Bethany’s Story: My Eye Started Bleeding the Day My First Child Was Born

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

By Ginger Vieira

“My first bleed was almost 12 years ago — the day my first baby was born,” explains Bethany, who’s lived with type 1 diabetes for nearly 40 years, since she was 3 years old.

Despite receiving preventative laser treatments to the concerning blood vessels in this area of her eye prior to and throughout her pregnancy, the stress of pregnancy and pre-eclampsia (high blood pressure during pregnancy) were enough to cause them to bleed.

“There was a bunch of trauma around that, because the bleed was the catalyst for me to have an emergency c-section. That was the biggest bleed I’ve had and it took a long time to clear up.”

Since then, Bethany has experienced minor bleeds off and on, but has also gone long stretches of time without any new bleeds.

Ginger Vieira

Image Source: Beyond Type 1

“Last October I had another bad one,” says Bethany. “It was so discouraging, because I haven’t had any new abnormal vessel growth, I’m not pregnant, I don’t have blood pressure issues, and my A1C is stellar. It just happened.”

“It’s cleared up since then without traditional treatments like a vitrectomy or steroid shots, but it took quite a while because it leaked more blood and fluid for a few weeks after the initial burst,” she adds. “At this point, I’d say I’m back to where I was pre-October in terms of vision, but maybe it’s a bit messier.”

My Experience With Laser Treatments for Retinopathy

“I’ve only had laser treatments,” says Bethany, who’s been able to manage her retinopathy without more invasive treatments.

“I’m not sure the experience qualifies as ‘pain’ so much as ‘misery’. It’s horribly uncomfortable, and it does begin to be painful as the treatment goes on, but it’s not what I’d describe as particularly painful.”

Eventually, Bethany says she used a low dose of a mild sedative to help take the anxiety out of receiving laser treatments. While it can’t change how it feels physically, it can help make the overall experience a bit less stressful.

“It’s hard to catch your breath, and it feels like being tortured, and my eyes pour with tears, but it’s all more of a dull feeling other than a bit of a sensation that a rubber band is being snapped behind your eye.”

Parenting a Newborn With Low Vision

“Nursing a baby and not being able to see her face clearly when she’s on your left side was heartbreaking,” recalls Bethany.

“Struggling to read a book to a child, wondering if you’ll have another bad bleed when you’re at the store with your child, not being able to lift an older child because it might exacerbate the bleed—it all sucked.”

Fortunately, by the time her second pregnancy began, Bethany’s eyes were ready.

“It was so much easier,” she says. “No pre-eclampsia, no eye issues. It was such a relief after being so terrified to try it all a second time.”

Today, she says she’s careful how much to share with her children about her eye complications.

“After my recent bad bleed, it was my oldest daughter (the one who was born the day of my first bleed) who held me while I sobbed, because she was ready to support me,” recalls Bethany. “That was so bittersweet and beyond meaningful.”

What My Vision Is Like Today

“I wouldn’t say I live with ‘low vision’ today but there is a blobby mess in one eye,” explains Bethany. “My brain has learned to adapt, and I can see around it. I don’t read super fine print very well, but I’m not sure I would even without retinopathy since I’m getting old!”

However, Bethany would say she did have low vision for a period of time — and it wasn’t easy.

“After those two bad bleeds, I did have trouble with the vision in one eye for a while, until the blood cleared. That was hard, but I’m grateful it wasn’t long-term.”

However she says that it’s also affected her life in other ways when there are bleeds.

“My eyes feel strained, I have headaches, and I definitely don’t feel comfortable driving until the bleeding has cleared up.”

The worry and anticipation of a potential new bleed feels like a ticking time bomb.

“I try not to think about what my vision could be like later in life, but I do wonder if I’ll be able to see my grandkids clearly, and if I should retire early so I can make the most of my later years while I still have vision. In day-to-day life it’s pretty minimal, but in terms of mental/emotional load it’s huge and it’s always there.”

