How Community Health Workers Impact Diabetes Care

This content originally appeared on diaTribe. Republished with permission.

By Andrew Briskin

Andrew Briskin joined the diaTribe Foundation in 2021 after graduating from the University of Pennsylvania with a degree in Health and Societies. Briskin is an Editor for diaTribe Learn.

Two major factors that lead to poor outcomes for people with diabetes are food insecurity and a lack of social support. Community health workers can address these issues, connecting people with diabetes to the resources they need.

Community health workers (CHWs) play a crucial role in addressing public health, particularly in communities with lower socioeconomic status and higher rates of chronic diseases, such as heart disease or diabetes. Two of the most significant social determinants of health impacting these communities – food insecurity and social support – can have a profound effect on the ability of people with diabetes to manage their condition. CHWs can play a direct role in addressing these factors by connecting people with resources to access healthy foods, helping them advocate for themselves, providing nutrition education, and connecting with and supporting individuals on a personal and community-wide level.

CHWs are typically members of the communities they serve, who are sometimes in a paid position and other times work as volunteers. Because of how important it is for CHWs to identify and communicate with the people in their community, they typically share the same background, ethnicity, and language. CHWs work in many locations throughout the community, which can include health clinics, government facilities, churches, food banks, other community centers/events, or traveling throughout the area.

Food insecurity is an economic and social condition of limited or uncertain access to adequate food, according to the US Department of Agriculture. People who deal with food insecurity are often only able to afford low-quality foods that lack nutritional value, have access to only a limited food variety, or have disrupted eating patterns (where you aren’t able to eat multiple balanced meals each day). For people with diabetes, these eating habits can be especially harmful when trying to manage things like weight and blood sugar.

Food insecurity, which is a growing problem throughout the United States, has been further exacerbated by the COVID-19 pandemic. Estimates for 2020 indicate that over 50 million people (or one in every six people) dealt with food insecurity in the United States, an increase of 4.1% since 2018. Rates of food insecurity among people with diabetes are also higher than the national average, with estimates suggesting that one in five people with diabetes face food insecurity during any given year, even without the COVID-19 pandemic adding additional stress.

At the ADCES 2021 conference last month, Dr. Anjulyn Ballard, a research and evaluation fellow at the CDC involved in advancing work of CHWs, said, “By CHWs addressing food insecurity and social support, health disparities can decrease significantly within communities.”

Dr. Betsy Rodriguez, senior public health advisor at the CDC Division of Diabetes who trains CHWs, focusing on reaching ethnic minorities and bilingual health communities, joined Dr. Ballard in the presentation. She said of CHWs, “Their advocacy can impact many healthcare-related issues such as improving health while lowering healthcare costs, improving access to primary care, and increasing screening for major conditions such as diabetes, just to name a few.”

Together, they outlined a few of the ways CHWs play an important role in addressing food insecurity and social support in the populations they serve. These roles include:

  • Advocating for individuals and communities. This involves connecting people with helpful resources while also encouraging people to advocate on their own behalf.
  • Conducting outreach. It’s important for CHWs to establish trust through regular communication with individuals in the community.
  • Coordinating access to healthcare. This includes making referrals to healthcare providers, ensuring that people make it to their appointments, and serving as a liaison between the clinics and the individuals assuring as many people as possible get the care they need.
  • Providing coaching and general social support. CHWs should be able to inform people on where to find community forums or others in the community that can provide social support.
  • Providing culturally appropriate health education. This means helping people understand the guidance they receive from their healthcare provider (for example if there are language or education barriers) and providing advice that considers the food, language, and traditions of the specific community they serve.
  • Addressing financial hardship and environmental needs. This involves encouraging people to apply for benefits such as SNAP and assisting them in the application process.

diaTribe recently spoke with Quisha Umemba, founder of Umemba Health, an organization that recruits and trains CHWs in Texas. A certified CHW instructor and diabetes care and education specialist, Umemba discussed how CHWs can support community members in addressing food insecurity and social support.

“CHWs can help people with diabetes advocate for better nutrition and food choices in their community,” Umemba said. “Often, people don’t know they can approach store managers or owners and request a different selection of foods. They also may not know how to approach their local representation in government or how to start a community petition to address issues like food insecurity.”

CHWs can also connect people with diabetes to their local food bank or farmer’s market to get the food they need. “They can provide nutrition education as well,” Umemba added. “Sometimes clients might have access to healthier foods but they don’t always know how to cook them.”

Not sure where to start? At findhelp.org you can enter your zip code and be immediately connected with food assistance, help paying bills, legal aid, and other free or reduced cost programs.

Increasing CHW engagement that focuses on specific interventions can help promote health equity. Unfortunately, there is still a great need for additional funding and resources for CHWs, especially during the pandemic.

Drs. Ballard and Rodriguez said the pandemic has negatively impacted the ability of CHWs to perform their roles. COVID-19 presented the challenge of providing specific pandemic-related support to communities without the necessary funding or virtual resources, they said. Plus, the economic hardships caused by COVID-19 led to an increased number of people requesting assistance from their CHWs with food, transportation, and financial issues.

Umemba agreed. “So much of what CHWs do revolves around establishing a trusted relationship with their clients,” she said. “It was difficult at the onset of the pandemic, but I believe for the most part that CHWs now see that personal interactions don’t just have to occur ‘in-person.’”

Drs. Ballard and Rodriguez also recommended specific interventions to better combat food insecurity and social support on the community level, such as developing standardized training and increasing funding for CHWs across the board. Umemba supported these interventions, lamenting the lack of federal regulations to support standardized training.

“There is no standardized training program for CHWs at the national level, as it is mostly governed by different states,” she said. “When I think about standardized training as it relates to food insecurity, first we need to make sure that CHWs know how to screen for it as well as the other social determinants of health. Also, we need to make sure resources are provided before the patient leaves the clinic, and that appropriate follow-up takes places. CHWs can be trained to screen, assemble and provide the appropriate resources and then follow-up as needed.”

In general, getting support from a community health worker in your area can be an extremely helpful resource not only for general guidance, but to improve your health and diabetes management.

Towards the end of the conversation, Umemba discussed her start in the field, making new observations on the interactions between people with diabetes and various members of the healthcare team such as fitness trainers, dieticians, nurses, and CHWs. Noting how each of these experts was able to connect with people with diabetes, Umemba observed that “year after year, virtually every single biometric including BMI, weight, blood pressure, cholesterol, etc., was better in the group taught by CHWs.”

She concluded that “the more charismatic and identifiable the instructor was, the better the participants did. There are plenty of people taking care of a person’s medical needs but not nearly enough people taking care of a person’s social needs. That’s why I’m such a big cheerleader for CHWs.”

If you need assistance related to food, shelter, healthcare, or financial resources, visit our “Affording Diabetes” resource page. On the right sidebar, you can find a helpful tool that allows you to enter your zip code and connect with a variety of resources in your area.

Source: diabetesdaily.com

10 Diabetes-Friendly and Affordable Finds at Trader Joe’s

Trader Joe’s is a great resource for people looking for convenient and affordable food that is diabetes-friendly and healthy.

The first Trader Joe’s was opened in 1967, and the business has grown to over 500 stores across the United States. They are known for their affordable branded products and offer great customer service, with a full refund guarantee if you are not satisfied with your purchase. The atmosphere is light and friendly with store managers referred to as “captains” and employees are “crew members”. Their Hawaiian shirts and friendly service make this a place you want to go back to.

