What Are SGLT-2 Inhibitors and How Can They Help Your Heart?

This content originally appeared on diaTribe. Republished with permission.

By Mary Barna Bridgeman

SGLT-2 inhibitors can protect your heart! This type of medicine is recommended for people with type 2 diabetes who have heart disease or risk factors related to heart disease. Learn about the use of these medicines, including side effects, their effect on A1C, and their role in supporting heart health

Diabetes is a risk factor for heart disease: people with diabetes are twice as likely to have heart disease or a stroke compared to those without diabetes. Heart disease is often a “silent” condition, meaning that symptoms are not necessarily present until a heart attack or a stroke actually happens. It is important for people with diabetes to realize they may be at risk – click to read more about the link between diabetes and heart disease from Know Diabetes By Heart.

There are many ways to take care of your heart and to reduce the risk of heart disease while living with diabetes. New medicines, including sodium-glucose cotransport 2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists, have been shown to protect the heart and reduce the risk of many specific heart-related outcomes. This article will focus on SGLT-2 medications, and our next article will focus on GLP-1 medications.

Heart diseases

Image source: diaTribe

Click to view and download diaTribe’s helpful infographic on preventing heart disease.

What are SGLT-2 inhibitors?

There are currently four medicines that are categorized as SGLT-2 inhibitors:

These medicines help people with type 2 diabetes manage their glucose levels: they work in the kidneys to lower sugar levels by increasing the amount of sugar that is passed in the urine. SGLT-2s increase time in range and reduce A1C levels while also lowering blood pressure and supporting weight loss. For people with diabetes who have had a heart attack or are at high risk of heart disease, or who have kidney disease or heart failure, these medicines could be considered regardless of A1C level. While SGLT-2 medications are expensive, some assistance programs are available to help with cost – see one of diaTribe’s most popular articles, “How to Get Diabetes Drugs For Free.”

What do you need to know about SGLT-2 inhibitors?

SGLT-2s have a low risk of causing hypoglycemia (low blood sugar levels). Because they increase sugar in the urine, side effects can include urinary tract infections and genital yeast infections in men and women. Dehydration (loss of fluid) and low blood pressure can also occur. Symptoms of dehydration or low blood pressure may include feeling faint, lightheaded, dizzy, or weak, especially upon standing.

Before starting an SGLT-2 inhibitor, here are some things to discuss with your healthcare team if you have type 2 diabetes:

  • How much water to drink each day
  • Ways to prevent dehydration and what to do if you cannot eat or you experience vomiting or diarrhea (these are conditions that may increase your risk of developing dehydration)
  • Any medicines you take to treat high blood pressure

When prescribed for people with type 2 diabetes, SGLT-2s rarely cause diabetic ketoacidosis (DKA), a serious and potentially life-threatening condition. For people with type 1 diabetes, DKA is a well-known risk when SGLT-2s are prescribed. Call your healthcare professional if you have warning signs of DKA: high levels of ketones in your blood or urine, nausea, vomiting, lack of appetite, abdominal pain, difficulty breathing, confusion, unusual fatigue, or sleepiness. When you are sick, vomiting, have diarrhea, or cannot drink enough fluids, you should follow a sick day plan – see Dr. Fran Kaufman’s article on developing your sick day management plan. Your healthcare professional may instruct you to test your urine or blood ketones and stop taking your medication until symptoms go away.

If you have type 1 diabetes or chronic kidney disease, depending on your level of kidney function, these medicines may not be for you. Additionally, SGLT-2s are associated with increased risk of lower limb amputation.

SGLT-2 inhibitors are usually taken as a pill once a day – often in the morning before breakfast – and can be taken with or without food.

What do SGLT-2 inhibitors have to do with heart health?

Results from clinical studies suggest SGLT-2 inhibitors may play an important role in lowering heart disease risks.

Jardiance was the first SGLT-2 inhibitor to show positive effects on heart health in the EMPA-REG OUTCOME trial. In this study, more than 7,020 adults with type 2 diabetes and a history of heart disease were followed. Participants received standard treatment for reducing heart disease risk – including statin medications, blood pressure-lowering drugs, aspirin, and other medicines – and diabetes care, plus treatment with Jardiance. Over a four-year period, results from the study showed that, compared to placebo (a “nothing” pill), Jardiance led to:

  • a 14% reduction in total cardiovascular events (heart attacks, strokes, heart-related deaths)
  • a 38% reduction in risk of heart-related death
  • a 32% reduction in overall death
  • a 35% reduction in hospitalizations from heart failure

Read diaTribe’s article on the results here.

Similarly, the heart protective effects of Invokana have been shown in two clinical studies, CANVAS and CANVAS-R. These two studies enrolled more than 10,140 adults with type 2 diabetes and a high risk of heart disease, randomly assigned to receive either Invokana or placebo treatment. In the CANVAS studies, treatment with Invokana led to the following:

  • a 14% reduction in total cardiovascular events (heart attacks, strokes, heart-related deaths)
  • a 13% reduction in risk of heart-related death
  • a 13% reduction in overall death
  • a 33% reduction in hospitalizations from heart failure

Read diaTribe’s article on the results here.

Farxiga may also reduce heart disease risks. In the DECLARE-TIMI 58 study, more than 17,000 people with type 2 diabetes received Farxiga; 40% of participants had known heart disease and 60% had risk factors for heart disease. Importantly, more than half of the people included in this study did not have existing heart disease. While Farxiga was not found to significantly reduce total cardiovascular events (heart attacks, strokes, heart-related deaths) compared with placebo, its use did lead to a 17% lower rate of heart-related death or hospitalization for heart failure. Read diaTribe’s article about the results here.