How My Diabetes Management Has Changed

“I smartened up with my diabetes management big time since the first time the doc saw something in my eye,” explains Bethany. “Since that day I’ve been highly motivated to do this well.”

Having lived with type 1 diabetes since age 3 in the 1980s with early glucose meter technology and insulin options were severely limited, Bethany feels quite sure the first 25 years of her life with diabetes led to the complications in her eyes.

“My A1c was usually in the low double digits when I was a child, because avoiding low blood sugars was considered the safest way to manage diabetes in a young child back then,” says Bethany.

By the time she was in her 20s, technology and advancements in insulin helped her manage an A1c in the 7s and 8s. Once she started using an insulin pump, she was able to maintain an A1c below 7.0 during both pregnancies.

“I’ve always, always, tried really hard with my diabetes,” adds Bethany, “but it was like I spent 25 years trying to solve a puzzle that finally started to come together in the last 15 with a pump, a continuous glucose monitor (CGM), and eating low-carb.”

While Bethany used an insulin pump for 5 years, she’s managed her diabetes with MDI (multiple daily injections) for the last 8 years, and maintained an A1c below 7 percent, and around 5.8 percent for the last year.

“Using a pump, two pregnancies, and eating mostly low-carb definitely taught me so much more than I knew before I used an insulin pump,” explains Bethany. “But I was having a lot of issues with scar tissue which made infusion sites for pumping complicated. And I hated being tethered to my pump.”

The mental game of diabetes, she adds, is a huge part of it.

“There’s always a fear lurking that it could happen again at any time. More so since this last one,” says Bethany. “You never really escape it because you never know that you’re safe. You can do everything right from a certain point on, but the damage is already done.”

Source: diabetesdaily.com

Heart Failure – The Overlooked Diabetes Complication, Part 1: What and Why?

This content originally appeared on diaTribe. Republished with permission.

By Ben Pallant

Learn what heart failure is, what it has to do with diabetes, and how to identify and talk about this complication that’s often less discussed.

Healthcare professionals often discuss diabetes complications such as vision loss (retinopathy), chronic kidney disease (nephropathy), and cardiovascular disease (referred to as atherosclerotic cardiovascular disease by healthcare professionals). However, there is a less talked about heart complication, heart failure. Heart failure refers to a condition where the heart’s ability to pump blood is less than normal, often meaning not enough blood is effectively circulating to the rest of the body.

This is part one of a two-part series on heart failure and diabetes.

What is heart failure?

First, it’s important to differentiate heart failure from other conditions such as cardiovascular disease, a heart attack, or cardiac arrest. There is also the broad term “heart disease,” which can encompass any heart issue. Because the names can get confusing, here are some brief explanations:

  • Cardiovascular disease, or atherosclerotic cardiovascular disease, is related to the process called atherosclerosis, which occurs when a substance called plaque builds up in your arteries making it difficult for blood to flow normally. The plaque buildup can be caused by high blood pressure, high cholesterol or triglycerides, smoking, or a number of other reasons. When it builds up in the arteries that supply blood to heart muscles or the brain, a heart attack or stroke can occur. Read our article on diabetes and heart disease here.
  • In a heart attack, the blood flow (and the oxygen supply, since blood carries oxygen throughout the body) to the heart muscle is blocked, causing damage to the heart muscle.
  • Heart failure happens when the heart isn’t able to pump enough blood to the rest of the body.
  • Cardiac arrest is the sudden loss of heart function. Usually due to an issue with the heart’s electrical system that disrupts a regular heartbeat, cardiac arrest causes the heart to stop pumping blood to the rest of the body.