I have a Trader Joe’s in walking distance from my house but do not take advantage of it enough. There are delicious frozen meals, fresh fruit galore, and tasty desserts all that won’t put you over budget. They also offer great wine and fresh flowers, making this a great place to run in and accomplish more than just picking up dinner.

I reached out to the diabetes online community and the Diabetes Daily forum members to get their recommendations on what to try next. Here are some healthy and affordable options to check out on your next visit.

1. Turkey Burgers

These turkey burgers are made with a combination of white and dark meat, rosemary, and salt, and contain 0 carbs and a whopping 22 grams of protein. They are also extremely convenient as you can cook them without defrosting them. These burgers come in a pack of 4 (think ahead, make two and throw the second over salad for lunch) and cost only $3.29, which makes for a few cheap meals. Be sure to check out their salmon and shrimp burgers too!

2. Mexican Style Riced Cauliflower

This flavorful spicy riced cauliflower makes for a great side dish next to your favorite protein or a great base for a burrito bowl. You can get creative and add grilled shrimp and have a delicious and healthy dinner that only contains 5 grams of carbs!

Cauliflower Gnocchi

Photo credit: Trader Joe’s

3. Cauliflower Gnocchi

Don’t be fooled by the fact it is made with 75% cauliflower. This delicious entree is made for Trader Joe’s in Italy, giving it a little more clout. For 16 net carbs, you can enjoy an authentic tasting pasta-like dish.

4. Oven-Baked Cheese Bites with Summer Truffle

I debated including this one because it is a seasonal item, but keep this on your radar for next year. With only 1 carb, this delicious snack packs a great amount of flavor, with a rare hint of ultra-gourmet truffles, and can be used to make a creative and healthy snack at your next celebration. The recipe attached suggests turning this into a luxe snack mix by adding nuts and pretzels.

5. Butternut Squash Mac N’ Cheese Bites

These bites are made from butternut squash, macaroni, a blend of cheddar and gouda cheese, and some seasonal spices. They are fried and make for a delicious appetizer or side. Coming in at only 18 carbs, this is a unique treat you can definitely sink your teeth into.

6. Egg Frittata with Swiss Cheese and Cauliflower

This is one of my favorite recommendations, to which a store employee agreed, as she excitedly told me she eats them 2-3 times a day!  Coming in at only 10 grams of carbs and 25 grams of protein for 2, this is a great low-carb, high-protein way to start your day that will keep you satiated until your lunch break.

Chewy Chocolate & Peanut Butter Protein Bars

Photo credit: Trader Joe’s

7. Chewy Chocolate and Peanut Butter Protein Bars

With only 12 net carbs, this Trader Joe’s protein bar rivals its competitors in taste and in price too. It can be tough to find good (and affordable) lower-carb snacks to eat on the go. This great snack on the go packs 10 grams of protein, making it a worthwhile snack to keep on hand.

8. Organic Freeze-Dried Berry Medley

If you are looking for something sweet without a ton of sugar to add to your smoothies, shakes, yogurts, and such, look no further. One entire bag only contains 29 carbs (along with 9 grams of protein), so you can feel free to use this sparingly to add some sweet flavor and healthy goodness to any of your favorite protein-filled snacks.

9. Jicama Sticks

This raw root vegetable is ready-prepared for you into small sticks so you can throw over a salad, or get creative and turn it into jicama french fries. Simply sprinkle with olive oil and any seasoning of your choosing and roast or air fry for about 10 minutes at 425 degrees (just double the time if you are using a conventional oven) for a crispy, tasty alternative to french fries.

10. Cauliflower Pizza Crust

This low-carb, high-fiber alternative to the real thing will keep your blood sugars stable and is quite tasty. Top this base with any of your favorite pizza toppings to make a delicious meal for you or your family.

This list just scratches the surface of what healthy finds Trader Joe’s has to offer. Please keep in mind that their offerings do change seasonally and while some of these are not linked to their website, I spoke with a manager who confirmed they are all still offered. Please be sure to also check out their dips, cheese spreads, and fresh produce.

Have you found any healthy good finds at Trader Joe’s? Be sure to share and comment below!

Source: diabetesdaily.com

Quiche the Crust Goodbye

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

This light veggie quiche is made without a traditional quiche crust in order to keep the carbs down. You can tailor it to your tastes with your favorite veggies and cheese, and pair it with these Cauliflower Hash Browns for breakfast, lunch, or dinner.

Quiche the Crust Goodbye

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Quiche the Crust Goodbye

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This easy, cheesy, fluffy egg casserole ditched the crust but kept the flavor so you’ll be eggcited to dish it up with your favorite fixins.
Course Breakfast
Cuisine French
Keyword quiche
Servings 4 servings
Calories 326kcal

Ingredients

  • 8 eggs
  • 1 cup milk or milk alternative. I used hemp milk, purchased from Trader Joe’s
  • 1-2 tablespoons seasoning I used Green Goddess Seasoning from Trader Joe’s
  • 1 cup cheese shredded. I used a Swiss/Gruyere blend
  • 1 cup sautéed veggies of choice I used chopped asparagus, mushrooms, and white onion
  • 3 tablespoons green onions finely chopped, plus 2 tablespoons for garnish
  • salt to taste
  • pepper to taste
  • ¼ cup goat cheese 1-2 oz, crumbled

Instructions

  • Preheat oven to 350 degrees.
  • Chop and sauté veggies in a large skillet over medium heat.
  • Crack eggs into a large mixing bowl and whisk.
  • Add seasoning, milk, and cheese to eggs, and whisk again until combined.
  • Add sautéed veggies and freshly chopped green onion, and whisk together.
  • Spray a 9×9 glass baking dish (or 9″ glass pie dish) with nonstick cooking spray and pour egg mixture into dish.
  • Bake for 40-45 minutes, or until set in the middle.
  • Garnish with more fresh green onion, crumbled goat cheese, and salt and pepper, if desired.

Nutrition

Calories: 326kcal | Carbohydrates: 7g | Protein: 23g | Fat: 23g | Saturated Fat: 12g | Polyunsaturated Fat: 2g | Monounsaturated Fat: 7g | Trans Fat: 1g | Cholesterol: 370mg | Sodium: 380mg | Potassium: 292mg | Fiber: 2g | Sugar: 4g | Vitamin A: 1111IU | Vitamin C: 1mg | Calcium: 404mg | Iron: 3mg


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.

Quiche the Crust Goodbye Recipe

Source: diabetesdaily.com

Overcoming Obstacles to Treat T1D in Ecuador

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

By Beyond Type 1 Editorial Team

Araceli Basurto is a certified diabetes educator and pharmaceutical chemist who runs an education center accredited by the International Diabetes Federation in Ecuador. She is also the president and founder of FUVIDA, a nonprofit supported by Life for a Child that provides children and young people with access to diabetes education, motivation, and support. The organization started with Arcaeli’s daughter, who was diagnosed with T1D at 2 years old, but now serves over 300 children.

Araceli recently sat down with Beyond Type 1 to discuss her organization’s mission, living with diabetes in Ecuador, and how you can help FUVIDA’s mission. This interview has been translated from Spanish, and edited for length and clarity.

Beyond Type 1What is FUVIDA’s mission?

Araceli: FUVIDA’s main objective is to provide education to families who have been affected by type 1 diabetes, whether they are children or adolescents, providing the necessary tools so that they are able to manage their condition at home. My personal mission is to ensure the health system provides the supplies and the necessary treatment so that these children and families have everything they need.