More recently, the DAPA-HF study evaluated the use of Farxiga for treating heart failure or death from heart disease in people with or without type 2 diabetes. The study included more than 4,700 people with heart failure; about 42% of those enrolled had type 2 diabetes. Farxiga was shown to reduce heart-related death or worsening heart failure by 26% compared to placebo, both in people with type 2 diabetes or without diabetes. Learn more about these results here.

All of the available SGLT-2 inhibitors have evidence suggesting benefits of this class of medications for people with established heart failure. Click to read diaTribe’s article on SGLT-2 Steglatro and heart health.

Other possible benefits of SGLT-2 inhibitors

InvokanaFarxiga, and Jardiance have also been shown to reduce the progression of kidney disease. Learn more about diabetes and kidney disease here.

SGLT-2s have been studied in people with type 1 diabetes, but are not yet approved for use by the FDA – you can learn about SGLT-2s for people with type 1 diabetes here.

What’s the bottom line?

You can reduce your risk of heart disease and promote heart health while living with diabetes. You and your healthcare team should develop a personalized plan to determine what ways are best for reducing your risk of heart disease. According to the latest evidence and treatment recommendations, SGLT-2 inhibitors may be most useful for people with type 2 diabetes and heart disease or at high risk of heart disease.

About Mary

Mary Barna Bridgeman, PharmD, BCPS, BCGP is a Clinical Professor at the Ernest Mario School of Pharmacy at Rutgers University. She practices as an Internal Medicine Clinical Pharmacist at Robert Wood Johnson University Hospital in New Brunswick, New Jersey.

This article is part of a series to help people with diabetes learn how to support heart health, made possible in part by the American Heart Association and American Diabetes Association’s Know Diabetes by Heart initiative.

Source: diabetesdaily.com

Exercise: Getting Started with Type 2 Diabetes

Everyone knows that if you live with type 2 diabetes, exercise will be beneficial not only for your blood sugars, but for your overall health and well-being. The tougher issue is to know where, when, and how to get started. Learn more about the risks, benefits, and factors to consider when starting an exercise regimen while living with type 2 diabetes. Please note: always check with your doctor before beginning any new exercise routine.

Benefits

The benefits of exercise for people with type 2 diabetes are well-known. Exercise helps maintain tighter blood sugar control, lowers the risk for heart disease and other cardiovascular complications, improves blood pressure levels, strengthens muscles and bones, and helps to improve quality of sleep and the body’s ability to handle stress. According to the CDC, adults should aim for at least 150 minutes of moderate-intensity aerobic physical activity (like walking) or 75 minutes of vigorous-intensity physical activity (like jogging or dancing) each week.

Factors to Consider

The best type of exercise is the type that you’ll do regularly, so a main factor to consider is finding something that you like doing. If you dislike the gym, don’t force yourself into a habit of going. If you love the outdoors, craft your fitness routine around hiking or a morning walk. If you love music, maybe take up dancing. The options are endless, so find an activity that you’ll enjoy, and you’re more likely to stick with it!

Recommended Types of Exercise

  • Walking
  • Jogging/Running
  • Hiking
  • Biking
  • Dancing
  • Weight/Strength Training
  • Pilates
  • Yoga
  • Swimming

Additionally, making a fitness activity a habit is the best way to make sure you do it regularly. Pair a walk while sipping your morning coffee each day, or make a date with a friend each Saturday afternoon for a hike in a local park. Opt to bike to work a few times per week, or go to the grocery store on foot, instead of driving. Creating a habit of exercise is the best way to make sure you stick to a new routine.

Make your fitness routine known by sharing your intentions with family and friends, and get them in on it, too. Having people around who support your new lifestyle will ensure that you keep at it, and they’ll benefit from joining in as well. It is also beneficial to have tech help you out. Read up on the 10 best fitness apps for beginners, and prepare to get hooked on being active, tracking your progress, and meeting measurable goals while getting healthier.

Precautions to Take

If you’re new to exercise, it’s important to ease into it. Start with walking, or simply moving more: take the stairs instead of the elevator, or park farther away from the entrance to the grocery store when you do your weekly shopping. Wear a pedometer or fitness watch to track your steps, and aim to get 10,000 each day.

It’s also important to check in with your doctor or care provider before starting any new exercise routine, to make sure you are healthy enough to begin. Also seek their input and advice on what exercise they recommend for you to get started. You will also want to discuss any potential adjustments to any of your diabetes medications before starting a new routine. Additionally, make sure you have quality shoes for walking and exercising, as healthy foot maintenance is vital for people with diabetes.

Lastly, make sure you’re always prepared for your workout with checking your blood sugar before, during, and afterwards to make sure you’re within your target range, and always carry low snacks and plenty of water with you to make sure you’re staying hydrated and protected from hypoglycemia while exercising.

It’s crucial to set realistic goals for your exercise. Are you looking for more peace of mind? To lose weight? To have a healthier HbA1c? Spend more time outside? Really get a clear focus on what you want to accomplish, and aim your exercise routine around that goal. Remember, start small so you don’t get overwhelmed.

Lastly, make sure you have fun. Exercise is about building healthier habits, getting your heart rate pumping, and enjoying yourself while doing something that’s good for you. If you’re not having fun, you’re not doing it right! Make sure to enjoy yourself, and you’ll find that a healthy exercise routine builds dividends over time.

Source: diabetesdaily.com

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

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

By Christel Oerum

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

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

Why I Decided to Try the Keto Diet

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

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

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

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

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

How I Implemented the Keto Diet

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

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

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

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

My Experience Following the Keto Diet

Christel

Image source: Beyond Type 1

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

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

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

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

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

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

None of the last two issues are really a surprise.

