time spent above 180 mg/dl by 1.2 hours per day when using MiniMed 670G and 1.9 hours per day when using AHCL.
  • Time in Range (TIR, time between 70-180 mg/dl) improved from a baseline of 57% to 63% using Minimed 670G and to 67% using AHCL.
  • Time spent below 70 mg/dl fell 0.2% of the time. While those 28 minutes a day may not be statistically significant – and time in severe hypoglycemia, or below 54 mg/dl, did not increase from baseline when using either algorithm – many people with diabetes would benefit from that additional half hour in range.

The graph below shows the time spent in glucose ranges during baseline, MiniMed 670G, and AHCL periods. For both algorithms, the Time in Range increase from baseline was significant – use of either AID system led to at least 14 hours more each week spent in range. Nevertheless, we also point out, of course, that the group (again, the group that has the most challenges of any age group managing diabetes) still experienced a fair amount of time above 250 mg/dl. This is  another reason for healthcare professionals and people with diabetes to think about the “whole person” when considering diabetes management, and another reason why we always recommend Adam Brown’s Bright Spots and Landmines for ways to improve diabetes management in terms of food, exercise, mindset, and sleep – it includes many strategies for people, especially teens and young adults, to use each day.

AID comparison

Image source: diaTribe

  • The biggest Time in Range improvement came overnight (between midnight to 6am). During this six-hour overnight period, AHCL users spent an average of 4.4 hours in range (74% TIR), compared to 4.2 hours (70% TIR) for 670G, and 3.5 hours (58% TIR) during baseline. While the overnight Time in Range difference between AHCL and 670G may not seem large, it added up to nearly a 22-hour difference over the three-month the AHCL period.
  • With daytime numbers, the average AHCL user spent 63 more hours (about 2.6 days) in range than the average 670G user in each three-month study period.

The graph below shows daytime and nighttime differences in time spent in range (70-180 mg/dl), and the data is included in a table at the end of this article. Better sleep the night before can also make diabetes management more effective during the day.

Comparison

Image source: diaTribe

  • Using MiniMed 670G drove an average A1C improvement from 7.9% to 7.6%, while AHCL use improved A1C from 7.9% to 7.4%.

Both systems showed extremely positive results and were found to be safe for use in young people with type 1 diabetes. The AID algorithms led to dramatic increases in Time in Range in a population that stands to benefit – over the course of a year, adolescents and young adults could spend more than ten additional days in range. The direct comparison between these two AID algorithms is highly informative – we hope to see similar trials in the future.

Comparison

Image source: diaTribe

Source: diabetesdaily.com

COVID-19 Vaccine: Experience and Thoughts from the Diabetes Community

We are almost one year into the COVID-19 pandemic and while it is still causing devastation, there is light at the end of the tunnel thanks to two companies, Pfizer and Moderna, now offering a vaccine.

It varies by state but healthcare workers and people over 75 years (over 65 in some states) are the first in line. After that, people with high-risk, pre-existing conditions will be next. See here to find out your exact eligibility per state.

Many people have mixed feelings about the vaccine. Some are certain they will get it, not only because they don’t believe the vaccine is at all harmful but because they want life to go back to normal as soon as possible, while also protecting their health. Others are reluctant, possibly questioning the novelty and quick turnaround of the vaccine and wondering if there may be unforeseen side effects.

We thought it would be nice to hear from people like ourselves, who also live with diabetes, and see how they feel about getting vaccinated. We also spoke to some people who have already received the vaccine and heard about their experiences with side effects.

We asked our own Diabetes Daily forum members and the diabetes online community and here is what they had to say:

My wife with type 2 diabetes also suffers from COPD, bronchitis, and asthma. Accordingly, she would have a problem surviving COVID, so we have both registered with the NJ Covid Registry and will take the vaccine as soon as it becomes available. ~ Don1942

As I see it, two of these vaccines (Pfizer and Moderna) use a completely new and untested approach called mRNA. They were tested for only a short term on young, healthy adults. Animal, medium, and long-term testing were bypassed entirely. No testing on those with various health issues, and no testing for drug interactions. They only claim to reduce the number of symptoms. Zero claims are made about keeping you from getting or transmitting the virus. Last statement verified by Fauci saying anti-social distancing, lockdowns, and masking will still apply once you have had the vaccine. Then there are the 3+% of those who are vaccinated who suffer worse side effects than the symptoms the drug is supposed to reduce, keeping in mind that in the age groups tested only 1% would ever show any symptoms at all.

Finally the manufacturers take zero fiscal responsibility for bad outcomes. If they don’t believe their drugs are safe, why should I? ~ BobCan2

I have a nephew that has a doctorate in biochemistry (currently working on gene therapy). Said “I would take any of the vaccines in a second.” His wife also an MD has had the Moderna vaccine. I have a niece that is working on her doctorate in microbiology who has had the vaccine. So yes, I will take it. ~ 1986

I’m a no. Given my recent extended exposure, I’m not concerned. I’ll gladly wait for herd immunity. ~ HaoleBoy

I am a surgeon. I got the first dose of the Moderna vaccine. Just a sore arm. I have reviewed all of the science presented to the FDA and have no concerns. Glad to have access! ~ Dr. Carrie D.

So I voted yes… I’ve stated before that I used to be in the vaccine industry and I trust the science and the process. It’s not new technology being used. ~ Jughed

I’m getting the Moderna vaccine on Monday. I am a special education teacher in WI and we are the first group identified in the school district. Blessing! ~ Melissa R.

I think most people of my age remember friends getting polio, and I also remember giving my father chickenpox, which made him very, very ill; so having seen the miracles these vaccines did for quality of life, and preventing unnecessary deaths, I know I am very much pro-vaccination. My name will go down for a vaccine when it finally arrives here, hopefully, next month. I’m eligible for priority vaccination because of my age and a couple of chronic conditions.

I am 81 years old and a type 1 diabetic for 75 years. I am very high risk if I have the COVID virus. I am scheduled for the vaccine on Wed, Jan 21. My only hesitance is that the vaccine is being given in the gym complex at the local high school. I will probably encounter several individuals in the parking lot, while entering the building, inside the building, etc. In some states, people are receiving the vaccine without getting out of their cars. I wish it was done that way here where I live. ~ Richard `57

I am getting mine next weekend. I am 100% behind the science and haven’t given it a negative thought. Bring it on! ~ Susan K.

I’ll have it as soon as it’s offered. I am just recovering from COVID and it is awful. Sugars were terrible. I never want it again if I can help it. ~ Michelle R.

