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

10 Most Common Questions Answered After a Type 2 Diagnosis

Facing a new diagnosis of type 2 diabetes can be a difficult and confusing time. Many ask “why me?”,  some may feel shame due to the stigma surrounding type 2,  while others want to know what they can proactively do to better their health. I asked people living with type 2 diabetes what their initial questions were at diagnosis. Hopefully, this can help some of you who are learning how to live with this new condition.

1. What is type 2 diabetes?

Type 2 diabetes is the presence of excess sugar in your blood due to your body’s resistance to insulin and, in many cases, production of too little insulin. You can think of insulin as the key that opens cells and allows glucose (i.e. sugar) to enter your cells. If your body is insulin resistant, then it cannot use the insulin effectively enough to allow the correct amount of sugar to enter your cells. In this case, it builds up in the blood, causing high blood sugar levels.

2. Why did this happen to me?

We know that there are both environmental and genetic factors associated with a type 2 diagnosis. We also know that obesity can lead to diabetes, but not everyone who is obese winds up with type 2 diabetes. Age, ethnicity and numerous other factors also come into play. Try not to be discouraged by your diagnosis. Instead, use it as an opportunity to start or maintain a healthy lifestyle. This will help you to avoid issues down the road, and can help turn the diagnosis into a positive change in your life.

3. What should my blood sugars be?

The American Diabetes Association (ADA) recommends a fasting or before meal blood glucose of 80-130 mg/dL and 1-2 hours after the beginning of the meal (postprandial) of less than 180 mg/dL. There are of course factors related to food and insulin doses that can affect these numbers. Fasting numbers should ideally be under 100 mg/dL, but this will vary from person to person. Talk to your healthcare provider to learn what their specific recommendations are for your unique situation.

4. Are there alternative treatments?

While there are complementary and alternative treatment options available, they do not claim to cure diabetes. However,  they may be beneficial in many ways that can indirectly improve your diabetes health. With that said, traditional medicine prescribed by your doctor should always be taken, and alternatives could be an addition to your regular treatment protocol.

One alternative approach that is a surefire way to help your overall health and improve your blood sugars is improving diet and exercise. Eating healthy — making sure you get plenty of protein and focus on unprocessed and nutritious foods, like plenty of vegetables — and making sure to stay active can help you to stay maintain optimal shape and blood sugars.

Other alternative treatments to consider are meditation and aromatherapy, both of which may help to alleviate stress, a contributor to high blood sugars. Also, be sure to explore acupuncture and acupressure if you have neuropathy-induced pain, as both of these are known to alleviate pain and improve circulation.

While some herbs and supplements may help prevent heart disease and have other health benefits, there is no evidence that they can actually help a person manage their diabetes. The ADA, in its 2017 Standard of Medical Care in Diabetes statement, stated the following, “There’s no evidence that taking supplements or vitamins benefits those with diabetes who do not have vitamin deficiencies.”

5. Will I have to go on insulin?

At diagnosis and in the early stages of type 2 diabetes, your doctor will likely advise you to incorporate lifestyle modifications, like diet and exercise, to help lower your blood sugar. If that doesn’t help, or if you are not diagnosed early on, then oral medication is often recommended. If your blood sugars aren’t at an optimal level, it is possible that your doctor may suggest going insulin.

While some people will think going on insulin means they failed at controlling their blood sugars on their own, that is not the case and oftentimes, people prefer to be on insulin as you can be more flexible with what you eat and when. Insulin may also help your pancreas to make insulin longer and has been shown to help control blood sugars better than oral medications alone. It doesn’t matter how, but that you maintain healthy blood sugars to avoid complications such as vision loss, nerve and kidney damage and heart disease.

6. What doctors should I see annually?

Living with diabetes could mean complications down the road so it is important to stay on top of your diabetes care so you can flag issues before they worsen. You should visit your eye doctor annually, such as an optometrist or ophthalmologist, to check for potentially serious conditions, such as: glaucoma, cataracts, diabetic retinopathy and diabetic macular edema.

Patients who have been living with type 2 diabetes for a long time are at a greater risk for kidney disease and may also need to be under a nephrologist’s care. They can also administer dialysis, for those patients undergoing dialysis treatment.

Photo credit: Adobe Stock

Podiatrists are also important doctors to routinely visit as nerve damage can ensue over time for patients living with diabetes. People with diabetes can also be more susceptible to wounds not healing properly, and podiatrists can check for infections that could worsen and lead to gangrene and even amputation.