We are keeping an eye on [the health system] because 2 or 3 years ago the government issued a resolution that has not yet been executed. So, our mission this year is to promote that and follow up with the government so that this law is executed, and the children can get insulin, test strips, glucose meters, everything necessary for daily life with type 1 diabetes.

How many people does FUVIDA help today and what services do you offer or provide for the people who reach out to you?

We currently have more than 300 families living with diabetes. Many of them have 2 or 3 children with diabetes in the same family. We help them with workshops, camps, talks, and we provide supplies to children with limited economic resources so that they can have treatment because the health system does not provide them, or if it is provided, it is done very inconsistently. For example, in the middle of this pandemic, it was impossible for children to attend hospitals and they did not have insulin available. We make sure that they have the treatment they need so that they can survive.

We know that, in Ecuador, as in other parts of Latin America and around the world, people have trouble accessing treatment, especially in a timely manner, and it may not be available to everyone. What happens in your country?

The main problem is that we do not have enough trained professionals, that people do not speak the same language within the same hospital. It can be a very serious problem. As an example, about 5 years ago the government began to provide analog insulin, glargine, but after it came, a lot of the glargine insulin was returned because healthcare workers did not know how to use it.

That is one of the most serious problems we have, that despite having all the logistics and being able to get analog insulins, access to treatment, and diabetes technology, not all the personnel are trained.

So, I think that having access to the medications that the government provides and having sufficient resources to buy them go hand in hand, and it is a different issue for health professionals to actually be able to use it and know how to dose it, know how to deliver it correctly so that parents, with proper education, may be able to make use of these treatments.

Tell me about your partnership with Life for a Child

Life for a Child has a very common phrase that says, “No child should die of diabetes.” This started when María de Alba was president of the International Diabetes Federation and saw that many children were dying from lack of access to insulin. She then asked the Federation to create a program to provide insulins.

We partnered with Life for a Child in 2003; With their donation, we are able to deliver test strips and insulin along with diabetes education. The parents receive a monthly education talk and can take their supplies. They are well aware that the correct use of insulin is what really ensures a good quality of life. Through a group of professionals, we help these young people and their parents so that they can dose correctly, have appropriate treatment, and also use the test strips.

What has been the most significant success story you have had within the Life for a Child program?

The success story does not end, it continues writing itself because the story really is watching the children grow up and knowing that they can enjoy going to school. There used to be families whose children did not go to school because they had diabetes, but that mentality has started changing.

The children have now graduated because we have practically been working for 26 years. We have been following their story and that is what gives us the satisfaction, knowing that there are children who are already university students, who have jobs. Families who had abandoned their jobs to dedicate their lives to taking care of a child at home, to take care of their diet.

Some mothers have taken steps back, and when we give them that freedom based on diabetes education, we instruct the children so they start taking responsibility depending on their age, they are already capable of managing their diabetes with their parents’ support and with professional medical visits, but now their mothers can leave their homes, they can function as women, as professionals. They can also help and contribute to the family and that, for me, I think is the most beautiful story, being able to give this diabetes community that freedom so the children can get an education, to empower mothers as professionals, as women. This has been the greatest triumph, seeing families smile with diabetes now.

What are the plans for FUVIDA?

In the middle of the pandemic we were able to build a camp house. The first stage is now done, there is a social area and there is a large kitchen, because the mothers themselves do the cooking. I have great hopes that by 2021 everything will be more normalized, and we can take some of the children to enjoy Machalilla beach, which is a beach only for FUVIDA children. In other words, they cannot get lost there, you can see them from afar and you know that only the FUVIDA family is there.

We also plan to put more pressure on the government. We cannot depend on international organizations alone; it is actually the government’s responsibility. Let’s hope that there is someone at the top who has a child with diabetes. I do not truly wish for that, but if they are affected by diabetes perhaps they would actually listen to us. Maybe diabetes has to be personal to them.

Is there anything else you would like people to know about FUVIDA?

We really always need medical supplies to expand the program, so that not only 100 children can get this type of treatment; We need pharmaceutical companies to provide more analog insulin. Also, know that FUVIDA is a source of inspiration for many mothers, because there are many mothers in the world who are directly affected and we are all capable of starting an organization, it does not matter if there are only 2 or 3 of us.

To find out how you can support young people living with type 1 in under-resourced countries visit Life for a Child

Source: diabetesdaily.com

Walking a Tightrope – Dealing with the Highs and Lows

This content originally appeared on diaTribe. Republished with permission.

By Julie Heverly

Julie Heverly joined The diaTribe Foundation in 2021 as the Director of Institutional Giving. Heverly was diagnosed with type 1 diabetes after her junior year at Washington & Jefferson College and she is a guest writer for diaTribe Learn.

Julie Heverly describes one harrowing day when her glucose levels teetered between way too high and way too low and how she navigated this challenge.

For me, life with diabetes is like walking on a tightrope. Sometimes my course is set, and I can navigate to the ledge on the other side gracefully. Yes, it’s difficult, and yes, it requires skills, knowledge, the right equipment, and bravery (and even some luck), but it’s doable. But other days, a big wind blows through, and that delicate tightrope act is put in jeopardy.

I recently experienced one of those really bad windstorms, and it knocked me right off the tightrope.

To help me stay in range, I wear a continuous glucose monitor (CGM) and a closed-loop insulin pump that can give me small doses of insulin (micro doses) when my glucose levels are high and that can halt insulin delivery when my glucose levels are dropping or anticipated to become below my desired range. It’s a helpful system that assists my daily management quite well overall. It is not, however, a fool-proof system or a cure.

On this particular day, I woke up determined to stay in range (as is my daily mindset). At 5:30 am my alarm clock went off. I exercised for an hour on the elliptical, showered, and got myself and my family ready for the day. I chose the same breakfast I’ve been eating for the past six months – low fat cottage cheese and fresh berries. Shortly after breakfast though, my glucose started creeping into the 300s, where it stayed, despite my best efforts, until 9:30 p.m.

That entire day, my stomach was nauseous, my head was foggy, and my mood resembled Oscar the Grouch. I tried my best to bring my glucose down just as I have been taught:

  • I calculated correction boluses through my pump.
  • I selected low carb meals for lunch and dinner, and I pre-bolused 15 minutes in advance for both meals.
  • I changed my pump site in case the canula had kinked.
  • I used a new vial of insulin in case the old one had turned bad.
  • I took a walk after dinner.
  • I hydrated myself throughout the day (I personally aim to drink half my body weight in ounces each day).
  • And finally, I even resorted to a manual injection correction.

It didn’t help, at least not at first. But as we all know, what goes up, must come down.

Snacks

Image source: diaTribe

By 10:30 pm, my stomach started to growl, and my CGM showed that my glucose levels were finally coming down, but rapidly. I dropped from that 300 mg/dL range to below 80 in less than 60 minutes, and my CGM warned that I would continue to drop without urgent treatment. I treated myself with my standard juice and peanut butter crackers and went to bed relieved that the unbudgeable high was gone. But 45 minutes into my sleep, I was awoken by another CGM alert. I was below target again. My CGM and pump began beeping once every 15 minutes for the next two and a half hours. Once again, I attempted everything I have been taught, but this time it was to raise my glucose levels:

  • I consumed 8 oz of juice and waited 15 minutes.
  • Then I ate some peanut butter crackers and waited 15 minutes.
  • Then I consumed 8 oz of milk and waited 15 minutes.
  • And finally, I ate approximately 50 grams of carbs in small doses (approximately 15 grams of carbs at a time over the course of two hours). I felt like I was eating everything in sight.

