Dr. Steven Edelman on Hypoglycemia + Glucagon

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

By Alexi Melvin

Dr. Steve Edelman, MD, is a diabetes specialist as well as the Founder of Taking Control of Your Diabetes (TCOYD) — an organization focused on empowering those with diabetes and encouraging them to “take a more active role managing their diabetes, and being self-advocates.”

Dr. Edelman recently took the time to chat with Beyond Type 1 about the importance of glucagon, among other key issues around hypoglycemia.

BT1: Thanks so much for speaking with us today Dr. Edelman — to start, can you talk about your personal background with type 1 diabetes?

Dr. Edelman: When I turned 15, I came down with all the drastic signs and symptoms and was diagnosed with type 1. 1970, they really were in the dark ages. So, my doctor put me on one shot of insulin and regular in the morning and we had urine testing and that was it. Could you imagine being on regular insulin just with breakfast?

And then eventually when I was an undergrad at UCLA, I ran into some really good diabetes doctors and they got me on the right track, but I did have really poor control for a long time. I didn’t really realize the importance of it. Unfortunately, as a result, I do have complications, but the good news is they’re stable.

What inspired you to create TCOYD?

It dawned on me that the education to people with diabetes was really quite lacking way back to 1995. I went to the Joslin clinic for my training. I went to UCSC to do clinical research, and I realized, all of the education was just going to healthcare professionals.

Not that it wasn’t good, but that’s the only direction it was going. I decided to put on a conference for people with diabetes at the San Diego convention center in September of 1995 and that was the beginning of TCOYD. And I was just going to do one conference here. I had two young kids and so I was just going to do it once a year. And that was a lot of work. But the feedback was so powerful, and people were, it’s a great phrase, so thirsty for information that I just said, “you can’t just stop at one a year” and then slowly spread. And then we started putting them on around the United States.

I felt that it was still important to educate healthcare professionals and about 15 years ago I kind of gave up on healthcare professionals. They were really stuck in the mud, really hard to change their practice habits, so that’s why I focused on patients. Then about 15 years ago, we started this program called Making the Connection, where we brought people with diabetes and healthcare professionals together in the same learning environment. The healthcare professionals got their own lectures in their own room at the convention centers and patients got their own, but in parts of the day, we brought them together. It was all in an effort to improve the doctor-patient relationship because our system is pretty broken. People are pretty pissed off at their caregivers. And if you don’t have trust in your caregiver and if the caregiver doesn’t have empathy back, it’s a bad combination.

So now we do our CME programs in parallel with our patient programs, and now we converted to virtual and I think we did a really good job. I don’t get much credit myself. If you’ve seen some of the crazy videos we do to try to keep education entertaining. I think we have a combination of good content and entertaining. I think the future’s going to be virtual learning for us. We have a conference on Saturday and we have people signed up from 60 different countries, about 3000 people across the United States, every state.

What sparked your desire to bring awareness to hypoglycemia and the need for glucagon options in particular?

A lot of people do not remember that in the old days there were people dying of hypoglycemia and it still occurs. Thanks to the continuous glucose monitor (CGM), it has gone down dramatically. I haven’t had any patients recently pass away from hypoglycemia, but I’ve had 10 people through the years, and they all were the same. They all had really good control. They were told a zillion times that they need to avoid complications, get their blood sugars down, but we didn’t have tools to prevent severe hypo. After having type 1 diabetes for 10 years, you kind of lose your response to hypoglycemia and you lose your symptoms. It’s really a sad thing.

What are some of the main issues that lead to severe hypoglycemia today?

Being a diabetes specialist, I see some pretty serious stuff all the time including people who failed at using the old glucagon kit, which delayed therapy and caused unbelievable hassles. I also have an uncle who had type 1 and he died from hypoglycemia and he had severe hypoglycemia unawareness. He had no complications of diabetes. He was treated at the Joslin Clinic when he was diagnosed, but he was so strict. I could not get him to back off like my other patients. And he basically got low and didn’t realize it. And that was it.

How have glucagon options progressed?