Other specialists to consider are a dietician and personal trainer, if you feel you need help with reaching your diet and fitness goals.

7. How much should I expect this disease to cost me?

Living with type two diabetes places a significant economic burden on the individual. Costs vary depending on what country you live in. A study conducted by the National Library of Medicine concluded that the average medical costs over someone’s lifetime were $85,200, of which 53% was due to treating diabetes complications, and 57% of the total attributed to macrovascular complications. Making sure to see your doctors regularly and staying on top of your diabetes management can result in long term savings in healthcare costs.

8. Can I manage it just through diet and exercise? Can it be reversed?

Remission of type 2 diabetes is possible.

While you can’t necessarily “reverse it” you can certainly control it and some can even put it into remission. This depends on the individual, their overall health, how far into the condition they are along with other factors such as beta-cell function and insulin resistance. However, with healthy eating and regular exercise, many are able to free themselves from medications, and maintain normal blood glucose levels, thus preventing complications.

Be wary of fad diets and gimmicks that promise to cure you of type 2 diabetes. Reversing and prolonging the progression of this disease is up to the individual and their dedication to a healthy lifestyle and numerous other health factors (like co-existing health conditions and access to the most appropriate and affordable healthcare) may help or hinder their efforts.

9. Does having diabetes lower my life expectancy?

Diabetes is historically known for shortening a person’s lifespan but the good news is that with medication, technology, and a little effort, this doesn’t have to be the case. According to the CDC, diabetes is the 7th most common cause of death in the United States. This statistic doesn’t distinguish type 1 from type 2 diabetes and it also doesn’t take into account all of the complications that could be the main cause for death.

If you are actively managing your diabetes, you are less likely to develop these issues that could lead to a shorter life span. And, on a positive note, many find that they are actually healthier once diagnosed, as it helps them to make better choices for a healthier lifestyle.

10. Are my children at risk?

While genetics do play a strong role, this only means you are more at risk of developing diabetes, not that you will necessarily be diagnosed. Many other factors come into play, and while diabetes runs in families, developing healthy habits, maintaining a healthy weight and keeping active can help stave off a diagnosis as well.

A diagnosis of type 2 diabetes doesn’t have to be a death sentence. With a little determination and support from your medical team and loved ones, you can manage this condition. Asking questions and staying on top of your diabetes care is key to maintaining long term success.

Source: diabetesdaily.com

Is “Brittle Diabetes” a Real Health Condition?

If you’ve been living with diabetes for some time, you’ve probably heard the term, “brittle diabetes”, and you may have even been told you have it (from a family member, a friend, or even a physician). This can be a controversial issue, as some people believe it doesn’t exist, some people feel that it’s an outdated label (for a condition that’s already so complicated and stigmatized), and some people feel that it’s accusatory (for a condition that’s already so hard to manage). On the other hand, there are people who truly do believe they have a form of diabetes that is particularly “brittle”, and that the category stands. So, what’s the deal?

Defining “Brittle Diabetes”

A quick online search defines brittle diabetes as a hard-to-control form of type 1 diabetes.  It is also called labile diabetes. People with brittle diabetes often have large swings in blood sugar levels, and the swings in blood sugar may require hospitalization. One’s symptoms for high and low blood sugars are similar to those with type 1 diabetes, but the difference is the amount of time it takes to go from hyperglycemic to hypoglycemic, often without apparent cause. This can prevent people with brittle diabetes from carrying out normal day-to-day activities.

According to the National Institutes of Health, only a tiny proportion of people with type 1 diabetes experience the drastic fluctuations in blood sugars that can frequently be described as “brittle,” affecting only 3 out of every 1,000 people with type 1 diabetes. Young, overweight women between the ages of 15-30 are most likely to be affected.

Risk Factors

The most significant risk factor for brittle diabetes, is (of course) type 1 diabetes, as it is a subset of the disease. Other risk factors include mental health issues like depression, anxiety disorders, and high stress. People whose bodies release too much cortisol (from high-stress situations) can experience temporary insulin resistance, which can spike blood sugars and worsen fluctuations, even when you’re not taking less insulin or eating more. Alternatively, those with digestive issues due to gastrointestinal nerve damage, celiac disease, or gastroparesis may experience a more “brittle” form of diabetes, due to malabsorption of nutrients, and thus may face unpredictable insulin dosing requirements. Young women who have a history of eating disorders are also at a higher risk for brittle diabetes.