Throughout all of this, I checked my glucose with my CGM and blood glucose meter regularly, but no matter what I seemed to try, my glucose sat between 60-70 mg/dL with downward facing arrows on my CGM. Thankfully, because I never fell to level 3 hypoglycemia (below 54 mg/dL, when mental or physical functioning is impaired), I did not need additional assistance or glucagon.

This is the point in the textbook story where a person should have their family on standby with a glucagon kit and their phone ready to call 911. But I don’t live in a textbook. I live in the real world where people are employed and need sleep to function properly. I had left my bedroom after the first six alarms so my husband could try and salvage some sleep. I had my phone at the ready, but I’ll admit to trying to fall back asleep after each course of treatment, making each alarm more upsetting and frustrating than the last.

Throughout the course of the night, I dealt with soaking sweats and shakes. My legs were able to carry me to find more carbs, but they felt like they would give out at any time. I knew I needed more glucose in my system, but I lacked the resolve to search for the best options and ended up eating whatever was closest to me.

My lack of control and inability to quickly resolve this situation left me with significant anxiety, feelings of helplessness, and guilt for potentially disrupting my family in the middle of the night. But perhaps the worst side effect of this hypoglycemic episode was the fear it provoked.

I’ve been living with type 1 diabetes for 23 years; I know the risks of hypoglycemia. In 2016, I was serving as the executive director for the American Diabetes Association in Western Pennsylvania, and while setting up for our annual diabetes camp, one of our best volunteers never arrived with our inflatable arch. This was incredibly unlike him, and we left message after message trying to reach him. A few days later, I learned that Gregg, who also had type 1 diabetes and who dealt with hypoglycemia unawareness, had died from hypoglycemia. Two years later, a 9-year-old girl named Sophia who had participated in the same diabetes camp the summer before, died at a sleepover, also from hypoglycemia.

Most of the time, diabetes is manageable thanks to new and evolving tools, therapy options, and tons of education. But every so often, there are days that are completely outside of the normal day-to-day. These days are difficult to manage and can only be explained by ambiguous culprits like stress or hormones. Those days are frustrating and sometimes scary. They remind me of Gregg and Sophia. I see their faces and I recall the heartbreak I shared with their families and loved ones when diabetes took them too soon. They also remind me to push through and to keep fighting.

At some point, during this particularly difficult glucose rollercoaster day, I remember falling asleep and thinking, “I’m exhausted, and I really hope that it’s my alarm clock that wakes me next and not my diabetes devices or a paramedic.”

Three hours later my alarm clock went off.

Thank you, Lord!

I felt like I had been hit by a truck, but it was a new day and I was given another chance to get it right.

I am so grateful to be dealing with diabetes in the age of CGMs, closed-loop insulin pumps, and helpful metrics like Time in Range that give me more information about my diabetes management. My life is better, easier, and healthier because of them. But there are still days when the best laid plans don’t always work.

After this incident, I contacted my endocrinologist. We decided to complete some basal rate testing to ensure my pump settings were currently correct. I also got a prescription for one of the new next-generation glucagon options. I’ve talked to my husband and daughter about learning how to use the new glucagon if I hit level 3 hypoglycemia. Finally, I resolved to work on balancing patience and vigilance with my diabetes management. That will be the toughest challenge.

Sometimes I wonder if Nick Jonas makes having diabetes look too cool. Or that maybe we have all done such a great job of thriving with this condition that the public, our families, and even those of us living with diabetes sometimes forget how dangerous diabetes can be when something in our world changes the wind near the tightrope that we walk 24 hours a day, 7 days a week, 365 days a year.

If you want to learn more about managing hyperglycemia or hypoglycemia, check out some of diaTribe’s helpful resources:

Source: diabetesdaily.com

“Our Trials are Totally Different.” The Denise Faustman Interview

There’s no question that Dr. Denise Faustman does things differently.

Dr. Faustman’s research has won her avid fans and raised millions from donors, but it has also provoked significant pushback from major diabetes organizations. Dr. Faustman wears that repudiation like a badge of honor, proof that her work is disruptive and important.

A Maverick Approach

Dr. Faustman takes an unconventional approach. Her work, which is focused on the underlying immune response responsible for type 1 diabetes, has led her to a very old and inexpensive drug, a tuberculosis vaccine used widely in the developing world. It’s a treatment that may have been hiding in plain sight for generations.

Dr. Faustman’s immune intervention trials also concentrate on adults with long-standing type 1 diabetes. By contrast, virtually all of her peers have targetted patients with new-onset diabetes, or even patients that have yet to develop diabetes. This approach is generally considered more likely to succeed, because the targets of the interventions have not yet entirely lost their ability to secrete insulin. But in Dr. Faustman’s telling, it hasn’t accomplished much yet:

“Over the last 30 years, immune intervention trials in type 1 diabetes haven’t had very good outcomes. The important diabetes advances have been different versions of insulin and new forms of blood testing, but the immune intervention trials have been a very sad point. Nothing’s worked very well, no new treatments have been approved.”

“Our trials are totally different. They’re all in people that have had diabetes for decades.”

Dr. Faustman told me that a who’s who of diabetes experts has told that her approach is crazy, a response that has clearly tickled her contrarian side.

“We thought the need is to treat the people that actually have the disease. It sounds like a no-brainer, but keep in mind that nobody else is doing it!”

The decision to study patients with long-established diabetes, which was originally made well over a decade ago, was inspired in part by financial constraints: “we could not afford to do new-onset diabetic trials.” And focusing on an incredibly inexpensive generic drug meant that Dr. Faustman had no way of interesting large pharmaceutical companies and their very large R&D budgets.

“It’s a terrible drug to make money off of.”

BCG

The drug is BCG, the Bacillus Calmette–Guérin vaccine, which was first used a century ago in order to protect patients from tuberculosis. It is considered extremely safe, and is still administered to millions of infants annually, most prominently in the developing world.

BCG first piqued Dr. Faustman’s interest because it was “the only drug in animal models that has worked in established diabetic mice.” Exactly why it worked, though, still requires some unraveling. The results of her Phase I trial – results that were both celebrated and questioned – showed that patients receiving the vaccine experienced impressive improvements in glucose control without restoring insulin production or insulin sensitivity.

Most immune intervention drug trials involve the suppression of immune cells that are harming the body – in the case of type 1 diabetes, the T-cells that attack the pancreatic Beta cells. But the BCG vaccine works the opposite way, not by depleting the immune system, but by putting something else back in.

“BCG adds to the microbiome. It’s actually the tuberculosis organism, inactivated. So you’re putting back in, effectively, tuberculosis. When you revaccinate with this vaccine, the reason it takes a little while is that it gets to your bone marrow and actually resets your stem cells in your bone marrow.”

Why would you want tuberculosis in your bone marrow? Dr. Faustman referred to the hygiene hypothesis, the idea that many autoimmune and allergic diseases are caused at least in part by our excessively sanitary modern world. Myobacterium tuberculosis may have co-evolved with humans for thousands of years, and its absence may therefore trigger immune system dysfunction.

“The absence of this organism has allowed these rogue immune systems to take off and create all these autoimmune diseases. We’re just reestablishing this synergistic relationship to get immune tolerance.”