There are a number of reasons why heart failure can occur, including coronary artery disease, high blood pressure, previous heart attacks, or other conditions and structural issues that damage the heart muscle (like cardiomyopathy or heart valve problems). Your chances of developing heart failure also increase as you get older. The heart’s inability to pump enough blood usually happens in one of two ways:

  1. When the heart muscle becomes stiff, the chambers in the heart cannot relax. This decreases the fill capacity of your heart chambers. Nevertheless, the heart is still able to release more than 50% of the blood in the heart chamber to the rest of the body. This type of heart failure is called “heart failure with preserved ejection fraction,” or HFpEF.
  2. When the heart muscle becomes weaker, not enough blood goes out to the body with each heartbeat. Thus, the percentage of blood that is released to the body is less than 50% of the amount in the heart chamber. This type of heart failure is called “heart failure with reduced ejection fraction,” or HFrEF.

Diabetes and prediabetes have been associated with both types of heart failure. Heart failure overall is a widespread health challenge – over 6 million Americans live with heart failure, and it leads to about 1 million hospitalizations per year in the US.

Heart failure is usually a chronic condition that progresses over time. At first, people may not experience any physical symptoms at all because the body has ways of trying to compensate – the heart may become bigger, it could develop more muscle mass, or it could try to pump faster. Over time though, heart failure worsens leading to shortness of breath, fatigue, inability to exercise, and more. Eventually the heart’s decreased ability to pump blood causes fluid to build up in other parts of the body, including the legs and lungs, which makes ordinary things like breathing and walking difficult. This is called congestive heart failure (CHF).

To learn more about heart failure, check out the American Heart Association’s heart failure resources.

What does heart failure have to do with diabetes?

Heart failure is unfortunately one of the most common and deadly complications of diabetes, especially for people with type 2 diabetes. They are two to four times more likely to develop heart failure than people without diabetes, and having diabetes increases a person’s risk for repeat hospitalizations for heart failure. This is partly because many of the key risk factors for heart failure are common in people with type 2 diabetes, such as a body mass index (BMI) over 25 (click here for a BMI calculator), high blood pressure, coronary artery disease, or a history of a heart attack. Other risk factors for heart failure include heart valve problems, sleep apnea, lung disease, and smoking.

But the shared risk factors alone don’t explain everything – diabetes itself is an independent risk factor for heart failure. According to several research studies, each percentage point increase in A1C is associated with an increased risk (8-36%) of heart failure. Researchers suspect that over time, high blood sugar levels either damage the cells of the heart muscles or force the heart to work harder due to damage to smaller blood vessels throughout the body and in the heart – this may be why high glucose levels are associated with heart failure.

Signs, symptoms, and screening

The Mayo Clinic and the American Heart Association have identified a number of possible symptoms of heart failure. These include:

  • Shortness of breath during activity or when you lie down
  • Tiredness and weakness
  • Swelling in your legs, ankles and feet, and very rapid weight gain (due to fluid retention)
  • Rapid or irregular heartbeat
  • Persistent coughing or wheezing (or coughing that produces pink, foamy mucus)
  • Chest pain if the heart failure is caused by a heart attack
  • Lack of appetite or nausea
  • Confusion or impaired thinking

It is especially important to seek immediate medical attention if you experience chest pain, severe fatigue or weakness, rapid or irregular heartbeats with shortness of breath or fainting, or sudden, severe shortness of breath especially if it is associated with coughing up pink, foamy mucus. For CHF especially, seeking timely medical attention is essential.

Talking to your healthcare team is key to making sure you are staying healthy, and it can help identify an early diagnosis. If you are experiencing any of the above symptoms, ask your healthcare professional if you can be tested for heart failure. Even if you aren’t exhibiting symptoms, start a conversation about what you can do to stay healthy and prevent future complications.

How do healthcare professionals test for heart failure?

Heart failure is most commonly assessed using medical imaging techniques that allow healthcare professionals to “see” the heart and assess its function. The most common test associated with heart failure is echocardiography (often called an “echo”) which is a non-invasive, painless ultrasound image of the heart. The echocardiogram can show how thick the heart muscle is and how much blood is pumped out of the left ventricle (one of the heart’s four chambers) with each beat. This information can be used to determine whether heart failure involves preserved or reduced ejection fraction.

