How Do We Measure Successful Diabetes Care?

This content originally appeared on diaTribe. Republished with permission.

By Arvind Sommi, Andrew Briskin

Quality measures are tools to evaluate the effectiveness and quality of healthcare. Measures such as A1C, blood pressure, and cholesterol are used to understand health at the population level to ensure people with diabetes are getting the best care possible. At The diaTribe Foundation, we believe that Time in Range would be a valuable addition to the quality measures for diabetes care.

During a routine office visit, your healthcare provider may check certain health measures such as your A1C, blood pressure, and cholesterol. These tests are primarily used to assess your individual health and the effectiveness of your diabetes treatment plan. They are also used to evaluate the overall quality of care provided when these results are combined across all patients in a healthcare professional’s office, healthcare system, or health plan.

Recent advances in glucose monitoring, and the increasing use of continuous glucose monitors (CGM), has led to wider use of the metric Time in Range (TIR), which is a helpful supplement to A1C in assessing your glucose management. Because of this, TIR could be a valuable addition to the quality measures for diabetes care if it became a more widespread metric – a feat that is challenged by barriers to accessing CGM and integrating it into electronic health records.

What is a quality measure?

Quality measures can encompass many things but generally include different types of measurement domains, as outlined below.

Diabetes care

Source: diaTribe

Some tests, such as A1C screening or blood pressure monitoring, can serve as both a healthcare process and an outcome measure.

At the population level, outcome measures evaluate whether certain established goals are reached for a group of people. For example, this might be the percentage of patients in a healthcare practice with an A1C greater than or less than 9.0%. Quality measures, in this way, are used by insurance providers, people with diabetes looking for the best healthcare professionals to use, researchers, employers, and reporting agencies to better understand the effectiveness of diabetes treatments and evaluate how effective healthcare professionals or health systems are.

How are quality measures used in diabetes care?

Quality measures are important in diabetes care because achieving these goals can decrease the risk of diabetes complications and lead to improved health outcomes for everyone. There are several quality measures in diabetes care, many of which you may be familiar with through routine office visits with your healthcare team, such as:

Primarily, the combined data from these tests across many people with diabetes is used to determine if certain treatment methods are effective for the entire population. The data can also be used to reinforce or dispute established standards of diabetes care and respond to new care innovations (such as the latest technology or treatments).

Along with their use in evaluating treatments and standards of care, quality measures can also be used to evaluate healthcare professionals. In some cases, healthcare provider reimbursements from Medicare or other insurance providers may be tied to results, particularly under a value-based care model (learn more about value-based care here). For example, A1C screenings might be reimbursed only if enough patients meet A1C targets below certain thresholds.

Why might including Time in Range in quality measures be helpful to you?

While A1C is the current quality measure used to assess glucose management in people with diabetes, A1C has limitations. The accuracy of A1C measurements can vary based on factors such as race/ethnicity or chronic kidney disease. A1C tests are also generally limited to every two to three months and only represent an average blood glucose level over that time, which means daily highs and lows are not explicitly captured. Additionally, while low blood sugar may lower your A1C, it can also increase your risk of severe hypoglycemia – meaning a lower A1C may be dangerous if you experience frequent low blood sugars or mild hypoglycemia.

Time in Range is a glucose metric typically measured by a CGM. It is the amount of time you spend in the target range – generally between 70 and 180 mg/dL. The goal for most people with diabetes is to have at least 70% of your glucose readings within this range. Understanding your TIR as well as your time above and below range can help you and your healthcare provider assess how your body responds to medications, food choices, daily activities, stress, and a variety of other factors that affect your glucose. The increased use of TIR could help equip people with diabetes and their healthcare team with the information they need to make vital healthcare decisions and experience better diabetes care.

Time in Range allows for quick, actionable steps to improve diabetes management and corresponding health outcomes,” said Dr. Diana Isaacs, a diabetes care and education specialist from the Cleveland Clinic. “Time in Range can be assessed more frequently and provides more actionable insight into glucose management. Making it a quality measure would increase the utilization of this powerful tool. It has the potential to revolutionize how we take care of people with diabetes.”

Increases in TIR have been associated with a reduced risk of microvascular complications such as eye (retinopathy) and nerve disease (neuropathy), with similar evidence emerging for other macrovascular complications such as heart disease. Plus, the use of CGM has increased dramatically over the last few years (for example in people with type 1 diabetes in the T1D Exchange registry, this number rose from 6% in 2011 to 38% in 2018), allowing more people with diabetes to use TIR data on a regular basis.

However, there are still barriers to integrating TIR as a quality measure for diabetes care. One major challenge is the many barriers to using a CGM. For instance, most insurers cover CGM only for a limited number of people with diabetes (for example, those with type 1 diabetes who take insulin). Until access is substantially expanded and more people are able to use CGM who wish to, TIR adoption into the standard quality measures will be difficult.

An additional challenge is that TIR data is not integrated into most electronic health records (EHR) used by clinicians, making it difficult for providers to analyze TIR data for all patients and to assess TIR at the community level. Efforts are currently underway to change these systems so that TIR can be integrated into her systems, similar to metrics like A1C and blood pressure; at the ADA Scientific Sessions this year Dr. Amy Criego spoke to the success that the International Diabetes Center in Minnesota has had with integrating Abbott LibreView data into their EHR.

Through the efforts of the Time in Range Coalition, diaTribe is working to increase awareness and hopefully the eventual adoption of TIR as a meaningful quality measure in diabetes care.

Source: diabetesdaily.com

Hitting a Nerve: Introduction to Neuropathy

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

What is neuropathy? And more specifically, what is diabetic neuropathy? What are the symptoms and how can you prevent and treat neuropathy?