Because of its many possible effects, BCG has lately become “fashionable” in the research community, Dr. Faustman told me. The old vaccine is being evaluated as a treatment for other serious autoimmune diseases, and it has also been theorized to provide protection against the novel coronavirus that causes COVID-19.

But how does all that help with your blood sugar levels? Dr. Faustman believes that when BCG vaccine “retrains” the immune system, it also causes the immune system itself to begin utilizing large amounts of glucose in the bloodstream.

“What really happens is that their white blood cells now become the regulator of sugar, and have restored sugar transport. So there are underlying defects in type 1 diabetes in the use of the lymphoid system as a sugar regulator, and BCG restores that.”

The Effect

“It’s definitely a game-changer. Our hope, based on the early results, is that it will lower your A1c 10-15%, stably. You can use less insulin, and have better blood sugar control.”

It is, however, a slow process:

“It takes a number of years to have its metabolic and immune effects. We know we need to follow these patients for 3-5 years to get the maximal effect. But it’s got good durability. It’s quite permanent.”

The nine patients that originally received the BCG vaccine for the Phase I trial are still checking in with Dr. Faustman’s lab every six months, and she says that they continue to enjoy dramatic improvements in glucose management.

“Everyone wants to know if we have any [trial participants] off insulin. We have one person off insulin. Normally when he’s on a fairly low dose of insulin his A1c is in the normal range. When he goes off insulin, he no longer goes into DKA, but he goes up to around 7.2%.

“Is it gonna last twenty years? Thirty years? We don’t know yet.”

Sample Size

One of the chief concerns that other experts have raised with Dr. Faustman’s work is the tiny sample used in her Phase I trial: a mere nine patients received the BCG vaccine.

Dr. Faustman is completely unphased by this criticism, arguing that the statistical significance of her results speaks for itself.

“A p-value of .05 is as statistically significant in a sample of 10 as it is in a sample of 200,000. The only difference is, in the sample of 10, everybody responded, and the magnitude of the response was large.

“If you have to design big trials, you have small effects and unresponsive groups. And that’s what you’re seeing in the [rest of the] diabetes community.”

The criticism of her work by major diabetes authorities, particularly ADA and JDRF, doesn’t seem to have phased her, although she admits that it has slowed down the pace of her trials. She quoted one of her most significant boosters, the late Lee Iococca, a rockstar among American executives as the CEO of Chrysler during the 1980s. Iacocca told her, “I love it when they’re shooting the cannons at me. It means I’ve got something good.”

Dr. Faustman continued: “If they didn’t think it was competitive, it wouldn’t matter to them. The fact that they shot their cannons, to issue statements that were not truthful, it shows that it mattered to them a lot, that it was threatening to them.” She believes that the criticism set forth by the ADA and JDRF in a remarkable joint letter was not only misguided but dishonest.

Don’t Do It Yourself

Referring to the BCG vaccine’s long history of safety, Dr. Faustman suggested that there was little downside to her proposed intervention.

I felt an uncomfortable comparison to some of the pandemic era’s health controversies, in particular to the arguments advanced by many in favor of poorly investigated COVID-19 treatments such as hydroxychloroquine and ivermectin. I asked her what she would say to readers that are ready to go get the BCG vaccine themselves, before it’s been evaluated by the FDA. It’s a question she deals with constantly.

About once a month, Dr. Faustman gets a call from a physician, asking confidentially where one might acquire BCG of the correct strain. Sometimes it’s pharmacies attempting to fulfill a prescription, sometimes it’s the patients (or parents) themselves.

“Everyone’s trying to do it in the closet because it’s a safe drug, right? People try to do it all the time. But you should really wait until we get the right strain and the dosing. What we try to say is that if you get vaccinated with the wrong strain of BCG, we’re not sure, when we give you the right strain, that it’s gonna work.”

The BCG vaccine may be easy to come by in countries where it is used frequently, but there’s no telling what strain you’d get and what the effects would be.

For patients that are very eager about BCG, Dr. Faustman recommends registering for one of her clinical trials.

Timeline to Treatment

There’s already a phase II trial underway, which will test the BCG vaccine in adults with long-standing type 1 diabetes. This expands the study size from 9 to over 200; Dr. Faustman expects that good results in a much larger cohort will finally resolve the criticism and controversy that has dogged her for years.

Meanwhile, her lab is beginning its first trial of children with type 1 diabetes.

In an ideal world, she told me, the phase II trial for adults would be followed by phase III, an even larger study which she would then present to the FDA for evaluation. In a best-case scenario, the approved drug could be administered to regular patients in “five to eight years.”

“We’re moving as fast as we can.”

Source: diabetesdaily.com

Matcha Latte Bombs: Low-Carb, Dairy-Free & Satisfying

This content originally appeared here. Republished with permission.

These keto-friendly green tea Matcha Latte Bombs are a fun take on the Tik Tok recipe trend, just like my Bulletproof Coffee Bombs! So if you’re looking for a little extra and want to have some fun, make these matcha latte bombs! There are a few simple steps to take to get them just right, so keep reading.

Sure, you could take these ingredients and make a regular matcha latte (and it would be fabulous!), but think it’s worth the extra effort to make the bombs because they have a super satisfying melt and pop.

Take it from a former barista, matcha lattes are even better than espresso!

Keto Matcha Latte Bombs

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Keto Matcha Latte Bombs

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Make the best ever bulletproof Keto Matcha Latte, and level it up with these fun melting bombs!
Course Drinks
Cuisine American
Keyword matcha
Prep Time 20 minutes
Cook Time 5 minutes
Total Time 25 minutes
Servings 1 serving
Calories 117kcal

Equipment

  • milk frother

Ingredients

Keto Matcha Latte

  • 1 cup almond milk unsweetened
  • 1 teaspoon matcha powder
  • 1.5 – 2 teaspoons monk fruit sweetener or erythritol
  • 2 teaspoons coconut oil

Optional Ingredients

  • 1 tablespoon whipped cream sugar-free
  • 1/8 teaspoon vanilla extract

Instructions

Make the Matcha Latte Bombs

  • Spoon about one teaspoon of softened room temperature coconut oil into each half sphere of your silicone mold, two half spheres for each bomb you plan to make. Pay extra attention to coat the sides, all the way up to the edges. Set the mold in the freezer for about 15 minutes, until hardened.
  • Use your hands to carefully remove the hardened half spheres, and set them on a chilled plate. Fill half of the pieces with matcha and sweetener.

    One at a time, rub the unfilled spheres face down in a warmed skillet, just for about 5 seconds. This will melt and flatten the edge, then use your fingers to close over one of the filled half spheres, smoothing and sealing the edges. If necessary, take a little more room temperature coconut oil and fill any gaps.

  • Set the filled bombs in the freezer for another 5 minutes, then sprinkle lightly with a little more matcha powder. Last, transfer the finished matcha bombs to an airtight container and store in the freezer until you’re ready to make your latte!

Make the Latte

  • Heat the almond milk in a small sauce pan until it starts to simmer, then transfer to a mug. Use a spoon to gently drop the the matcha bomb into the mug and wait for it to melt. Use a milk frother to fully combine and froth.

Notes

To store: Set in an airtight container and store in the freezer until you’re ready to use them!