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

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

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

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

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

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

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

Source: diabetesdaily.com

How to Increase Your Life Expectancy

If 2020 has taught us anything, it’s that health is everything. There are simple steps everyone can take to increase their life expectancy, and to give individuals the best chance at living a long, healthy life. Incorporate these simple habits into your daily and weekly routines to increase your life expectancy and improve your health now and into the future.

1. Keep Your HbA1c Low, TiR High

If you live with diabetes, one of the healthiest life-extending habits you can adopt is keeping your HbA1c low and time in range (TiR) high. Tightly managing blood sugar levels can help prevent devastating complications such as blindness, amputation, heart disease, kidney failure and premature death.

In addition, since the HbA1c test is simply an average of one’s high blood sugars and low blood sugars, it’s important to keep your blood sugar consistent and stable, with your time in your target range as high as you can get it. Studies have linked more stable blood sugars (and not gigantic swings between highs and lows) to longer life for those with diabetes. Most people aim for an HbA1c lower than 7%, but check with your doctor for your ideal target.

2. Wear Sunscreen

Wearing sunscreen daily is crucial for preventing the deadliest form of skin cancer, melanoma. Even on cloudy days, your skin will absorb 80% of the sun’s rays, and with it, harmful UV radiation. The American Academy of Dermatology recommends using a broad-spectrum sunscreen of at least 30 SPF every time you go outside. Ample use is crucial: On average, people only use about 20-25% of the amount of sunscreen needed for sufficient protection, so make sure to lather up!

3. Move Your Body

It’s no surprise that exercise is healthy for people, especially people living with chronic conditions like diabetes. Exercise is crucial for heart health, to manage blood sugars, increase lung capacity, and build and tone muscles to prevent future injury. All of the short term benefits of exercise add up to a longer, healthier life. Aim for 30 minutes of moderate exercise most days of the week, more if able! A study showed that people who exercise vigorously for only 3 hours a week had cells that were 9 years younger than nonexercisers.

Photo credit: Adobe Stock

4. Spend Time Outside

Nearly 50% of adults have low vitamin D levels, due to our sedentary lifestyle and the fact that most Americans live and work inside most hours of the day. Vitamin D (which can be absorbed right into the skin when people go outside) is important for proper immune system functioning, healthy teeth and bones, managing depression, and may even help prevent both type 1 and type 2 diabetes! Getting outside for just 15 minutes a day is usually enough to maintain adequate vitamin D levels for most people.

5. Spend More Time with Family & Friends

Blue Zone countries, places around the world that have notoriously long, healthy life expectancies, place a lot of emphasis on socializing with family and friends. Having a social circle can help people get through hard times, reduce daily stress, boost resilience and immune response, and act as a literal shoulder to cry on. This is especially important for people with diabetes who can oftentimes feel isolated and alone with their condition. Connecting with others in our struggle can help extend life expectancy: studies show that maintaining a social circle can help people live up to 50% longer, and having just 3 close social ties can decrease your risk of an early death by 200%. 

6. Eat Whole Foods, Mostly Plants

Consuming a diet rich in fruits and vegetables will be full of vitamins, minerals, and antioxidants that can extend life. Even if you don’t go completely vegetarian or vegan, eating more whole, unprocessed foods is beneficial for a healthy life, and to prevent diabetes complications. Many studies over the years have correlated a plant-forward diet to a lower risk of premature death, as well as protective factors against cancer, heart disease, depression, and dementia. People who eat mostly plants tend to have lower body weight, healthier blood pressure levels, and have significantly lower mortality risk. Bon Appetit!

7. Meditate to Manage Stress

Stress has been correlated with shorter life expectancies, and learning to manage it through meditation and yoga can improve and lengthen your life. Successfully managing stress through meditation can improve the quantity and quality of your sleep, boost your immune response, and improve your relationships, all of which add up to a healthier, longer life. Check out some free meditation apps to get you going!

Photo credit: Adobe Stock

8. See Your Doctor Regularly

Regularly seeing your doctor for screens and tests can catch diseases early (such as cancer), and can ensure an appropriate and timely treatment plan if something is detected. Mammograms, colonoscopies, and pap smears are some of the routine tests and screens scientifically proven to decrease mortality from the diseases they screen for. It may not be fun, but it’s proven, effective, and worth it!

9. Reduce Your Sugar Intake

Sugar is the new tobacco. Dr. Aseem Malhotra, a cardiologist from England, shares, “…added sugar is completely unnecessary. Contrary to what the food industry wants you to believe, the body doesn’t require any carbohydrate energy from added sugar.”

There is evidence linking sugar not only to obesity and higher incidence rates of type 2 diabetes, but also to liver disease, heart disease and tooth decay (which can lead to dementia). If you cut out added sugar from your diet, you are also more likely to gravitate to unpackaged, whole foods, which are chock full of vitamins, minerals, antioxidants, and life-extending properties.

10. Get More Sleep

One in three Americans don’t get enough sleep. Lack of sleep has been linked with a plethora of negative outcomes on many body systems, including cardiovascular, endocrine, immune, and nervous systems. Side effects of not getting enough Zs include obesity, heart disease, hypertension, anxiety, depression, alcohol abuse, stroke and increased risk of developing cancer that can all shorten one’s life. Sleep is when the body replenishes cells, is crucial to proper brain functioning, regulates one’s metabolism, and repairs damage done to the body during the day. Adequate sleep promotes healing of all body systems, and getting enough of it can extend your life. Aim for 7-9 hours per night.