When someone hears about the long-term complications of diabetes, problems with the feet, foot ulcers, and even amputations are often brought up and can be some of the scariest outcomes. What leads to these issues is something called neuropathy, or damage to the nerves.

But neuropathy, and those subsequent complications, aren’t by any means a given – and prevention is possible. What is neuropathy and what can you do to avoid it entirely, or minimize it so that you can keep your feet, and the rest of your body, as healthy as possible?

What is the difference between neuropathy and diabetic neuropathy?

Neuropathy is the term used to describe any damage to nerves in the body (for example, an injury from a car accident can damage the nerves). Diabetic neuropathy, or diabetes-related neuropathy, is the term used to specifically describe the nerve damage from high glucose levels (hyperglycemia) over the long term.

Diabetes can cause three main types of neuropathies: peripheral neuropathy (medically referred to as distal symmetric sensorimotor polyneuropathy), autonomic neuropathy, and focal neuropathy.

Peripheral neuropathy affects the nerves outside of the brain and spinal cord, and often leads to symptoms involving the hands and feet. “This is what most people associate with diabetes-related neuropathy,” said Chris Memering, a nurse and inpatient diabetes care and education specialist at CarolinaEast Health System in New Bern, North Carolina.

Peripheral neuropathy involving the feet is the most common form of diabetic neuropathy. Loss of function in particular nerve fibers can change sensation and reduce strength in the foot. Loss of sensation can lead to injury from shoes that don’t fit, stepping on sharp objects you can’t feel, or not knowing the sidewalk is too hot. Neuropathy can also lead to pain, burning or other unpleasant sensations which may respond to medication.

But diabetes isn’t the only condition that can cause peripheral neuropathy. Other conditions that can lead to peripheral neuropathy include heavy alcohol consumption, trauma, nerve entrapment (such as that which occurs in carpal tunnel syndrome), vitamin B deficiency, chemotherapy, and an autoimmune process that attacks the nerves.

Neuropathy can also affect the functioning of the autonomic nervous system (which controls things like blood pressure, heart rate, digestion, and bowel and bladder function). This is called autonomic neuropathy. Autonomic neuropathy can lead to a variety of complications.

“In diabetes care, many people are familiar with hypoglycemia unawareness, erectile dysfunction or female sexual dysfunction, gastroparesis [when the stomach can’t empty properly and digestion slows], neurogenic bladder [when the nerves that tell your brain to tighten or release the bladder muscles don’t operate properly], or orthostatic blood pressure changes [dropping blood pressure when you stand up],” Memering said, adding that all these could be a result of neuropathy.

Finally, focal neuropathy results from issues with one or more nerve roots and usually happens suddenly. Focal neuropathies often involve both motor functioning – such as weakness – and sensory deficits, which can cause discomfort and pain.

What causes neuropathy?

Chronic hyperglycemia can damage both small and large nerve fibers. Over time, elevated glucose levels, often made worse by high triglycerides (a type of fat that can be found in the blood) and associated with inflammation (the body’s natural way of fighting infection) can cause damage to the nerves. That damage disrupts the way nerves interpret sensory information and how the messages about sensation are transmitted to the brain.

Usually, nerve damage from high blood sugar levels happens in the long nerves first (which run from your spine down to your toes), which is why the symptoms of peripheral neuropathy occur first in the feet. “The length of time someone has lived with diabetes increases their risk of developing neuropathies, as does that person’s level of blood glucose, in terms of A1C, Time in Range, and glucose variability,” Memering explained.

In essence, higher glucose levels over time increases your risk for developing neuropathy. This was confirmed by the famous Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications study (EDIC). The studies showed that the prevalence of confirmed peripheral neuropathy was 64% lower among participants in the intensive management group (those who managed their blood glucose carefully with treatment and kept their levels as close to normal as possible).

What does neuropathy feel like?

Symptoms of neuropathy usually start in the toes and progress upward. The sensations experienced with peripheral neuropathy differ from person to person. Some describe the feelings they have as numbness or tingling, while others say it feels like burning. Some say they are sensitive to being touched and cannot bear the feeling of a sheet or blanket covering their feet, while others describe it as feeling like they are always wearing a sock or a glove.

“Ultimately, you could end up losing protective sensation – which can be very dangerous and puts you at risk of not realizing when a part of your body is hurting or being injured,” Memering said. “While you may be able to still feel pressure – you know you are stepping on the ground with your foot – you may not be able to feel pain if you step on something sharp or hot.” This means you might not withdraw your foot from the unsafe environment, harming it further, and without realizing the extent of the damage.

The biggest concern about peripheral neuropathy involving the feet is that the loss of normal pain sensation can lead to greater skin and tissue damage. “Injury can result in the formation of a foot ulcer, which, if infected, can progress to ongoing tissue damage that can lead to amputation,” said Dr. Robert Gabbay, the chief scientific and medical officer for the American Diabetes Association. That’s why it’s so important to prevent, recognize, and treat any symptoms of neuropathy.

How is neuropathy diagnosed?

To assess for neuropathy, your healthcare team should do a thorough examination of your feet looking for sores or ulcers, changes in skin color, diminished pulses and any abnormality or injury to your foot. They can test for diminished strength, a change in your ability to know the position of your toes, and a change in sensation or sensory perception.

A foot exam will always involve taking off your socks and shoes, and your healthcare professional will inspect your feet to check for color changes, pulses, open areas, redness, rashes, and the overall condition of your feet, said Dr. Cecilia C. Low Wang, a professor of endocrinology, diabetes, and metabolism at the University of Colorado Anschultz School of Medicine.

A monofilament test uses a soft fiber to test for sensation in various parts of the feet and body, and a tuning fork can also help healthcare professionals understand how much sensation a person has lost. The monofilament test, as well as a pinprick test, can check to make sure you have good sensation, while other tests will evaluate vibration and position sense (whether you are aware of where your foot is). “The main question I would suggest asking your diabetes provider is whether they notice anything concerning about your foot exam, and whether they think you need to do anything different, or see an additional specialist, such as a podiatrist,” said Dr. Low Wang.