With the old glucagon kits, you had to be almost like a chemist to put these things together. And think about it, the person administrating and getting the glucagon ready to give, they’re typically not medically oriented. They’re the mother, the sister, coworker. And you’ve got to squirt diluted fluid into a little vile of powdered glucagon, mix it up, make sure it’s all dissolved. Then you got to suck it back out into the syringe. Then you got to take the syringe and jab it into someone on the ground that’s typically having a seizure or biting their tongue or rolling over, or demonstrating pretty bizarre behavior, which can occur. And when someone’s like that, time is of the essence. Anything that could make the quick administration of glucagon in an easy way for almost anybody, no matter what type of background is, is so important.

What would you say is the biggest obstacle around glucagon access today?

I think the biggest issue today is people do not have a valid prescription for it. I always have this analogy, if you have a house or an apartment and it gets robbed and they steal everything that’s important to you, what do you do next? You get an alarm system on your house. And I always say that same analogy. If someone’s had a bad hypo, they always have glucagon with them, but they did not have one at the time that they really needed it when they had a bad hypo. So, we have to really say, “Yeah, it can occur even if you’re on CGM, especially if you’re a type 2 on insulin as well,” cause that happens. And you got to have a valid glucagon kit with you, a valid meaning unexpired. These new glucagon kits last much longer. They don’t expire as fast as the older ones do, so that’s also helpful.

What are some ways that the CGM can most effectively help avoid hypos?

Well, one of the things I do in clinic is to really check where people set their upper and lower alerts. I had a patient yesterday in clinic who has had type 1 for 60 years. Her A1C is unbelievable, but she does have hypo unawareness and her lower alert was 65. You have to convince people that the extra alerts are worth it to you.

A lot of people said they put their lower alert at 65 and they don’t realize this situation called the “lag time.” So, when your blood sugar is dropping, even if you have a diagonal arrow down compared to, even worse, one arrow down or two arrows down, looking at the Dexcom arrows, they don’t realize that the glucose in your circulation is probably much lower than it appears on the Dexcom monitor or your phone. Because the Dexcom sensor and other sensors too, they measure the glucose in the subcutaneous tissue, and there’s a lag between the subcutaneous tissue and the circulation.

When your Dexcom goes off or when your CGM goes off at 65, and if your trend arrow’s going down, you could be 45 or 40. So that’s really an important issue, especially for people that their symptoms aren’t as obvious anymore. You could be caught off guard. And I had multiple patients that has occurred with. And then unfortunately, as you know, the majority of T1Ds in this country do not wear a CGM and that’s the topic of a whole other story.

Does this lag time issue apply to a regular glucometer as well?

Yes. If your blood sugar is dropping, your meter or CGM may be perfectly accurate of the subcutaneous tissue at 65. If you checked your blood sugar with a meter, it’s still going to say 65, but your circulation that’s going to your brain might be 45. So, the lag time is key. You could have the most accurate meter or CGM in the world, it doesn’t affect the lag time.

Is there anything else that you would want people to know about glucagon options that you don’t think is discussed enough?

I would say this, people have to ask their caregiver for it because in a busy clinic, it’s typically the last on the list and it’s important that they ask for a glucagon prescription.

I think they need to know that there’s two now that are just as easy to use as an EpiPen. Obviously, one is the nasal spray (BAQSIMI). But these devices aren’t for them, they’re for people who are going to be around them and that they should get more than one if they’re going to be at work or out of the house a significant part of the day. And have their best friend or their coworker be on the cautious side because when you least expect it, it can happen.

Source: diabetesdaily.com

Jill’s Soon-To-Be-Famous Veggie Fritters

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.

By Jill Yapo, TCOYD’s Director of Operations, and frequent Yapo’s Home Catering Iron Chef Night Champion

These fritters are a delicious side dish on their own, but they can easily star as a main course. Top them with ham, cheese and a fried egg for breakfast (or breakfast for dinner) or dress ’em up with marinara and melted provolone…you may have to hide leftovers in the back of the fridge to save a few extras for yourself.