These small, easy changes can add up to many more healthy years. Try to incorporate a few of these strategies into your routine today to increase your life expectancy!

Source: diabetesdaily.com

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

By Dr. Francine Kaufman

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

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

Click to jump down to a section:

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

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

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

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

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

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

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

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

Table

Image source: diaTribe

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

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

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

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

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

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

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

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

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

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

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

Key Messages:  

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

About Fran

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

Source: diabetesdaily.com

Making the Most of CGM: Uncover the Magic of Your Ambulatory Glucose Profile

This content originally appeared on diaTribe. Republished with permission.

By Cindy Takigawa and Frida Velcani

What’s an AGP report, and what does it show? Why does my AGP matter? How can I use an AGP report to improve my blood glucose levels and time in range?

Having diabetes is a full-time job: you have to simultaneously monitor your diet, activity, stress, and even sleep. On top of that, you need to calculate and manage the number of carbs you consume in each meal, and keep careful tabs on your blood sugar levels. The Ambulatory Glucose Profile (AGP) report, developed by the International Diabetes Center, is a tool that provides a simplified way to look at data on your blood glucose patterns and trends. It has been recognized as a standard of care for reporting continuous glucose monitor (CGM) data by the American Diabetes Association. In this article, we explain what an AGP report is and how you can use the information to help you navigate your diabetes management.

CGM App

Image source: diaTribe

What is an ambulatory glucose profile report?

An AGP report is a standardized, single-page report that includes glucose statistics like time in range, a summary glucose profile, and daily glucose graphs. It converts blood glucose readings from a CGM device into a detailed picture, allowing you to quickly visualize the time you spend above and below your target range. The report is based on at least seven days of CGM data, with 14 days of data (or more) considered ideal. Currently, many CGMs include a version of the AGP report in their devices and reporting software.

An AGP report that summarizes data provided by self-monitoring of blood glucose (SMBG) is currently being developed. This article focuses on CGM AGP reports.

Why does my ambulatory glucose profile matter?

The AGP report is the same no matter what device you use – it allows your healthcare team to assess blood glucose levels and trends in a standard way for everyone they see. Below you’ll find sample AGP reports from Abbott, Dexcom, and Senseonics.

The AGP report shows patterns in a user-friendly way so that people with diabetes can easily identify the times of day when glucose levels are consistently low, high, or fluctuating. The general goal for people with diabetes is to have their glucose levels stay within the target range of 70 to 180 mg/dL for at least 70% of the day, spending less than 4% of their time in hypoglycemia (under 70 mg/dL). The information from an AGP report can help you have a discussion with your healthcare team about goals for your diabetes management and ways you can achieve them. The data offered by this report can help make your care far more precise and effective.

What exactly does your AGP show?

The standard AGP (designed by the International Diabetes Center and shown above) will show your data like this:

  • Glucose Statistics and Targets: This section displays metrics including average glucose, glucose variability, and Glucose Management Indicator (GMI), which can be thought of as your predicted A1C. It also includes the dates and number of days in the report, as well as the percent of time that the CGM was used to collect data. While time in range goals can be individualized, the expert-defined goals for various groups of people with diabetes can be found in this section. You can read more about time in range targets here.
  • Time in Ranges: This color-coded bar chart helps you visualize the percentage of time spent above and below your target range.
  • Ambulatory Glucose Profile: This graph combines all of your glucose readings over time to display your trends across a 24-hour period. At the end of this article you can find examples of what this will look like for your specific CGM.
    • Black line: the median of all the readings. Half of your glucose values are above the middle black line and half are below.
    • Green lines: this is your target glucose range.
    • Dark blue area: 50% of glucose values lie in this area.
    • Light blue area: 90% of glucose values lie in this area. This percentage may differ between AGP reports. The International Diabetes Center report includes 90% of glucose values, while the Eversense report shows 80% of glucose values.
    • Dotted blue lines: 5% of the highest and lowest glucose values are above and below this line, respectively.
  • Daily Glucose Profiles: Each box shows your glucose pattern from a single day.
    • Yellow area: instances of high glucose (hyperglycemia).
    • Red area: instances of low glucose (hypoglycemia).

How can I interpret an ambulatory glucose profile report?

An AGP report combines several days of blood glucose readings into one snapshot. Once you have identified daily patterns, you can work with your healthcare team to adjust your medications and insulin dosing to spend more time in range. You may also discuss timing of food or physical activity, what you are eating, or ways to reduce stress. Here are some steps you can take to understand your data:

1.     Look at your time in range. The goal is to shift the numbers into the 70 – 180 mg/dl target range while having fewer lows and extreme highs. Each AGP report includes a bar chart of your time in range; one way to see this goal in action is to aim for more “green” and less “red” on the bar chart.

2.    Keep track of the usual times you wake up, go to sleep, eat meals and snacks, and are physically active. Food, activity, medication doses, and dozens of other factors can affect your blood glucose levels. Recording these activities and their timing will help you understand your AGP report and the patterns you see.

3.    Identify times when your glucose levels are lowest and highest, and look for times of more variability. Speak with your healthcare professional about what factors may be causing highs, lows, and variability in your AGP and how you can reduce them. The wider the shaded blue areas on your report, the more variability there is in your glucose levels.

4.    If you can, compare your current and past AGP reports, and create an action plan with your healthcare team. What strategies did you use previously to make changes? Identify a few steps to improve your glucose patterns moving forward.

To learn more about how people with diabetes and healthcare professionals can use AGP, click here. For more resources on time in range, check out diaTribe’s comprehensive library here.