In this age of telehealth visits, some podiatrists have been sending a monofilament (a small strand of nylon attached to a piece of plastic) to a person’s home and teaching them how to use it to determine if they have reduced sensation in different areas of the feet. Podiatrists might even examine a person’s foot onscreen during a video visit and ask questions about how the foot feels or looks. “If there’s something of concern, they will schedule an in-person visit,” added Memering.

If someone is experiencing symptoms of autonomic neuropathy, a healthcare professional may recommend a specific test depending on what the autonomic symptoms are. For example, if there are issues with blood pressure control, taking your blood pressure as you change positions from lying to sitting to standing or using a formal tilt-table test, may show loss of autonomic control of how your body regulates your blood pressure. If you have symptoms of delayed gastric-emptying (stomach-emptying), specialized radiology tests might be ordered that show the time it takes for food to exit the stomach. The Mayo Clinic has an informative list about many of these tests. If you have any symptoms of autonomic neuropathy, such as bladder or erectile dysfunction, feeling faint on standing up, or bloating and fullness, talk to your healthcare professional and explain what you are experiencing.

What are the best treatment options for neuropathy, especially in the hands and feet?

Although it is not always possible to prevent neuropathy completely, the best way to slow its progression (as shown in the DCCT) is to closely manage your blood sugar levels and try to stay in range as much of the time as possible. If neuropathy does develop, medications can decrease the burning and tingling sensations, said Dr. Gabbay.

“Diabetes is a leading cause of neuropathy, and the higher someone’s blood sugar levels are over time, the more likely they are to develop neuropathy,” Dr. Gabbay said. “The good news is by managing blood sugar levels, one can significantly reduce their risk of developing neuropathy.”

With painful neuropathy, “treatments are generally to try to manage symptoms,” Memering said. “Medications such as Neurontin [gabapentin, a drug used for pain and seizures], Lyrica [pregabalin, a drug used for pain and seizures], or Cymbalta [duloxetine, a drug used for chemical balance in the brain] may be used to help with pain associated with painful peripheral neuropathies. These medications can be very effective, but it may take a few weeks to adjust and find the right dose. However, people should know that the medications can also be somewhat sedating.” Other drugs that may be effective include drugs used for mood disorders such as venlafaxine, nortriptyline, or amitriptyline, said Dr. Low Wang, but they may have side effects at higher doses and with older age.

Dr. Gabbay added that neuropathy “is a very active area of research to identify new and effective treatments.”

There are also various treatments to help improve the symptoms of autonomic neuropathy:

  • For Postural Blood Pressure Changes:
    • If you have a significant decrease in your blood pressure on standing, your healthcare professional can teach you how to get up slowly to allow your body to regulate your blood pressure with positional change.
    • You can also wear an abdominal binder, which Memering described as “a big elastic girdle that puts more pressure on the big blood vessels in the body,” so that they have more support when changing positions.
    • Other treatments include adjusting salt intake, using compression stockings, doing physical activity to avoid deconditioning, and staying hydrated, said Dr. Low Wang.
  • For Neurogenic Bladder:
    • If you are experiencing a neurogenic bladder, urinating at regular intervals during the day and night can help the bladder empty even if you no longer feel the urge to urinate. You might also undergo a urinalysis or a bladder scan, said Dr. Low Wang. Medications can also help.
  • For Gastroparesis:
    • Eating low-fiber, low-fat foods in smaller and more frequent meals and getting a greater proportion of calories from liquids might help, said Dr. Low Wang.
    • Sometimes the drug metoclopramide (Reglan) may be prescribed and gastric electrical stimulation might be used in severe cases.
  • For Erectile Dysfunction:
    • You may be prescribed one of the medications – sildenafil, tadalafil, avanafil, or vandenafil – but you may also need to undergo a physical exam, or other tests.

If you are experiencing any of the symptoms of neuropathy, you should speak with your healthcare professional to determine what diagnostic tests need to be done and what treatment course might be best for you.

Can you reverse diabetic neuropathy?

Currently, neuropathy can’t be reversed, but its progression may be slowed. Keeping blood sugar levels in the recommended targets is the key to doing so, Memering said. “The use of diabetes technology may be very helpful – especially continuous glucose monitors – for keeping your blood sugar in range, along with eating a varied diet, including vegetables and fruits, and exercising regularly,” she said.

Tips for living with diabetes and neuropathy

The two best things someone with diabetic neuropathy can do are to:

  1. Manage their blood sugar levels to keep the neuropathy from getting worse.
  2. Check their feet regularly, both at home and during healthcare appointments.

Check your feet at home

Dr. Gabbay, Dr. Low Wang, and Memering each recommended that all people with diabetes, whether young or old, newly diagnosed or not, should regularly check their feet. Dr. Gabbay advised, “Use a mirror to see the bottoms of the feet and make sure there are no cuts or ulcerations” that would need immediate attention to ensure they don’t worsen. If need be, ask someone in your household to help you inspect your feet.
To help avoid foot injury, Dr. Low Wang recommended: “Always wear socks and well-fitting shoes, avoid going barefoot, and look at shoes before putting them on to be sure there is nothing in them.”

No matter where you are in your diabetes journey, daily foot checks “partly establish the habit before there are any problems, but are also a way to get to know your body so you can understand what is normal for you and what is not,” Memering said. “That way, when there is a change, you can all your healthcare office right away. Don’t wait until your next appointment ­ – call,” she said, adding that they should be able to tell you if you need to make an appointment right away.