Diagnosis

Diagnosing brittle diabetes can be difficult. Oftentimes, a diagnosis of brittle diabetes will accompany a psychological diagnosis such as depression or anxiety, and the two conditions can feed into each other. A person with high cortisol levels, depression, and stress may neglect to eat a healthy diet, which can exacerbate the fluctuations in their blood sugar levels even further, and out of control blood sugar levels can worsen depression and anxiety. One study showed that people with brittle diabetes have a greater hormonal response to stress than those without brittle diabetes.

Treatment

The treatment of brittle diabetes will often include treating any underlying psychological disorders first, and to control the level of stress one is experiencing. It can be helpful to consult with a counselor who specializes in diabetes. Psychotherapy has proven effective in treating those with brittle diabetes and achieving better health outcomes. Those with brittle diabetes may require a long, in-patient hospitalization (in a controlled environment), where food, exercise, and stress is monitored closely, to achieve better baseline data for more successful long term control.

Additionally, people with brittle diabetes may find that wearing a continuous glucose monitor (CGM) and an insulin pump can help them achieve better health outcomes than using multiple daily injections as their insulin therapy. If an insulin pump or CGM will not work for your lifestyle or budget, reducing carbohydrates in your diet and establishing a regular exercise routine and way to handle stress can help minimize the drastic fluctuations in blood sugar levels.

Important to Note

It’s important to remember that the official diagnosis of brittle diabetes is extremely rare, and usually accompanies an underlying psychological disorder, like depression, anxiety, high levels of cortisol, or an eating disorder. Sometimes people with type 1 diabetes who struggle with malabsorption of nutrients in the gastrointestinal tract (from gastroparesis or celiac disease) may also suffer from these extreme fluctuations in blood glucose, which may present as ‘brittle’.

It’s normal for people with type 1 diabetes to have extreme fluctuations in blood glucose (and that may be why you’re insulted if someone deems your diabetes “brittle”), and it not be officially characterized as brittle diabetes. However, if you fear that you may have this rare condition, seek medical care immediately. Hospital stays are much more common in people with brittle diabetes, and attending school and/or work is much more difficult. While not fatal in and of itself, people with brittle diabetes are much more vulnerable to experiencing a diabetic coma and suffering severe complications. Talking with your healthcare provider can help you understand more about this condition, and can help you make a plan to manage or prevent it, and address the underlying digestive and/or psychological issues that may be worsening your blood sugar levels.

Have you been diagnosed with “brittle diabetes”? How have you managed this condition? Do you think it warrants a separate diagnosis? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

Are People with Diabetes Immunocompromised?

What does it mean to be immunocompromised?

Simply put, the term “immunocompromised” means that the person’s immune system is not functioning properly to fight off infections. This could be due to a number of reasons, including underlying health conditions, or specific medications that the person is taking.

For example, patients who are HIV-positive are considered immunocompromised. This is because HIV invades the T cells (a type of white blood cell), which are a major component of our immune system. When functioning normally, T cells help to effectively clear various infections. Because HIV affects the T cells, the immune system of these patients may not respond as effectively, and they may struggle with complications from infections that most healthy people would easily recover from.

Similarly, some classes of medications can directly inhibit immune system responses. For instance, patients who are taking anti-rejection medications following an organ or tissue transplant are considered immunocompromised. This is also the case for patients who take immunosuppressive agents for other reasons, including for the treatment of certain autoimmune conditions and cancers.

Also, because immune system function is underdeveloped in very young children and declining in the very elderly, one may consider that the very young and the very old might be considered immunocompromised to a degree (because the immune system is not functioning quite as efficiently as it does in a healthy adult).

So, what about diabetes? Could diabetes, on its own, affect our immune system function to such a degree that would be considered “immunocompromised”? Are people with diabetes, by definition of just having the condition, immunocompromised?

It is known that high blood glucose levels can negatively affect immune system function, likely doing so through several mechanisms. High blood glucose levels are linked to negative clinical outcomes in the context of infections. The importance of maintaining optimal blood glucose management, and especially during infection and in the hospital setting, has been described in the scientific literature.

It is also well-established that patients with diabetes who achieve the recommended A1c levels have a markedly lowered risk for developing infections or complications from infections as compared to those with higher A1cs. You can read more about the connection between blood glucose levels and health complications here.

One expert commentary published in the Canadian Medical Association Journal explains,

“The evidence indicates that an immunocompromised state occurs only in the context of poor glycemic control with severe complications such as diabetic ketoacidosis or in adults with vasculopathy and peripheral neuropathy.”

