6 Tasty Recipes for Peanut Butter Lovers

March kicks off with National Peanut Butter Lovers Day. While we think there’s more than enough reason to celebrate the existence of our all-time favorite spread every day, we’re honoring this event by featuring low-carb peanut butter recipes you (and your pancreas) will love.

Chocolate Peanut Butter Shortbread

Photo credit: Jennifer Shun

Chocolate Peanut Butter Shortbread

This shortbread is candy and cookie rolled into one. It uses low-carb almond and coconut flours for its base and rich dark chocolate with a tad of espresso for its topping, making it a flavorful option for snacks or dessert.

No-bake peanut butter cookies

Photo credit: Lisa MarcAurele

Peanut Butter No-Bake Cookies

No oven, no problem. With this recipe, you just mix the peanut butter with sunflower and pumpkin seeds, chocolate chips, and other ingredients for the batter, scoop them onto a baking sheet, and place them in the freezer. After 2 hours, you get to enjoy a sweet, crunchy, and satisfying dessert.

Peanut Butter Cheesecake

Photo credit: Brenda Bennett

Low-Carb Peanut Butter Cheesecake

Peanut butter in cheesecake sounds good, and it tastes even better if you top it with sugar-free melted chocolate. This recipe guides you on how to prepare this magical treat — without an oven. You make the crust in the processor and the cheesecake in the mixer. After putting them together, you let them set in the fridge for a few hours before adding the optional toppings.

Peanut Butter Smoothie

Photo credit: Carine Claudepierre

Peanut Butter Smoothie

This peanut butter smoothie is a light and refreshing drink for snacks. On days when you barely have time to make breakfast, or you’re bored with eggs and bacon, this can be a good alternative too. Add a scoop of low-carb protein powder if you want to make it extra fulfilling.

Peanut Butter Ice Cream

Photo credit: Taryn Scarfone

Peanut Butter Ice Cream

While the creamy and rich ice cream tastes good, the peanutty caramel sauce makes this treat even more savory. Top it with roasted salted peanuts for more protein, fiber, and crunch. If you prefer chocolate instead, the recipe has a link to a 3-ingredient keto hot fudge.

Peanut Sauce

Do you love munching vegetables for snacks? Use this recipe for your dipping sauce. Made by stirring only 5 ingredients in a bowl, this sauce has the right combination of salty, sweet, and sour. It’s also versatile; you can use it for salads, in noodle dishes, and on cooked chicken among others.

How do you like to use peanut butter in the kitchen? Share your tips with us in the comments!

Source: diabetesdaily.com

Keto Cinnamon Rolls Recipe with Coconut Flour Fathead Dough

This content originally appeared on Low Carb Yum. Republished with permission.

The first time I made low-carb cinnamon rolls, I never shared them on my blog because I didn’t love the texture. Cinnamon rolls need to be soft and chewy. Otherwise, they just aren’t right.

But a few years later, I had the idea to use the fathead dough from my low-carb bagels. That dough uses coconut flour, which I prefer to almond flour.

Sure enough, coconut flour was the answer! I was so impressed with how these keto cinnamon rolls turned out the second time. The dough is light and fluffy, like a traditional pastry, with just the right amount of sweetness.

These remind me so much of Cinnabon rolls, especially when served warm! They are amazing fresh out of the oven. If eating them later, I recommend reheating them in the microwave for about 40 seconds.

Coconut flour cinnamon rolls make for a delicious grab-and-go breakfast, or the perfect treat to savor alongside your morning coffee. They are also very straightforward to make.

keto cinnamon rolls

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Keto Cinnamon Rolls

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It’s simple to make low-carb cinnamon rolls using coconut flour fathead dough. Serve them warm with melted cream cheese icing on top. They are a heavenly treat any time of day.
Course Breads and Baked Goods, Breakfast, Snack
Cuisine American
Keyword cinnamon
Prep Time 15 minutes
Cook Time 16 minutes
Total Time 31 minutes
Servings 12 people
Calories 209kcal

Ingredients

Dough:

  • 60 grams coconut flour about ½ cup
  • ¼ cup low-carb sugar substitute
  • 2 tablespoon baking powder can be cut in half to reduce sodium but may not rise as well
  • 250 grams mozzarella cheese shredded, about 2-½ cups
  • 55 grams cream cheese 2 ounces
  • 3 large eggs beaten
  • 2 tablespoons butter melted, add a bit more if needed and use unsalted to reduce sodium
  • ½ teaspoon vanilla extract optional

Filling:

  • ¼ cup low-carb brown sweetener
  • 1 teaspoon cinnamon
  • 3 tablespoons butter softened, can be omitted but gives a better filling taste

Icing:

  • 3 ounces cream cheese softened
  • 3 tablespoons butter softened
  • ¼ cup Swerve Confectioners Powdered Sweetener
  • ¼ teaspoon vanilla extract
  • low-carb almond or coconut milk if needed

Instructions

  • Preheat oven to 400°F and grease a 9×13-inch pan baking pan if needed.
  • Mix coconut flour, low-carb sweetener, and baking powder in a small bowl. Set aside.
  • Melt mozzarella cheese and cream cheese in microwave on high power for one minute. Stir. Place back in microwave on high for another minute. Stir.
  • Add in beaten eggs, butter, vanilla extract (if using), and coconut flour mixture until a dough is formed. Dough should be a bit wet and sticky. If dry, try adding in another egg or more butter.
  • Roll dough out into a rectangle about 9×12 inches.
  • In small bowl, combine the brown low-carb sweetener with cinnamon. Spread butter evenly over the dough then sprinkle the cinnamon mix on top.
  • Roll dough into a log starting at one of the shorter ends. Slice into 1-inch thick rounds.
  • Rounds into prepared baking pan. Bake at 400°F for about 14-16 minutes or until lightly browned. Allow to cool slightly on a wire rack.
  • In a medium mixing bowl, cream the cream cheese and butter with an electric mixer. Beat in the powdered sweetener and vanilla extract. Add in a little low-carb milk (coconut or almond) if needed to thin the icing.

Notes

Pecans can be added to the cinnamon mixture if desired.

Nutrition

Serving: 1roll | Calories: 209kcal | Carbohydrates: 4g | Protein: 7g | Fat: 17g | Saturated Fat: 10g | Cholesterol: 90mg | Sodium: 262mg | Potassium: 249mg | Fiber: 1g | Sugar: 1g | Vitamin A: 590IU | Calcium: 213mg | Iron: 0.6mg


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 Cinnamon Rolls Recipe with Coconut Flour Fathead Dough Recipe

Source: diabetesdaily.com

When You Can Expect to Get Your COVID-19 Vaccine

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

By Lala Jackson

We now have two FDA-approved and safe COVID-19 vaccines in the US! So as a person with type 1 diabetes, you may be wondering when you can get yours.

The answer? Unclear. It’s all a bit of a logistical mess right now, but here’s what we do know – when you are able to receive your COVID-19 vaccine is dependent on your age, your specific health history (not necessarily whether or not you can check the ‘type 1 diabetes’ box on a form), the state and county in which you live, your employment type, and your healthcare provider’s recommendations.

