Too often, “low-carb” cookie products are full of junk ingredients and they taste like a diet gone wrong. Bleh. 

I’m happy to report that these cookies — from Chip Monk Baking (website) — are delicious!

Here’s what you need to know about these tasty cookies!

What’s in a Chip Monk cookie?

Base ingredients in a Chip Monk cookie:

• Almond flour
• Allulose
• Butter
• Eggs
• Macadamia nuts
• Vanilla extract
• Monk fruit extract
• Salt
• Konjac powder
• Psyllium husk powder
• Baking Soda
• Baking Powder
• Other ingredients based on different flavors

Chip Monk cookies are:

• Grain-free
• Gluten-free
• Keto
• Vegan option: chocolate chip flavor

Nutrition information per cookie (varying slightly based on the flavor): 

• 70 to 90 calories
• 7 to 8 grams of fat
• 1 gram of net carbs 
• Less than 1 gram of sugar

Cost of Chip Monk cookies:

Good things never come cheap! For a box of 16 cookies, you’ll pay about $22.  

Take a look at their online shop to find discounts and deals.  My take is that these cookies cost far less than buying a bakery cookie and are much better for you.

Chip Monk cookies are sweetened mostly with allulose

Allulose is one of the newest sugar-alternatives on the market and it’s one I’m very fond of because it tastes good, it doesn’t impact your blood sugar, and it doesn’t wreak havoc on your stomach like erythritol and xylitol.

Allulose comes from a few very specific fruits, including jackfruit and figs. Unlike erythritol (and all the sweeteners that end in “tol”), it is not sugar alcohol which means it isn’t going to give you tremendous gas! (Personally, I can’t eat things that are sweetened primarily with erythritol or xylitol because my stomach is irritated for the next 24 hours.)

And here’s the best part of allulose: it contains 70 percent of the sweetness of sugar, but only 3 percent of the calories. 

Even more awesome, about 70 percent of the allulose you consume is excreted through your urine.

Don’t forget about the monk fruit

Monk fruit is also used in these cookies, and while it’s not a “zero impact” sweetener, it’s tremendously lower than regular ol’ sugar. (And personally, these cookies had almost no impact on my blood sugar, so monk fruit clearly agrees with me! More on this later.)

“Monk fruit sweetener is created by removing the seeds and skin of the fruit and crushing it to collect the juice, which is then dried into a concentrated powder,” explains Chip Monk Baking.

Monk fruit does not bother your stomach at all, making it a great alternative to sugar even though it will impact your blood sugar a bit.

“Monk fruit gets its intense sweetness from unique antioxidants called mogrosides. During processing, mogrosides are separated from the fresh-pressed juice. This extract is 100–250 times sweeter than table sugar, so monk fruit is often mixed with other natural products, like allulose, to reduce the intensity of the sweetness.”

Chip Monk cookies contain a little bit of erythritol & stevia

There is 1 gram of erythritol in each cookie — which is why you definitely shouldn’t eat more than a 2 or 3 in a sitting if you’re sensitive to sugar alcohols. (Probably a wise approach to any cookie, right?) 

Stevia leaf is simply a plant that tastes sweet. Harmless and simple when consumed in reasonable quantities. It’s used in the vanilla or chocolate chips in some of the Chip Monk cookie flavors.

No big deal. And again, these are really minor ingredients in the overall cookie. 

So how do they taste?

Okay, so if you’re looking for crunchy cookies — these are not for you.

Chip Monk cookies are very softy and perfectly chewy. They taste like real food because they are made with real food ingredients! I really can’t say it any more simply than that.

They are delicious!

I’m pretty picky about both the ingredients and the taste of a low-carb product, and these cookies pass the test with flying colors. 

I’d say they’re actually a little too sweet. I wouldn’t mind if they were less sweet. But aside from that, they are really tasty. 

Honestly, they taste and feel and look like homemade cookies. These aren’t products. These are true cookies. Chip Monk Baking must have a sweet grandma doing their baking for them because these really taste like your grandma’s cookies!

The post Product Review: Chip Monk Cookies – Low Carb, Keto & Gluten-Free! first appeared on Insulin Nation.

The only problem is traditional glucagon kits — made by Novo Nordisk or Eli Lilly and Company — require a series of steps that can be overwhelming and confusing when a friend or family member is trying to administer glucagon for a person struggling with severe hypoglycemia. 