There is some debate concerning the pathophysiology of both type 1 and type 2 diabetes as related to aberrant inflammatory responses and what this could mean for responses to certain infections. However, this is a complex and multifactorial topic, of which much remains to be elucidated at this time, and we cannot generalize based on theoretical and/or poorly characterized physiological processes in this patient population.

What is well-established, is that for patients who are able to maintain optimal glycemic management, and in the absence of other factors (such as related complications, a medication that may suppress immune system function), diabetes, on its own, does not make the patient automatically immunocompromised. However, for patients who frequently experience very high blood glucose levels and certain associated complications, immune system function can be negatively affected. This subset of patients might be considered “immunocompromised” due to the frequency and severity of hyperglycemia as compared to those with more optimal glycemic management and/or other complicating factors.

Also, it’s important to remember that when talking about an entire population of people with diabetes, on average, these patients are more likely to be immunocompromised. In addition to (generally) having higher than normal blood glucose levels for a considerable proportion of time, many people with diabetes are more likely to also have other health conditions that may negatively affect their immune system function. One example, in particular for patients with type 2 diabetes, is obesity, which is known to negatively impact immune function.

In summary, to accurately determine whether a patient with diabetes is “immunocompromised”, we must consider their overall health, including other health conditions, the medications that they use, as well as their age and glycemic management. Simply having diabetes does not, on its own, necessarily mean that the patient is immunocompromised, although as a group, this patient population is more likely to have immune system function issues.

Source: diabetesdaily.com

Keeping Your Immune System Healthy

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

By Mariana Gomez and T’ara Smith

Perhaps you’ve read about boosting your immune system to protect you from infections and other illnesses, including the Coronavirus. But, there aren’t any magic foods, supplements, or one-size-fits-all solutions to boosting your immune system because it’s a complex network of cells, organs, tissues, and proteins. Still, healthy living provides its benefits, including keeping our immune systems strong, and research is being conducted to study the effects of nutrition, exercise, mental health, and others on our immune response.

How Diabetes Impacts Your Immune System

Type 1 diabetes is an autoimmune disease. There is not enough evidence to identify the cause but we know that our immune system insulin-producing cells are destroyed. We now know that people with type 1 diabetes are more likely to have a co-occurring autoimmune disorder. The reason that co-occurring autoimmune disorders are so common isn’t yet known. We also know that hyperglycemia can affect our immune system’s response so it would represent a barrier for recovery and fighting virus and bacteria. This does not happen only in type 1 diabetes (T1D) but other types of diabetes as well.

People with type 2 diabetes should be aware of the impact the disease has on their immune system as well. Hyperglycemia in diabetes is a probable cause of the disruption of how the immune system functions. Humans also produce “natural killer” cells that are critical to human immunity. A study showed people with type 2 diabetes have lower counts of these cells compared to those without diabetes and with prediabetes. This makes it harder to defend the body against viruses, diseases, and diabetes-related complications.

Overall, people with diabetes are more susceptible to common infections such as the flu and pneumonia. To protect your immune system, stay up-to-date on your doctor’s visits, get vaccinated against the flu, and get screened for complications.

Essential Nutrients for a Strong Immune System

Another way you can protect your immune system is through nutrition. With a healthy diet, food can help protect you against illnesses and help improve recovery. Different foods contain different quantities and types of nutrients and micronutrients. Therefore it is important to include a variety of food groups in your diet. Vitamins A, B6, C, E, magnesium, and zinc play important roles in our immune function.

How Vitamins + Minerals Help Your Immune System

Vitamins and minerals are known as essential micronutrients. Even though they are needed for our health, our bodies can’t make them on our own or enough of essential micronutrients, therefore, they must be obtained through food. There are nearly 30 vitamins and minerals the human body can’t make on its own. A healthy diet will include different groups of foods that contain some of these nutrients.

Micronutrient malnutrition results in a lack of vitamins and trace minerals that can affect the response of our immune system to fight different health conditions. The NIH lists the recommended dietary allowances (RDA) for vitamins and minerals. While this provides general guidelines for different age groups, please talk to a nutritionist or your doctor about recommended intakes for you.

Vitamin A is an anti-inflammation vitamin that helps develop and regulate the immune system and protect against infections. This Vitamin can be found in sweet potatoes, carrots, broccoli, spinach, red bell peppers, apricots, eggs, and milk. While vitamin A is important, it is possible to consume too much of it. High intake of vitamin A from supplements and some medications can cause headaches, dizziness, coma, and death. According to the NIH, pregnant women shouldn’t consume high doses of vitamin A supplements.