Remember, as with many complications of diabetes, for neuropathy prevention is key! To learn more, view or download our infographic on preventing neuropathy.

About Cheryl

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

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

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

Source: diabetesdaily.com

Most Important Vitamins People with Diabetes Need

People with diabetes have special dietary requirements, but unfortunately, lots of important vitamins and minerals are lacking in the standard American diet. That’s where vitamins can play a crucial role in supplementing one’s health. This article will outline the most important vitamins that people with diabetes need to live their healthiest life.

Vitamin B12

People with diabetes with nerve damage in their hands and feet may see their symptoms worsen if they have a vitamin B12 deficiency. Vitamin B12 helps improve the health of red blood cells and boosts brain function.

Studies show that long-term use of the diabetes drug Metformin can lead to a vitamin B12 deficiency, and strong sources of the vitamin can be found in fish, dairy milk, meat products, and eggs. There are also vegan and vegetarian forms of Vitamin B12 that can be taken orally in pill form.

Vitamin D

Vitamin D deficiencies are common in people with both type 1 and type 2 diabetes, and a recent study out of Denmark has shown that people with diabetes who have a Vitamin D deficiency are at an increased risk of diabetes complications and premature death. Solving for this vitamin is cheap and easy: sitting in the sun for 15-20 minutes per day without sunscreen will restore most deficiencies, or Vitamin D can be found in fish, dairy products, or egg yolks.

Vitamin C

Increasing one’s intake of Vitamin C helps control the levels of sorbitol in the blood, which can be harmful at high levels and may contribute to retinopathy and kidney damage, which are common complications of diabetes. Vitamin C can also increase insulin sensitivity, reduce insulin resistance, and help people improve their HbA1c levels.

Vitamin C is found in many fruits (and juices) such as lemons, oranges, tomatoes, guava, watermelon, and strawberries, and is also readily available in supplement form. It is also abundant in vegetables like cauliflower, Brussels sprouts, broccoli, and peppers.

Chromium

Studies show that chromium, found in brewer’s yeast, improves insulin sensitivity and tolerance in people with type 2 diabetes. Chromium helps maintain healthy skin, hair, and eyes. It is effective at supporting the nervous system and enhancing immune system function. Chromium can be found only in trace amounts in foods like meat, spices, and grains, so people with diabetes should take chromium supplements.

Curcumin

A 2013 meta-analysis shows that curcumin (the active ingredient in turmeric) lowers blood glucose levels, increases insulin sensitivity, and stabilizes blood sugar levels, helping to decrease the likelihood of complications in people with diabetes. Researchers also found that curcumin may play a role in diabetes prevention.

Turmeric and curcumin also help improve mood, which is important for people with diabetes as depression and anxiety are found at much higher rates in this population, aid in digestion, and even improve immune system health.

This extract can be found in over-the-counter supplements and can be added to foods in its natural form (Turmeric), found in the spice aisle of any grocery store. Make sure to consume turmeric with black pepper, as the spice enhances curcumin absorption in the body by up to 2,000%, maximizing its benefits.

Always work with your doctor and/or registered dietitian to determine which vitamins you should incorporate into your daily routine. Your doctor will most likely order a blood test or urine sample to determine what’s needed, but supplementing your diet with more vitamins and minerals can be helpful to achieve better blood sugars and lower HbA1c levels in the short term, and may even prevent long-term diabetes complications and premature death.

Source: diabetesdaily.com

Managing My Anxiety of Possible Retinopathy

I remember feeling anxious. Sitting in the waiting room of the eye doctor in March of 2019, I knew this sensation all too well. It came from my experience of receiving “bad news” one too many times. I was nervous but quietly tried to connect with the inner knowing that I was not the only person who has to go through these types of feelings. With a deep breath in and a long breath out, I thought of my friends within the diabetes community who constantly remind me that I’m never alone.

When you live with diabetes, it often feels like you’re just waiting for that next thing to go wrong. We try to be positive but at the end of the day we’re still human and being scared of the unknown is normal. Even people without diabetes typically know the risks associated with trying to manage blood sugars without a properly functioning pancreas and/or metabolism. Heart disease, nerve damage, kidney failure, and blindness are issues people with diabetes may live in fear of since day one of their diagnosis.

Deep down, I knew something was off. My vision had changed enough that I had a sneaky suspicion this time would bring that moment where I would be told that there were now signs of diabetes in my eyes. And I was right.

The doctor informed me that I had retinal bleeds in both my eyes but that “I didn’t need to worry” and they wouldn’t need to treat it just yet. She even kindly offered to check them again in 6 months time if that might make me feel better. It did… and at the same time, it didn’t. I suddenly felt sick to my stomach. Thoughts of friends who have gone through so much with their eyes raced through my mind. Would I have to experience all of that, too?

Photo credit: Sarah Macleod

I started to cry and felt the same sadness wash over me that I had felt in 2012 after being diagnosed with gastroparesis. The guilt and shame I had been working through for years knocked on the door to my heart but I knew that the only way through this moment was to face this new information with acceptance and an attitude that I wasn’t powerless.

I had been taking a pump break while in yoga teacher training and had decided to continue on injections after I had graduated from the program. However, upon being diagnosed with retinopathy, I made the decision to switch back to my insulin pump once again. Everyone is different, but for me, having an insulin pump is a privilege and asset I couldn’t ignore. I knew that utilizing the technology available to me would be in my best interest.

When it came time for my next appointment, the world had already been impacted by COVID-19 and I wasn’t able to get my eyes checked when I had anticipated. I did my best not to let the fear creep in, but working from home and being on screens more than ever before didn’t do much to quell my anxious mind. Yet I knew I had to keep going.