I will not be getting one. Mostly because I can’t help but think childhood vaccines play a major role in type 1 diabetes in the first place as vaccines are designed to trigger the immune system. ~ Fabian B.

I plan on getting the J&J one once it’s approved. I’m uncomfortable with the speed of the first two on the market, despite all I know everyone is saying. I feel better about the slow poke even if it’s irrational. ~ Caroline L.

Nope, nope and nope again. ~Kristin R.

I won’t be giving it to my son or myself. ~ Julie P.

I plan on getting one. In Nebraska, people living with diabetes are now eligible. ~ Wendy G.

My daughter is type 1 but it is not approved for children yet but she will not receive one and will remain not vaccinated as she always has been. ~ Stefanie R.

Here is what the people who have already received the vaccine had to say:

I had both doses. I’m 10 days out and still feel very run down. I was COVID-tested yesterday because it felt like a mild case but was negative. I received the vaccine 2 weeks ago and no side effects. Type 1 for 55 years. ~ Cindi H.

Tolerated both injections. Side effects were mild, with some deep muscle soreness, at least for me. I did note some insulin resistance post injections. ~ Chris A.

I got my first dose a couple of weeks ago and will get my next one in two weeks. I just had a sore arm and a little fatigued the next day. By the third day, I felt pretty normal. I didn’t notice any changes to my insulin sensitivity or blood sugar levels. ~ Karissa G.

I received both doses. My only issues were headache, fatigue, and chills.

COVID vaccine update #2: 24 hours later, I don’t feel horrible, but definitely off. Some body aches, headache and overall sluggishness. I went to bed at about 8:30 and “slept” till 10:30. (with my saul dog interruptions and the baby kicking my bladder, etc.)” ~ Nicole M.

I had mine because I work for the National Health Service and I had no side effects at all. ~ Kate B.

I was nauseous after my first dose for about 12 hours. I took a Zofran and was fine. ~ Jamie B.

I did have side effects (pain, mild fever) but I won’t hesitate to go for the second shot.

I have completed the series and just had a sore arm for a couple of days each time.

No side effects beyond a sore arm. I like the peace of mind and I did extensive research before getting it to fully understand what I was getting into. ~ Sarah R.

My 82-year old identical twin sisters each received the first dose. One got the Pfizer and the other the Moderna. No adverse reactions thus far. The one that got the Pfizer has allergies so was a bit concerned but had no reaction. ~ Auburn75

It should be mandatory that vaccines like this are taken. It’s not a conspiracy theory. There aren’t robots in the vaccine. This whole virus story isn’t a hoax, and this hasn’t been started because some people are simply trying to make some money. The sheer lunacy I’ve seen out there is beyond description. Some people think the world is flat. I’ve gotten both doses and have had zero side effects. ~ Sheralyn B.

I received my first vaccine on Jan 8 with minimal side effects being a sore arm and mild low blood sugars. On Jan 27 I received my second vaccine. Initially only had a sore arm and headache but after 36 hours, developed mild fever of 99.7, body aches, headache, continued low blood sugars, and a grape side swollen lymph node in my armpit, the arm I received my vaccine in. Fever and swollen lymph node improved with Tylenol and Ibuprofen! ~ Carlie W.

Will you be getting the vaccine once it is available to you? Have you had one or both doses and experienced side effects? Share and comment below!

Source: diabetesdaily.com

CGMs to “Hack” Your Blood Sugar? People with Diabetes Speak Up

It’s becoming more and more common: whether in a coffee shop in Silicon Valley or in a weightlifting gym in Boulder, Colorado, people without diabetes are using continuous glucose monitors (CGMs) to “hack” their blood sugars, lose weight, and hone their diets accordingly. This article will explore the use of CGMs in the non-diabetic population, what the backlash from the diabetes community has been, and what the call to action should be.

CGMs for More Than Just Diabetes Management?

According to one website that promotes the use of CGMs in a non-diabetic population,

“ Wearing a CGM can facilitate the effort for someone who wants to hack their diet, blood sugar control, and overall health. This technology can go beyond a single blood sugar reading that a blood glucose meter provides. A CGM can provide real-time insight on whether blood sugar is trending up or down.”

What may seem like an innocuous accessory for the upper-class elite has many people with diabetes enraged. CGMs are crucial in providing regular, near-constant blood glucose readings to track time spent in range (TIR), identifying patterns in blood sugars, and anticipating both low and high levels.

The Original Purpose of a Continuous Glucose Monitor

For people with diabetes, they are life-saving, and more and more often are being coupled with insulin pumps that will then increase or suspend insulin according to the blood sugar that a CGM reads. It almost entirely eliminates the need for manual finger testing and has proven to help lower HbA1c levels, reduce dangerous low blood sugars, increase time in range, prevent unnecessary emergency room (ER) visits, and save the health care system money and save many lives. It has quickly become a necessity for tight diabetes management in recent years for many people.

For something so seemingly necessary for most people with diabetes, it clearly isn’t seen that way by industry: 16 states, including California (the most populous), do not have Medicaid coverage for continuous glucose monitors at all. And while most private health insurance plans (and even Medicare) now cover CGMs, affording one without health insurance is nearly impossible: the most popular CGM and the one that most commonly connects with insulin pumps, the Dexcom CGM, costs thousands of dollars out of pocket per month without insurance.

So when someone with diabetes, who is already struggling to afford their insulin, goes to the local coffee shop and overhears two dudes from Crossfit comparing their (perfect) blood sugar readings on their respective CGMs over their non-fat decaf lattes, the inequity of the situation can be enough to make your skin crawl.

Clair from Illinois says,

“The general population using CGM devices trivializes them.”

Cate from Nebraska adds,

“It absolutely incenses me [when non-diabetics use CGMs]. There’s a local doctor in my area who treats patients for weight loss and gives everyone a free CGM; meanwhile, it’s an arm and a leg to refill my own.”

Bonnie from Minneapolis says,

“It drives me absolutely bananas.”

We Are All Just Products of the System

Managing diabetes with a continuous glucose monitor is life-changing, but it is expensive, and living with diabetes in America is anything but easy. We have the most expensive insulin prices in the world, health insurance isn’t compulsory or cheap, and even when you do have a job that has health insurance, necessary diabetes technology is sometimes not even covered or affordable under your plan.

Seeing people use technology that we need can be seen as a slap in the face, but we’re directing our anger at the wrong place. The problem with accessibility in the United States is not a supply issue. The problem with accessibility in the United States is that we use health care as a commodity when it is not. We put health care into a capitalist box when it’s something that should be treated as the human right it is. We’ve priced people out of their lives. We treat things like insulin and insulin pumps and continuous glucose monitors as if they’re elastic goods when they’re 100% inelastic. We cannot negotiate our own pricing for insulin. We can’t haggle down the price or walk away. We need the drug or we die.