Occasionally, you might even be using a glucagon kit on yourself — for example, if you have a severe stomach bug and just vomited repeatedly but have a large dose of insulin in your bloodstream for the food you just ate.

Regardless of who is administering the glucagon, it’s rarely used during a calm moment. And it’s likely something they’ve never had to do before.

Recently, the FDA-approved “Gvoke” — a prefilled glucagon syringe from Xeris Pharmaceuticals that sets itself apart from the others. 

Let’s take a closer look at glucagon and Gvoke.

What is glucagon?

Glucagon is a hormone that your body produces that tells your liver to release some of its stored glycogen. Glycogen is essentially glucose that has been stored in the liver (and in your muscles). 

Once released, glycogen is quickly converted into glucose and it gives your body (and brain) fuel to function.

For people with diabetes, the extra surge of glucose raises your blood sugar. During a severe low blood sugar, however, this is a very good thing!

What is Gvoke?

Gvoke (website) is a prefilled glucagon syringe, available with a prescription from your doctor. You can order it here.

Older forms of injectable glucagon contained a dry powder and a separate vial of water until you’re about to use it, 

The Gvoke glucagon prefilled syringe, on the other hand, is already mixed. This means there are no steps or directions to follow to ensure the pen is ready to use.

“The Eli Lilly or Novo Nordisk glucagon kits explain that as soon as you mix it up, you have to throw out the remaining contents because it won’t last very long,” explains Xeris. “It’s kept with sterile water and becomes this cumbersome 9-step process of getting the glucagon into the body. All because of water!”

(Xeris is actually Greek for “without water.”)

The Gvoke is approved for use in anyone over the age of 2 years old, and comes in two doses:

• Children under 99 lbs: use the .5 mg prefilled syringe dose
• Children over 99 lbs, Adults and children over age 12: use the 1 mg prefilled syringe dose

After using Gvoke, you or a family member should consider calling 911 if you lost consciousness during your low blood sugar, or if you need further medical support. 

You should also contact your healthcare team and keep a close eye on your blood sugar levels during the 24 hours following severe hypoglycemia. You may find your blood sugar rebounds severely — spiking high for many hours while it recovers from the severe low.

Severe hypoglycemia is no joke. You may have never experienced it after a decade or several of life with diabetes, but anyone taking insulin is vulnerable.

Get yourself any type of glucagon kit and tell your friends and family where you keep it. Just in case.

The post Gvoke: The FDA-Approved PreFilled Glucagon Syringe that Could Save Your Life first appeared on Insulin Nation.

Healthier Lipid Profile Associated with Pump Use

The study, which used data collected from 14,290 adolescent T1Ds from around the world, found that children on insulin pumps had more favorable blood lipid values than those on MDI.

High LDL, high nonHDL, low HDL, and high overall cholesterol are all associated with an increased risk of CVD. In diabetics, a decrease of 1 mmol/l of LDL cholesterol was associated with a 21% decrease in vascular events. While the importance of maintaining favorable lipid levels is widely known, this is the first large scale study to correlate insulin delivery method with blood lipid values.

Even after adjusting for confounding factors such as A1C, age, and the onset of diabetes, the researchers found that the LDL and nonHDL cholesterol levels were significantly higher, and HDL levels significantly lower in the group of diabetics using pump therapy compared to those on MDI.

While this study looked at a wide range of patients with varying degrees of control, a similar, much smaller study looking at 48 T1D children also found significantly more favorable lipid levels in pump users, despite similar A1C levels between the groups. 

How Does Insulin Injection Method Affect Lipid Profiles?

Both these studies show a surprising but significant association between insulin therapy type and blood lipid levels. But how, when comparing two individuals with similar blood sugar control, does the method of insulin injection influence cholesterol?

At this point, researchers can only speculate.

There is some reason to believe that intensified insulin treatment can enhance the action of lipoprotein lipase. This can lead to an increase in HDL cholesterol levels in diabetics. This healthy cholesterol helps rid the blood of bad cholesterol and higher HDL values are considered a marker of heart health.

Since pump therapy tends to be more pinpointed than MDI, it would make sense that HDL levels of pump users would be higher on average than those on MDI.

The intense degree of therapy provided by pumps also helps reduce the variability of blood sugars in diabetics. Widely variable blood sugars appear to be more of a risk factor for CVD than sustained higher blood sugars. Researchers believe this has to do with the higher impact on oxidative stress markers and lipid metabolism seen during blood sugar swings. Since diabetics on pumps typically have tighter control of their blood glucose, they are less likely to suffer from high LDL and nonHDL cholesterol.