Other imaging tests include an x-ray, an MRI, and a myocardial perfusion scan. An x-ray can see if the heart is enlarged or if there is fluid in the lungs, two signs of CHF. If your healthcare professional is concerned that there may be damage to the heart muscle or blockages of major blood vessels to the heart muscle, they may recommend an MRI. A myocardial perfusion scan uses a tiny amount of a radioactive substance that allows the heart to be imaged. It can show how well the heart muscle is pumping and areas with poor blood flow. This scan is often done with an exercise stress test (explained below).

In addition to these different imaging techniques, healthcare professionals use exercise stress tests (which measure how a person responds to increasingly difficult exercise) as a measure of heart function, blood tests to check for heart failure-associated strain on the kidney and liver, or an electrocardiogram (EKG or ECG) test to look at the heart’s electrical activity for signs of a heart attack and to see if the heart rhythm is abnormal.

Before any of these heart tests are ordered, your healthcare team will usually conduct a physical exam to determine what your symptoms are and what tests are needed. It’s important to be honest – your healthcare team needs to know about your lifestyle, including whether you smoke cigarettes, eat a lot of high-fat foods, and are physically active. Be prepared to answer other questions too:

  • When did symptoms begin?
  • How severe are the symptoms?
  • Does anything make the symptoms better or worse?
  • Do you have a family history of heart disease, diabetes, or high blood pressure?
  • Are you taking any medications, including over-the counter-drugs, vitamins, supplements, or prescriptions?

To learn more about heart failure, including prevention, medication options, and management tips, read “Heart Failure – The Overlooked Diabetes Complication, Part 2: Prevention and Management,” which our team will be updating this summer. You can also check out the Know Diabetes By Heart resources on heart failure.

This article was originally published on June 15, 2018. It was updated in May 2021 by Matthew Garza as part of a series to help people with diabetes learn how to support heart health, made possible in part by the American Heart Association and American Diabetes Association’s Know Diabetes by Heart initiative.

Source: diabetesdaily.com

The Latest on Eylea: A Leading Treatment for Diabetes-Related Retinopathy

This content originally appeared on diaTribe. Republished with permission.

By Kira Wang

New results on Eylea, a treatment for diabetes-related retinopathy, show that the therapy reduces the risk of more serious eye complications when used for prevention.

Key findings were recently published on Eylea, a common therapy in the US used to treat several eye conditions including diabetes-related eye disease. According to Dr. Jennifer Sun (co-chair of the Diabetic Retinopathy Clinical Research Network), 60% of patients may not know they have some form of early-stage diabetes-related retinopathy which may not affect one’s ability to see. The clinical trial was focused on prevention: does early Eylea treatment of diabetes-related retinopathy result in better vision later on? The answer may not yet be clear – while Eylea was found to reduce specific vision-threatening complications, it did not meaningfully improve vision outcomes in the published study.

Eylea is an approved treatment for diabetes-related macular edema and diabetes-related retinopathy, two of the eye complications associated with diabetes. Eylea is an anti-VEGF therapy, meaning that the drug blocks VEGF, a protein that is necessary for new blood vessel growth. The medication is injected into the eye by an ophthalmologist every four to 16 weeks, depending on the severity of the eye disease.

The trial looked at 328 adults with early-stage diabetes-related retinopathy (also called non-proliferative diabetes-related retinopathy) and excellent vision. At the beginning of the study, about half of the eyes received Eylea injections every 16 weeks, and the other half received a placebo injection (which included no medication). The preliminary data were reported through two years. The study will continue for a total of four years.