For months, I tried to find a balance between discipline and letting go of what I simply could not control. I stayed connected with the diabetes community and my peers who understood what it was like to be managing diabetes daily while also navigating additional complications, illnesses, and issues. Utilizing tools like emotional freedom technique, guided meditation, and yoga continued to be a way I could serve myself while remaining focused on the balance I wanted to achieve.

I can’t tell you how many tears I cried. The worry would consume me most when I thought of a potential future pregnancy, breastfeeding, and motherhood. I wanted to see the children of my dreams and soak in every freckle on their face, their tiny fingers, and little toes. I wanted to see my children grow and watch them become who they were meant to be. If I lost my vision, how could any of these dreams come true? I found acceptance in knowing that I was willing to do whatever it took to preserve my vision even if that meant facing treatment options that terrified me.

It took me so long to make that next eye doctor’s appointment. Yet I knew in 2021 I wanted to address any of the issues I had been avoiding because of the fears that still existed within. The night before my appointment, I joined a meditation session with my diabetes friends and appreciated the energy, loving-kindness, and support that our “diabetesangha” was offering to me. It allowed me to relax, be present with how I was feeling, and honor any emotion that was coming to the surface to be acknowledged and released.

Sitting in that chair again, eyes dilated and heart open, I felt hopeful that I may be given the news that nothing had changed and to just keep working towards optimal glycemic control. However, the news I received was even better than I had anticipated. The doctor told me she could no longer see any signs of diabetes in my eyes. The retinal bleeds were gone and I was doing just fine. I was overjoyed and elated at the knowledge that I had reversed my diabetic retinopathy.

Each one of us living with diabetes is different. Despite ardent efforts and steadfast diligence, we don’t always receive positive news or the outcomes we are most hopeful for. Yet it is important to recognize that we must not give up even when we’re given bad news. There are avenues of support as well as resources and recommendations from peers and professionals that can offer us a sense of empowerment. If you are struggling with diabetes complications, remember that you are never alone and that there are people who understand what you’re going through. Don’t lose hope and keep in mind that there are many paths to healing ourselves body, mind, and spirit.

Source: diabetesdaily.com

Advice for Parents From Adults Who Grew Up as a Type 1

I am very grateful to have been diagnosed with type 1 diabetes at the age of 37. I think of all the times where having type 1 would have been challenging growing up. Navigating diabetes and childhood and adolescence isn’t easy but with love and support, anyone growing up with type 1 diabetes can thrive!

Oftentimes there are discussions within the diabetes online community that help others on how to navigate their role in this disease. Whether they are the person living with diabetes or a “type 3”, which is a loved one or caregiver, many people seek advice from others who have lived through it. A common post you will find is a dedicated parent asking for help from those who are now adults but have lived with this condition almost their entire lives. Being a parent of a child with type 1 is tricky, to say the least. You want to give them independence but you also worry and it is a tough balancing act.

We decided to ask our community of people with type 1 who have lived with it since childhood, “What do you appreciate most about how your parents dealt with your disease and what do you wish they did differently?”

Let’s be clear. This isn’t to fault or finger-point at parents who have a challenging role, as not only a parent, but a pancreas too. This information is solely to serve our community with insights and observations that can help them play a positive and supportive role in their child’s journey.

Photo credit: Adobe Stock

Here is what people who have lived with diabetes since childhood had to say:

“I cannot tell you how vital my parents were. They made this normal. They changed everything they were doing in an instant. If they questioned anything they never did it in front of me. They supported me and they encouraged me. They taught me to look at this as an opportunity to educate others because I was diagnosed in 1980 and we knew no one at the time. They taught me resilience and self-esteem in handling this disease. They let me know I could do anything. When I wanted to go to college far away, they didn’t discourage me. They never held me back. And this goes for every aspect of my life, not just this. I miss them both every day because they were my biggest fans and I knew it and still do.” – Sarah G.

“My parents didn’t hover. They basically let me control it with support and help. They guided me, we talked about it frequently, but they didn’t control it…I was diagnosed at 8. They never told me I couldn’t stay at a friend’s house and never treated me differently. I was able to do everything a normal kid would do.” – Andrea H.

“Encourage self-reliance. This is normal, We are normal. I am always in awe of you parents. You are amazing.” – Sarah G.

“I was diagnosed at 15 and felt capable of managing it. They didn’t bother me yet encouraged and helped in any way I needed. What I wish I knew was about low-carb and not just follow mainstream medicine. But hey, I’m not sure how open to that I would have been as a teenager so who knows”. – Shaina R.

“They bought me a pony, which I took full care of and showed them. I was up at 5 am and didn’t stop to the sun went down. Oh yes, I had diabetes. OK, I will handle that too.” – Laura W.

“I like the idea of making it into a science experiment. Obviously, it all depends on the child and parent and other considerations but an approach of “thinking out loud” is a good thing.” – Halvdan W.

“Back in 1971 when I was 16, I imagine that a doctor told my parents I was old enough to handle it by myself. They never told me that but they didn’t even learn how to give shots or test my urine! But back then, one shot a day and testing urine weren’t that big of a deal. I’m glad they did it that way. I just figured it out on my own and I’m better for it. Now I’m healthy at 66 and happy!” – Aimee P.

“I’m glad they made me take responsibility right away.”- Kelly L.

“Unwavering support. Crazy over the top, unwavering support and agreeing with me anytime I screamed, cried, cursed about how messed up it was that I had diabetes. She was also on the front foot regarding low-carb and would fight any doctor or anyone who spoke to me in a way that was condescending, rude, dismissive, etc. Just knowing she was there and that I could ask for help means so much to me and it’s helped me feel empowered to run my own race and do what is in my best interest.” – Gemma B.