Overall, having type 1 diabetes does not seem to put anyone more at risk for contracting the novel coronavirus, but other factors like older age, high-exposure employment, consistently elevated blood glucose levels, or other non-diabetes related health factors like obesity and hypertension may increase your risk of infection.

However, we also know that diabetes care itself is made far more complicated after contracting COVID-19 and protecting anyone with diabetes from COVID-19 is our ultimate goal. That’s why Beyond Type 1 has signed onto calls to action urging equal prioritization and is working closely with JDRF, the ADA, and other diabetes patient organizations to advocate for all people with diabetes to be included in Phase 1c of the CDC’s immunization recommendations.

Additionally, because vaccine rollout is happening on a state level, individual advocacy at a state level may be more efficient than federal action. In your community, reach out to your state representatives to let them know that people with any type of diabetes should be included in Phase 1c. Utilize JDRF’s COVID-19 Vaccine Access Toolkit for more resources.

The COVID-19 Vaccine Phased Us Rollout

In the US, the vaccine is being rolled out in phases in *most* states. Already, there are inconsistencies that make it difficult to estimate when you might get a vaccine.

Following approval of the vaccines, the CDC’s Advisory Committee on Immunization Practices created a set of rollout guidelines they recommend for states to follow. These guidelines include phased recommendations for which groups of people should be prioritized to receive the COVID-19 vaccines based on risk factors like older age, underlying health conditions, and lines of work that expose them to COVID-19.

Phase 1a is in process, having begun in December 2020 immediately following the approval of the COVID-19 vaccines in the US. It includes frontline healthcare providers and residents of nursing homes, where COVID-19 cases and deaths have been dramatically highest.

Phase 1b is happening in some states already, includes people over the age of 74, and expands to more frontline workers, including first responders, food and agricultural workers, U.S. Postal Service workers, manufacturing workers, grocery store workers, public transit workers, teachers, and child care workers.

Phase 1c is also happening in some states already, while still several months out others. This phase includes people over the age of 64, anyone else aged 16 or above with medical conditions that increase the risk for severe COVID-19*, and all other essential workers, like those in transportation and logistics, water and wastewater, food service, construction, finance, information technology and communications, energy, legal, media, public safety, and public health workers.

Note that Phase 1c is a BROAD group of people, and this is where things get a bit fuzzy. It is up to each state to control rollout. Many states are following the CDC’s recommendations quite closely, some are following them but not precisely (grouping some phases together, accelerating others), and some have created their own systems, often down to a county-by-county basis.

*What Does This Mean for People With Diabetes?

For people living with diabetes who are not otherwise prioritized because of age or employment type, Phase 1c is the one to look at carefully. As defined by the CDC, people aged 16 or over with medical conditions that increase the risk for severe COVID-19 are included in this phase. But what medical conditions are included?

Short answer – it’s in flux and it depends entirely on your state. Important to remember is that the CDC’s recommendations are just that – recommendations. They have very purposely created guidelines to inform rollout based on most recently available data on high-risk medical conditions, but their guidelines are not meant to be absolute law.

Currently included in Phase 1c recommendations are people with the following conditions: cancer, chronic kidney disease, sickle cell disease, COPD, Down Syndrome, heart conditions, weakened immune systems, obesity, pregnancy, smoking, or Type 2 diabetes.

This means that for those with type 1 or any type of diabetes other than Type 2, you are possibly, depending on your state, not included in the initial rollout and may need to wait to receive your vaccine with the general population, which is likely to be in April 2021 or later.

But don’t panic – as we’ll explain further below, you may still be able to receive the vaccine earlier, based on state or based on your specific health history.

Type 1 Diabetes + COVID-19

Type 1 diabetes itself is not likely to make you more at risk of catching coronavirus. While some have pointed toward the callout of people with immunocompromised systems being in Phase 1c, it is important to remember that having an autoimmune disease (where the immune system attacks itself) is not the same thing as being immunocompromised (where the immune system is susceptible to outside illnesses).

However, other factors associated with T1D may increase your risk of more intense symptoms and severe complications, and if you have to get hospitalized for COVID-19, diabetes care becomes dicey.

This is a piece that has been very confusing and not communicated as clearly as it could be throughout the pandemic – the factors that make a person with any type of diabetes most at risk catching coronavirus and for experiencing severe symptoms and complications of COVID-19 are systemic racism (like being denied or not believed when care is needed), healthcare access issues (like not being able to see a doctor for non-COVID care when needed, or not being able to afford medications and supplies because of job or healthcare loss), consistently elevated blood glucose levels, recent diabetes ketoacidosisjobs that increase exposure to COVID-19, etc.

Type 1 diabetes combined with these factors does create elevated risk. But well-controlled type 1 diabetes on its own does not seem to make someone more at risk of severe illness from COVID-19.

A few studies have raised concerns that outcomes for people with type 1 diabetes who get COVID-19 are far more severe than a person without diabetes, but digging into those studies provides clarity on what’s actually being shown.

  • In May 2020, the UK’s health system released numbers showing severe hospitalization and death rates for people with diabetes. It sounded scary, but what it did not clarify was that additional risk factors like heart disease were of great impact to outcomes, and that the study actually showed that people with type 1 diabetes and no other underlying risk factors like older age or other health history actually did quite well – they were not frequently hospitalized for COVID-19 and those who were had low frequencies of severe outcomes.
  • In December 2020, a similar study was released in Diabetes Care, with a headline saying that COVID-19 severity is tripled in the diabetes community. But again, what it did not immediately clarify was how much the severity was dependent on additional factors, like race (due to long-standing systemic racism), elevated HbA1c, hypertension, lack of diabetes technology, lack of health insurance, less diabetes technology use, etc.

Another study that shows these risk factors well was published in July 2020, outlining the fact that older age and other health-related risk factors were more impactful on severe outcomes than diabetes itself, particularly type 1 diabetes.

Overall, yes – anyone living with diabetes of any type needs to pay careful attention to their health amidst this pandemic. The safest thing anyone can do is practice safety measures to avoid getting COVID-19. For those who cannot – essential workers or people who otherwise have to be exposed to the virus – or those with other underlying health factors, those are the most important factors that must be taken into consideration for priority vaccination.

But just having type 1 diabetes alone, if you are otherwise healthy and not significantly exposed to the virus, should not give you reason to panic. Perhaps more important is ensuring everyone in the general public gets vaccinated as quickly as possible so that diabetes care can be safely accessed, and so hospitals and ICUs are not overwhelmed by COVID-19 patients in the event of emergency diabetes care needs.

How You Get Your Vaccine

Look up your state health department’s guidelines. If it is unclear or you are unsatisfied with what you’ve found, go ahead and reach out to your healthcare provider. Particularly if you have a healthcare provider like an endocrinologist who helps you take care of your diabetes, they may have some insider information on how their hospital or practice is planning to distribute the vaccine.

Remember to be kind and patient – healthcare providers are carrying an immense amount and they may not have an answer for you immediately.