The researchers were studying two main outcomes in these eyes:

  • Changes in the anatomy of the retina (for evidence of either a more advanced stage of diabetes-related retinopathy, called proliferative diabetes-related retinopathy, or the development of swelling called center-involved diabetes-related macular edema). These can be thought of as structural changes in the eye.
  • A functional difference in participants’ ability to see, known as their visual acuity. See below for key findings after two-years:

The trial found that Eylea led to improved anatomical outcomes and reduced the risk of more serious eye complications:

  • Eylea reduced the risk of developing complications by 68% when compared to the placebo. The probability of developing any complication was 16% in the Eylea group and 44% in the placebo group.
  • Individually, participants taking Eylea were 66% less likely to develop more advanced stages of diabetes-related retinopathy (proliferative diabetes-related retinopathy) and 64% less likely to develop macular edema with vision loss.
  • People receiving placebo injections were five times more likely to need additional treatment (with Eylea) with worsening of the eye disease.
  • There was no difference in the vision quality of either group after two years (excellent vision in 75% of the treatment group and 72% of the placebo group).

The four-year results of the trial will be important in determining whether the higher rate of complications in the placebo group might eventually lead to more vision loss in that group. If this is the case, treating diabetes-retinopathy in its earliest stages with Eylea may present a long-term benefit for vision.

There are several treatment options for diabetes-related eye disease, including oral medications, laser treatments for the eyes, and therapies like Eylea. Increasingly, surgical techniques are being used for less advanced stages of diabetes-related eye disease. Other novel strategies are also being investigated to avoid needing regular injections into the eye.

More information is needed before Eylea can be considered for use as a widespread tool to prevent worsening of diabetes-related retinopathy. Dr. Sun’s bottom line for clinicians and patients? “With regular follow-up and rigorous evaluation, the chances of continuing to have good vision, even with severe non-proliferative diabetic retinopathy and moderate non-proliferative diabetic retinopathy, are excellent. I don’t think this study says that early treatment should be routinely given yet. It is important to hang tight and wait for four-year results.”

The most important action people with diabetes can take is to have an annual dilated eye exam, in addition to managing glucose, blood pressure, and cholesterol levels. If diabetes-related eye disease worsens, there a number of options that can be used to prevent vision loss. To learn more about protecting your eyes and treating eye disease, check out our series: Caring For Your Eyes.

Source: diabetesdaily.com

Diabetes & Smoking: What You Need to Know

Most of us know that smoking is horrible for one’s health. According to the Centers for Disease Control and Prevention (CDC), tobacco use is the leading cause of preventable death in the United States, yet over 34 million Americans still smoke tobacco cigarettes nearly every day.

Unsurprisingly, smoking is even worse for your health if you live with diabetes. This article will outline the reasons why smoking is so bad for people with diabetes and what you can do to stop smoking.

Smoking Is Bad for Everyone

Smoking is the leading cause of lung diseases, including COPD, emphysema, and chronic bronchitis. Smoking also contributes to the growth and development of many types of cancer, including cancers of the mouth and throat, voice box, esophagus, stomach, kidney, pancreas, liver, bladder, cervix, colon and rectum, and acute myeloid leukemia. On average, life expectancy for smokers is at least 10 years shorter than for nonsmokers.

The American people have known for a long time that smoking causes cancer. Nearly 60 years ago, in 1964, the then U.S. Surgeon General Luther Terry issued a definitive report linking smoking cigarettes with lung cancer for the first time. Smoking is even worse for people living with chronic diseases, especially diabetes.

Why Is Smoking Especially Bad for People With Diabetes?

People with diabetes who smoke are more likely to have serious health problems and complications, including heart and kidney disease, poor blood flow to the extremities, increased risk of infections, higher incidence of foot ulcers, increased rates of lower limb amputation, and retinopathy, which increases the likelihood of blindness than people with diabetes who do not smoke.

Why is this so?

People with diabetes are constantly working to manage their blood sugars and prevent complications brought on by the disease that include damage to the nerves, eyes, kidneys, and heart. The tobacco in cigarettes exacerbates these issues and accelerates the rate of decline in a person already suffering from a chronic disease.

There are over 7,000 chemicals in cigarettes, 70 of which are directly linked to the development of cancer, aging, and oxidative stress. For example, some of the chemicals found in cigarettes include toilet cleaner, candle wax, insecticide, arsenic, nicotine, lighter fluid, and carbon monoxide, just to name a few. These addicting, dangerous chemicals cause harm to your body’s cells, interfering with their normal function.