Differing Explanations and Further Research

Of course, all of the above explanations are just theories. There is also the very real possibility that real-world factors are influencing these results more than the insulin injection method.

For instance, no information was included in the data concerning the socio-economic background or lifestyle of each patient. It is possible that patients on pumps, which are vastly more expensive than the needles used for MDIs, were also from wealthier backgrounds with better access to healthcare, fresh food, and diabetes education. All of these factors would have a direct impact on blood lipid levels.

Another important factor to consider is the use of continuous glucose monitors (CGMs). CGMs have been shown to have a positive impact on both pump and MDI patients. However, the vast majority of CGM users are on pump therapy, making up about 21% of total pump users and only 5% of total MDI users. Like pumps, CGMs give the patient much tighter control and increase the time blood sugar is within a healthy range. The ability of CGMs to help diabetics maintain healthy blood glucose may even outperform insulin pumps, according to a recent study.

If pump therapy does indeed provide a patient with the ability to maintain a healthier blood lipid profile, then this is huge news that should be taken seriously by the healthcare community. 

Healthy cholesterol levels are vital to avoiding unnecessary cardiac complications in a population of people who are already at increased risk of CVD. According to this study, putting adolescents directly on pumps after diagnosis could play a huge role in adding to their life expectancy. 

Of course, before we can expect insurance companies and doctors to get behind this idea, we need more research into the actual cause of lipid changes in diabetics and how insulin therapy may play into it. We also need additional studies into the benefits of pump use on cholesterol in older diabetics as well as comparisons between pump and CGM therapy and overall lipid values.

For now, there does seem to be a correlation between tighter, less variable blood sugar control and healthier cholesterol levels. This is one finding that all T1Ds and healthcare professionals should keep in their mind while striving to achieve better heart health through more traditional means.

The post Insulin Pumps May Be Ticket to Better Cholesterol first appeared on Insulin Nation.

We spoke with Amir Farzam, CEO of MontMed (website) about SiteSmart, a new color-based site rotation system for insulin pen users. Read his impressive bio at the end of the article.

If you have type 1 diabetes are using insulin pens to control your blood sugar, you are probably vaguely aware that you should be rotating your injection sites. But what exactly does that mean? And, more importantly, how are you supposed to remember where to inject when you have so many other things to keep track of?

If you are like most T1Ds, you may not know exactly what site rotation entails or how to do it correctly. And even if you do know, you probably don’t do it as often as you should simply because it’s hard to keep track of day after day.

With so much to think about when managing your diabetes, ignoring this one little concept may not seem like a big deal. But failing to change up your injection sites is likely having a huge impact on your overall BG control. Luckily, MontMed, a company out of Canada, has come up with a simple system called SiteSmart that makes site rotation easy to do without adding any extra steps to your routine.

Failure to Rotate Sites May Make Blood Sugars More Unpredictable

You are not alone if you have never been told to rotate your injection sites. Newly diagnosed people with diabetes get so much information at once, that this little tidbit often fails to stick. Worse still, many doctors aren’t aware of the importance of site rotation or how to effectively teach the practice.

For those who are new to the concept, site rotation simply entails switching between viable injection sites–such as your upper arms, buttocks, and stomach, as well as using as most real estate as possible within that zone–each time you take your insulin. If you use one location too frequently, the constant trauma to the skin and underlying tissues by the needle and injected insulin can cause excess fat tissue to form. 

This common complication is known as lipohypertrophy and it is estimated that as many as 65% of insulin users suffer from lipohypertrophy. If you are one of them, your diabetes management is likely suffering. 

Lipohypertrophy is a lump under the skin caused by the accumulation of extra fat at the site of many subcutaneous injections of insulin. (Wikipedia)

Not only can this fatty scar tissue cause pain and inflammation, but it can actually affect how well insulin is absorbed. In fact, studies have shown that it can result in 37% lower insulin exposure and 58% higher mean blood sugar after injection. To make matters worse, if you are like most people, you will have a mix of lipo tissue and normal tissue. This can result in widely variable BG outcomes from the same insulin dose depending on where you inject.

Not surprisingly, all this poorly absorbed insulin and variation in blood sugar outcomes can have a significant effect on your A1C. Multiple studies have found a link between a lack of proper site rotation and an increased risk of lipohypertrophy. In fact, lack of proper site rotation has been shown to be the most important risk factor in causing lipohypertrophy, which in turn, has an important impact on glycemic control. 