Every vaccine taken decreases the risk and prevents the spread of COVID-19. While it is frustrating to watch the logistical mess, the more people who get vaccinated quickly the better, and in the meantime, continue to practice safe measures that protect you and your loved ones from COVID-19, including doing your best to keep tight control of your blood sugar levels, wearing a mask and physical distancing from anyone outside of your household, and avoiding indoor gatherings.

Source: diabetesdaily.com

Toddler Changes His Own Dexcom on TikTok: Advice From His Mom

TikTok has become more than just a place to dance along to the latest trend; it has become a platform for advocacy for many issues, and diabetes has received increased exposure thanks to this social media app. I couldn’t believe my eyes when I saw a TikTok of a very young boy putting on his own Dexcom G6! And he did it with confidence, bravery, and pride. I wanted to share Daxon’s story in the hopes that it inspires others as well. I reached out to his mom who was gladly happy to chat.

Hi Cassie, thank you so much for taking the time to answer my questions! I would love for our community to get to know Daxon a little better! He is such a great role model for other children living with type 1 diabetes (T1D)!

At what age was Daxon diagnosed and what were the symptoms?

Daxon was diagnosed exactly 1 month from his second birthday at 23 months old.

He started to get a bad temper spring of 2019 and we never understood why. He would get so upset so easily and we just thought it was because of terrible twos. In July, he threw up twice one morning for no reason and out of the blue. He started throwing up at nighttime multiple nights in a row and only at night. I took him to his pediatrician, and they told me “it’s probably the stomach bug, it’ll pass” but I told him “but randomly like that? It doesn’t make sense”.

After about two weeks, it stopped until August. He threw up one more time in the morning and then stopped. Once again, we had no idea why. At the end of August he started drinking and peeing excessively. What really gave it away was that he was drenched from head to toe in pee after a 2-hour nap period one day and that was it. I checked his sugar and it was 461 mg/dL (borderline DKA).

How did you as a family adapt to your new normal?

Honestly, we are still trying to adapt. We take it day by day because it is always changing. The one thing about diabetes is that no matter what, it is different each day. Even if you do the same exact thing, sugars will change.

Did you change Daxon’s and/or your family’s diet at all? What are his favorite go-to foods that don’t wreak havoc on his blood sugars? I’m sure lots of moms could use some tips!

I did not completely change his diet, but I do swap stuff out for healthier carbs and a lower glycemic index. He does low-carb bread, cheese, and crackers instead of mac-n-cheese, Go-Gurts, Two Good yogurts instead of the higher-carb ones, chicken meatballs instead of chicken nuggets, Fairlife milk instead of others  (because of his milk allergy, but it is better carb-wise also), keto-friendly cereal because others spike so much that I cannot get it down for hours, keto-friendly bread only because the GI level is so much better. There are some other changes, but the family has not changed any really. He does still eat candy, it is just more in moderation than before.

His go-to foods are pork rinds eggs, a brownie bar called “Good to Go”, keto-friendly ice cream, yellow bell peppers, broccoli, really any vegetable, cheese sticks, pepperoni, lollipop suckers. Any time we are out Chik-fil-A, grilled chicken and fruit are a must. That is all I can think of right now.

Photo credit: Cassie Daniels

At what point did you start using the Omnipod and Dexcom G6? How did Daxon handle that? 

The Dexcom was a month after being diagnosed and he did not handle it well at first. We would have to hold him down to get him to let me put it on. It was a nightmare but once he watched a friend of ours put her’s on and she told him “you have a robot just like me” he got used to it and now it is normal. When his phone tells us it’s time to change it, he’ll tell me “robot needs changed” and he will 100% do it solo now which is amazing.

The Omnipod was a little different. His first endo wouldn’t approve it because they thought he would take it off, so we had to wait but once we switched to a different hospital, they got him on it right away; so, he was about 7 months in when he was able to get the pod. At first, once again — NOT a fan and it was horrible — but once he learned it meant “no more shots” he was perfectly fine with it (sometimes). We will scream — and I mean scream  — the song “Baby Shark” so he will not hear the clicking for the needle and that seems to help also. He is currently working on putting the insulin in his pod so he is super excited about that.

I know I personally prefer shots, but am often intrigued by the control some pumpers get. Do you find using the pump helps make blood sugar management easier?

The pump for us personally is a lot better for different reasons. Omnipod allows such a small dose, so even 1 gram of carbs he would get some insulin, but with shots, we would have to round up or down, which meant [more fluctuations for him]. Also, in the middle of the night, being able to give him insulin without even touching him has been great. I hated waking him up to poke him with a needle. Also, when on the go we can dose from the front seat of the car. However, if he ever decides that he wants to stop the pump and go back to shots I will support him and what he wants 100%.

@cdaniels2015

95% completely solo 💙💙💙💙 He’s get the hang of this soooo quickly 😭🙏💙 #typeonediabadass #BigBoy

♬ Bang! – AJR

I couldn’t believe my eyes when my diabestie, Hillary Emmons,  sent me this TikTok of Daxon changing his own Dexcom! I am so impressed and inspired! At what point did he express interest in doing that?

After about six months of being a type 1, he has always been curious about everything. He has been checking his own sugar with the meter since about 6 months in when needed to be checked. And recently he was really showing interest in the Dexcom and doing it solo. He did half of it one day and then the next change he did it completely on his own, all I did was hold it and help place it. I never asked him to do it because I didn’t think he was ready for that task yet but that day he told me “I do it” and that was it. Now he is showing interest in some of the Omnipod stuff, which is amazing because he feels in control.

I give you credit as a parent for letting him own his management and giving him the confidence to know he can manage his disease! What would you like to tell other parents about how to get children to want to be a part of their daily care?

Make it positive, make it fun, and make it normal. We have the JDRF bear and we practiced on that since being diagnosed. At first, we used it so he could understand more of it. We also got his big brother and all the other family members involved since day one. We check everyone’s sugars, so it is normal for everyone. All the children in our family (our boys and our 3 nieces) have been very curious about it since day one.

I see you are using TikTok as a platform for awareness and this one video alone got over 103,000 likes! Kudos! What would you like people to take away from your videos?

I want people to know the signs of T1D and to normalize it. I hate when I see people hide that they check their sugar or even giving their self insulin. I want to help parents have a voice for their children because doctors sometimes do not listen, and we need to be loud for our children and to follow their gut. I have a lot of people say that he encouraged their children to try putting the Dexcom on solo and I love that it is helping other children also. One of my TikToks potentially saved a child from dying. Her sugar was almost 1000 mg/dL and she was in DKA and doctors were surprised she wasn’t in a coma. Children should not die for people [not being able] to figure out what is wrong!

Does Daxon enjoy making the TikTok videos? I think “injecting” some humor and fun is the best medicine of all! And one you can all do together as a family!

Daxon loves showing people his stuff. He knows it makes him unique and he loves seeing others who are like him. So, when people duet his videos and they show their Dex or pod it’s helpful for him also to see that there are others like him.

Photo credit: Cassie Daniels

What else does Daxon like to do with his free time when he’s not managing his diabetes and TikTok’ing?