Abbott AGP

CGM App

Image source: diaTribe

Dexcom AGP

Dexcom

Image source: diaTribe

Eversense AGP

AGP

Image source: diaTribe

Source: diabetesdaily.com

Top 20 Healthy and Affordable Walmart Food Finds

Walmart, America’s most popular retail chain, has been increasing its options of healthy foods, with plenty of plant-based, vegan, paleo, gluten-free, and keto-friendly options at affordable prices. They also have a private-label organic line, Great Value Organic, which offers quality tasting organic products that are more affordable than its brand name competitors.

Here is a list of healthy and affordable Walmart finds that not only taste great but won’t break the bank.

1. Walmart’s Great Value Organic Frozen Fruit Line

I love fresh fruit but I don’t eat it quick enough and usually wind up having to throw most out. With Walmart’s own line of frozen fruit, I can buy affordable frozen fruit in bulk. Fruit is a great source of fiber and antioxidants and I love adding them to a protein smoothie or mixing into my favorite Greek yogurt.  You can’t go wrong with the $8.47  price tag for 32 ounces, especially because none will go to waste.

2. Great Value Pesto Spirals

These tasty frozen pesto spirals made from zucchini and carrot noodles are only 5 grams of carbs per ¾ cup serving and low-calorie too. They can be used as a simple side dish or turned into a restaurant-quality cuisine. Try adding grilled chicken or shrimp, and your favorite sauce! They are only $2.98 per a 12-ounce package and the options are unlimited!

3. CauliPower Baked Chicken Tenders

This is one of my favorite finds because it is something that my whole family can enjoy. These baked chicken fingers are gluten-free, coated in cauliflower and only 10 grams net carbs per serving (about two chicken fingers). My kids love it as is and I like to get creative with it and turn it into salads and entrees with healthy spices and sauce. It is affordable to feed the whole family with a price of $5.98 for a 16 oz package.

4. Jimmy Dean’s Delights Broccoli and Cheese Egg’wich

This high-protein, low-carb breakfast option is made with egg frittata flavored with broccoli as the “wich” with chicken sausage and cheese layered in between. This great on-the-go meal is packed with 14 grams of protein and only 8 grams of carb, making this a perfect, low-carb choice to start your day.

5. Pb2 Peanut Butter Powder

This is an item I was reluctant to try for quite some time. Once I tried it, I wish I had sooner since there are so many ways to use this product. You can either mix with water or almond milk to use like peanut butter (I enjoy it with a few Bake Believe chocolate chips) or simply add the powder to any desserts or shakes for an added punch of peanut butter flavor. With only 5 grams of carb, 45 calories and 1.5 grams of fat per serving, this is definitely an item worth considering. It costs $8.47 for a 16-ounce jar and will last you for quite some time.

6. Deebee’s Organics Superfruit Freezie

This product is such a great find. I first became familiar with these ice pops at a friend’s house and all the children devoured them. The mom specifically purchases these because they are free from the top 8 allergens, including peanuts, tree nuts, milk, egg, fish and shellfish, soy and wheat, making this a safe choice for her 7-year-old daughter who has multiple allergies. They have no artificial flavors, colors or preservatives and come in at only 7 grams of sugar per ice pop, making this the perfect treat when your kid is already operating on a sugar high. Each box comes with three delicious flavors–Strawberry Lemon, Mango Orange and Blueberry Pomegranate and costs 3.98 for 10 bars making it an affordable dessert when having guests.

7. Bake Believe Keto-Friendly Chocolate Chips

I reviewed this product last year and have been buying it ever since. Unlike their competitors, their price is affordable and it tastes great too. This is still a best-kept secret so make sure to scoop these up if your store has them in stock. With only 60 calories, 4.5 grams of fat and 1 gram net carb per serving you can indulge without worrying about your nutrition goals or your blood sugar. Bake Believe chocolate chips cost just a fraction of the other brands, with a price tag of only $3.98 for a 9-ounce bag, making this one of my favorites on this list!

8. Badia Organic Chia, Flax and Hemp Seeds

This variety of seeds is a great plant-based source of omega-3 fatty acids, proteins, and minerals such as magnesium, zinc and iron. They come in a handy container that you can put right into your fridge or freezer to give it the longest shelf life. The chia seeds are extremely affordable at $19.44 for an enormous 5.5 lb container that will last you a long time and won’t spoil.

9. Great Value Coconut and Almond Flour

I love baking my own low-carb alternatives to some of my favorite desserts but it is very expensive to do so. In a regular retail grocery store, almond flour can cost around $10 dollars for a 1-lb bag. For two pounds, Great Value’s organic coconut and almond flour are considerably less than my normal go-to brands with a price of $4.98 for coconut and $12.98 for almond flour.

10. Whisps Cheese Crisps

This gluten-free and keto-friendly snack comes in individual portions, perfect for back to school, for both you and your children. With only 1 gram carb, 110 calories and 6 grams of protein, this is a great choice that will not spike your blood sugars. At Walmart this product costs $3.47, the lowest of anywhere I’ve ever purchased. I will be sure to pick some up on my next visit!

11. Kale

For just $1, you can get a 1-lb bag of frozen kale — plenty of health benefits and the cooking options are limitless. This one is a no brainer to add to your shopping cart.

12. Great Value Deluxe Mixed Nuts

As with many other items, Great Value boasts some of the lowest prices for nuts that I’ve ever seen. This one is a particular favorite of mine; make sure to get the lightly-salted version. A large container weighing 15.25 ounces will only cost you $7.98! Store the nuts in the fridge for longest shelf life.