Vitamin B6 helps improve immune response to the increase in the production of antibodies, a protective protein produced by the immune system to fight antigens in the body. Vitamin B6 is found in a variety of foods. Food sources of vitamin B6 include pork, fish, poultry, bread, eggs, cottage cheese, tofu, and wholegrain foods such as oatmeal and brown rice. Getting too much vitamin B6 from food is rare. However, from supplements, long-term use for a year or more can lead to nerve damage.

Vitamin C also known as ascorbic acid, helps your immune system by fighting free radicals that cause cancer and other diseases. It’s a popular nutrient to fight or treat the common cold. While focusing on vitamin C consumption may not prevent you from getting sick, it could decrease the length and severity of cold symptoms. It also helps by stimulating the formation of antibodies. This vitamin can be found in oranges, grapefruit, tangerines, red bell pepper, papaya, strawberries, tomato juice, among others. Too much vitamin C can cause diarrhea, nausea, and stomach cramps.

Vitamin E works as an antioxidant, which protects the cells from damage by free radicals and helps the body fight infections. This vitamin can be found in sunflower seeds, almonds, vegetable oils, hazelnuts, and spinach and other green leafy vegetables. There isn’t a risk of consuming too much vitamin E from foods. Precautions should be taken when taking supplements, which could interfere with other treatments such as chemotherapy or radiation therapy.

Magnesium is a nutrient that our body needs to regulate the function and work of our muscles and the nervous system. It is involved in the process of forming protein, bone mass and genetic material. It is found in legumes, nuts, seeds, whole grains, green leafy vegetables, milk, yogurt among others.

Zinc is found in cells throughout the body. It helps the immune system fight bacteria and viruses and is needed to produce proteins and DNA. During pregnancy, infancy, and childhood, the body requires zinc to grow. Zinc can be found in oysters, red meat, poultry, crab, lobster, cereals, beans, nuts, whole grains, and dairy products.

Drinks That Help Your Immune System

You can find or create your own drinks to help your immune system. Some beverages you may want to try at home that are high in important immune-friendly vitamins are:

*Juices may be high in carbs and sugar, so if you can, opt for unsweetened teas like green/chamomile teas, or whole fruits.”

Alcoholic beverages are generally fine to consume in moderation. Drinking too much alcohol can lead to a weaker immune system. Heavy drinkers are more likely to get pneumonia and drinking too much alcohol at once can slow your body’s ability to ward off infections.

Should You Use Supplements to Help Your Immune System?

Supplements are used in cases where diet is not able to sufficiently provide micronutrients. While supplements aren’t meant to replace a balanced diet, they’re used to help people with other health conditions and may be prone to nutrient deficiencies. Many vitamin and mineral supplements can be purchased over the counter. But, check with your physician or a registered dietitian nutritionist to see if you actually need them. If you’re taking other medications, talk to your doctor on how vitamin and mineral supplements can interfere with those drugs.

Other Things You Can Do to Stay Healthy

A healthy diet is definitely a big part of remaining healthy. Other things you can do on a regular basis to maintain your health is to practice good hygiene (i.e. washing your hands), see your healthcare provider routinely, keeping an emergency medical plan and your emergency contacts updated. Also, prioritize physical activity and refrain from smoking. From a mental and emotional health perspective, practice stress-relieving techniques and know the signs of diabetes burnout.

Source: diabetesdaily.com

If Your Blood Sugar Could Talk

The diabetes online community (DOC) is great for finding information, asking for advice but also for a much-needed laugh. Over the past few weeks, Levi Davenport’s video that humanizes his blood sugar has gone viral within our community and many are finding this two-part video series not only hilarious but therapeutic as well.

I caught up with Levi to ask him a few questions about his own type 1 diabetes (T1D), the way he copes and his intentions of this well thought out video. Please make sure to watch the two-part video at the end!

When were you diagnosed? How did you handle the diagnosis?

I was diagnosed with type 1 when I was 15 years old, in 2004. I was playing high school baseball, and looking forward to getting my driver’s license. The last thing I was interested in dealing with was diabetes.

Photo credit: Levi Davenport

Did you have a good support system from family, friends, and doctors?

Absolutely, I was surrounded by fantastic people – family, friends, and Vanderbilt Children’s Hospital. I had no family history. I caught a very bad stomach bug (think – very bad). Afterwards, over the next 10 days, I lost 14 lbs. and had what I later came to know were the symptoms of high blood glucose. A doctor visit later, I was told I was the proud new owner of a dead pancreas. That was it. I had a two-week hospital stay and then my parents drove me back and forth to Vanderbilt to go through the T1D ‘crash course.’ None of us knew anything about type 1 and to date, I am the only diabetic in our family.