“I wish they were involved. I was 9 when I was diagnosed and I felt really alone. Ask my mother about insulin and she will say she doesn’t know a thing about it. Plus she always told me I couldn’t have kids cause I have diabetes. Another lie, I met many type 1 ladies having 2-4 kids. Just focus on the positivity! As parents get involved and show you care! Communicate with your kids on their food choices, what activities they plan, double check they have everything, It’s great to get involved as a team.” – G.C.

“I wish they would have tightened up my diet a bit by feeding me fewer carbs but the dieticians and endos in the 90s told them I needed x amount per meal or I would die so they did what they thought they had to do. Eventually, they stopped listening though. All in all, they did a great job.” – C.S.

“All I can say is I wish they had found Dr. Bernstein and his methods. There is a lot I wish, but that is the biggest one!” – R.M.

“I liked that they sent me to a diabetes camp. That’s where I learned how to take of myself.” – Sally C.

“I’m grateful they let me be in charge and stay independent instead of micro-managing. I wish they had been more willing to learn about better control and nutrition. Although few doctors I’ve ever had were much help there so my parents were just going along with what they were told. I learned how to get better control in my late 20s through my own research and worry about the long-term damage that’s already been done. I’m now trying to help my parents take better care of their own health problems through nutrition and a healthier lifestyle.” – Melissa S.

“Even though I couldn’t see it then, my mom gave me the space I needed as a teenager to make mistakes and learn. She must have been so anxious by my behavior and I feel bad for that. But she supported me and set me up with everything I needed to become successful as an adult. She cheers me on now and I hope she knows I’m only doing so well because of her.” – Kelsey S.

“I was 12 when I was diagnosed and my parents did what they were told– just dose for the high-carb meals. Well, here I am at 30 years old with diabetic retinopathy that caused swelling when I was pregnant and I had to get injections and lasers in my eye which was super painful. I also have peripheral neuropathy so that is fun too. I eat low-carb/keto now to avoid spikes the best I can.” – A.R.

“They did a great job at encouraging me to embrace being diabetic, without it being something I needed to hide or feel quiet/embarrassed about. My mom brought a lot of enthusiasm into my diabetes management. Diabetes just became to me this interesting fun tidbit I could share with others and never saw it as something that reduced my value as a person. However, they did not make mental health support a priority, not giving me viable options which I needed as I had a severe needle phobia. It took me about 6 years after diagnosis to do my first injection, with upwards of 10 hours each week since diagnosis working on forcing myself to give a shot before I succeeded. And it wasn’t until 4-5 years after that, before it became “no big deal to me” It scares me to think I could have become on of those young diabetics that rarely take insulin because they wouldn’t acknowledge how serious my phobia was.” – A.A.

“I always felt empowered to manage this disease on my own from an early age. They never pushed but followed my cues and let me take over when I was ready. They did a great balancing act and I look at all the parents now in our community and my hats go off to you. You are all doing an incredible job.” – Matt. F.

“I felt like my disease wasn’t spoken about in front of others. It bothered me since it still always existed even in those moments. It gave me a huge complex about my disease and led me to many social issues down the road since I felt ashamed. I recommend talking freely about your child’s condition and never make them feel like they should hide it! They will have a much healthier outlook on their disease and that will translate to many other aspects of their life.” – V.V.

“Stay positive! Be there to listen! Educate yourselves and never settle for a doctor that you aren’t absolutely thrilled with. Find a doctor that both you and your child feel comfortable with. It may take time but it will be worth the wait for a much better experience for you both.” – Nicole M.

I hope the advice from members of our community helps you navigate your role as a parent of a type 1 child. Remember, every child is different and every situation is unique. Communicate with your child and do what works best for you, your child and your family.

Did you grow up living with type 1 diabetes? Do you have any advice to give parents raising a  child living with type 1 diabetes? Please share and comment below!

Source: diabetesdaily.com

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

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

Celiac Disease: What You Need to Know

Celiac disease is an autoimmune condition that affects nearly 8% of all people living with diabetes and only 1% of the general population. Celiac presents as an immune response to eating gluten, which is a protein found in wheat, barley, and rye products, which can cause inflammation of the gut.

Type 1 diabetes and celiac disease are often diagnosed together, both being autoimmune conditions. This article will explain what celiac disease is, what are the common symptoms, how to treat it, and strategies for living with this condition if you have diabetes.

What Exactly Is Celiac Disease?

Celiac disease is a common autoimmune disease in the United States, with more than 200,000 new diagnoses per year. In people who develop celiac disease, their immune system responds to the protein gluten, creating inflammation that can damage the lining of the small intestines over time. If left untreated, it can cause serious medical complications such as chronic diarrhea, malnutrition, anemia, weight loss, ulcers, and bowel cancer.

What Are the Symptoms of Celiac Disease?

The most common symptoms of celiac disease include:

  • Diarrhea
  • Bloating
  • Fatigue
  • Foul-smelling stool
  • Weight loss
  • Stomach pain
  • Vomiting
  • Nausea

Many adults with celiac disease present with symptoms completely unrelated to the GI tract, including:

  • Anemia
  • Osteoporosis
  • Skin rashes
  • Headache
  • Extreme fatigue
  • Mouth ulcers
  • Joint pain

Even worse, some patients have no symptoms at all, so if you are at heightened risk for celiac disease, be sure to get checked regularly to catch it early to prevent negative health outcomes later on down the line.

How Is It Diagnosed?

According to the Mayo Clinic, celiac disease is diagnosed by two blood tests. Doctors will use serology testing to detect elevated levels of antibodies in the blood. If detected, this indicates an immune response to gluten, and thus a diagnosis of celiac disease is made. Additionally, genetic testing for leukocyte antigens (HLA-DQ2 & HLA-DQ8) can be used to rule out celiac disease in patients. If you have symptoms of celiac disease or suspect that you have the condition, talk with your doctor about getting these blood tests.

What Is the Connection Between Diabetes and Celiac Disease?