13. Great Value Oils

The selection of oils at Walmart is impressive and there is no doubt you’ll find what you are looking for. I prefer to use avocado oil for my grilling due to its ability to withstand high heat. And I use a lot of coconut oil when I’m baking. Both of these oils cost less than in my local grocery store, with coconut oil costing $4.62 for 14 ounces and avocado oil $ 7.47 for a 25.5-ounce bottle.

14. Fairlife Chocolate Milk

With 50% less sugar than regular chocolate milk and 9 essential nutrients, Fairlife chocolate milk is what I give my kids to make sure they are getting a healthy source of vitamins and minerals. It is also packed with protein coming in at 13 grams per cup. I personally use Fairlife to treat my low blood sugar. It has just enough sugar to raise my sugar and some fat and protein to keep it stable. It also happens to be delicious! At Walmart, you can find Fairlife for $3.18 for 52 fluid ounces.

15. Good Food Made Simple Egg White Patties

I think my mouth dropped to the floor when I found this gem. These patties are already cooked and can become a part of your favorite breakfast sandwich or wrap, or eaten on their own, with some bacon and avocado on the side!  This is an easy and protein-packed food to put on your shopping list and only costs $3.98 for 6 patties!

16. CauliPOWER Margherita Pizza

It can be difficult to find a store-bought, plant-based pizza option without it costing a small fortune. These delicious cauliflower-based, gluten-free pizzas have 30% less sugar than other leading pizza brands and only cost $6.48 for a personal pie.

17. LaCroix Sparkling Water

LaCroix sparkling water is a delicious alternative to high-sugar soda and a nice change of pace from plain water. With no calories, sugar or sodium, you can feel good about keeping this stocked in your fridge. LaCroix comes in an assortment of flavors and can also be great as a mixer with your favorite adult beverage. And you can’t beat the price of $11.99 for 24 cans.

18. Oscar Meyer P3 Chicken, Monterey, and Cashews Portable Protein Pack

This is an incredible option for those who are carb-conscious and looking to get in some protein, too. Each individually-sized pack comes with seasoned rotisserie chicken, cashew pieces and Monterey Jack cheese. It contains 12 grams of protein, making it very macro-friendly. If your children like it, this is a great and affordable option to bring to school at just $1.50 each.

19. Great Value Pasta Sauce

This sauce has a full serving of veggies and contains only 9 grams net of carb in each ½ cup serving. There are also other options, like Marinara sauce, that are even lower in carbohydrate and equally as delicious! This sauce is also gluten-free and contains no saturated or trans fat. It’s taste rivals that of its brand name competitors but its price of just $0.88 cents cannot be beaten!

20. Green Giant Riced Vegetables Cauliflower Risotto Medley

Green Giant used to just mean soggy string beans or corn niblets in a can. Now you have an assortment of vegetables turned into “rice” with a fraction of the calories and carbs. The Cauliflower Risotto Medley tastes rich and creamy but only has 20 calories and 4 grams carb per serving. This is a favorite of mine and is very affordable coming in at just $2.48 for a 10-oz bag.

Walmart is a one-stop-shop for many of us and saves us from running a ton of errands. Now, with Walmart offering all of these delicious and affordable options, we can save time and money while also looking after our own and our family’s health!

Have you found any delicious, healthy and affordable foods at Walmart? Share and comment below!

Source: diabetesdaily.com

Hypoglycemia Preparedness: How to Know Before You Go Low

This content originally appeared on diaTribe. Republished with permission.

By Lorena Bergstrom

A new awareness campaign helps people with diabetes recognize and plan for low blood sugar with emergency toolkits, discussion prompts, journaling, and a support network  

Low blood sugar can be a scary thing – it often sneaks up when people least expect it, quickly shifting from a minor annoyance to a potentially dangerous situation. In fact, a Canadian study found that people with diabetes (type 1 and type 2) experience severe hypoglycemia an average of 2.5 times each year. While type 2 diabetes typically presents a lower hypoglycemic risk than type 1, insulin and oral medications can still cause low blood sugar. However, you can take many steps to protect yourself.

We spoke with endocrinologist Dr. Gregory Dodell (with Mount Sinai in New York) and singer Crystal Bowersox about Lilly’s new Know Before the Low campaign, an important initiative to raise awareness about hypoglycemia. Bowersox and Dr. Dodell hope this program will empower people with diabetes to recognize signs of low blood sugar, start conversations with their peers, and prepare for emergencies before they happen.

Dodell

Image source: diaTribe

Know Before the Low offers information about managing hypoglycemia; it includes a chart of physical and cognitive symptoms, a tip list for emergency planning, and a guide for building a support network. Dr. Dodell said that unfortunately most diabetes literature focuses on controlling high blood sugar – even though low blood sugar can be more dangerous. He said that the campaign aims to address this information gap by “helping people and healthcare professionals talk about low blood sugar and prevent future episodes.”

To start, every person with diabetes should build an emergency toolkit, including:

  • Glucose tablets or sugary snacks
  • Glucagon – read about emergency nasal glucagon (Baqsimi) and ready-to-use autoinjector pens (Gvoke)
  • Glucose monitor (continuous glucose monitor or fingerstick blood glucose meter)
  • Emergency contact information

Bowersox makes her emergency pouch easily accessible to her friends and family: “My family, including my 11-year-old son, knows what to do if I have a hypoglycemic episode or emergency. I think it’s important for an individual’s entire support network to be aware of this.” Of course, it may seem inconvenient to carry around an entire toolkit when going out, but many of the new glucagons (like Gvoke and Baqsimi) are much more portable and easier to use than the glucagon previously available.