People without diabetes see products like continuous glucose monitors as the valuable goods they are and are willing to pay for them. No person who uses a CGM recreationally has it covered by their insurance, and it’s important to remember that.

It’s not a zero-sum game where someone’s CGM that’s paid for out of pocket in San Francisco precludes another person on Maine’s Medicaid program from accessing one of their own, but it feels like it does. Instead of taking our anger out on the gym-rat in Colorado who’s paying thousands of dollars out of pocket for their Dexcom each month (which is stupid, but why question their motives?), we should be angry at the government and systems that created this situation to begin with.

If the United States had a single-payer health care system where everyone who lives here had health coverage, we wouldn’t care what people buy on the free market. If all plans (including Medicaid!) covered CGM use for people with diabetes at 100% of the cost, it wouldn’t bother us what anyone else was doing with their blood sugar levels (diabetic or not). It’s a symptom of a system that denies people with diabetes the proper care and regular, reliable access to proper durable medical equipment that makes them covet these devices as much as we do. There’s nothing inherently wrong with people without diabetes using CGMs, but it does sure feel like there should be. 

CGM for non-diabetic population

Photo credit: iStock

Some People Support Wider Use of CGMs

In speaking with others for this story, I found several people who encourage non-diabetics to use CGMs, like Mindy, a registered dietician from Colorado,

“I am pleased that there is adequate supply for people without diabetes who can view the real-time movements and fluctuations of blood glucose. The more understanding there is in groups of non-DMs, maybe we can finally change the direction of people diagnosed with (type 2) in the future.”

Christie, from California, added,

“being mad about someone having a CGM that they bought on the free-market is similar to someone with hypertension being angry over another person having an at-home blood pressure monitor. It just doesn’t compute.”

In a country with nearly 100 million people living with prediabetes, learning to respond to blood sugar trends and figuring out which foods work best for your body can only be a good thing. And although it hasn’t happened yet, the more “mainstream” these devices become, the more affordable they’re bound to become, which would be great for everyone. Additionally, for shy diabetics, CGMs becoming more mainstream can also take away the stigma of having a visible device on your body 24/7. It’s suddenly “cool”.

Benefits for Everyone

Whether or not you have diabetes, a continuous glucose monitor can help with several things:

  • Learning how your body responds to certain foods (grapes versus crackers, for instance)
  • Identifying blood sugar patterns around mealtime and exercise
  • Diagnosing diabetes before the onset of ketoacidosis (DKA) in people at high risk (people who are overweight, obese, live with prediabetes, or who have the antibodies for type 1 diabetes)
  • Improving blood sugar to help maximize energy for a workouts
  • Helping people lose weight by managing their hunger (which is the result of fewer blood sugar fluctuations throughout the day)

In a country where over 70 million adults are obese and another 99 million are overweight, having more data regarding how our bodies respond to the foods we eat is vital. We have a type 2 diabetes epidemic on our hands that is only getting worse, and wider CGM usage may help curb that, but people need to be careful.

Using them as “wellness gimmicks” may bombard those who truly do not understand the relationship between glucose and blood sugars, leaving users overwhelmed with data and confused, while not making any dietary changes at all. In a true market economy, the greater the demand, the more competition will spring up, the more prices will fall (for both people with and without diabetes).

The real issue that people need to focus on is making sure that everyone with diabetes who wants a CGM can get one, but people without diabetes accessing CGMs on the open market will not prevent that from happening. We need to push for greater coverage for CGMs on the private and public health insurance market with our elected officials and make sure that we inch ever closer to the illustrious universal health care system that other industrialized countries enjoy. We need to make sure that everyone with diabetes has access to affordable insulin, pumps, and supplies (including CGMs), with strong grassroots advocacy to equip people with all the tools they need to thrive. If we achieve universal health care maybe someday everyone who truly needs a CGM can get one, but until then, let the Crossfit bro with his Dexcom sensor alone. Although you can let him know that the caffeine in his latte will raise his blood sugar a few points in the meantime.

Source: diabetesdaily.com

New Target A1C Recommended for Youth with Type 1 Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Matthew Garza and Lydia Davis

The American Diabetes Association has lowered the A1C target for children to less than 7.0%, aiming to improve long-term health outcomes without increasing hypoglycemic events.

The American Diabetes Association (ADA) recently issued a new recommendation on A1C targets for children: youth with type 1 diabetes should aim for an A1C below 7.0%, rather than the previously recommended target of 7.5%. The ADA also emphasized that although this is a target for the general population of children with type 1 diabetes, it is important that each child’s A1C goal be personalized, taking into account hypoglycemia awareness, baseline A1C, and other health issues.

In 2018, the American Diabetes Association (ADA) reiterated its long-held recommendation that children with type 1 diabetes should aim to have an A1C of less than 7.5%. This target was designed to help prevent severe hypoglycemia (low blood sugar) in children. The ADA has revised that position in light of a recent review paper, which showed that elevated blood glucose levels can lead to significant complications during child development, including abnormal brain development, an increase in heart problems, retinopathy, and neuropathy. The review also showed that newer diabetes therapies and technology have resulted in a lower risk for severe hypoglycemia.

However, for certain groups of at-risk children, this new recommendation may not apply, and it may be safer to target an A1C of 7.5% or higher. Children with low hypoglycemia awareness, those who cannot alert others to symptoms of hypoglycemia, those without access to helpful diabetes technology (such as continuous glucose monitoring), and those who cannot test their blood glucose levels regularly should continue to aim for an A1C of less than 7.5%. Children with a history of severe hypoglycemia should aim for an A1C of less than 8.0%.

In contrast, children who are not at risk for hypoglycemia (for example during the often-experienced “honeymoon” period) should aim for an A1C as low as 6.5%.

The lower A1C goal of 7.0% will hopefully lead to a reduction in diabetes complications during childhood and throughout the lives of people with type 1 diabetes, without increasing their risk of severe hypoglycemia while they are young.

Source: diabetesdaily.com

Diabetes and Hangovers: What You Need to Know

Anyone who lives with diabetes knows that a hangover can wreak havoc not only on productivity and sense of well-being but also on your blood sugars, leaving them unpredictable for hours and even days. When you’ve had too much to drink and you’re feeling hungover, what can you do?

This article will touch upon the best course of action to take to help your diabetes management when you are hungover, the best food and beverages to help treat a hangover, and how you can prevent a hangover in the future.

What Exactly Is a Hangover?