Yield: 8-10 fritters (depending on how big/thick you make them)

Print

Veggie Fritters

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Crispy on the outside, tender on the inside, everyone will flip for these golden fried goodies that are a tasty way to get your veggies in. We think they’ll be a new family favorite (plus it’s just fun to say fritters).
Course Appetizer, Main Course, Side Dish
Cuisine American
Keyword vegetables
Servings 10 fritters
Calories 84kcal

Ingredients

  • 1 15 oz can chickpeas garbanzo beans
  • 2 medium zucchinis grated (approximately 2 cups)
  • 1 large carrot peeled and grated (approximately 1 cup)
  • 2 tablespoons grated onion yellow, white or red – your preference – approximately ¼ of a medium onion
  • 2 large eggs lightly beaten
  • ¾ cup panko or plain bread crumbs
  • 2 tablespoons fresh basil chopped (or 2 teaspoons dried – I think fresh has more flavor though)
  • 2 teaspoons garlic powder
  • 1 teaspoon salt
  • 1 teaspoon pepper
  • olive oil

Ingredients for Garnish Option #1:

  • plain Greek yogurt
  • green onion diced

Ingredients for Garnish Option #2*:

  • 1/3 cup plain Greek yogurt
  • ¼ tsp salt
  • 2 small garlic clove or 1 medium, minced or grated
  • green onion chives, basil or dill, diced

Instructions

  • Drain chickpeas. Rough mash them with a fork or potato masher in a large bowl (it does not need to be smooth). Set aside.
  • Grate zucchini with the large part of your grater. Place in the center of a clean dishtowel or cloth.
  • Peel and large grate carrot. Place in the dish towel or cloth with zucchini.
  • Grate onion and add to zucchini and carrots in the dishtowel.
  • Bring the four corners of the dishtowel together and twist around the veggies squeezing out as much moisture as possible. (I think this step counts towards your exercise for the day).
  • Add veggies, panko, egg, basil, garlic powder, salt, and pepper to the bowl with the mashed chickpeas.
  • Stir until completely combined.
  • Heat olive oil in a large skillet on medium heat. Add about 1 tablespoon of oil per fritter.
  • Scoop about ¼ cup of mixture into your hand press to compress it into a patty. You can make them smaller if you want more of an appetizer size.
  • Cook for about 2-3 minutes, until the underside is golden brown, then flip and repeat.
  • Serve with a dollop of plain Greek yogurt and diced green onion. Enjoy!

Notes

*Note for garnish option #2:

Put Greek yogurt in a microwave-safe bowl, add salt and garlic (I used a microplane to grate it but you can finely mince or use the smallest grate on your regular grater) and stir to combine. Microwave for 20-30 seconds and stir. You will have more of a garlic cream sauce for your fritters. Sprinkle your preferred green herb on top. Warning, it has a pretty strong garlic flavor, so make sure you aren’t doing any public speaking or going on a first date after eating!

Nutrition

Calories: 84kcal | Carbohydrates: 13g | Protein: 5g | Fat: 2g | Fiber: 2g | Sugar: 1.5g


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

Jill’s Soon-To-Be-Famous Veggie Fritters Recipe

Source: diabetesdaily.com

3-Ingredient Hot Chocolate: Mmmm

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.

Did you know that a regular coffee shop hot chocolate can easily have 400 calories, 40 grams of carbs and 40 grams of sugar? Delicious, but yowza! Be your own barista and give this one a try – it’s under 200 calories, has 10 net carbs and only 1g of sugar.

Here’s what we used:

Photo credit: Sarah Severance (TCOYD)

3-ingredient hot chocolate

Print

3-Ingredient Hot Chocolate: Mmmm

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Treat yourself to a simply sweet homemade hot chocolate. Made with real chocolate and coconut whipped cream, it’s like a hug in a mug.
Course Drinks
Cuisine American
Keyword Chocolate
Servings 1 mug
Calories 170kcal

Ingredients

  • 1 cup unsweetened vanilla almond milk
  • 1/3 Lily’s low sugar chocolate bar
  • 2 tbsp coconut whipped cream

Instructions

  • Heat the almond milk and the chocolate bar in a small saucepan over low heat. Stir occasionally to mix the chocolate as it melts. Do not bring it to a boil, only simmer until melted/warm.
  • Pour into your favorite mug and top with whipped cream. You can also add a shot of espresso or a shot of something stronger.