Keep in mind that for many people with diabetes, nighttime is both the most dangerous and the most common time to experience hypoglycemia. Dr. Dodell shared some useful advice: “If you see a downward trend before bed, you should eat a snack. It’s better to wake up high and correct during the day than have a low blood sugar episode overnight, which could cause many more complications and inconveniences. It’s also important for people with diabetes to know the triggers that can cause lows at night.” In short: check blood glucose before bed, play it safe, and know your risk factors. Additionally, daily routines have changed during COVID-19; you may be eating different foods, exercising more or less, and experiencing higher stress. All these factors may affect your blood sugar, especially at night.

Everyone’s body is different, but common risk factors for hypoglycemia include:

  • Exercise
  • Too much insulin
  • Fasting or low carbohydrate intake
  • Alcohol
  • Medications
  • Stress
  • Hormonal fluctuations
  • Illness

For a full list, check out Adam Brown and diaTribe’s 42 factors that affect blood glucose from his book Bright Spots & Landmines.

Hypoglycemia is different for everyone, so it is essential to be aware of your own body. Try to observe the symptoms you experience, and make note of potential triggers. Bowersox recommended keeping track of patterns: “Keeping a log or journal of things such as physical or emotional activity and comparing it to your blood sugar data could be a good way to see if there are trends that are causing you to go low. Ultimately, it’s important to share that information with your support network.” Know yourself – there are many factors that can lead to hypoglycemia, so it’s important to learn your own patterns of low blood sugar so that you can avoid these experiences.

KBTL

Image source: diaTribe

Perhaps the most critical part of Know Before the Low is its emphasis on connecting with your support network – family, friends, coworkers, teachers, and others. Bowersox said that she once had to ask her audience for candy to raise her blood sugar; fans were supportive and thanked her for raising awareness about diabetes. However, it can sometimes be difficult or uncomfortable to start conversations about diabetes and hypoglycemia with the people around us. Dr. Dodell explained that keeping the dialogue casual yet informative can be an opportunity to teach people something new: “You’re not putting a burden on them, but just explaining how diabetes affects your life. By broaching the topic casually, you can treat the conversation as more of a heads up than bestowing a responsibility. Just make sure to explain that you are carefully managing your diabetes, but there is a chance of an emergency. Not everyone has met someone with diabetes, but just explaining it and educating them can be a great preventive step.”

By sharing information about hypoglycemia signs, symptoms, and treatments, you can empower your peers to step in during an emergency. As Bowersox said, “Knowledge is power! When your network has information, they are empowered to help you, especially with low blood sugar. When I travel, my quality of life is improved by just educating and speaking up. Practice with your mirror, practice with your pet, but make sure your support network is there for you.”

As this project raises awareness of hypoglycemia, we hope it encourages people with diabetes, their healthcare professionals, and their support networks to engage in valuable discussions. As Dr. Dodell so perfectly concluded, “This campaign is one of the first to address the dangers of hypoglycemia. It is groundbreaking, and allows people to get needed resources. Diabetes experts and endocrinologists know that high blood sugar can sometimes be better than low blood sugar.”

For more information, read diaTribe’s article on hypoglycemia unawareness.

Source: diabetesdaily.com

REVIEW: Companion Medical’s InPen, A Smart Delivery System

Companion Medical’s smart insulin delivery, the InPen, is a reusable injector pen plus user-friendly mobile device which allows individuals to improve their diabetes management. I choose multiple daily injections (MDI) over a pump for various reasons, but I cannot deny that a pump allows for more precise calculations. With InPen, people on multiple daily injections can achieve the same accuracy plus so much more!

What Is It?

The InPen is a reusable injector pen that not only helps you calculate your doses but also keeps a log of insulin data for up to a year. The InPen connects, via Bluetooth, to the smartphone app, and keeps track of all your insulin deliveries.

InPen is now approved for all ages (7 and over, or under the supervision of an adult), who are insulin-dependent. The pen can deliver between .5 units to 30 units of insulin, dialed in half-unit increments. The pen is compatible with the Lily Humalog, Novo Nordisk Novolog and Fiasp U-100 3.0 ml insulin cartridges.

InPen is compatible with all Apple iOS devices that support iOS 10 or greater. It is also compatible with Android (more info about compatibility here).

What Does It Do?

I made sure to use this pen for about a month before writing my review. I am in awe of how easy this pen makes my management. Up to now, to be quite frank, I am guilty of a lot of “WAGS” (wild a** guesses) and then winding up too high or too low. I also really never kept tabs on when my last insulin dose was, so would find myself stacking quite often. Thanks to InPen, a lot of this carelessness has been eliminated. Here are all the amazing things it can do:

1. Insulin delivery information

The InPen connects to the app via Bluetooth which allows the app to store your insulin delivery information and shows you how much insulin you have taken and how much you have on board. There have been so many times when I would correct a high, not realizing I still had insulin on board, which led to episodes of hypoglycemia. As you can see here, your information appears in real time from your lock screen.

InPen Screenshot 1

Screenshot from Companion Medical

2. Built-in calculator

The InPen has a built-in calculator to help you get the most accurate dose possible. Your physician enters your settings, and it will give a recommendation on how much to dose. It takes into account your previous insulin delivery, your current blood sugar and the number of carbs you are eating. Since I have been using this feature, my blood sugars have improved greatly.

InPen Screenshot 2

Screenshot from Companion Medical

3. Reminders

It also has a reminder to take your long-lasting insulin. There have been so many times when I can’t remember if I took my Tresiba. I know this is a common problem for people on daily injections. This takes the burden off of the individual and has proven to be one of my favorite features.