A hangover, quite simply, is the culmination of unpleasant symptoms that develop several hours after drinking too much alcohol. Common signs of a hangover include:

  • Headache
  • Nausea, vomiting, or stomach pain
  • Light and sound sensitivity
  • Fatigue
  • Thirst
  • Dizziness
  • Poor sleep quality
  • Decreased ability to concentrate

More severe symptoms of a hangover include:

  • Shallow breathing
  • Low body temperature
  • Excessive vomiting (not able to hold down water)
  • Confusion
  • Seizures
  • Blue-tinged skin
  • Loss of consciousness

If someone you know is experiencing severe symptoms of a hangover, seek emergency medical treatment immediately, or call 911.

So You’re Hungover; What Should You Do?

A hangover’s nemesis is time and hydration. Most hangovers disappear within 24 hours, although some can last for days. It can be excruciating, but sometimes you simply must wait it out.

While you’re waiting, the next best thing you can do is hydrate with water (about 15.5 cups, or 3.7 liters, of fluids a day for men and about 11.5 cups, or 2.7 liters, of fluids a day for women), and make sure to get plenty of electrolytes from sources such as coconut water and sports drinks (although make sure to count carbohydrates and dose insulin appropriately, if needed).

The caffeine in coffee can also energize you and can be beneficial for headaches and sleepiness after a night of drinking. Staying adequately hydrated will also make blood sugar management easier.

It is also extremely important to keep a close watch on your blood sugars and watch for any signs or symptoms of developing diabetic ketoacidosis (DKA), which can be life-threatening. Check your blood sugar every few hours or wear a continuous glucose monitor (CGM) to make sure you’re staying in range, as recommended by your doctor.

If you notice your blood sugar remaining stubbornly high (at or above 250 mg/dL) for several hours or more and you have moderate to high ketones, contact your doctor right away and seek medical attention to prevent developing DKA. You may need IV fluids administered at a hospital to hydrate and an intravenous insulin drip, which can bring blood sugars down more aggressively than subcutaneous injections at home.

Some people experience low blood sugars after a night of drinking because the liver is busy processing the alcohol content from drinks consumed, leaving one to fend for themselves because glycogen (glucose) will not be released if one’s blood sugar starts to drop. The more one drinks, the greater the likelihood of low blood sugar, which can be dangerous.

glucose tabs

Tip: Carry glucose tabs when you’re drinking with friends. | Photo credit: iStock

People with diabetes should always carry glucose tabs or gel with them in case of an emergency low and should check their blood sugar regularly both during and after drinking. It’s also important to remember that some diabetes medications may not work as well if too much alcohol is consumed, especially type 2 diabetes medications.

If your blood sugars are staying within range and you don’t feel too nauseous, make sure to eat a good meal, which helps combat hangovers and stabilizes blood sugar. Aim for a balance of carbohydrates, fat, and protein. Some recommended foods include:

  • Bananas
  • Oranges
  • Eggs
  • Avocados
  • Rice
  • Oatmeal
  • Toast
  • Crackers
  • Clear broth soup

Getting plenty of sleep also helps remedy a hangover; alcohol notoriously disturbs sleep patterns, so if you didn’t get a good night’s rest after drinking, taking a nap the next day can help you bounce back quicker.

Some people take over-the-counter pain relievers, such as aspirin or ibuprofen, to manage symptoms. If you’re unsure what to take or are worried about the side effects of any over-the-counter medication, talk with your doctor about what will work best for you.

Finally, even though you may not feel well, getting outside for a quick, 20-minute walk can help revitalize you, get some fresh air into your lungs, and help you feel better faster. While vigorous exercise is not recommended while hungover, some light exercise can boost not only your mental health but will charge the cardiovascular system and speed up recovery.

How to Prevent a Hangover

The surest way to prevent a hangover is by abstaining from alcohol or only drinking in moderation. Some other tactics to help prevent hangovers include:

  • Drink alcohol only with food and never on an empty stomach
  • Drink slowly
  • Make sure you stay hydrated with water while drinking (a good rule of thumb is drinking one glass of water for every alcoholic beverage)
  • Keep a close watch on your blood sugar (sugary alcoholic beverages can make your blood sugars spike, while the alcohol itself can make you crash. Be wary of both consequences and check your blood sugar often).
  • Avoid sugary mixed drinks and sweet wines, which are not only bad for blood sugars but may also make hangovers much worse. Instead, mix liquor with water, seltzer water, or diet drinks.
  • Know your limits, and stick to them
  • Stick with friends or family who will watch (and potentially limit) your alcohol intake
  • Avoid alcohol that contains higher amounts of congeners: congeners give many types of alcoholic beverages their flavor. They are found in larger amounts primarily in dark liquors (like brandy and bourbon) and contribute to worse hangovers. Instead, choose lighter beverages such as vodka, white wine, or gin
  • Eat something (like a banana) and drink water before going to bed after a night of drinking

Hangovers are an unpleasant side-effect of drinking alcohol, and having a hangover with diabetes makes them all the more complicated. But with these strategies, you can help prevent hangovers in the future, while still imbibing from time to time.

If you think you have a problem with drinking or develop signs of alcohol addiction, get help immediately.

Source: diabetesdaily.com

My Decision to Get Screened for Type 1 Diabetes

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

By Jorge A. Aguilar

My mom lives with type 1 diabetes. Do you wonder what that is? Well, type 1 diabetes is a life condition in which you have to be careful in what you eat, your exercise, and you have to have good control of your blood sugar levels and make a balance with the insulin you need. This is because your body destroys the cells that make insulin and then stops making it.

When I Was Little

Since I was born my mom taught me how to help her change her insulin pump and refill it, I would pass her the things she needed and we pretended that I was a health professional. I learned quickly how to inject insulin and she also taught me how to help her in an emergency.

I remember one morning I wanted to show her something in a video game, to which she said, “Yes, I’m coming.” That’s completely normal except for the fact that she sounded weird in some way. I called my dad and it turned out that my mom had hypoglycemia and I had to help her. Fortunately, I acted in time and she sure doesn’t even remember.

Type 1 Diabetes Is Interesting and Sometimes Worrisome

I find it interesting that it is normal for people with diabetes to inject insulin and endure pain from time to time. Even vaccines scare me, they scare the hell out of me.

It is sometimes scary to think that she could have hypoglycemia while sleeping and might not wake up. It’s also scary to be extra careful with what you eat and to avoid eating certain types of food if you want to have everything under a perfect balance. It seems that living with type 1 diabetes is a lot of work.