Daxon is a typical boy and I mean ALL boy. He rough houses with his brother, loves to color, help with dishes, cooking, loves to read books, play outside, ride his 4-wheeler, and absolutely loves cuddling with me. I think him being a T1D made our bond even stronger.

How does Daxon feel about being a TikTok sensation and knowing that he is helping to inspire many other children just like himself!

I have told him many times that he is helping other children and I don’t think he really understands what it means yet, but he always smiles and says “they have a robot like me” or he’ll go “yay that makes me happy”. I ask him “do you want to make a video?” and normally he’ll tell me “yessss let’s make a video”. I will never make him make TikToks so if he tells me no then I’ll leave it alone.

I ask this in every interview! Do you think they’ll be a cure in Daxon’s lifetime?

100% honestly I do not foresee a cure ever. They make way too much money from insulin (when it should be free, but that’s another story for another time). I wish there would be a cure, but I don’t see it happening.

Daxon

Photo credit: Cassie Daniels

What advice helped you? Can you pass it along to parents of newly diagnosed children?

My advice for parents is:

  1. Take one day at a time because it is an always-changing, never-stopping, headache of a disease.
  2. Do your best and never get down on your child for their blood sugars. That is the one thing I will never do to Daxon, anytime he has “bad” sugars, I never express it to him or show it on my face because it is not his fault, so I don’t want him to feel like he is failing.
  3. Always tell your child they can still do anything they like and never change activities. Just change foods to help [manage sugars during] the activities. For example, we took Daxon and his brother to a trampoline park and I knew his sugar was going to drop. He started at 170 mg/dL and dropped to 50 mg/dL. I was prepared with milk, yogurt, chocolate, and others, so he could still have fun and be a kid.
  4. Try not to have a fight if sugars are not in range, because everything is magnified if high or low. So what I do with Daxon if he is high or low and has a temper tantrum, I ignore it and let him do what he needs to do. Once he calms down, we discuss what happened and I explain I understand he doesn’t feel good but he doesn’t need to act that way.
  5. Treat them like you would any other child because diabetes does NOT define them.

Where do you see going with your advocacy and awareness on social media or elsewhere? Do you have other plans in the future?

I would love to bring more awareness to this disease. I would love for there to be a law that pediatricians must check A1c every year or every other year. They check your iron, and they check lead so why not diabetes? [Some] pediatricians think that younger children cannot get diabetes until at least six years old which is not true. It is ridiculous because a child’s death is avoidable if people were more aware of the signs and doctors tested when they should.

Thanks again Cassie, we really appreciate you taking the time! I look forward to continuing to follow Daxon’s journey and see how many kids he inspires along the way!

Source: diabetesdaily.com

Getting the Most Out of Your Remote Healthcare Visits

This content originally appeared on Integrated Diabetes Services. Republished with permission.

By Gary Scheiner MS, CDCES

A long, long time ago, before the days of coronavirus, there was a little diabetes care practice called Integrated Diabetes Services (we’ll just call it IDS for short). IDS taught people with diabetes all the wonderful things they can do to manage their diabetes. Word got out, and people who lived far from IDS’s local hamlet (better known as Philadelphia) wanted to work with IDS. Even people IN the hamlet wanted to work with IDS but were often too busy to make the trip to the office. So IDS had an idea: “Let’s offer our services via phone and the internet so that everybody who wants to work with us can work with us!” The idea took off, and IDS grew and grew.

And virtual diabetes care was born.

Today, in response to the COVID-19 pandemic, virtual healthcare has become a virtual norm. Often referred to as “telehealth” or “telemedicine,” people with diabetes are connecting with their healthcare providers for everything from medical appointments to self-management education to coaching sessions. Some consults are conducted via phone calls, while others utilize web-based video programs (like Zoom) or simple email or text messages. Regardless of the form, virtual care can be highly effective. But it can also have its limitations. Whether you’ve been receiving virtual healthcare for months or have yet to give it a try, it pays to learn how to use it effectively. Because virtual care will certainly outlive the pandemic.

What Can… and Can’t… Be Accomplished Virtually

Most diabetes care services, including medical treatment and self-management education, can be provided effectively on a remote basis. We have managed to teach our clients everything from advanced carb counting techniques to strength training routines to self-analysis of glucose monitoring data, all while helping them fine-tune their insulin program, on a 100% virtual basis.

Some clinics and private healthcare providers have gone 100% virtual since the pandemic began, while others are using a “hybrid” approach – periodic in-person appointments with virtual care in-between. Depending on the reason you’re seeking care, a hybrid approach makes a lot of sense. While virtual visits are generally more efficient and economical (and in many cases safer) than in-person appointments, there are some things that are challenging to accomplish on a remote basis. From a diabetes standpoint, this includes:

  • Checking the skin for overused injection sites
  • Learning how to use medical devices (especially for the first time)
  • Examining the thyroid gland and lymph nodes
  • Evaluating glucose data (unless you can download and transmit data to your provider)
  • Performing a professional foot exam
  • Listening to the heart rhythm and feeling peripheral pulses
  • Checking for signs of neuropathy and retinopathy
  • Measuring vital signs (unless you have equipment for doing so at home)

The Logistics

Virtual care can be provided in a variety of ways, ranging from a phone call to an email, text message or video conference. Video can add a great deal to the quality of a consultation, as it allows you and your healthcare provider to pick up on body language and other visual cues. It also permits demonstrations (such as how to estimate a 1-cup portion of food), evaluation of your techniques (such as how to insert a pump infusion set), and use of a marker board for demonstrating complex subjects (such as injection site rotation or how certain medications work).

When using video, it is important to have access to high-speed internet. A computer is almost always better than a phone for video appointments, as the screen is larger and has better resolution. If you have the ability to download your diabetes data, do so and share access with your healthcare provider a day or two prior to the appointment. It may also be helpful to share some of your “vital” signs at the time of the appointment – a thermometer, scale, and blood pressure cuff are good to have at home.

In many cases, care provided on a remote/virtual basis is covered by health insurance at the same level as an in-person appointment. This applies to public as well as private health insurance. However, some plans require your provider to perform specific functions during the consultation (such as reviewing glucose data) in order for the appointment to qualify for coverage. Best to check with your healthcare provider when scheduling the appointment to make sure the virtual service will be covered. At our practice (which is 100% private-pay), virtual and in-person services are charged at the same rates.

If security is of the utmost importance to you, virtual care may not be your best option. Although there are web-based programs and apps that meet HIPPA guidelines, there really is no way to guarantee who has access to your information at the other end. My advice is to weigh the many benefits of virtual care against the (minuscule) security risk that virtual care poses.

Optimizing the Virtual Experience

Just like in-person appointments, virtual care can be HIGHLY productive if you do a little bit of preparation.