A Global study on injection techniques with 13,289 insulin users has shown that people who were rotating their site properly had almost .6% lower A1C on average compared to those who don’t. They also had less lipohypertrophy, less glucose variability, less unexplained hypoglycemia and were using less insulin.

But don’t worry if you’re one of the majority of T1D patients who don’t rotate, as it’s never too late to learn. In fact, people with diabetes who received training on injection techniques, including site rotation, saw an A1C drop between 0.5% and 1.0%, depending on their degree of lipohypertrophy, after just six months of proper site rotation and injection techniques.  

Even better still, MontMed’s new product, SiteSmart, is here to do all the hard work for you.

SiteSmart Is a No Brainer for Pen Users

Knowing that you should rotate your sites is one thing. Actually remembering to do it properly and constantly, is another. SiteSmart helps you remember to rotate your sites without adding any additional steps to your already complex management schedule.

So how does it work? 

By incorporating colors to transform pen needles into a tool that helps insulin users achieve better injection site rotation.

Sitemart consists of a box of 100 pen needles in 4 distinctive colors of 25 needles each.  

Each box includes a body diagram with typical injection sites outlined, and a pad of colored stickers, which forms an association tool. The first step is simply to create your own injection site rotation plan by assigning each color of pen needles to each injection site. 

Then, each time you pick up a pen needle to inject, simply inject in the site associated with the color of the pen needle on your plan. And that’s it! No need to track, no need to think about where to inject,  no need to remember where you injected last… This simple technique assures that you switch sites based on the color of pen needle you pull from the box. ‘

You can also access a web app version of the body map association tool on your phone, through a QR code directly on the packaging. 

Since most T1Ds inject insulin multiple times each day, it shouldn’t be long before you remember which color is associated with each injection site.

Once you have the color associations committed to memory, all the hard work is done. The mixed assortment of colored pen needles in each box and the probability of picking any one color will guarantee you rotate your sites frequently throughout the week. 

Insulin Users in the US Will Have to Wait

The only downside to this super-simple product is that it is not yet available in the US. If you live in Canada, you do have the option to choose the SiteSmart pen needles in place of traditional pen needles.

Montmed, the company behind the SiteSmart concept, is in early discussions with several potential partners. We hope they succeed in finding a commercial partner who is committed to improving diabetes care by integrating this product into their portfolio of pen needles so that insulin users in the US can also benefit from this innovation. Not only would manufacturing colored pen needles be easy and cost-effective for a company that already sells similar products, but the value to consumers and payers would be huge. 

Current studies indicate this product is so simple to use that most insulin users improve site rotation and improve outcomes, making it a no brainer for insurance companies to cover.

Such a simple, easy-to-use, and effective product may seem too good to be true. Unfortunately, if you live in the US right now, it is. But, with such promising results from initial trials and a potential to corner the pen needle market though clinical value, we are hopeful this product will be picked up by an American company and become available in the states very soon.

Background of Amir Farzam

Amir has worked for 13 years as an entrepreneur and CEO in diabetes medical device commercialization as well as not-for-profit diabetes education. His expertise is developing company strategy while leading all operational tactics and building business models anchored in innovation. 

Prior to Montmed, Amir co-founded and led Farir Teb, an Iran-based medical device company, which became the market leader of diabetes devices in Iran over a period of 5 years. 

Amir also co-founded and sat on the board of directors of Gabric Diabetes Education Association, which became the best practice of diabetes education in MENA (Middle-East and North Africa), a member of IDF (International Diabetes Federation) and recognized by WHO (World Health Organization).

The post Easy, Affordable Tool to Improve Site Rotation first appeared on Insulin Nation.

Dosing insulin around meals that are high in both carbs and high in fat can be very, very tricky. 

You aren’t alone if you’ve tried to carefully calculate your insulin dose for pizza only to find your blood sugar plummeting two hours later…then spiking to 400 mg/dL 2 hours after that.

Why these foods are so tricky

When you eat a cupcake or a slice of pizza, it does begin to digest like normal food but trouble arises when that tremendous fat content (generally anything over 15 to 20 grams) slows down the breakdown of the high carbohydrate content.

So, if you take the whole dose of insulin to cover the carbohydrates and the fat content, the insulin will inevitably be active before the entire meal has been digested.