Know My Risks

I know there is some genetic risk. I understand that this means that at some point in my life I could develop type 1 diabetes although I also understand, from what I read and my mother has told me, that this risk is small. I think whatever it is I would like to know if I have that risk or not to be prepared later in my life.

I think that if I knew if I had antibodies that would one day attack the cells in my body that produce insulin, I could be calm but also very prepared because I would let my parents know if I had any symptoms like the ones my mother usually talks about at work: thirst, really wanting to go to the bathroom, feeling very hungry, and feeling very tired, among others.

Know Your Risks

My mom helped me ask Indigo for his opinion. Indigo’s mother also lives with type 1 diabetes and he told us that he would definitely have this test done because “knowing the risk, he could take action.” He told us that getting tested would help him get ready by asking his mother lots of questions. He confessed that he would pay more attention to the things his mom does and says and that it would definitely not cause him stress because he has seen her taking good care of herself and succeeding. He does not consider this as something complicated as he spends a lot of time watching his mother do all this and other stuff in life.

I think that if it were possible for everyone to take the test they should do it because, on the one hand, it does not affect you at all to take a test, on the other you contribute to science and finally, it is a good way to prepare yourself mentally for what comes in your lifetime. If it comes.

You should take a diabetes antibody test because you may learn that you are likely to develop type 1 diabetes and you may learn to take better care of yourself with or without risk.

Source: diabetesdaily.com

Diabetes is Ruff: Diving into the World of Diabetes Service Dogs

This content originally appeared on diaTribe. Republished with permission.

By Julia Kenney

When you think of tools to help you manage diabetes, you likely think of therapies and devices – but what about dogs? We spoke with Mark Ruefenacht, who trained the first diabetes service dog in the world, to learn how these special animals can support people with diabetes.

There are many reasons to love dogs. Because they are cute, because they are smart, because they are the furry best friends you didn’t know you needed, and they love you unconditionally. But did you know that some dogs can also save your life and help you manage diabetes? Just one more thing to add to the list.

In diabetes, severe cases of high or low blood sugar (hyperglycemia and hypoglycemia, respectively) are dangerous and can lead to serious long and short-term health complications. Diabetes service dogs are trained to help, specifically when the owner’s blood sugar is too low or too high.

There are two kinds of diabetes service dogs, Medical Response Dogs and Diabetic Alert Dogs. Medical Response Dogs are trained to respond to the symptoms of severe low blood sugar such as fatigue, loss of consciousness, and seizure-like behavior to help notify you and others of hypoglycemic events. Medical Response Dogs can also retrieve “low” supplies such as food, drinks, or an emergency kit. Diabetic Alert Dogs, also referred to as DADs, are trained to smell the compounds that are released from someone’s body when blood sugar is high or low. Because of this, Diabetic Alert Dogs are able to alert their owners of dangerous levels of blood sugar before they become symptomatic. A variety of breeds can be trained to be diabetes service dogs, including golden retrievers, Labrador retrievers, mixed-sporting breeds, and poodles.

Dog

Image source: diaTribe

Nobody knows more about these dogs than Mark Ruefenacht, founder of Dogs4Diabetics (D4D), one of the leading diabetes service dog training organizations in the world. Ruefenacht  has lived with diabetes for over 30 years and got involved with service dogs for the blind due to his family history of diabetes-related eye disease (retinopathy). After an incident of severe hypoglycemia, Ruefenacht started training Armstrong, the world’s first diabetes service dog, to recognize and respond to the scent of hypoglycemia in his sweat and breath. Through training and testing, Ruefenacht found that there might be a scent associated with hypoglycemia that is common among people with diabetes and could be taught to other dogs. Since then, he has helped train hundreds more dogs with D4D. In our interview, Ruefanacht shared his insights on the benefits of Diabetic Alert Dogs and how to know if they are right for you.

How are Diabetic Alert Dogs trained? Who are they trained for?

Diabetic Alert Dogs are typically trained for people with type 1 diabetes or insulin-dependent type 2 diabetes. This is for two reasons. As Ruefenacht describes, people with type 2 diabetes who are not dependent on insulin typically do not have life-threatening low blood sugars. Because of this, Diabetic Alert Dogs are most helpful for people who are insulin-dependent. Furthermore, under the Americans with Disabilities Act, service dogs can only be given to people with a recognized disability, which could cause barriers to getting a service dog, especially for people with type 2 diabetes who are not insulin dependent. There are additional requirements and limitations for public service dogs under the Americans with Disabilities Act, so diabetes service dog organizations also train dogs in various support skills to help people with diabetes at home (and not in public). Dogs4Diabetics refers to these dogs as “Diabetes Buddy Dogs.” If you are wondering whether you could qualify for a service dog, talk to a service dog organization.

As for the training these dogs receive, the programs typically focus on scent discrimination. This means that the dogs are taught to detect smells in the air associated with blood sugar changes and to ignore smells associated with normal, safe bodily functions. Ruefenacht said, “The big myth is that dogs are smelling blood sugar. But the dogs are actually sensing the compounds that come out of the liver when the blood sugar is either dropping rapidly or is low.” Though humans can’t detect these smells, dogs likely can. Scientists are not sure what exactly the dogs identify, but research suggests that it’s ketones (for high blood sugar) and may be a natural chemical called isoprene (for low blood sugar). Ruefenacht uses low and high blood sugar breath samples to train the dogs; after about six months of intensive training, they can distinguish these scents in people.

Can diabetes service dogs reliably alert their owners to changes in glucose levels? It depends on the dog and it’s training – but research shows that diabetes service dogs can often be effective, and that quality of life and diabetes management tends to improve in owners. According to Kim Denton, who works for Dogs4Diabetics and has had type 1 diabetes with hypoglycemia unawareness for over 40 years, having a Diabetic Alert Dog “changed my life for the better by helping me keep my blood glucose in a much tighter range, which means fewer health complications and I feel much better both physically and mentally.”

How can diabetes service dogs help their owners?

Dog

Image source: diaTribe

Denton says that her dog, Troy, “has saved my life so many times by alerting me before my glucose dropped to a life-threatening level, that I can’t keep track anymore. Troy tells me long before my CGM detects a rapid drop or rise in my glucose levels, and he does it without that annoying beeping! If my sugar starts dropping while I am sleeping, Troy jumps on me to wake me up and will continue licking my face if I start to fade off.” In addition to alerting owners to early changes in blood sugar so that they can act to stabilize glucose levels, there are other skills that diabetes service dogs can learn. Here are some examples, though every organization has different training programs:

  • Alert the owner to audio signals from insulin pumps, continuous glucose monitors (CGM), and other devices. This is especially helpful for people with impaired hearing, for children, and for diabetes management while sleeping.
  • Alert people nearby to help the owner in cases of severe blood sugar changes, or retrieve a cell phone.
  • Retrieve medications and other necessary supplies in an emergency.
  • Provide emotional support.