Nutrition

Calories: 117kcal | Carbohydrates: 1g | Protein: 3g | Fat: 11g | Saturated Fat: 7g | Sodium: 325mg | Potassium: 1mg | Fiber: 1g | Sugar: 1g | Vitamin A: 200IU | Calcium: 300mg | Iron: 1mg


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.

Keto Matcha Latte Bombs Recipe

Source: diabetesdaily.com

10 Fruits with 10 Net Carbs or Less

Fruits are high in vitamins and minerals and have several health benefits, including reducing the risk of obesity, heart attack, and stroke. However, all fruit contains sugar, and this can be challenging for those of us living with type 1 or type 2 diabetes. The fruit mentioned below all have a carbohydrate count of 10 carbs and are low GI foods which means they won’t spike you as quickly. These fruits are also loaded with fiber, which can help keep you fuller longer, promote good digestion, and help your overall blood sugar management.

Be mindful of the carb count of the fruit you’re eating: it will help you enjoy this healthy and delicious food without spiking your blood sugar. And please note that fresh fruit and frozen fruit are always better choices than fruit that comes in a can or jar. Also, avoid processed fruits and dried fruits that contain extra sugar.

Here are 10 fruits that contain 10 carbs or less per serving:

Tomatoes

Surprise! The tomato is a fruit, and I find it to be one of the most versatile fruits to work with. You can eat tomatoes over a salad, serve them with fresh mozzarella and a drizzle of balsamic vinegar, roast them, or turn them into a sauce and add it to any of your favorite proteins. Tomatoes contain a slew of vitamins, minerals and antioxidants and only contain 4.8 grams of net carbs for an average-sized tomato (about 123 grams/4.3 punches).

avocado

Avocados

Containing only 1.7 grams of net carbs per 3.5 ounces/100 grams of avocados, this is a great choice that is full of healthy fats and antioxidants. It is also high in fiber, contains potassium, Vitamin K, Vitamin C, and folate. Adding some avocado to a salad is a flavorful way to get in some good nutrients without spiking your blood sugar. You can also turn this into guacamole and serve it with your favorite crudite.

Strawberries

This personal favorite of mine contains only 8 net grams of carbs per cup. This fruit is high in vitamins, fiber, and antioxidants, along with many other nutritional benefits. You can do so much with strawberries and don’t have to worry too much about your blood sugars. Make a smoothie, toss on your favorite summer salad, or dice them up and add to greek yogurt. Add a drizzle of sugar-free chocolate syrup for a decadent and healthy snack.

Lemon and Lime

While most people don’t actually eat whole lemons and limes, either is a great addition to water to make it more palatable. It is also great to mix with your favorite alcohol for a low-sugar tasty drink. Lemon and lime both only contain 7 net carbs per serving, so feel free to use them generously in your drinks and to season meals as well.

Blackberries

Out of all the really fruity fruits, berries contain the lowest amount of carbs, only 8 net carbs per cup. (Blueberries, by contrast, contain 17 net carbs per 1 cup serving). They are packed with vitamins and high in fiber, making them a great choice.

kiwi

Photo credit: Pranjall Kumar (Unsplash)

Kiwi

Unbeknownst to many, kiwis are berries, and like most other berries they have minimal sugar, coming in at 8 net carbs per kiwi. The health benefits of kiwis are plentiful, they are packed with vitamins, antioxidants and are high in fiber, which will help aid digestion. When it comes to using kiwi, the options are endless- smoothies, puddings, desserts, even bread. Check out these recipes for more ideas on how to use this super fruit.

Plums

This fruit only contains 7.5 net carbs per average-sized plum and is packed with nutrition. Plums have also been found to reduce blood sugar thanks to a hormone, adiponectin, which helps regular blood sugars.  The fiber will also help avoid a quick spike in your blood glucose levels.

Rhubarb

Coming it at only 1 net carb per cup, this fruit is worth the effort. You can eat it on its own (only the stalk; the leaves are poisonous), but most people use it to bake with. This superfruit is packed with vitamins and antioxidants and has numerous health benefits, such as aiding collagen production and fighting inflammation, to name a few.

Watermelon

With only 8 grams of carbs per 100 grams/3.5 ounces of watermelon, this is a delicious refreshing fruit you can enjoy any time of year. Not just high in vitamins and antioxidants, watermelon also contains lycopene, which has has been found to lower blood pressure and cholesterol, reduce inflammation, and benefit brain health.

Cantaloupe

Like watermelon, cantaloupe only contains 8 grams of carbs per 100 grams/3.5 ounces. It is full of vitamin A, C, and potassium. You can get pretty creative with this succulent fruit by turning it into sorbet, cantaloupe chia pudding, or even this refreshing drink

Do you try to stick to low-carb fruits? What are some of your favorites and how do they impact your blood sugar levels? Share and comment below!

Source: diabetesdaily.com

We Asked an Immunologist Your Questions About COVID-19 Vaccine Safety

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

By Lala Jackson

August 2021 is starting to feel like March 2020 – the COVID-19 delta and other emerging variants are more dangerous than the original virus, but what does that mean? Cases are rising rapidly, are we safe? Do we need to wear masks or not? Vaccines work, but do they for everyone?

To get some clarity, we spoke with Bernard Khor, MD, PhD, of the Benaroya Research Institute at Virginia Mason in Seattle, Washington. Dr. Khor’s laboratory is trying to find new ways to treat autoimmune diseases, specifically for people living with Down Syndrome as they are more likely to develop autoimmune diseases like type 1 diabetes. Because he spends so much time researching immune responses, we published his interview on whether type 1 diabetes means a person is immunocompromised and wanted to talk with him more about COVID-19 vaccine safety for people with type 1 diabetes.

Beyond Type 1: Are people with type 1 diabetes more likely to get COVID-19?

Dr. Khor: People who have autoimmune diseases aren’t necessarily immunocompromised; instead we can think of it as having a dysregulated immune system. That’s what causes the immune system to attack its own body. It does not necessarily mean that they don’t respond appropriately against infections.

What we do know is that, if they catch it, people with type 1 diabetes are more susceptible to worse outcomes from COVID. If it were my child or loved one living with type 1 diabetes, I would do everything I could to mitigate that risk.

What about the delta variant? How did we get here?

The delta variant and other variants we’re seeing start to develop are worse for everyone. These mutations happen because the virus has had time to persist and improve itself. If we were able to completely contain it, if everyone got the vaccines right now, we could stop this pattern by giving it nowhere to hide. But if the coronavirus is hiding in 30 to 40 percent of the population, it will come back and come back worse again and again. It’s just a matter of time.

That’s the thing about a virus – it’s not a one time threat. It’s an ongoing, adaptable threat. It’s a virus that mutates. It’s trying to survive. It can change and adapt to circumstances. There’s another variant coming out from Peru that’s getting more powerful – it’s affecting younger people, it’s leading to more rapid hospitalization, it’s a worse disease.

I cannot overstate how much COVID-19 needs to be respected. The writing on the wall was very clear from the beginning. We have seen outbreaks of diseases before and we have seen pandemics before. They are all agents that need to be respected immensely.

Other forms of coronavirus – SARS, MERS – were incredibly bad. In both cases we basically escaped worse outcomes because we got lucky; transmission rates of those viruses weren’t as high as COVID. Now we have COVID. We started off unlucky, and if we don’t respect it, it will get worse. It can cause death, it can cause disability, it can cause horrible outcomes. We’ve seen nursing homes decimated, it’s devastating.