In a person with diabetes, the harm caused by a cigarette’s chemicals and nicotine causes chronic inflammation, resulting in insulin resistance and higher blood sugars, and thus makes it harder to manage one’s diabetes.

All of these issues compound to make diabetes management harder, and complications more likely. For people with diabetes, the health risks of smoking a cigarette is four times greater than for someone without diabetes.

Even more striking, a 2014 study revealed that smokers are 30-40% also more likely to develop type 2 diabetes, making the relationship between cigarette smoking and diabetes a vicious cycle.

quit smoking

Photo credit: Adobe Stock

Reduce Your Risk and Improve Your Health by Quitting Smoking

The best thing to do if you have diabetes and smoke is to quit immediately, and it’s never too late to quit! Quitting smoking before age 40 results in lifespans as long as people who have never smoked, and one’s lungs start to immediately heal the day they stop smoking.

Quitting smoking before the age of 40 reduces the risk of death (associated with continued smoking) by 90%, and quitting before age 30 avoids more than 97% of the risk of death associated with continued smoking into adulthood. The sooner, the better, but there never is a bad time to quit smoking.

Studies have shown that people who have diabetes start to respond to insulin better and their insulin resistance drops within 8 weeks of quitting smoking. 

Quitting smoking may be one of the hardest tasks you ever undertake, but the benefits are worth it: a longer, healthier life, better blood sugars, lower HbA1c levels, and fewer diabetes complications.

How to Stop Smoking

There are many resources available to people who want to quit smoking, including:

If you have diabetes and you’re a smoker, take heart: there is never a bad time to quit smoking, and quitting smoking won’t only improve your overall health, your diabetes management will likely become easier as well.

Quit smoking not only for yourself but for the health of your family as well. Lean on your loved ones for support, and work with your doctor to find a treatment plan that will work for you, minimize withdrawal symptoms, and make the transition to a smoke-free life easier.

Whatever it takes, give yourself grace: a new study reveals that smokers try to quit 30 times before they succeed, and living with the stress of diabetes can make those attempts even more challenging, but definitely more worthwhile for you and your health.

Have you quit smoking or tried to quit smoking in the past? What has worked best for you? Share your story in the comments below.

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

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

This content originally appeared on diaTribe. Republished with permission.

By Julia Kenney

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

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

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

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

Dog

Image source: diaTribe

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

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

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

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

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

How can diabetes service dogs help their owners?

Dog

Image source: diaTribe

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

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

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

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

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

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

Could a diabetes service dog be right for me? 

Dog

Image source: diaTribe

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

There are a few more important things to think about:

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

Want to learn more about diabetes service dogs?

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

Source: diabetesdaily.com

How the Keto Diet Paved the Way for a “Normal” Life

By Matt Barrie

I have type 1 diabetes since age three, and am now 37 years old. Living a ‘normal life’ has always been my number 1 goal, but how this has manifested has been different through different stages of my life. As a teenager, I hung out with friends and wanted to do all the same things as them, eat the same things as them and just be a ‘normal’ kid. I made it through, although there were several seizures and hospital visits.

My twenties had their ups and downs both with health and life events. I had weight fluctuations from quite low to an extra unhealthy 20 lbs., and my HbA1cs were also all over the map. By 26, I made some big changes and adopted a healthy, standard carb-diet lifestyle and enjoyed that sense of ‘normalcy’ that we all crave. I played soccer, ran, skied, and lifted weights.

By my late twenties, I made some big life-changing decisions, like heading back to school to change direction with my career. Through studying and supporting myself at the same time, my health began to slip slowly and steadily. By the time my degree was finished, I had put on 50+ lbs., had developed very unhealthy eating habits, and could barely make it up a flight of stairs without being out of breath.