  • Do yourself and your healthcare provider a favor and download your devices, including meters, pumps, CGMs, and any logging apps you may be using, prior to the appointment. If you don’t know how to download, ask your healthcare provider for instructions, or contact our office… we can set up a virtual consultation and show you how. If you have not downloaded your information before, don’t be intimidated. It is easier than you think. People in their 80s and 90s can do it. Oh, and look over the data yourself before the appointment so that you can have a productive discussion with your healthcare provider.
  • Be prepared with a list of your current medications, including doses and when you take them. Check before the appointment to see if you need refills on any of your medications or supplies. If you take insulin, have all the details available: basal doses (and timing), bolus/mealtime doses (and dosing formulas if you use insulin:carb ratios), correction formulas (for fixing highs/lows), and adjustments for physical activity.
  • Try to get your labwork done prior to virtual appointments. This will give your healthcare provider important information about how your current program is working.
  • To enhance the quality of the virtual meeting, do your best to cut down the background noise (TV off, pets in another room, etc…) and distractions (get someone to watch the kids). Use of a headset may be preferable to using the speakers/microphone on your phone or computer, especially if there is background noise or you have limited hearing.
  • Use a large screen/monitor so that it will be easy to see details and do screen-sharing. And use front lighting rather than rear lighting. When the lights or window are behind you, you may look more like a black shadow than your beautiful self. “Ring” lights are popular for providing front-lighting.
  • Provide some of your own vitals if possible – weight, temperature, blood pressure, current blood sugar. This is important information that your healthcare provider can use to enhance your care.
  • Prepare a list of topics/questions that you want to discuss. Ideally, write them on paper so that you can take notes during the appointment. If there is a great deal of detail covered, ask your healthcare provider to send you an appointment summary by mail or email.
  • Be in a private place that allows you to speak openly and show any body parts that might need to be examined – including your feet and injection/infusion sites.
  • Be a patient patient! Technical issues can sometimes happen. It is perfectly fine to switch to a basic phone call or reschedule for another time.
  • Courtesy. Be on-time for your virtual appointment. If you are delayed, call your healthcare provider’s office to let them know. And if you are not sure how to login or use the video conferencing system, call your provider beforehand for detailed instructions. This will help to avoid delays. Have your calendar handy so that a follow-up can be scheduled right away. Oh, one other thing: Try not to be eating during the appointment… it is distracting and a bit rude. However, treating a low blood sugar is always permissible!

If there is one thing we’ve learned during the pandemic, it’s that virtual care is a win-win for just about everybody. Expect it to grow in use long after the pandemic. In-person care will never go away completely, but for treating/managing a condition like diabetes, virtual care has a lot to offer… especially if you use it wisely.

Note: Gary Scheiner is Owner and Clinical Director of Integrated Diabetes Services, a private practice specializing in advanced education and intensive glucose management for insulin users. Consultations are available in-person and worldwide via phone and internet. For more information, visit Integrated Diabetes.com, email sales@integrateddiabetes.com, or call (877) 735-3648; outside North America, call + 1-610-642-6055.

Source: diabetesdaily.com

Easy At-Home Gym Hacks

We are nearly a year into the pandemic, which has all but frozen life as we used to know it. It has required a shift in thinking, and a transition to doing most everything at home: work, school, and even exercise. Most gyms across the country are either still closed or operating at extremely limited capacity, and many people feel more comfortable working out from the comfort of their own homes until herd immunity is achieved in the United States.

But how can you get a good, full-body workout at home, when time, space, and equipment is limited? These are our top tips.

Keep a Routine

The best workout is the one you’ll do consistently, and that means making your exercise time routine. It should be no different than when you would typically go to a physical gym: exercise should happen during the same time and in the same place every day.

This also helps create boundaries with work and family. If you go to the garage every morning at 6 a.m. for dedicated “gym” time, the kids will soon learn that you’re not available to play then. Alternatively, if you block out 20 minutes at noon every day for a run on your Outlook calendar, your boss is much less likely to schedule impromptu meetings during that time.

Also, it’s important to know yourself. If you’re a morning person and start to fade around dinnertime, don’t wait to get your exercise in after the kids go to sleep. By prioritizing your exercise time and making it routine, you’re guaranteed to make it a habit that will stick.

Set Yourself Up for Success

Adjusting to home workouts does not need to be complicated. You can start small with Youtube yoga and dance videos, high-intensity interval training (HIIT) workouts, and even meditation to deal with stress. Listening to Spotify or Pandora while working out can help bring fresh music to your routine, too.

Accumulating some at-home gym equipment can also keep you stimulated and less likely to become bored.

Michelle, from Madison, Wisconsin, says that she uses the Nike training app religiously, as it helps prevent ennui and always mixes up workouts. The app comes with multi-week programs, including a prescribed series of workouts, nutrition tips, and wellness guidance to help users build healthy habits. Each flexible program is led by a Nike Master Trainer and is created to cater to those working out at home.

Additionally, Michelle recommends Bowflex adjustable dumbbells, which replace 15 sets of weights! The weights adjust from 5 up to 52.5 lbs each. By easily turning the dial you can change the resistance, enabling you to gradually increase your strength.

Ryan, from Albany, New York, uses the Bowflex C6 bike in combination with the Peloton app (which is just $15 per month!). The bike has 100 levels of resistance, just like the Peloton bike, but is half the cost, so you can follow along to Peloton workouts while saving a ton of money.

If you’re not into collecting a ton of equipment but want to build strength and get your heart rate up, simply investing in a kettlebell and a jump rope can be all you need to take squats and lunges to the next level.

If you don’t want to buy all new equipment for your home, see if you can crowdsource some from friends and family. Pool resources together, and share weights, a rack, a bicycle, treadmill, or other equipment, to make assembling an at-home gym more affordable.

Jennifer, from Des Moines, Iowa, says, “My sister lives across town and has a great treadmill in her garage. She works the night shift and I work during the day, so will pop on over to her house to get a run in on cold mornings while she’s still at work. It works perfectly.”

Some people have even had luck renting equipment or even borrowing equipment from their gyms while they are closed due to COVID-19 restrictions. Jessica, from Boulder, Colorado, says. “I emailed my local rec center, and they’ve let me borrow some heavier kettlebells that would have been prohibitively expensive to buy. They let members borrow equipment for 72 hours, which works perfectly to spice up my workout routines.”

exercise accountability buddy

Photo credit: iStock

Find an Accountability Buddy

No one is inspired to exercise all the time. Having a friend or family member checking in with you to make sure you’re meeting your fitness goals can be a crucial nudge to help you stick to your routine. Perhaps you have a weekly check-in call with a friend every Friday to review what you did to get your heart pumping, or you email different workout plans to each other every week to stay motivated.

If you feel safe enough to do so, maybe you meet someone for a walk each weekend, to get fresh air and a change of scenery. Whatever you do, it should help you stay motivated, not hinder your progress.

Even if your accountability buddy isn’t actively trying to improve their fitness or lose weight, they could benefit too: a recent study showed that when 130 couples were tracked over six months, the accountability buddy not actively trying to lose weight had success in some weight loss too, if their partner was on an exercise plan.

Make It Fun!

In this strange time, it’s important to make exercise fun. Have goals and work hard to meet them, but make sure to celebrate your progress, too. Maybe you’re trying to deadlift 150 lbs, lower your HbA1c, do twenty weighted lunges in a row, or run a faster mile.

If and when you meet those goals, celebrate them! This may look different in 2021, but ordering takeaway coffee from a favorite coffee shop, ordering your favorite candle online, or buying a new swimsuit are all well-deserved awards for hard work put in at home.