We as scientists can make the best thing we possibly can, but it doesn’t matter if no one uses it. I see this as our generation’s World War event. We’re lucky that many of us are inside, that we have Netflix and ways to work from home. But the societal impact is every bit as serious.

Are people with type 1 diabetes more likely to have a particularly bad reaction to the vaccine?

All the data points to no. You’ll rarely hear a scientist say never—1 in millions is not never—but all the studies to date say no, and we can have confidence in that because there’s been a lot of post-marketing assessment of these vaccines. We have a lot of people who have taken the vaccines already worldwide to see how it’s working.

And that’s what we look at—the remarkably low rate of adverse reactions that are reported and tracked, versus the highly measurable rates of severe illness or death, or of long-term disability from long haul COVID.

What about the fear that vaccines in general can lead to new or more autoimmune issues? Can you explain the risk?

It’s a terrible thing to come down or have your child come down with a severe life-long illness. Type 1 diabetes is so diabolically difficult, and it’ll be different for different people. It’s a slog. So of course we want to know why it happens. Especially when you’re trying to find that important of an answer, our minds are programmed to look for patterns, but when you look from a single case, you’re only able to make the pattern from the single situation. Huge studies have uniformly debunked the idea that vaccinations commonly cause autoimmune issues.

That’s the benefit of our system – it’s very transparent. When there are adverse effects, we know about them. There are rare occurrences that have been seen; an example was a batch of flu vaccines in the 1970s, where several people came down with a rare autoimmune disorder called Guillain-Barré syndrome (GBS). Even in that instance, the risk of getting GBS was ten times less than the risk of death from flu. The cost benefit ratio is not even close.

Editor’s Note: There have been 100 reports of GBS among people who received the Johnson & Johnson vaccine, from approximately 12.5 million doses administered. Each year in the United States, an estimated 3,000 to 6,000 people develop GBS. Most people fully recover from the disorder. Whenever health issues like these do arise from vaccines, the FDA requires revisions to the information provided to vaccine recipients and healthcare providers so that they know about potential risks. No similar pattern has been identified with the Moderna and Pfizer-BioNTech COVID-19 vaccines.

How can we trust vaccines that only have emergency use authorization (EUA) And are not fully approved?

Editor’s Note: Since this interview was published on August 10, 2021, the FDA has granted the Pfizer and BioNTech COVID-19 vaccine full approval for ages 16 and up, with the EUA still in effect for ages 12-15 and booster doses for immunocompromised individuals. 

I think it’s incredible that we have a vaccine ready as quickly as we did – that has been due to immense collaborative work from the entire global scientific community. That work happened because of the immense threat and impact of COVID-19.

In this case, scientists worked hard, building upon decades of existing research to make this thing work. In a sense, we also got lucky. We are so fortunate that these vaccines work as well as they do. We built this nice big shiny thing, now we have to walk on in. Because scientists can build the best possible solution and it means nothing if people don’t use it.

Lack of full approval—which we know is coming soon—is due to the fact that the FDA has a rigid and bureaucratic approval process. It’s not wrong. But it makes it very slow even once the medicine and science has been proven, as is the case with the COVID-19 vaccines we offer in the US.

But no corners have been cut—the data has been reviewed, the process has been transparent. Everyone understands the need for post-marketing surveillance, ongoing data from the vaccines as they are administered. No expense has been spared for that.

How do we know that people who take the COVID-19 vaccine won’t face health issues from it in twenty years?

I cannot think of a scientific mechanism to be worried about that. I do know that COVID is here and is a very real risk, right now. We fear the unknown; the fear of the known has become hard to remind people of. After more than a year, we’ve gotten used to the bear that’s in the house. We can get worried about how we’re dealing with the bear, or we can go ahead and get the bear out of the house.

We heard discussion a few weeks ago about the psychology of choosing to take the COVID-19 vaccine; that to humans, it’s scarier to face making a choice and something bad happening, like taking the vaccine and getting sick from it, and less scary if something bad happens to you passively, like getting COVID-19 when you are going about your daily life trying to be careful. It feels like less responsibility. What are your thoughts on this?

Choosing not to do something is as much a choice as doing something. It’s about the risk of not doing it, not taking the vaccine.

You can always be nervous about some infinitesimal risk of doing something, but there’s a true risk of not doing something in this particular case. And the risk is not just what might happen to you if you get COVID, it’s the risk of all the people you might pass COVID to, including grandparents and children.

Because it’s not a question of if you will be exposed to COVID-19, it’s a question of when.

Source: diabetesdaily.com

Your Brain and Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Brett Goerl and Matthew Garza

Recent studies have shown a link between brain diseases like Alzheimer’s and Parkinson’s and diabetes.  Unfortunately, these conditions are becoming more common as our population grows older. Find out more and ways to improve brain health.

What are neurodegenerative diseases?

The term “neurodegenerative diseases” refers to a range of diseases in which the cells in our brains break down and can no longer perform their designated functions associated with movement or mental ability, according to the EU Joint Programme – Neurodegenerative Disease Research. The most common neurodegenerative diseases that affect people with diabetes are mild cognitive impairment (MCI) and dementia, which includes Alzheimer’s disease.

As we age, it is completely normal for our memory, thinking, and judgment to slightly decline. However, MCI occurs when our mental abilities decline faster than expected and begin to interfere with our daily lives. Age is by far the biggest risk factor for MCI, but diabetes, smoking, high blood pressure and cholesterol, obesity, and depression can further increase a person’s risk of developing MCI.

In around 10-15% of cases each year, the mental decline seen in MCI may progress further, making it difficult for us to carry out a healthy and happy life. When this happens, it is called dementia. The two most common types of dementia that affect people with diabetes are Alzheimer’s disease (AD) and vascular dementia.

While the symptoms of AD and vascular dementia are similar, they are caused by two different processes that occur in our brains. AD is thought to be caused by the abnormal build-up of proteins in the brain. One protein is “amyloid,” which clumps together in spaces around brain cells. The other protein is “tau,” which get tangled up inside brain cells. Vascular dementia, on the other hand, occurs when the blood vessels in our brain become narrow or start to bleed. This reduces the brain’s ability to get the oxygen it needs to keep brain cells healthy and for the brain to function properly. In both cases, brain cells become damaged, leading to a wide range of problems such as memory loss, worsened judgment, and personality changes.

AD is the most common form of dementia in the US, making up 60-70% of dementia cases. In the US, an estimated 5.4 million people of all ages are affected by AD, and one in eight people 65 years and older suffer from it. Considering the 14.3 million adults aged 65 and older in the U.S. who have diabetes, and it is easy to see why Alzheimer’s disease and diabetes are two of the most common diseases of aging. And recent research has suggested that they may be linked in various ways.

How do neurodegenerative diseases like Alzheimer’s and vascular dementia relate to diabetes? 

We often think of diabetes as a problem with our metabolism since the lack of insulin (in type 1 diabetes) or insulin resistance (in type 2 diabetes) affects our body’s ability to maintain normal blood glucose levels. However, our brain consumes the most glucose compared to any other organ in our body. While the brain accounts for roughly 2% of our body weight, it uses almost 20% of the sugars we eat or release from our body’s stores.

An increasing amount of research shows that people with AD and other forms of dementia experience insulin resistance in the CNS (central nervous system, which includes the brain and the spinal cord), similar to what people with type 2 diabetes experience in other areas of the body, such as the muscles, the liver, and the fat. Scientists have yet to determine exactly what the relationship between diabetes and AD or other forms of dementia may be caused by, but there are a few theories that have been proposed.