It is important to know that diabetes service dogs are an additive tool to help people manage their diabetes. A service dog should never replace CGM, self-monitoring blood glucose with fingersticks, hypoglycemia prevention methods, or healthy lifestyle efforts; a diabetes service dog can be an additional form of support for people with diabetes.

How do service dogs provide emotional support? Why is this important?

The majority of diabetes service dogs are also trained with emotional support and wellness skills. This means that in addition to helping people manage their blood sugar, these dogs can also help improve their owner’s mental and emotional wellbeing. This is especially important for people with diabetes because of the stress that often comes with long-term management of a chronic condition – learn about diabetes distress and how to reduce it here. People with diabetes are also two to three times more likely to experience symptoms of depression than the general population, according to the CDC.

Ruefenacht is keenly aware of the relationship between diabetes and mental health, and he has worked to address this through his diabetes service dog training programs. Ruefenacht says his clients appreciate the diabetes management component of the service dog training, “but they value the companionship and emotional support more.” Like most other dogs, diabetes service dogs are companions and become part of the owner’s family. Many owners appreciate the stress-relieving experience of walking, playing, or just being with a dog, which can be incredibly helpful for people with diabetes. Denton says “Troy understands not only my need to have normal glucose levels but also my need for comfort and companionship when my diabetes gets me down.” Dogs can also be trained to cater to specific mental health conditions such as depression and anxiety.

Could a diabetes service dog be right for me? 

Dog

Image source: diaTribe

Diabetes service dogs are a great option for some people, but not for everyone. There are several ways that people can get support in managing their diabetes, and it is important to think about what works best for you – for example, Diabetic Alert Dogs are trained to sense blood sugar changes in their owners, but for many, this can be accomplished using a CGM. Diabetes service dogs can be a helpful option for people who frequently experience episodes of hypoglycemia, experience hypoglycemia unawareness, need help regulating their blood sugar at night, or need additional support. According to Taylor Johnson, who has type 1 diabetes and a Diabetic Alert Dog named Claire, “Having a service dog is the best decision I’ve ever made regarding my diabetes management. I love gadgets and tech but they are not foolproof, and Claire is the additional piece of mind I need to sleep at night.” Talk with your healthcare professional to assess your need for a diabetes service dog if it is something that you are considering – and remember, a diabetes service dog will not replace the need for careful glucose monitoring and hypoglycemia prevention efforts.

There are a few more important things to think about:

  • Cost: The process of getting and training diabetes service dogs and their owners can be expensive. There are some organizations that provide training services for free or for a reduced cost for those who qualify. Other organizations offer financial assistance or payment plans for those who qualify. For example, as a 501(c)(3) nonprofit that relies on charitable donations, D4D does not charge its clients for the dogs or other program services which significantly reduces the costs of owning a diabetes service dog.
  • Time: Owners also need to put a significant amount of time into training and maintaining the skills of their diabetes service dog outside of the formal training the dogs receive. This includes participation in some of the initial training of the dog, giving the dog time to acclimate to your specific needs as a person with diabetes, and follow-up training throughout the dog’s lifetime.

Want to learn more about diabetes service dogs?

  • Check out some different diabetes service dog organizations to get a sense of the application process, service dog training programs, and service dog community

Source: diabetesdaily.com

Tech on the Horizon: Where Will Automated Insulin Delivery (AID) be in 2021?

This content originally appeared on diaTribe. Republished with permission.

By Albert Cai

What AID systems are currently available, what can we expect in the next year, and where is AID technology headed?

Want more information just like this?

As we enter 2021, we’re taking a look at what’s ahead for automated insulin delivery (AID) systems. Because the COVID-19 pandemic delayed many clinical trials and FDA reviews in 2020, several companies are expecting to launch new AID systems in 2021. This list covers many of the most notable upcoming products, but there are likely others on the horizon – if you know of a system you think we should track, please let us know.

Click to jump to a product, organized by expected launch date. You’ll find detailed descriptions and possible launch timelines for each, reflecting US availability.

What is automated insulin delivery (AID)?

Automated insulin delivery has many names – artificial pancreas, hybrid closed loop, bionic pancreas, predictive low-glucose suspend – but all share the same goal: combining continuous glucose monitors (CGMs) with smart algorithms to automatically adjust insulin delivery via an insulin pump. AID systems aim to reduce or eliminate hypoglycemia, improve Time in Range, and reduce hyperglycemia – especially postmeal and overnight.

When thinking about the development of AID technology, it’s often helpful to think in stages.

  • Stage 1: The most basic AID system might shut off the insulin pump whenever the user’s CGM readings drop below a certain number, such as 70 mg/dl, to reduce time spent in hypoglycemia and help prevent severe hypoglycemia.
  • Stage 2: The AID system could predict when glucose is going to go low and automatically reduce or stop insulin delivery to further help prevent hypoglycemia.
  • Stage 3: The AID system may be able to automatically adjust basal insulin delivery depending on whether the user’s glucose is trending up or down, and taking into account other factors, such as insulin on board. This adjustment of basal insulin would aim to increase Time in Range (TIR), and help prevent both high and low glucose levels. At this stage, the user would still have to manually give meal boluses and correction boluses.
  • Stage 4: The AID system will be able to deliver correction boluses when glucose values are high. These small adjustment boluses would be a further step in improving TIR, with less time with hyperglycemia.
  • Stage 5: The systems will be able to detect meals and automatically deliver a system-calculated meal bolus to reduce postmeal high blood glucose levels. With the elimination of manual meal bolusing, the system is considered to be a “fully closed loop” System.

Currently available products are in stages 3-4. By the end of 2021, we may have multiple stage 4 systems available.

Medtronic MiniMed 670G and 770G – already available 

AID

Image source: diaTribe

Now available for people over the age of two.

What is it? Medtronic’s MiniMed 670G has been available since spring 2017 and was the first stage 3 AID system to be cleared by the FDA. Prior to the 670G, Medtronic released stage 1 and stage 2 systems (Medtronic MiniMed 530Gand 630G, respectively). More recently, the MiniMed 770G system was cleared in the US in September 2020. Both the MiniMed 670G and 770G systems use the same insulin adjustment algorithm, which adjusts basal insulin delivery every five minutes based on CGM readings, targeting 120 mg/dl. The target glucose level can be temporarily raised to 150 mg/dl when low blood sugar (is a concern, such as during exercise or sleepovers for children. Both systems come with Medtronic’s Guardian Sensor 3 CGM, which has seven-day wear and requires two fingerstick calibrations per day (although four are recommended). See our article from 2016 for a full breakdown on the MiniMed 670G and from September for more on the 770G.