At first, you might have concluded that this means you need less insulin for pizza. So the next time you eat it, take 5 units of fast-acting insulin and check your blood sugar 2 hours after eating to find an in-range blood sugar. Only to find that 4 hours later, your blood sugar is above 400 mg/dL.

If you use an insulin pump, you can create this same effect by using a dual-wave bolus. A dual-wave bolus allows you to take some of your normal dose of insulin up front, and some insulin is delivered over the course of several hours.

Pizza, tacos, lasagna, cake, Ben & Jerry’s ice cream…these things are not magically impossible. They simply digest extremely slowly. 

So your insulin dosing strategy needs to address this compared to a more “normal” meal.

My personal insulin dosing strategy for high-carb / high-fat foods

Personally, I’ve come up with a strategy that generally works — and I’d like to share it with you!

Please remember that these specifics are what works for my body. The dosage of insulin and timing may be different for your body.

• I know that for 1 large slice of cake or 2 normal sized cupcakes, my body needs a total of 10 to 12 units of fast-acting insulin.
• So, I give myself 4 or 5 units when I begin eating.
• I check my blood sugar 2 hours after eating to find, hopefully, that my blood sugar is near 100 mg/dL. 
• Then I take the remaining half of my dose.

Two things you’ll find challenging…

First

It is daunting and scary to take 6 units of fast-acting insulin when you know your blood sugar is 106 mg/dL two hours after eating a meal.

The way to work through that fear is pretty simple though: check your blood sugar, take good notes, check your blood sugar again.

A low blood sugar can’t hurt you if you see it coming by checking your blood sugar frequently to see the evidence. By evidence, I mean: see the proof that you really still are digesting that pizza and you really did need that second dose of 6 units of insulin even though your blood sugar was 106 mg/dL at the time you took it.

Prove to yourself that you do indeed digest that food that slowly and you’ll build confidence in the art of taking that much insulin two hours after eating.

Second

Not all pizza is created equal.

If I eat the gluten-free pizza from the local pizzeria, Mimmos, I’m going to need a different amount of insulin for that meal compared to the gluten-free pizza from Costco.

• The crusts are completely different.
• The amount of cheese is totally different.
• The insulin I need is totally different.

Instead of worrying about carbohydrate counts (because the high-fat content demands insulin even though it contains no carbohydrates), take good notes on how many slices of pizza you ate and where that pizza came from. 

Was that a homemade cupcake? Or a store-bought cupcake?

Little differences in ingredients have a big impact on how much insulin you need: two doses of 4 units? Or two doses of 7 units?

Take good notes. Check your blood sugar often. This is a science experiment like every other day with diabetes. 

The post Insulin Dosing Tips for Pizza, Chinese Food, Lasagna, and Cake! first appeared on Insulin Nation.

Carbohydrate central!

Chasing high blood sugars all day on Thanksgiving (and likely the day after) is not fun. But it isn’t your only option, either.

Here are 3 tips for making type 1 diabetes management more successful on Thanksgiving. 

Increase your background insulin

While the insulin we bolus technically covers our mealtime insulin needs, a significant change in your calorie consumption has a big impact on your background insulin needs, too. 

Anticipate that Thanksgiving, and possibly the day after, will be BIG Carb Days and boost your background insulin in advance.

For example, have you ever noticed that your blood sugar the day after eating pizza runs a little higher and is a little more stubborn? The extra glucose produced from those higher-calorie meals linger in a variety of ways — and easily mean you’ll need more insulin the day of and the day after.

Instead of chasing your blood sugar with bolus after bolus after bolus, you’ll have a much easier time staying in your goal blood sugar range if you increase your long-acting insulin dose or set a temporary higher basal rate in your pump.

Talk to your healthcare team about taking 20 to 30 percent more background insulin on the day of Thanksgiving (13 units instead of 10, for example) or setting a temporary basal rate of 20 to 30 percent more insulin. 

If you normally take your long-acting insulin dose at night, you could take your normal long-acting dose the night before Thanksgiving, and then take 30 percent more midmorning on Thanksgiving day.

And if you plan on eating leftover pie and mashed potatoes all weekend, you’ll likely want to keep that higher dose going. 

Choose the carbs you love the most!

Personally, I’ve never understood the appeal of stuffing, nor do I need to eat sweet potatoes with marshmallows on top (gross!). But mashed potatoes, homemade cranberry sauce, gravy, and blueberry pie definitely score high on my “carbohydrate priorities” list. 