Working out at home does not need to be boring or uninspired. With these tips, you can keep your fitness levels high, stay motivated, save money, and get healthier, even during the quarantine. Remember to always check with your doctor before starting a new exercise routine.

Have you been working out at home during the pandemic? How is it going for you? What strategies or advice would you give others? Share this post and comment below!

Source: diabetesdaily.com

Keto Nutella Fat Bombs

This content originally appeared here. Republished with permission.

Fat bombs are bite-sized snacks that are sugar-free, very low in carbohydrates, and high in fat, and they can be sweet or savory. They’re usually designed to help keep you in ketosis, but you don’t have to be in ketosis to enjoy fat bombs. Our bodies need fat to thrive, so there’s an easy Paleo-friendly adaptation included below.

And what better way to enjoy a fat bomb than with the famous flavors of Nutella! Nutty, earthy, and distinct hazelnut flavor paired with rich chocolate are what give Nutella its nutella-ness, and those foods are both keto and Paleo-friendly. Just add some creamy coconut oil and whatever sweetener you prefer, depending on if you’d prefer to keep it keto or Paleo, and you’re in business!

This dessert is gluten-free, grain-free, and refined sugar-free. So no matter who you’re cooking for, there’s something for everyone to love!

Print

Keto Nutella Fat Bombs

.wprm-recipe-rating .wprm-rating-star.wprm-rating-star-full svg * { fill: #343434; }

Made in the blender with just four ingredients, these are the perfect no-bake treat or dessert!
Course Dessert
Cuisine American
Keyword fat bombs, nutella
Prep Time 10 minutes
Resting Time 30 minutes
Total Time 40 minutes
Servings 12 servings
Calories 182kcal

Equipment

  • High speed blender or food processor

Ingredients

  • 1 cup hazelnut butter
  • 1/3 cup coconut oil
  • 1/4 cup cocoa powder or substitute cacao powder + 1/4 tsp. vanilla extract
  • 3 – 3.5 tbsp monk fruit sweetener swerve (erythritol), or xylotol, or substitute any Paleo or Keto friendly sweetener of choice – see notes below for more options.
  • 1/2 tsp flakey sea salt optional
  • 1 tbsp chopped hazelnuts optional

Instructions

  • Add all ingredients to a high speed blender or food processor. Blend until completely smooth.
  • Pour the mixture into 12 lined muffin cups and transfer to the refrigerator. If you aren’t using muffin cups, transfer the mixture to a bowl and set in the refrigerator.
  • Allow the fat bombs to chill for at least 30 minutes. Remove the fat bombs from the muffin cups or scoop from the bowl into small 1-2 inch balls. Sprinkle with flakey sea salt and hazelnuts, if using. Keep chilled in the refrigerator or freezer until you're ready to serve, and enjoy!

Notes

Keto-friendly sweetener substitutions: 1/4 tsp liquid stevia.

Paleo sweetener options: 4 dates, 4 tablespoons maple syrup, or 4 tablespoons agave.

To store: Transfer to an airtight container and store in the refrigerator for 2-4 weeks or freezer for 1-2 months. Keep chilled until serving.

Nutrition

Calories: 182kcal | Carbohydrates: 4g | Protein: 3g | Fat: 18g | Saturated Fat: 6g | Sodium: 1mg | Potassium: 163mg | Fiber: 3g | Sugar: 1g | Vitamin C: 1mg | Calcium: 25mg | 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 Nutella Fat Bombs Recipe

Source: diabetesdaily.com

Rare Until It Happens to You: The Kycie Terry Story

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

By Jordan Jendricks

Jamie Terry doesn’t know what exactly it is about her daughter that resonates so deeply with people. But there’s something about the combination of her curly blond hair, striking blue eyes, and the circumstances around her unfortunate and preventable death that have incredible staying power, inspiring countless others to action.

“There have been many times that I’ve thought about that. There are sick children all over the world, why Kycie? But there’s something about her and I truly believe she was here on a mission. She’s still on a mission. I just think there’s a reason behind it all.”

Because even now, five years after her tragic passing, strangers from around the world still reach out to the Terry family about their little girl. They remember Kycie and her story, which has reached thousands and saved an untold number of lives. Kycie’s father, Josh, has lost count of how many other parents have thanked him, explaining they, too, might have lost a child if not for his daughter’s story.

“I don’t know why it went as viral as it did. I think she just has a face, too. And you can see how heartbreaking it was and how hard she worked to try and get back. If you lose a child or you lose a family member, to think that they died for nothing, it’s that much harder. To know that she’s made a difference in other people’s lives and helped save other people’s lives, and saved a lot of heartache and struggles, it’s more doable.”

Kycie Jai Terry was the second youngest of six children and the only girl. After four boys, Jamie remembers crying tears of joy over her fifth ultrasound and the realization she would finally have a little girl. She remembers her daughter as a vibrant child, who loved to dress up, ride bikes and catch lizards; who was a little bit of everything and unique, as her name suggests.

“I don’t think I realized at that time, but now I think there’s a reason that she has this unique name because you Google her and she pops up and it’s because she needed to make a difference in the world.”

Where Things Went Wrong

Kycie

Image source: Beyond Type 1

Kycie was diagnosed with type 1 diabetes on January 30th, 2015 while in DKA (diabetic ketoacidosis). Where her story differs from many who live with undiagnosed type 1 and go into DKA is that she ultimately experienced cerebral edema, a condition where fluid builds up around the brain, causing pressure and swelling. This complication was occurring unbeknownst to the healthcare providers treating her at the time, wreaking havoc on Kycie’s brain and nervous system as she slept in her ER room bed. Less than 1% of pediatric patients in DKA experience cerebral edema, making it rare, though this statistic was of little comfort to the Terry family. As Josh puts it, “It’s always rare until it happens to you.”

As he recalls, Kycie’s initial symptoms started with a headache, then a stomachache. It seemed like she might have had a stomach flu, then strep. But she didn’t get better with antibiotics; in fact, she worsened. She didn’t want to eat, she only wanted fluids, and she was suddenly remarkably skinny. The Terrys felt an urgency to take their daughter to the hospital as her condition only seemed to get worse. She was extremely lethargic once there, and Josh recalls her fruity breath, a tell-tale sign of ketones. Sure enough, the doctor quickly revealed the cause of the problem: “She has type 1 diabetes.”

But Kycie’s blood sugar was difficult to control. Later, the Terrys would learn that during this time in the ER, doctors were focusing solely on treating her diabetes without realizing that she had experienced any brain damage, or that it was growing worse. With blood sugar readings over 1,100 mg/dl (61 mmol/L), Kycie was in severe DKA and needed to be life-flighted to a children’s hospital five hours away. After landing, she suffered a seizure on the ambulance ride from the airport to the hospital. Four hours later, she was intubated, on a ventilator, unresponsive and in a diabetic coma.