InPen Screenshot 3

Photo credit: Companion Medical

4. Reports

The InPen generates reports that you can share with your healthcare team. These comprehensive reports will allow for easier decisions regarding changes to your diabetes management.

Screenshot from Companion Medical

5. Temperature alerts

The InPen comes complete with temperature alerts! It will notify you anytime your pen is in temperatures too hot or too cold which could make your insulin ineffective. This will come in handy during my next vacation or even if I leave my bag in the car for too long.

6. Syncing to Dexcom

InPen can sync up to the Dexcom continuous glucose monitor, via the Health app. This allows you to see your continuous glucose monitor graph on your logbook and reporting feature of the app.

Screenshot from Companion Medical

How Can I Get the InPen?

Many commercial insurance companies cover InPen, you can fill out this form and a representative will contact you about your copay. They also have a copay assistance program.  Commercially insured InPen customers will not have to pay more than $35 dollars a year which is a small price for better control.

Conclusion

I think InPen is a game-changer for anyone on multiple daily injections. With all of the capabilities the InPen offers, I can achieve better blood sugar numbers. I feel more in control of my diabetes because now I am confident that I am administering the right doses. I am also avoiding stacking insulin, which means fewer blood sugar roller coasters, and now I also have reminders to take my long-lasting insulin.

InPen can also help empower children to make better choices and manage their own diabetes. You can even sync two different pens if a child wanted to leave one pen at school and one at home.

Using InPen has helped me take back some control of my diabetes. It allows me to feel more in control and allows me to spend less time thinking about my condition. I can’t imagine going back to MDI without InPen in my toolbox and highly recommend this to anyone else who prefers injections over the pump.

Source: diabetesdaily.com

Healthiest and Most Efficient Ways to Treat a Low

Everyone who lives with diabetes has been there: you wake up low in the middle of the night, make your way (wobbly) to the kitchen, and completely overeat with sugary snacks, quickly sending your blood sugar onto an endless roller coaster ride of highs and lows. It feels terrible to then wake up the next morning with high blood sugar, and seemingly sends your day into diabetes chaos. So, how can you prevent that? Here are the healthiest and most efficient ways to treat a low blood sugar, without all the negative repercussions.

Time Is Your Friend

It’s generally recommended to treat a low blood sugar with 15 grams of fast-acting carbohydrates to start, and then to wait 15 minutes, retest your blood sugar, and treat again, if you’re still low. This, of course, depends on your individual circumstances (body weight, hormones, activity level, stress, etc.), so follow your doctor’s recommendations, but that’s the general rule of thumb.

What most people do, though, is to treat with 15 grams, and then keep on eating, because they still feel bad. But just like insulin, carbohydrates take some time to hit your bloodstream, so even if you’re still feeling low, you need to trust the process and wait until the sugar starts to work.

Don’t Overtreat with Sugar

The line between being low and being hungry is sometimes thin, and often one will conflate the other. If you’re low but also feeling the need to snack, try and pair your low treat with something higher in fat and protein: an apple (to treat the low) paired with peanut butter (to fix your hunger pangs) works nicely, and won’t send you into a rebound high. Cereal and milk is another nice pairing, or even cheese and a pear. Make sure to eat the fast-acting carbohydrate first, though, to adequately treat the low blood sugar, before enjoying a higher fat or protein snack thereafter.

Additionally, you may need to actually bolus to cover a snack after you’ve treated your low. Don’t forget to do this, as it’s crucial to preventing a rebound high!

Don’t Treat Lows with Foods You Love

Stopping the treatment of a low blood sugar at 15 grams of carbohydrates is a lot harder when it’s mint chocolate chip ice cream or a brownie sundae. If you’re having trouble with the overtreatment of lows, try to treat it as purely medical: eating only glucose tablets or some other form of fast-acting carbohydrate that you save solely for the treatment of hypoglycemia (and that you won’t be tempted to overtreat with!).

For me, coconut water and glucose gels are perfect for this. It’s measurable and not all that enjoyable to eat, and stopping at 15 grams of carbohydrates is very easy.

Apples, oranges, grapes, and bananas are all great low snacks. Photo credit: Adobe Stock

Eat Fresh and Use a Food Scale

If you’re trying to have a healthier low snack, try avoiding pre-packaged foods: crackers, granola bars and fruit snacks are all processed, and usually contain lots of preservatives, emulsifiers and fillers. Opting for something that doesn’t come prepackaged will be healthier in the long run: apples, oranges, grapes, and bananas are all great low snacks.

This can become tricky when tracking carbohydrates, though, so using a food scale to count the exact amount of carbohydrates you’re getting will be key to not overtreating. Apples, for example, can range anywhere from 15-50 grams of carbohydrate, so make sure you’re weighing your fresh produce! You can even do this ahead of time, and pack baggies of pre-cut and weighed fruit for a quick grab and go options for when you drop low.

Give Yourself Some Grace

At the end of the day, you are a human being trying to function as a vital organ 24 hours a day. It’s hard. You will have high and low blood sugars, and your treatment of them won’t always be perfect. You are allowed to make mistakes and missteps and second guess yourself while figuring your way out of a 50 mg/dL. And if that means eating a little too much of something not entirely healthy one time (or more often than not), it’s okay. Allow yourself some grace to figure out what management style will work best for you. You will make mistakes, so try and learn the best you can, and forgive yourself often.

What’s your favorite and most convenient low snack? What low treatment works best for you? Do you struggle with the “roller-coaster” after treating a low? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

1 2 3 9

Search

+