Just because there are 9 different types of starchy carbs on the table doesn’t mean you have to eat them all.

Choose the carbohydrates that matter most to you. 

Are the crackers and cheese everyone’s eating before Thanksgiving dinner really worth the carbs? 

Maybe. Maybe not. For me, no — I’ll save those carbs for dinner, and have something lighter for an early day meal. (Probably a salad!)

Ask yourself in advance, ‘which carbs matter the most to me?’

Don’t take your insulin dose all at once

When you put that much food in your belly within just a few hours, you’ll inevitably be digesting those calories for hours and hours.

If you count up all the carbohydrates on your plate and take the full dose of insulin right then, you’ll probably end up low in two hours. Then you’ll treat the low, and end up sky-high a few hours after that because the rest of your dinner is finally being digested.

Remember, when you consume a large serving of fat and/or protein, you’ll need insulin to compensate for those macronutrients, too. It’s not just about carbohydrates. 

Most likely, you’ll eat a big plate of food, go back for a smaller plate of seconds, and then an hour later, have a big piece of pie!

My Action Plan for Turkey Day

My action plan for Thanksgiving is simple:

• I try to skip seconds
• I take at least 5 units of insulin every 2 hours until I total 15 to 20 units depending on how much I ate.
• I check my blood sugar frequently to be sure I didn’t over-or-under-estimate my insulin needs. 

Remember, More Insulin

Conquering type 1 diabetes on a day like Thanksgiving just requires… more insulin than you’re used to taking. 

That insulin needs to be spread out over the course of many hours instead of being taken around the time you eat because the extra fat and protein mixed with all those carbs will extend the time your food takes to fully digest. 

As always, work with your healthcare team if you aren’t accustomed to adjusting and manipulating your insulin doses on your own. 

Check often. Give thanks. Enjoy!

The post Thanksgiving with Type 1 Diabetes: 3 Blood Sugar Management Tips first appeared on Insulin Nation.

Despite the fact that heart disease affects men at a greater rate and typically strikes males at a younger age, a new meta-analysis has found that women with diabetes are much more likely to suffer from heart conditions and artery blockages than men with diabetes.

There is no straightforward answer to why women with diabetes, and women with type 1 diabetic, in particular, are at higher risk than the general population. That said, there are some steps you can take to protect yourself from becoming a statistic.

Disheartening Findings of New Meta-Analysis

The study, published in Diabetologia, looked at the data of over 12 million diabetics published in various PubMed studies. Their goal was to compare the rates of heart disease and heart-related deaths between the sexes. They also kept track of diabetes type.

They found that type 1 women have a 47% greater excess risk of heart failure than type 1 men. Type 2 women are also at increased risk compared to their male counterparts, but only at about 9% greater excess risk.

Compared to non-diabetic women: T1D women were five times more likely to suffer from heart failure while T2D women were twice as likely to develop heart failure than non-diabetic women.

While the average first heart attack for males happens around age 66, women typically do not have their first heart attack until about 72. However, this “age protection” does not appear to apply to diabetic women, who are more likely to have a heart attack at a younger age than the general population.

Overall, there was a clear indication that heart disease disproportionately affects diabetic women, with type 1s being at the greatest risk.

Why Is Heart Disease So Prevalent in T1D Women?

This study did not provide an answer as to why this disparity exists between T1D women and T1D men.

We do know from previous data that diabetic women have a significantly greater risk of developing coronary heart disease, stroke, dementia, and cancer than diabetic men. While this information certainly makes the study findings less surprising, it does little to answer the question of why women seem so much more prone to cardiovascular complications of diabetes.

One potential reason for the higher heart disease in women may lie in the differences between how men and women store fat. 

Women typically store fat around the midsection, something that has been historically associated with higher cholesterol and other markers for cardiovascular disease. Since diabetes itself is also associated with less favorable blood lipid values (see Insulin Pumps may be the Ticket to Better Cholesterol), these factors may work together to exponentially increase heart disease risk in women.

There is also evidence that diabetic women receive delayed diagnosis, less intense care, and experience poorer glycemic control than men. The researchers were quick to point out that women experience two years longer duration on average of prediabetes compared to men. This prolonged exposure to elevated blood sugars could account for greater initial vascular damage. But this factor would only help explain the data seen in type 2 diabetics, as type 1s do not typically suffer through long periods of prediabetes.