An MRI was completed after Kycie was in a coma for over 24 hours, revealing for the first time the cerebral edema. Doctors told the Terrys that they didn’t expect her to live, but Kycie fought, ultimately coming to breathe again on her own before waking up. She spent the next 111 days in the hospital to relearn basic functions, after which she was able to go home and live with her family for another month and a half, though her life was entirely different. It was suddenly a feat for the five-year-old to hold her own head up, smile, or roll over by herself. Josh remembers feeling torn and heartbroken to see his daughter’s life suddenly so difficult.

“I remember sitting up there and thinking what a horrible situation she was in – a situation I wouldn’t want to be in. If I was in that place, I wouldn’t want to live that life,” he shares. “At the same time, she’s my little girl and it’s my job to protect her and my job to be there for her. It was a really hard place to be.”

Kycie

Image source: Beyond Type 1

The family continued on, taking care of their daughter and treasuring the few good times during otherwise long days. They documented their new normal, sharing feel-good moments and milestones on social media.

Kycie then caught a virus that led to pneumonia and another hospitalization, setting back some of her progress and making her less responsive. Though she was able to return home after growing stronger, in the early morning hours of July 11th, her oxygen levels were extremely low and her parents were poised to take her to the hospital yet again. Before they could leave the house, the second youngest Terry passed away peacefully in her father’s arms. She was a few months shy of her sixth birthday.

Her Legacy Lives On

Kycie is well-known now in the diabetes community, her story having touched so many all over the world. Beyond Type 1’s Warning Signs Awareness Campaign, which began in 2016, was inspired by her story and the reality that both misdiagnosis and missed diagnoses are problems that can be solved through education and awareness. Josh and Jamie both can’t underscore enough the importance of being able to recognize the signs and symptoms of type 1 diabetes.

“To get an early diagnosis is so critical. If you can catch type 1 before DKA, you’ve saved yourself the possibility of brain damage,” Josh explains. “And so that early recognition is so vital, not just because of the scariness of DKA, but because of the unknown that comes with it.”

Jamie reflects on her own lack of knowledge about diabetes in general and how Kycie’s situation truly opened her eyes to a chronic illness that affects so many on a daily basis.

“I knew nothing about it. And the thing that’s crazy with Kycie is it all happened so fast. Within five days, she had a traumatic brain injury,” she explains.

Jamie sympathizes with everyone who manages type 1 diabetes, having gotten a small taste of the complexity of the disease while caring for Kycie’s type 1 diabetes (T1D) the short time she was able: “That’s what is heartbreaking to me. Anyone that ever comes up to me and tells me they have type 1, the first thing I say to them is ‘I’m so sorry’ because it’s so much to take on. And we didn’t even get to.”

The Terry family now advocates for safe and early diagnoses of type 1 diabetes, sharing about Kycie whenever they can and working with local hospitals to help improve type 1 protocols. In Josh’s practice as an optometrist, he lectures others in his field on type 1 and the importance of recognizing changes in vision as potential signs. Their family is continually touched by the outpouring of love for their little girl and all they’ve been through, the community they’ve found through their loss and the surprising amount of good that has come out of an otherwise tragic situation.

As Jamie puts it, “There’s no greater title than ‘Kycie’s mom.’ It will always be hard to live without her, but part of the healing journey has been to know that she has saved and continues to save lives.”

Source: diabetesdaily.com

Is COVID-19 Causing a Diabetes Epidemic?

As the COVID-19 pandemic rages on into its second year, researchers have discovered a new, disturbing trend: there has been a statistically significant rise in both type 1 and type 2 diabetes diagnoses observed in patients after an experience of severe COVID-19. Even more disturbing is that nearly 14.4% of people who are hospitalized with COVID-19 go on to have either a type 1 or type 2 diabetes diagnosis, according to a November 2020 study that followed nearly 4,000 patients with severe COVID-19 infections.

It’s too early to tell if these forms of diabetes are permanent or temporary, but the correlation between severe COVID-19 cases and the development of diabetes is strong.

It’s well known that viruses can sometimes trigger diabetes. When someone contracts a virus, the immune system starts mounting a defense to fight it, mostly with T-cells. Sometimes the body will overreact, and start destroying its own pancreatic beta cells, the result being type 1 diabetes.

Scientists believe the same thing may be happening in the case of COVID-19 patients. Traditionally, COVID-19 has been an attack on the lungs, but a host of other issues and complications have come to light from sufferers of “long-haul COVID”: neurological disorders, blood clots, kidney failure, heart damage, and now many believe an epidemic of both type 1 and type 2 diabetes diagnoses may soon be added to the list.

The association between other coronaviruses and the development of diabetes has been made in the past during the SARS outbreak as well.

After the 2003 SARS pandemic, Chinese researchers tracked 39 patients who had developed high blood sugar levels characteristic of a diabetes diagnosis, within days of hospitalization with the disease. For all but six, blood sugar levels had returned to normal by their hospital discharge, and only two still had diabetes after two years.

This isn’t entirely new, either. Doctors in Wuhan, China reported a link between COVID-19 and elevated blood sugar levels back in April 2020. Italian scientists also looked into whether higher blood sugar levels could lead to a diagnosis of diabetes. That study, from May 2020, admitted more research needed to be conducted before a conclusion was reached.

Because COVID-19 is a global pandemic and the link to new diabetes cases has been observed in multiple countries, researchers globally are collecting data points about those patients in a registry called CoviDIAB.

Scientists do not know whether COVID-19 might exacerbate already developing issues or actually cause them; some believe it’s both. Many people who have had COVID-19 and have gone on to develop type 2 diabetes already have existing risk factors, such as obesity and a family history of the disease. Perhaps the increased medical attention sought out by people suffering from COVID-19 has detected the disease early, when a diagnosis was inevitable later on down the line anyway. Some medical experts believe that more people are getting medical attention than ever before, being closely monitored by experts in the field, and are unveiling underlying issues that may have been there all along.

Another theory is that elevated blood sugar levels also are common among those taking dexamethasone, a steroid that is a common treatment for COVID-19. Steroid-induced diabetes is rare, but not unheard of, and may trigger diabetes in people who have no known health risks for the disease.

“Researchers are working like crazy to see if COVID attacks the beta cells of the pancreas, which makes insulin,” pediatrician Dr. Dyan Hes said. “Some studies feel that they do, but other studies have been repeatedly saying it is not attracted to the beta-cell.”

How exactly the two conditions are connected isn’t quite clear yet, but a prominent theory is that the COVID-19 virus destroys or alters insulin-producing beta cells in the pancreas possibly by binding to ACE2 receptors, according to a short letter published in the New England Journal of Medicine.

Whatever the association is, researchers from the journal of Diabetes, Obesity, and Metabolism say a direct effect of COVID-19 on the development of diabetes, “should be considered.”

Francesco Rubino, a diabetes surgery professor at King’s College London, is convinced there is a connection between the two conditions and has been tracking and studying the phenomenon since early last year. “We really need to dig deeper, but it sounds like we do have a real problem with COVID and diabetes.”

Additionally, Rubino thinks the type of diabetes being developed as a result of COVID-19 may be a hybrid form, something of a cross between type 1 and type 2. His findings show that the symptoms in these patients have some characteristics of each form of diabetes, which he finds concerning.