Being a kid is hard enough. Did you feel different and isolated due to your new normal?

Internally yes, and angry. Externally no, but only because I chose to hide it from everyone — friends, teammates, girlfriends, teachers. I only told people about it when I absolutely had to. I did not handle the adjustment well.

Did your diagnosis affect any of your life decisions (what you wanted to be when you grew up, going away to college, etc.)? 

Not at all. I don’t let T1D stand between me and something I have my mind set on doing. You are only limited in life by what you are willing to do.

Did anything in your life have to change in order for you to optimally manage this disease?

Oh yes, I had several dark years. I lost an incredible amount of weight. I am 6’5 and went from fit to emaciated in a matter of 2 years. I dropped from 240 lbs to 186 lbs. The catalyst for me was my children. I was in bed one night and felt my shins and thighs tingling. I realized that it was the beginning of neuropathy. I gave thought to how many years I was shaving off my life by ignoring my health, and within 2 months I had an insulin pump, continuous glucose monitor (CGM), and a watch that showed my blood glucose.

Photo credit: Levi Davenport

Did you turn to your family and friends for support?

Not really, I am a pretty private person when it comes to feelings and emotions (working on that).  After years of shutting everyone down, I could definitely see that they were happy to see what was happening though. Especially my wife. Living with a 24-hour grump took great patience. Since starting on the pump/CGM I have regained the 50 lbs and I felt so much better that I no longer cared about who knew I was a T1D.

Once I found the DOC, the face of this disease changed for me. Not only the information I got from others living with type 1 but I made real friendships that helped me feel less alone. Did you go online for support and information? Have you made any online connections that have helped lessen the burden of this disease?

I turned to the DOC when I started learning about resources like Spike and Xdrip. Shortly after, I discovered the social media groups and pages. I couldn’t believe it. If you aren’t a member of a T1D page or group, you need to check them out. There is a wealth of knowledge to be had, as well as encouragement and community. Seeing all of the people participating, commenting, sharing experiences and advice was very motivating. It also was when I realized I needed to find a way to contribute to the cause.

You clearly have a great sense of humor, do you find humor to be therapeutic?

I definitely find it therapeutic. It is a great pressure relief valve. I spend most of my day focused, serious, and perhaps not smiling enough. People in my professional life were somewhat shocked to see me be silly in that video.

Speaking of humor, what do you think of all the diabetes jokes out there?

If it is funny, I can laugh at it. Diabetes wins if you let it get in your head.

Your video has gone viral within the DOC. Did you expect such a positive reaction from our community?

I’m completely blown away. My channel ‘Between Two Lines’ is very new. I remember talking to my wife about making a funny video and being very nervous. Wondering if anyone would even think it was funny? Would anyone relate to it? You are really putting yourself out there to be ridiculed when trying to take something serious and use humor to encourage and inform. The T1D community is awesome. I’m glad people enjoyed the video and will certainly be making more of them.

What do you think makes it so relatable? What is one of your favorite moments? I know I laughed the whole time and have had the same thoughts and feelings as “Mr. Blood Sugar.”

I’m not sure I even know. Perhaps it is that many others feel the same way I do. Diabetes is stupid. I hate it. I hate everything about it. I wouldn’t wish it upon my worst enemy. But you know what? It isn’t going anywhere and I’m not going to let it steal the happiness from my life. So, I tried to find some humor in it.

My favorite moment was when “Blood Sugar” pulled his hoodie tight over his head to ignore me joking about muscles. Reminded me of my sister and how she responds to my younger brother and me bragging about fitness and working out.

What made you think of the idea in the first place?

There are a million funny videos out there that we all watch every day. I just thought I would take a stab at making one about being diabetic. It was important to me though for it to be funny, but not making fun of the fact that I had diabetes.

At the end of the day, what was your main objective of this video and what would you like people to take away from it?

The main objective of the video was actually to inform. Humor is a great tool for educating. I wanted people with diabetes to laugh, relate, and feel relief that they aren’t the only ones dealing with that garbage. I wanted non-diabetics to be able to watch the video and laugh – but learn about some of the things their diabetic friends, family, or coworkers deal with.

Thanks again for giving us all a laugh. I was away and having a tough time with my blood sugar and laughter was certainly the best medicine!

Part 1:

Part 2:

Source: diabetesdaily.com

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