Notes

Net carbs: 10g

Nutrition

Calories: 170kcal | Carbohydrates: 20g | Protein: 3g | Fat: 13g | Fiber: 10g | Sugar: 1g


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

3-Ingredient Hot Chocolate_ Mmmm Recipe

Source: diabetesdaily.com

5 Turkey Recipes for the Holidays

The holiday season can mean different things for different people. Whether you’re celebrating it to embrace your spirituality, spend time with loved ones, or enjoy the long break, one thing is certain: you will most likely celebrate it with food. So we gathered a list of recipes using turkey, the popular meat of choice at Christmastime.

Balsamic Turkey

Photo credit: Jennifer Shun

Balsamic Turkey

This Italian-inspired dish is savory and moist with the added vegetables, balsamic mixture, and herbs. Simply arrange the ingredients in the crockpot or slow cooker as instructed, wait for six hours, and voilà, your hands-off meal is ready for the entire family.

Roast Turkey with Orange-Spice Rub

Photo credit: American Diabetes Association’s Diabetes Food Hub | TCOYD

Roast Turkey with Orange-Spice Rub

Spreading the orange zest mixture on the turkey breast may require careful attention, but when you’ve finished that step, you just need to wait for about two hours for the turkey to get fully roasted. The rub goes so well with the meat you want to make it a tasty centerpiece for your holiday feast.

Low Carb Turkey Hash

Photo credit: Brenda Bennett

Low-Carb Turkey Hash

Combine your turkey (or chicken) leftovers and some fresh, low-carb vegetables for a flavorful breakfast, lunch, or brunch. Top your hash with a fried egg and drizzle it with some dressing for more protein and flavor. Yes, this recipe is proof that you can save food (and money) and still prepare delicious meals.

Whole30 Turkey Burgers with Chipotle Ketchup

Photo credit: Laura Miner

Turkey Burgers with Chipotle Ketchup

Turkey may seem dry for burgers but adding mashed sweet potatoes will solve that problem. And when you add bell peppers, onions, and herbs to the mix, these baked burgers become more exciting for both adults and kids. Serve with chipotle ketchup and sliced avocado, lettuce wraps, or other greens.

Turkey Meatloaf Muffins

Photo credit: Lisa MarcAurele

Ground Turkey Meatloaf Muffins

This recipe uses mozzarella cheese, ground turkey, and pork rinds for the mini meatloaves, but it also suggests other options that may already be in your fridge. This makes it a popular, flexible dish to serve for busy families. It is also simple to prepare: Mix all ingredients in a bowl and divide the mixture between the muffin tins. Bake and then serve. No slicing needed!

Which of these recipes are you trying for the holiday season? Let us know in the comments.

5 Turkey Recipes for the Holidays

Source: diabetesdaily.com

A Volleyball Named Wilson and Diabetes Isolation

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.

By David Greene

Over 23,000,000 people in the United States have been diagnosed with diabetes. That is almost 1 in every 10 people. The irony is that despite these numbers, many of us feel isolated by our diabetes. This is problematic in that we are undeniably social creatures. Our physical and emotional well-beings are dependent on social connectedness. We need human contact. This is reflected in the ways we use punishment to enforce rules. Effective parenting recommends the use of time outs to correct children’s behaviors. Communities use prisons and prisons use solitary confinement. Religious groups use ex-communication or shunning. And countries use exile. Being isolated from human contact is considered the ultimate sacrifice. Who can forget Tom Hanks’ portrayal of Chuck Noland, a FedEx executive marooned on a small Pacific island in the film Castaway? In order to survive, Noland bonded with “Wilson”, a smudged volleyball that takes on the appearance of a human face. Just a movie you say? Research has shown that people marooned are often found dead even though they had access to all the required food, water, and shelter needed for survival. They died of isolation. They died of loneliness. Our need for human interaction is essential.

Our Own Diabetes Island?

You can’t throw a rock without hitting someone with diabetes. I’m not suggesting this, living with diabetes is tough enough. Just trying to make a point. But we are everywhere. We are in Hollywood, professional sports, beauty pageants, government, and every type of business and industry. We even sit on the United States Supreme Court. Yet research suggests that people with diabetes often feel a sense of personal failure, guilt, shame, distress and embarrassment. Browne and her colleagues called diabetes “the blame and shame disease”. When surveyed, people with diabetes reported feeling rejected, discriminated against, and isolated. To make matters worse, people without diabetes are not aware that people with diabetes have these feelings. For all the same reasons that isolation isn’t good for people without diabetes, it isn’t good for people with diabetes. Add to that, social isolation directly impacts our ability to live with and manage diabetes. It has been correlated with poorer glycemic control, more complications, higher medical costs, increased cognitive impairment, impaired quality of life, and poorer self-care behaviors.