Researchers are also now seeing a rise in type 2 diabetes diagnoses in children who have had asymptomatic COVID-19, which is even more troubling, as many schools are back in session, many public places do not require masks on children, and the tipping point of a diabetes epidemic may rest solely on the shoulders of our youngest, most vulnerable citizens.

This can also complicate a few things for people: firstly, that neither the Pfizer-BioNtech nor the Moderna COVID-19 vaccines are approved for children, and secondly, that type 1 diabetes is not being prioritized on the Centers for Disease Control and Prevention’s list for vaccine dissemination. States are able to follow their guidance or dismiss it out of hand, but federally, there is no coordination to prioritize the population.

With nearly 10% (34 million people) of the United States already affected by diabetes, and another 100 million living with prediabetes, the tidal wave of COVID-19 cases could very well send our country into catastrophe fighting two disasters at once: both uncontrolled community spread of COVID-19 along with a (COVID-triggered) explosion of new diabetes diagnoses, especially in children. This would not only send our country into panic mode but could also completely overwhelm our already fragile health care system that everyone is so heavily relying on.

Scientists are rushing to find the exact connection between severe COVID-19 cases and new diagnoses of diabetes, but between diabetes being a major risk factor for death in COVID-19 cases (nearly 40% of COVID-19 deaths have been in patients with diabetes), along with the increased risk of developing diabetes from a severe bout of COVID-19, one thing is for sure: we need to find the connection and fast and get the diabetes community and those at risk for diabetes vaccinated as quickly as possible. We don’t have time to waste.

 

Source: diabetesdaily.com

Study Compares MiniMed 780G and MiniMed 670G Algorithms

This content originally appeared on diaTribe. Republished with permission.

By Albert Cai

A new study in adolescents and young adults with type 1 diabetes directly compared two automated insulin delivery algorithms. Medtronic’s newer Advanced Hybrid Closed Loop (built into the MiniMed 780G system) improved glucose management more than the MiniMed 670G, though both systems showed impressive increases in Time in Range for this population. Ultimately, the 670G gave users over an hour and a half more time in range each day, while the 780G gave wearers over two hours every day in range!

Two Medtronic automated insulin delivery algorithms, the Advanced Hybrid Closed Loop and the MiniMed 670G, were recently compared in a cross-over study, allowing 113 participants to use both algorithms. Results from the study were published in the medical journal The Lancet. Notably, the study tested this technology in adolescents and young adults with type 1 diabetes ­– a group for which diabetes management is notoriously challenging. View our resources for adolescents with diabetes here.

For an introduction to automated insulin delivery (AID), check out our piece on current and coming-soon AID systems in 2021.

What is the MiniMed 670G?

The MiniMed 670G is an AID system that has been available since spring 2017 – it was the first system ever to “close the loop.” The system includes the MiniMed 670G pump, the Guardian Sensor 3 continuous glucose monitor (CGM), and an automated insulin adjustment algorithm. The algorithm adjusts basal insulin delivery every five minutes based on CGM readings, and a target of 120 mg/dl.

What is Advanced Hybrid Closed Loop?

Advanced Hybrid Closed Loop (AHCL) is Medtronic’s next-generation AID algorithm. The AHCL algorithm is used in Medtronic’s MiniMed 780G system, which is currently available in at least twelve countries in Europe. While it is not yet available in the US, Medtronic hopes to launch the 780G in the US this spring. In addition to automatic basal rate adjustments, the AHCL algorithm can also deliver automatic correction boluses and has an adjustable glucose target that goes down to 100 mg/dl. This is big news because many people using closed loop do not want to target the higher 120 mg/dl, even as a safety measure. The 780G algorithm is designed to have fewer alarms and even simpler operation than the MiniMed 670G system.

What was the study?

The newly published FLAIR (Fuzzy Logic Automated Insulin Regulation) study was conducted over six months across seven diabetes centers (four in the US, two in Europe, and one in Israel). The study enrolled 113 adolescents and young adults (ages 14-29) with type 1 diabetes. The study sample is notable, because teens and young adults with type 1 diabetes have the highest average A1C levels of any age group.

At the beginning of the study, participants performed their usual diabetes management routine for two weeks to establish their baseline glucose levels. Half of the group was then randomly assigned to use the MiniMed 670G system, while the other half of the group used the same pump and CGM, but with the new AHCL algorithm. After three months – the halfway point of the study – the two groups “crossed over,” switching to the opposite technology.

What were the results?

Nearly every measure of glucose management favored the AHCL period over the MiniMed 670G:

  • Compared to baseline, participants reduced time spent above 180 mg/dl by 1.2 hours per day when using MiniMed 670G and 1.9 hours per day when using AHCL.
  • Time in Range (TIR, time between 70-180 mg/dl) improved from a baseline of 57% to 63% using Minimed 670G and to 67% using AHCL.
  • Time spent below 70 mg/dl fell 0.2% of the time. While those 28 minutes a day may not be statistically significant – and time in severe hypoglycemia, or below 54 mg/dl, did not increase from baseline when using either algorithm – many people with diabetes would benefit from that additional half hour in range.

The graph below shows the time spent in glucose ranges during baseline, MiniMed 670G, and AHCL periods. For both algorithms, the Time in Range increase from baseline was significant – use of either AID system led to at least 14 hours more each week spent in range. Nevertheless, we also point out, of course, that the group (again, the group that has the most challenges of any age group managing diabetes) still experienced a fair amount of time above 250 mg/dl. This is  another reason for healthcare professionals and people with diabetes to think about the “whole person” when considering diabetes management, and another reason why we always recommend Adam Brown’s Bright Spots and Landmines for ways to improve diabetes management in terms of food, exercise, mindset, and sleep – it includes many strategies for people, especially teens and young adults, to use each day.

AID comparison

Image source: diaTribe

  • The biggest Time in Range improvement came overnight (between midnight to 6am). During this six-hour overnight period, AHCL users spent an average of 4.4 hours in range (74% TIR), compared to 4.2 hours (70% TIR) for 670G, and 3.5 hours (58% TIR) during baseline. While the overnight Time in Range difference between AHCL and 670G may not seem large, it added up to nearly a 22-hour difference over the three-month the AHCL period.
  • With daytime numbers, the average AHCL user spent 63 more hours (about 2.6 days) in range than the average 670G user in each three-month study period.

The graph below shows daytime and nighttime differences in time spent in range (70-180 mg/dl), and the data is included in a table at the end of this article. Better sleep the night before can also make diabetes management more effective during the day.

Comparison

Image source: diaTribe

  • Using MiniMed 670G drove an average A1C improvement from 7.9% to 7.6%, while AHCL use improved A1C from 7.9% to 7.4%.

Both systems showed extremely positive results and were found to be safe for use in young people with type 1 diabetes. The AID algorithms led to dramatic increases in Time in Range in a population that stands to benefit – over the course of a year, adolescents and young adults could spend more than ten additional days in range. The direct comparison between these two AID algorithms is highly informative – we hope to see similar trials in the future.

Comparison

Image source: diaTribe

Source: diabetesdaily.com

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