What’s the difference between the MiniMed 670G and 770G? As mentioned, both the MiniMed 670G and 770G systems use the same insulin adjustment algorithm and the same CGM. However, the newer MiniMed 770G has an improved pump: the 770G pump includes Bluetooth connectivity and can be paired to the MiniMed Mobile smartphone app (available for the iOS and Android) for users to view their CGM and pump information without pulling out their pumps. The app also allows users to share their data with others in real-time. Note: users can only view information but cannot control the pump (e.g., deliver a bolus, adjust basal rates) from the app. Bluetooth connectivity also means the system’s insulin adjustment algorithm can be updated. Medtronic has promised current MiniMed 770G users a free upgrade to the MiniMed 780G when that system becomes available (more below). Finally, the MiniMed 670G is only cleared in the US for people over the age of seven, while the MiniMed 770G is cleared for people over the age of two.

Medtronic management recently shared that algorithms will become an increasingly important part of the diabetes ecosystem, and presumably, a key differentiator for companies – lots of exciting times ahead with AID, that is for certain.

Tandem Control-IQ – already available in US

AID

Image source: diaTribe

Now available for people six years and older.

What is it? The Control-IQ system from Tandem was cleared by the FDA at the end of 2019 and launched to customers in January 2020. It’s precursor – Basal-IQ – was cleared in 2018. The Control-IQ system uses Tandem’s t:slim X2 pump, Dexcom’s G6 CGM which requires no fingerstick calibrations, and the Control-IQ insulin adjustment algorithm. In addition to automatic basal rate adjustments and predictive insulin suspension, the Control-IQ system is the only AID system with automatic correction boluses: when it predicts glucose to be above 180 mg/dL in 30 minutes, the system will deliver 60% of the correction bolus needed to reach a target of 110 mg/dL. Control-IQ targets glucose values between 112.5 and 160 mg/dL, though users can turn on or schedule “Sleep Activity” mode to achieve 112.5-120 mg/dL by the morning. This past summer, Tandem launched the t:connect smartphone app (for iOS and Android), which allows users to check their pump and CGM data on their phones.

What’s next? With the current t:connect smartphone app, users can view information but cannot control the pump (e.g., deliver a bolus, adjust basal rates). Tandem has already submitted an updated app with pump control to the FDA and expects to launch that functionality in 2021. Tandem has also mentioned enhancements to the Control-IQ algorithm that are expected in 2021. While we haven’t heard many specifics, we believe it’s likely that these enhancements will focus on improving glycemic outcomes, personalization, and usability of the system.

Insulet Omnipod 5 – expected early-to-mid-2021 

AID

Image source: diaTribe

FDA submission is likely coming soon (if it hasn’t occurred already), and Insulet aims for a “limited” launch in early-to-mid 2021. Insulet has completed the clinical trial for Omnipod 5 but has not shared the results.

What’s new? Omnipod 5 is Insulet’s AID for its popular Omnipod disposable pumps, also called patch pumps. If you’ve been following the field, you’ll know that Insulet previously called the new system Horizon – same system, new name. Omnipod 5 uses Dexcom’s G6 CGM, and Insulet expects to launch the system with smartphone control capability; users can still opt for a dedicated controller device, since smartphone control will be available for Android users first. Insulet is working on an iPhone version for Omnipod 5, though that will not be available at launch. Insulet is also working with Tidepool (more below) on an iPhone-based AID system. Omnipod 5 will have adjustable targets between 100 to 150 mg/dl. Because the Omnipod pump will store the algorithm and communicate directly with Dexcom G6, the system will work even without the smartphone or pump controller nearby.

Medtronic MiniMed 780G – expected mid-2021

AID

Image source: diaTribe

Pivotal trial completed for 780G and presented at ADA 2020. Medtronic aims to submit the system to the FDA by January 2021 with launch coming around mid-2021 for adults (either ages 14+ or 18+).

What’s new? The MiniMed 780G will be Medtronic’s second AID algorithm and a significant upgrade over the MiniMed 670G and 770G systems. In addition to automatic basal rate adjustments, the MiniMed 780G will include automatic correction boluses and an adjustable glucose target down to 100 mg/dl. The system will also have fewer alarms and simpler operation with the goal of further increasing Time in Range. The MiniMed 770G and MiniMed 780G pumps are identical, meaning MiniMed 780G users will also be able to use the MiniMed Mobile smartphone app for viewing pump data, uploading pump data wirelessly, and updating their pump wirelessly. As the pumps are identical, Medtronic has promised that those who purchase the MiniMed 770G now will be able to wirelessly upgrade to the MiniMed 780G for free when 780G does become available. Finally, the MiniMed 780G will use the same Guardian Sensor 3 CGM as the 670G and 770G, which requires two fingerstick calibrations per day and has a seven-day wear time. As a sidenote, an improved CGM sensor is in development by Medtronic, but isn’t expected to be available when MiniMed 780G launches.

The MiniMed 780G is already available in many countries in Europe, and data from a clinical trial was presented at the ADA 2020 conference. On average, the 157 participants in the study (ages 14-75) saw their Time in Range improve by 1.4 hours per day (69% to 75%) while using the system – that’s particularly notable given the low baseline of the A1C. Speaking of A1C, the A1C improved by 0.5% (7.5% to 7%) after using the system.

Beta Bionics insulin-only iLet – expected mid-to-late-2021

AID

Image source: diaTribe

Pivotal trial underway with completion expected in the first half of 2021. Launch expected mid-to-late-2021, though this is subject to change.

What’s new? Beta Bionics is a Massachusetts-based startup developing an AID pump and algorithm called iLet. iLet will work with Dexcom and Senseonics’ CGMs (and possibly others in the future) and is designed to be especially user-friendly. diaTribe founder Kelly Close participated in an early Beta Bionics trial (2013!) and raved about the system and how easy the pump seems. At set up, users only need to enter body weight (no insulin-to-carb ratio, sensitivity factor, basal rates, etc.), and the system will learn more over time. To bolus, users will use icons to describe meals as containing more, less, or the same amount of carbs as usual (no carb counting). The insulin-only clinical trial for iLet began in the summer of 2020 and is expected to wrap up in the first half of 2021. Beta Bionics aims to launch iLet mid-to-late-2021, though this could be delayed as the FDA continues to prioritize COVID-19-related devices.