Doctors were giving me all the warnings, my HbA1c was up in the 8s and 9s and most significantly, the diabetic retinopathy that had begun to develop in my 20s worsened and progressed into macular retinal edema. So, monthly visits to the ophthalmologist (daily, when I developed an infection from the injections I was getting that almost took my eye!) became my new normal. With fear as a driving factor and determination as the driving force, I jumped into action, although not sure where to begin.

keto diet

Moussaka made with eggplant, zucchini, cashew-béchamel, ground beef sauce and cheese. Photo credit: Matt Barrie

I started experimenting with the ketogenic diet after reading that it had proved successful for many people with diabetes, both types 1 and 2. This was around 3.5 years ago. Most of the success I read about then was regarding type 2 diabetes and reversing it with the diet.

I was very curious though how I could make this work for myself so the experimenting began. I tried cyclical, where you rotate carbs in and out, but this didn’t work. I tried semi-strict, with the infamous ‘cheat days’ which I needed at the time to preserve those foods I ‘missed’, but ultimately this didn’t work either. I tried many different iterations of the diet and for two years saw small successes – up to 20 lbs. [weight loss] here and there. It was enough to keep me going but I never saw that breakthrough success that I was truly after.

After the summer of 2019, I had taken a ‘break’ with visiting relatives and had gained back all my losses and then some. It was very discouraging, but it was the motivation I needed to make a serious change. I hit a saturation point where I knew I couldn’t keep continuing on the way I had been. I weighed in over 210 lbs., which on my 5’8″ frame felt like [an extra] 100 lbs. I committed to myself that I would be absolutely strict keto, I signed up with a trainer twice a week to stay accountable, and committed to running twice a week. I also began practicing intermittent fasting with the 16 hour/8 hour split between my fasting and eating window.

Photo credit: Matt Barrie

Within the first month, I dropped 15 lbs. and the weight and body composition began to change week by week, month by month. By the time the pandemic hit, I was well on my way to my weight loss goal and was able to stay on track. I lost 50 lbs. by April of 2020 and have been working on building lean muscle mass ever since!

My insulin needs have dropped significantly – basal by about a quarter and fast-acting by over 3/4! My HbA1c is in the low 6s and most significantly, I have reversed my macular edema and the retinopathy seems to be going into remission as well. My ophthalmologist was blown away that there was no fluid in my retina.

Photo credit: Matt Barrie

It’s hard to put into words the effect these lifestyle changes have had in my life. My energy, ability to perform, clarity of mind, spirit, and purpose are all significantly improved. Thinking and being told by convention that carbs were essential led me to high levels of insulin resistance, fat storage, yo-yo blood sugars, and unnecessary highs and lows due to over-correction. I now enjoy steady blood glucose levels during exercise, during waking hours, and overnight. I’m also enjoying much lower insulin needs and feel confident that my risk of diabetic complications is significantly decreased.

Keto Diet - Matt Barrie

Left: Sablefish (black cod) with puréed butternut squash, pan-fried Brussels and topped with red cabbage sauerkraut. Right: Grilled pork chop with seared zu Chinju, roasted carrots and cauliflower. Finished with mushroom cream sauce. Photo credit: Matt Barrie

I can’t shout from the roof loud enough that the ketogenic lifestyle can be such a powerful tool for diabetes management! I’m not saying it’s the only way, but it has certainly worked for me and changed my life. At first, you do miss the foods from a standard carbohydrate diet that we are all programmed to accept, but with time the cravings go away and the way you feel on the other side is totally worth it! It doesn’t even feel like a sacrifice anymore and being creative in the kitchen to make satisfying, delicious food is all part of the fun!

Left: Zucchini tuna melts with cheese and avocado mayo. Right: Cauliflower, bacon and asparagus soup with homemade almond flour cheese scone. Photo credit: Matt Barrie

If you’d like to follow my journey and pick up any tips and tricks I’ve discovered along the way, I’ve recently started a public Instagram account. You can follow along @type1ketoguy.

Source: diabetesdaily.com

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