Women Need to Take Additional Steps to Reduce Their Risk

Even if this new data doesn’t do much to explain why women are at such an increased risk of diabetes-related heart complications, it certainly does provide a dire warning about the importance of heart health for us diabetic females.

I recently wrote an article focusing on the importance of heart health for diabetics. In it are five tips to reduce your risk of CVD. While these steps seem more important than ever if you are a woman, there are some additional tips worth considering that are specific to females.

Atypical symptoms and delayed treatment

Women, in general, are more likely to have atypical symptoms of heart failure and heart attack than men.

Even worse, the average woman will wait 54 hours to seek treatment for heart attack compared to only 16 hours for men.

This may be one reason that the survival rate of men with heart disease is so much greater than women. In fact, only 36% of men will die within five years of their first heart attack while 47% of women will.

While these numbers are not specific to diabetics, they do shed some much-needed light on the existing disparities between men and women with heart disease.

Become your best advocate

As someone who is at increased risk of suffering from one of these episodes, it is extremely important that you educate yourself on the symptoms of a heart attack and how these can be different for women. And, since there is mounting evidence that the healthcare system fails more often with women than with men to diagnose and treat women suffering from heart failure, it is especially important that you advocate for yourself. 

There is also evidence that the same lack of care exists for women with diabetes. So the same advice is true for working with your endocrinologist to assure your blood sugars are under the tightest control they can be.

Avoid stress

Lastly, multiple studies looking at stress have found that women are affected much more negatively by household stress than men. 

Since stress has a known negative impact on heart health and blood pressure, it is even more important for diabetic women to find useful and consistent ways to cope with their stress.

Recognize your risk

While it may be frustrating to see studies like this that present such dire data without any real substance as to why that data exists, the message of this meta-analysis is still an important one. 

While we may not know for sure why this disparity exists, know that as a woman with diabetes, there are still steps you can and should take that will decrease your risk of heart disease.

The post Heart Disease Risk Is Greatest in Women with Type 1 Diabetes first appeared on Insulin Nation.

Now, after 4 years of experience with contracting nasty 24-hour stomach bugs every goddamn winter, I know how to prepare for that brief but potentially devastating day. 

*If you do believe you have the flu — not a stomach virus — call your doctor ASAP about this new flu treatment for people with diabetes.

When a person with type 1 diabetes has a stomach bug or flu

As a person with type 1 diabetes, if you contract a virus that causes you to vomit repeatedly, you need to go to the ER to get intravenous fluids and potentially glucose. 

If you puke repeatedly, and cannot keep fluids or food down, and try to “tough it out” at home…you will eventually be overwhelmed by ketones and likely find yourself in DKA within 12 hours. You may also battle with severely low blood sugars depending on how your insulin is adjusted before and during all that puking. 

RULE: If you cannot keep fluids down, you need to go to the ER for support. 

You’ll only be in the ER for a few hours if you go shortly after that first bout of puking. If, however, you wait at home, trying to “tough it out,” and you don’t go until you’re in DKA the next morning, you’ll be at the hospital a lot longer. 

Just go to the ER as soon as you know you have a stomach virus or flu, get rehydrated, and get out of there within a few hours.

Here are 2 things I make sure to have in my home at the start of the flu and stomach bug season.

Emergency Glucagon Kit (check the expiration date!)

I’ve never needed one of these glucagon kits for their initial purpose: for someone else to administer when you’ve lost consciousness or the ability to drink/chew because of severe low blood sugar.

But I have needed a glucagon kit!!   When I was 8 months pregnant, I had just eaten Christmas dinner with my in-laws, and 2 hours later started vomiting like crazy. But there were 15 units of insulin in my bloodstream and none of the food I ate had been fully digested. And then I puked all of it up and out. An ideal opportunity for severe hypoglycemia!

My blood sugar was 45 mg/dL and I couldn’t even consume a single glucose tab without violently vomiting again.

Yes, we drove like hell to the hospital to get saline and intravenous glucose, but it would’ve been far less of an emergency if I’d had a glucagon kit to inject myself with. I would’ve given myself a partial dose of the glucagon, and driven at a normal speed to the hospital to get intravenous fluids to address the issue of dehydration. 

Now, at the start of every winter, I make sure I have an up to date emergency glucagon kit. 

If you don’t have one, simply ask your doctor for a prescription to get one ASAP. 