Since type 1 diabetes and celiac are both autoimmune diseases, developing one condition increases the likelihood of developing the other condition. There is no link between developing type 2 diabetes and celiac disease. Nearly 8% of people with type 1 diabetes also have celiac disease, which is 8 times higher than the general population of 1%.

Since the prevalence is so high, it is helpful that people with both type 1 diabetes or celiac disease are regularly tested for the other condition. Undiagnosed celiac disease in people with type 1 diabetes can cause unstable blood sugar levels, and damage absorption of nutrients in foods necessary to manage diabetes.

What Causes Celiac Disease?

Like type 1 diabetes, the exact cause of celiac disease is unknown. It is a combination of genetics and environmental triggers such as infant-feeding practices (bottle versus breastfed), gastrointestinal infections, and the health of one’s microbiome may contribute as well. Other environmental triggers such as surgery, blunt trauma, pregnancy, childbirth, stress, or infections can also cause celiac disease.

What Are the Risk Factors for Celiac Disease?

Risk factors for celiac disease include:

  • Type 1 diabetes
  • Family history of celiac disease
  • Having either the HLA-DQ2 or HLA-DQ8 gene
  • Down syndrome or Turner syndrome
  • Hashimoto disease
  • Colitis
  • Addison’s disease

Photo credit: iStock

How Do You Treat Celiac Disease?

There is no cure for celiac disease, but by following a strict gluten-free diet, you can live a long and healthy life with the condition. Work with your doctor to find an eating plan that will work for you.

A recent study found a small but significantly increased risk of death in people with celiac disease, with mortality at the highest risk for those diagnosed between 18 and 39 years old. The study revealed that the risk of death was increased in the first year after diagnosis, but persisted even ten years later.

The increased risk of death for people with celiac disease is associated with complications from chronic inflammation, such as heart disease, cancer, and respiratory disease.

Managing Celiac Disease With Type 1 Diabetes

Managing celiac disease with type 1 diabetes will take more discipline, intention, and structure to what and how you eat. While a double diagnosis of celiac disease and type 1 diabetes is not something that anyone wants, people who already live with type 1 diabetes are somewhat advantageous when they receive a celiac disease diagnosis.

People living with diabetes are already used to closely monitoring what and how they eat, and are more likely to already follow a lower-carbohydrate diet, usually with fewer grains, and thus gluten. More than ever before, grocery stores and restaurants are offering gluten-free options, with everything from cereal to bread to waffles to lasagna being accessible for people with celiac disease. Check out our top recommendations for gluten-free and diabetes-friendly snacks.

Work with your doctor and nutritionist to find an eating plan that will work for both your celiac disease and type 1 diabetes to ensure that you’re getting all of the vitamins, minerals, and nutrients you require to thrive. As you assimilate to a gluten-free lifestyle, make sure to keep a close watch on your blood sugars, as malabsorption issues may have been having an altering effect on your levels. Note any differences, and talk about them with your doctor and care team.

Complications of Celiac Disease

You can live a long, normal life with celiac disease, but it will take some lifestyle adjustments. If left untreated, celiac disease can contribute to the following complications:

  • Osteoporosis, due to malabsorption of key nutrients such as calcium and vitamin D
  • Malnutrition, leading to anemia and weight loss. This can also stunt or slow growth
  • Infertility and miscarriage
  • Lactose intolerance, from a damaged small intestine; once you’ve been eating a gluten-free diet for 6 months to a year, the healed small intestine should help with the digestion of dairy once again
  • Cancer, including intestinal lymphoma and small bowel cancer
  • Nervous system problems, such as seizures and peripheral neuropathy

While it’s a serious and incurable condition, celiac disease doesn’t have to greatly affect your life. Work with your doctor and care team to adjust to a strict, gluten-free diet, and you can live a long, healthy life with celiac. If you have signs or symptoms of celiac disease and are at heightened risk for developing it, contact your doctor to get tested right away.

Source: diabetesdaily.com

Marijuana as a Treatment for Neuropathy: Emerging Evidence

Marijuana, or cannabis, has a long history of human use. Although it remains federally illegal, many states have opened the door to medical, and even recreational use legislation. Notably, more and more research studies are being conducted on the medicinal properties of cannabis, and a growing body of evidence now supports the relevance and efficacy of this plant and its compounds in the treatment of various health conditions.

Here, I focus on a common diabetes complication, peripheral neuropathy, and the emerging scientific evidence for the use of marijuana to reduce pain associated with this condition. If you want to learn more about marijuana and diabetes in general, please check out our recently updated and comprehensive resource:

Marijuana and Diabetes: What You Need to Know

What is Neuropathy?

Over time, high blood glucose levels can damage blood vessels and affect nerve function. A common complication of long-standing diabetes, especially for those who have chronically high blood glucose levels, is neuropathy. Neuropathy occurs due to nerve damage from high blood glucose levels and patients often experience numbness, tingling, and pain (most often occurring in the legs and feet).

Common treatment strategies include optimizing glycemic management to help prevent disease progression, as well as pain management with medications like Lyrica (pregabalin), Neurontin (gabapentin), and sometimes with certain antidepressants.

Research Shows Cannabis Is a Promising Treatment

Recent research points to the potential benefits of cannabis for the treatment of peripheral neuropathy pain. According to Way of Leaf, nine states – Arkansas, Connecticut, Missouri, Montana, New Mexico, New York, North Dakota, Pennsylvania, and West Virginia – already list neuropathies as a “qualifying condition” for medical marijuana use.

Experts say that there is now “substantial evidence” that cannabis is effective in treating chronic pain. So far, at least three studies have evaluated the efficacy in the treatment of diabetic peripheral neuropathy.