We All Need a Wilson

Some of us are lucky enough to have wonderful “Wilsons” in our lives who support and help us deal with diabetes. Others, not so much. Regardless, research has suggested that educating family, friends, and colleagues about diabetes and encouraging communication about our challenges and needs can increase support and acceptance.

Support groups have long been an effective intervention for the isolating effects of diabetes. In addition to gaining first-hand information about diabetes through other people’s experiences, they provide reciprocal support from others with diabetes, and the opportunity to feel less lonely, isolated or judged. The curative effect of “universality”, knowing that you are not alone and that there are others who are struggling with similar issues, has long been recognized.

Summer camps for people with diabetes represent a unique type of support group. Surrounded by people with similar issues, camps have been found to help people connect with others, gain confidence, reduce anger and anxiety, increase self-esteem, and feel normal again.

And social media is able to provide a wealth of opportunities, connections, and information. For resources on how to get connected to the diabetes online community, click here.

But I preach to the choir. You are reading this on Taking Control of Your Diabetes, a premier diabetes social media platform. I have never met any of the TCOYD folks in person, but I feel connected with them and supported by them.

Back on the Mainland

Ultimately changing the socially isolating nature of diabetes will require societal change. Organizations such as TCOYD, the American Diabetes Association, and the Juvenile Diabetes Research Foundation are making great strides in connecting and organizing people with diabetes. Although the ultimate goal is to cure diabetes, an important side effect is bringing awareness and social acceptance to the disease. These organizations offer a range of opportunities for people to better understand their diabetes and connect with others. They include options such as newsletters, magazines, websites, chat rooms, forums, local chapters, marches, political advocacy, and fundraisers.

Spoiler Alert for the Three People Yet to See Castaway

In one of the more heart-wrenching scenes in Castaway, Noland loses Wilson in rough seas while escaping the island. However, with Wilson’s help, he survived. In the words of Alfred Lord Tennyson, it’s better to have loved and lost, than never to have loved at all. Okay, I admit this analogy of escaping our diabetes isolation is a bit cheesy. But I still believe we are well served by finding our Wilsons, and perhaps even pulling together a quick game of volleyball.

Source: diabetesdaily.com

Recipe Roundup: Peanut Butter and Chocolate Combos

Peanut butter is a favorite spread for many reasons. It’s not only creamy, crunchy, and tasty, but it’s also rich in protein, unsaturated fat, and iron, among other nutrients. For many people with diabetes, they include peanut butter in their diet because it’s low glycemic — it doesn’t raise blood sugar abruptly.  Versatility is another […]
Source: diabetesdaily.com

Recipe Roundup: Have Your Dessert (& Eat It Too!)

As we advance toward the holiday season at warp speed, having some low-carb dessert recipes in mind will help us stay on track during family and friend pot-lucks and celebrations while we enjoy our cake (or muffins or doughnuts), too! In this month’s Recipe Roundup, we share desserts that not only taste as good as […]
Source: diabetesdaily.com

How Can I Talk to My Loved One About Their Diabetes If They Don’t Want to Talk About It?

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.By Susan Guzman Dear Counselor’s Corner, My sister-in-law was recently diagnosed with type 2 diabetes, and I would love to be able to help her any way I can. However, every time I try to talk to her about it, she changes […]
Source: diabetesdaily.com

Kitchen Makeover: What to Purge and What to Stock Up On

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.By Dana Palermo If you had to choose the healthiest food option between a product labeled “natural” and another one labeled “healthy”, which would you pick? They both sound good, right? Well you might have to dig a little deeper because there’s actually no […]
Source: diabetesdaily.com

30-Minute Chicken Fajita Salad with Chimichurri Dressing

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.Celebrate spring with this colorful, easy, and filling (yes, filling!) Mexican salad from TCOYD and Joyful Healthy Eats! 30-Minute Chicken Fajita Salad with Chimichurri Dressing Eat the rainbow with a savory burst of roasted yellow and red peppers, ripe avocado, grilled chicken […]
Source: diabetesdaily.com

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