  • One of these theories focuses on brain insulin resistance, which is when brain cells stop responding normally to insulin, leading to problems related to the ways our brain cells communicate, use energy, and fight infection.
    • Insulin receptors can be found in many areas of the brain, where they are involved with brain cell growth, communication, and survival. While insulin levels are lower in the brain than in the bloodstream, all the insulin that makes its way to the brain comes from the same insulin produced in the pancreas – it crosses over what is known as the blood-brain barrier (or BBB). This barrier prevents unwanted things from the bloodstream from entering the brain. However, injected insulin does not cross the BBB. The reduced transport of insulin across the BBB may be why brain insulin levels are lower when the body experiences insulin resistance (such as in pre-diabetes and type 2 diabetes) and in diseases such as AD.
    • Insulin in the brain is known to help control our metabolism in certain other organs of the body, like the liver and fat tissue. The hypothalamus, the part of our brain that controls hunger, thirst, and emotions, is highly sensitive to levels of insulin in the brain. The association between type 2 diabetes and brain health may be due to problems with insulin’s actions in the hypothalamus, increasing a person’s likelihood of developing whole-body insulin resistance.
  • Diabetes also increases the risk for damaged blood vessels, leading to heart disease and stroke. Damaged blood vessels can starve the brain of oxygen, leading to cognitive decline and vascular dementia.
  • Diabetes disrupts how our bodies produce amylin, a hormone related to insulin that helps our bodies digest food. People with obesity and pre-diabetes often have high amounts of amylin, some of which can circulate and cross into the brain. Studies have shown that amylin can interact with the same protein deposits in the brain known to cause AD.
  • Experiencing hyperglycemia for long periods of time can degrade the myelin sheath (a protective layer that surrounds your neurons). This leads to issues in how your nerves send and receive signals to your body. It can also lead to your brain cells dying.

Type 1 diabetes could be a risk factor for dementia for many of the same reasons as type 2 diabetes. In particular, the cardiovascular complications such as heart disease and stroke that are associated with type 1 diabetes could provide an explanation for its relationship with vascular dementia. Additionally, higher rates of cognitive dysfunction for those with type 1 diabetes could be related to frequent cases of hyperglycemia and hypoglycemia. Indeed, severe hypoglycemic and hypoglycemic events are associated with increased dementia risk for older adults with type 1 diabetes.

Is diabetes a risk factor for developing neurodegenerative disease? 

On average, people with diabetes experience slightly more cognitive difficulties associated with MCI across their lifespan, but experiencing cognitive difficulty does not mean you will eventually get diagnosed with dementia or AD. The prevalence of type 2 diabetes and neurodegenerative diseases, however, both increase with age, meaning it is more common for older people (65+ years) with type 2 diabetes to get diagnosed with vascular dementia or AD.

Data suggests that people with diabetes have a 73% increase in the risk of developing any type of dementia and 56% increase in the risk of developing AD compared to people who do not have diabetes. This makes diabetes one of the strongest risk factors for getting dementia aside from aging. Health measures like A1C, cholesterolhigh blood pressure(or hypertension), and eGFR are negatively impacted by diabetes and may also be associated with cognitive performance and neurodegenerative diseases.

  • In the ACCORD-MIND trial, the largest and most rigorous study on diabetes and the brain to date, higher A1C levels were associated with lower cognitive function in people with diabetes. Similarly, another study found that the risk for dementia increased as a person’s A1C level increased, regardless of whether or not the person had type 2 diabetes.
  • A recent analysis of over 100 studies found that higher levels of LDL cholesterol (known as “bad cholesterol”) was an independent risk factor for the development of AD.
  • High blood pressure in middle-aged people has been linked to future cognitive decline and dementia, and in particular, vascular dementia. This may be due to high blood pressure in the brain causing damage to blood vessels, such as small blockages and bleeding.
  • In a study on kidney health and dementia recently published recently, researchers found that lower rates of kidney filtration (as measured by eGFR) were associated with higher risk of onset of both vascular dementia and AD.

What about Parkinson’s Disease?

Parkinson’s Disease (PD) is another neurodegenerative disease associated with aging. In PD, the cells in your brain deteriorate and begins to affect a person’s ability to perform daily activities associated with movement. Symptoms can include tremors (rhythmic shaking), muscle stiffness and rigidity, and PD can even slow your movement in a process called bradykinesia. It can also lead to other symptoms not associated with movement such as disrupting sleep, constipation, anxiety, depression, and fatigue.

As with other neurodegenerative diseases, research has been conducted to identify if there is a link between diabetes and PD. In particular, one study from 2018 showed an association between the two conditions. The researchers looked at the English National Hospital Episode Statistics and Mortality Data from 1999-2011 and divided the data into two cohorts, those with type 2 diabetes (2,017,115 people) at the time of hospital admission and those without (6,173,208 people). It was found that those with diabetes had a 30% higher chance of developing PD than those without, and the younger a person was with diagnosed type 2 diabetes, the more likely their chance of developing PD.

Though researchers do not yet understand the exact way that diabetes and PD are related, they do have a few hypotheses. Namely, there is the chance that certain genetic abnormalities that lead to diabetes may also lead to PD; even if one of these conditions does not directly cause the other, people who have one may be more likely to also have the other. In addition, when diabetes and PD coexist in a person, they may create a more hostile environment in the brain, leading the neurodegenerative processes underway in PD to speed up and be more severe.

What are strategies to reduce the risk of developing a neurodegenerative disease?

There is evidence that leading a healthy lifestyle can reduce your risk of developing diabetes-related complications like dementia or PD. For example, heart attacks and stroke can increase the risk of developing vascular dementia; therefore, lifestyle modifications that help you maintain an ideal blood pressure and levels of cholesterol for your age and health status are important. This can be accomplished by exercising regularly and consuming a diet low in saturated fat, salt, and sugar.

Below are some other tips for improving brain health, which can go a long way in reducing the risk of neurodegenerative diseases like AD. The good news is that many of these strategies are also recommended for managing diabetes.

  • Take control of your blood glucose levels by aiming for a greater time-in-range (TIR). To learn more about time-in-range goals, click here.
  • Smoking is associated with higher rates of dementia. In a recent review, smokers were 40% more likely to develop AD than non-smokers. Given that people with diabetes are at an increased risk of developing dementia, smoking is likely to increase this risk further. If you smoke or experience nicotine addiction, talk to your healthcare professional about a plan to quit or cut back.
  • Keep blood pressure at the target discussed with your health care provider (which might be 130/80 mmHg or less, if you are at high risk of cardiovascular disease) by exercising regularly and eating a diet low in salt (aim for less than 2,300 mg of sodium each day)
  • Take your diabetes medications consistently and as directed by your healthcare team. Some early evidence shows that certain diabetes drugs, like GLP-1 receptor agonists, may be beneficial for brain health. In fact, exenatide, a GLP-1 receptor agonist, is currently in clinical trials for treating PD.
  • A very active area of research focuses on the dementia-preventing effects of having an active and stimulating mental life and rich social networks. Working to maintain an active and socially rich lifestyle could help prevent some of the effects of diabetes on dementia risk.

If you are 65 years of age or older and have memory concerns or other cognitive complaints (i.e., brain fog, depression, personality change), talk to your healthcare provider about getting a cognitive assessment. Learn more here.

Source: diabetesdaily.com

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