For example, one preliminary randomized clinical trial conducted in 2015 identified a “dose-dependent reduction in diabetic peripheral neuropathy pain” in patients whose pain was not alleviated by other treatment strategies. This study focused on the effects of inhaled cannabis. Interestingly, another clinical trial that evaluated the efficacy of Sativex, an oral spay containing cannabis-derived ingredients (THC and CBD), did not find a significant improvement in pain reduction as compared to the placebo arm in their analysis.

It is possible that there are additional compounds that contribute or synergize with the known active compounds to deliver the therapeutic effects. Experts explain:

“Currently, there is a debate about the so-called “entourage effect” which refers to the idea that compounds other than cannabinoids in marijuana (i.e. terpenes and flavonoids) are important in its therapeutic effects. This idea has wide lay-popularity, but little scientific evidence to support it.”

Overall, while more research is needed, there is increasing evidence that cannabis can be useful for treating neuropathic pain:

“The scientific literature demonstrates some efficacy of medical marijuana/cannabis in the treatment of chronic neuropathic pain. Clinical trials of different routes of administration (sublingual, oral, smoked, and vaporized) have demonstrated analgesic benefit in the treatment of this costly and disabling condition and some treatment guidelines for neuropathic pain recommend consideration of cannabinoids as a second or third line agent.”

They also note the potential financial challenges that may come with using cannabis to treat neuropathy:

“As expenses for medical marijuana are not covered by health plans and are out-of-pocket, knowing the cost-effectiveness of medical marijuana may impact patients’ decisions regarding its use. Based on a recent published article, inhaled cannabis appears to be cost-effective when used as second or third-line treatment in chronic neuropathic pain.”

Summary

The medicinal properties of cannabis have been described for thousands of years, and now more and more modern research study outcomes suggest that cannabis and cannabis-based treatments are effective and well-tolerated for a variety of ailments. So far, several studies have shown that cannabis-based treatment approaches for neuropathy are effective, although additional investigation is warranted.

What do you think? Please share your thoughts on your experiences with neuropathy in the comments below. Have you tried or considered using this type of alternative treatment?

References

Heimerl K; “Medical Marijuana and Cannabidiol (CBD): Perception vs Facts” (2019) American Academy of Osteopathy (OMED 2019) http://files.academyofosteopathy.org/CME/OMED2019/Heimerl_MedicalMarijuana.pdf

Mechtler L, Ralyea C, Hart P, Bargnes V; “Medical Cannabis in the Treatment of Neuropathy” (2020) Neurology, 94(15S). https://n.neurology.org/content/94/15_Supplement/5020

Nemergut G; Marijuana (2019) Pain, pp. 315-319. https://link.springer.com/chapter/10.1007/978-3-319-99124-5_69#enumeration

Robinson-Papp J. and Dehbashi S; “Medical Marijuana for Peripheral Neuropathy” (2019) Neuropathy Hope Newsletter, Western Neuropathy Association. P.1 https://pnhelp.org/application/files/1415/6081/5051/WNAENews0719L.pdf

Wallace MS, Marcotte TD, Umlauf A; “Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy” (2015) Journal of Pain 16(7): 616-627. https://pubmed.ncbi.nlm.nih.gov/25843054/

Source: diabetesdaily.com

Study Sheds Light on How High Blood Sugar Can Cause Complications Years Later

People with all types of diabetes are at a higher risk for numerous health complications, in particular for various vascular problems. While it is known that consistently tight glycemic management can greatly minimize these health risks, there are numerous factors which will determine long-term health outcomes.

One interesting concept is that of “metabolic memory,” a phenomenon that suggests high blood glucose levels experienced early on (for instance, before and some time after diagnosis) may still play a role in the development of complications years later, even if blood glucose has been generally well-managed. Several theories have been proposed as to why this may be, and most recently, researchers at the City of Hope conducted a study that may help explain why. The results of the study were recently published in Nature Metabolism.

Researchers selected patients from the DCCT/EDIC trials and compared their DNA to identify differences as they relate to glycemic management histories. The scientists were looking at something called DNA methylation, a process that involves the attachment of chemical groups (methyl groups) to specific regions of DNA.

The addition of certain chemical groups to DNA can change its function. This is one example of epigenetic regulation, a way that gene expression can be altered without a change in the actual DNA sequence (i.e., a mutation). These chemical groups that bind to the DNA can change the way that gene behaves, may affect the function of other genes and alter various physiological events downstream.

In this study, the authors report that they uncovered a connection between the HbA1c levels of patients at the end of the DCCT, their DNA methylation patterns, and the development of complications later in life. They believe that these differences in DNA methylation may promote the development of diabetes-related retinopathy and neuropathy (and likely other complications as well). In fact, many of these changes were occurring in genes that are directly relevant to the development of complications.

Rama Natarajan, PhD, one of the authors of the study, had this to say in a recent press release:

“This comprehensive study has systematically compared the epigenetic states of a large number of type 1 diabetic subjects with their glycemic history and their future development of key diabetic complications over 18 years. While the link between epigenetics and diabetes and related complications has been reported before, this is the first large scale study in type 1 diabetes showing that a prior history of high glucose levels can cause persistent changes in DNA methylation to facilitate metabolic memory and trigger future diabetic complications. This study provides the first evidence in humans supporting the link between DNA methylation in inflammatory and stem cells, a patient’s blood sugar history and development of future complications.”

Having a better understanding of detectable “markers” for complications before they even develop may mean earlier detection (i.e., via blood test) and more timely treatment of diabetes complications in the future. This research group is currently continuing to explore these findings, in collaboration with other research groups. They are planning to evaluate the relationship of DNA methylation and other diabetes-related complications, as well as investigate whether these changes may be a reliable biomarker for early detection. They are also investigating what other epigenetic changes may be relevant in metabolic memory.

Source: diabetesdaily.com

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