What’s next? Beta Bionics’ iLet is unique from the other pumps on this list, because it is designed to work in either insulin-only or insulin-and-glucagon configurations. With glucagon, Beta Bionics believes the system can reduce hypoglycemia while maintaining stable glucose levels and potentially even better-than-average, lower glucose levels due to availability of glucagon. Currently, there are different views on using glucagon in an AID system – in addition to the potential for improved glycemic management, there are uncertainties around glucagon pricing and availability. Regardless, the insulin-and-glucagon version of iLet is still a few years away.

Tidepool Loop – launch timing unclear

AID

Image source: diaTribe

Online observational study completed, and launch timeline depends on FDA progress.

What’s new? Unlike the others in this list, Tidepool is a non-profit and is working on the AID algorithm only; Tidepool does not have its own insulin pump or its own pump and CGM combination (like Medtronic). About two years ago, Tidepool announced plans to submit the do-it-yourself (DIY) Loop app to the FDA to become an officially supported app available on the Apple App Store, compatible with in-warranty, commercially available pumps and CGMs. For now, DIY Loop is a free, publicly available, open-source, non-FDA-approved AID system that works with Dexcom and Medtronic CGMs and old Medtronic and Insulet pumps. Read about Adam Brown’s experience using DIY Loop here. For those who are very interested in the project, there is a great deal to learn from notes that Tidepool shares about its communications with FDA – the latest notes are from a mid-2020 meeting.

Initially, Tidepool plans to launch with Insulet Omnipod and Dexcom G6 compatibility. To set it apart from the DIY-version, Tidepool Loop will have different colors, guardrails around certain settings, and a built-in tutorial for new users. A 12-month, completely virtual study was performed with Loop users and will support Tidepool’s submission of Loop to the FDA. The six-month data was presented at ATTD 2020 showing a Time in Range increase of about 1.4 hours per day (67% to 73%) with Loop. Tidepool also announced in November, 2020 that its human factors study had also been completed – this is another required step of the FDA submission. Much of what Tidepool is doing is unprecedented, so the launch timing is unclear.  In an update on January 8th, Tidepool shared that it has now completed FDA submission of Loop.

Source: diabetesdaily.com

Exhaustion and the Sleep-Interrupted Caregiver

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

By Bonnie O’Neil

Nights are the most draining of all. With the weight of our daily work, parental responsibility, and type 1 diabetes (T1D) caregiving still heavy on our shoulders, at day’s end we long to lay our burden down, retreat to the comfort of our bed, and fall gently asleep. But once T1D breaches a family’s sense of well-being, nightfall no longer signals a time of stillness. For those of us in the trenches of T1D, nightfall ushers in a time of heightened readiness…

It’s basketball season for my growing nine-year-old son, so the past several nights I’ve had to test his blood sugar throughout the night. The sleep interruption has taken its toll. I’m bone-weary with no prospect of sleep anytime soon.

I’ve been testing my son’s blood sugar for hours, but despite my best attempts to elevate his blood sugar, his numbers still aren’t high enough for me to safely go to sleep. My noble efforts are no match for what his small body can do without a functioning pancreas.

By midnight I can stay awake no longer. His blood sugar is still not where it needs to be, so I slip under the covers, setting my alarm for thirty minutes. When the alarm rings, I struggle to get to my feet, wrestling with the slumber that keeps me pinned to the bed. Willing myself to think clearly, I make my way down the hall to my son’s room, prick his finger, and wait for the meter to complete its five-second countdown.

Sixty-eight.

Oh, come on. He has consumed five juice boxes by now. Drink one more, sweet baby. I will be back again in twenty minutes to check on you.

I crawl back into bed, setting my alarm for twenty minutes, and close my heavy eyes. Eventually, things begin moving in the right direction. I make one final test at 3:00 a.m., just to be safe.

It was a six-juice-box night. When the alarm rings at 6:30 a.m. signaling the start of a new day, I can barely lift my head off the pillow. Jittery and unable to think clearly, I move as if in a fog. This is not the type of morning fatigue a slow cup of coffee will remedy.

Love Till It Hurts

When sleep interruptions carry with them elements of fear, they take an even greater toll on us. Haunting questions jar us to attention. What if my alarm doesn’t wake me? What if his blood sugar drops too low and he has a seizure? What if I miss an eight-hour high and she awakens with ketones? Our fears are real, and they propel us to get up, even when our bodies cry out for sleep.

This is when we long for the pre-diagnosis days of sleep-filled nights and less stress-filled days. But when we continue to wish away our child’s illness rather than accept it, resentment blocks us from loving our child sacrificially.

One night as I sat vigil, when fear was at its greatest and my sense of control at its weakest, a new question emerged. Is my heart expansive enough to fully embrace that which I cannot change so I might unreservedly love the child I hold before me? Accepting how things are — even if painful — frees me to care for my child with an open heart rather than a bitter heart.

And wherever the heart is open, love can grow.

Genuine love always requires sacrifice. The hours of the night watch have taught me to love until it hurts. As I learn to love my child well — by accepting life as it is and doing my best to care for him at the moment — the real transformation can begin within me. When I practice loving sacrificially, I know hope is not dead.

Where there is genuine love there will always be hope.

Be Good to Yourself

Likewise, I must offer myself grace when I most need it.

The day after a sleepless night is especially challenging for us caregivers. Crushed by fatigue, our tempers are short, and we tend to overreact to people and situations. When I react out of sleep deprivation, guilt points a finger at me. You’re not doing a good enough job. You should do better. The accusations are deafening. But if I can get still enough to quiet this voice, another voice emerges.

Be good to yourself.

The words, barely audible, rose up out of my spirit one fatigue-drenched day after an especially difficult night. Be good to yourself today. Sometimes we need our inner voice to remind us that the nighttime work of caregiving may be the most important work we will ever undertake. When we choose to sacrifice our own needs for the well-being of our child, we are choosing love.

Don’t minimize this. Your vigilant care is the greatest gift you can offer your child.

Being good to myself means redefining some of the expectations I may have for my day. In the busy seasons of life, it is especially important to reject the tyranny of what the culture says we should do and to choose instead to focus on what is healthy for us to do. That may include reevaluating our calendars, postponing appointments that can easily be rescheduled. Looking for ways to say no to optional activities that take more of our energy and focus, and yes to activities that are in some measure restorative. Accepting offers of help from friends or fifteen minutes of quiet to catch our breath. Above all, we can offer ourselves the grace to go slower than usual.

Accepting this offer of grace creates the space we need to re-center.

Be good to yourself today is now my constant refrain. I hope you’ll make it yours.

Source: diabetesdaily.com

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