TIP: Tape an insulin syringe to your glucagon kit. You can use this draw out the glucagon (after following the directions and mixing the powder with the liquid), to easily inject a smaller dose of glucagon. If you’re conscious and using this kit during a stomach bug, you likely don’t need the full dose. It’s also a lot easier to inject via an insulin syringe than the mega-needle that comes with the kit.

(I tried to get one of the newer types of glucagon but my pharmacy doesn’t carry it yet.)

Pedialyte and Gatorade (not the sugar-free versions!)

After you get home from the hospital, and your blood sugar is stable and you’re done puking, you’ll need to continue hydrating. But you probably won’t want to eat any food yet either. 

Drinking a mixture of Pedialyte and Gatorade will give you not only electrolytes, sodium, and zinc, it will also give your body some sugar. You do not want to consume zero calories after you get home from the hospital. This could easily lead you to develop ketones again. Your body needs fuel. Sipping a combination of these two beverages will prevent those ketones.

I don’t drink Pedialyte straight because it’s gross! It has a thickness to it that I find pretty unbearable. By mixing it with Gatorade, it’s enjoyable to sip after a day of puking and being in the hospital. 

And yes, you need insulin for the carbohydrates in these beverages but likely a lot less than usual because you aren’t eating any other calories. Work with your healthcare team to discuss your insulin dosing adjustments during or after you are discharged from the ER.

What about anti-vomit medications?

Zofran is an example of a prescription medication that is intended to prevent puking. 

But here’s the thing: 

• First, if you have a real stomach bug, it ain’t gonna work. 
• Secondly, you’re gonna puke it up before it’s ever digested, which circles back to my first point — it ain’t gonna work.

At the hospital, you can receive anti-vomit medications like Zofran intravenously, or — even more fun — in a capsule that is inserted into your bum. (Yup, you read that right.) 

My point is: having Zofran pills at home isn’t likely going to keep you from vomiting if you get a stomach virus or the flu. You’re going to puke. And you’re going to need a trip to the ER to get rehydrated intravenously.

Stomach bug and flu season is a b*tch if you live with type 1 diabetes. It comes with a degree of danger and emergency that those insulin-producing friends of ours simply don’t have to deal with.

Get your flu shot. Get your glucagon kit. Get your Pedialyte and Gatorade, and get to the hospital if you start puking and can’t keep fluids down. 

The post Type 1 Diabetes: How I Prepare for Flu & Stomach Bug Season first appeared on Insulin Nation.

Since you were likely more concerned with how to calculate doses, carb count, and just live with this terrifying condition, you probably never even considered that there might be more options out there. But now that you have lived with diabetes for a few years, it’s time to consider the very real possibility that the insulin you are on right now isn’t the best choice for your lifestyle and needs.

Here’s a look at the most popular pump-compatible insulins and the pros and cons of each.

At a Glance: How Pump Insulins Differ

Chart data from a WebMD article adjusted based on press releases, studies, and the manufacturer’s websites for Humalog, Novolog, Apidra, and Fiasp.

Every insulin brings something slightly different to the table. Some have quick peak times and are used up quickly, while others peak more slowly and stick around for a while. But all have one thing in common: varying averages that change based on the person who is using them.

Pros, Cons, and Who Will Benefit from Each Type of Insulin

How long insulin takes to start working and when it peaks are only one piece of the puzzle. Different insulins are absorbed at different rates, with some made to target the early rise in blood sugar after a meal while others are meant to work harder for longer durations. 

Humalog

Humalog is one of the most popular insulins utilized by pump users. This popularity comes largely from the fact that it is covered by about 80% of insurance plans.

Much like Novolog, Humalog has a relatively quick onset time and works consistently over the course of about 3 hours. Unlike its direct competitor, there is a large variation in when this insulin will peak, depending on the person.

Many users report that Humalog works very quickly to bring down their post-meal sugars, even faster than Novolog. Others report the exact opposite, finding this insulin sluggish in its peak time, leading to a higher blood sugar before a steep drop back to normal.

Unfortunately, there is no way to know how this insulin will work for you until you try it. If you are looking for insulin with a super-fast peak and you are one of the lucky ones, this might work really well for you. On the other hand, if you tend to eat meals with high fat or fiber content, the slower peak time could be what you need. Of course, your body might react to this insulin in a way that produces the opposite peak time than what you are looking for, so it may be worth experimenting for a month or two.

Novolog

While there is still much debate about which of the two most popular insulins people like better, Novolog does seem to provide more consistent results than Humalog. Whether or not people are happy with those results still depends on the person.

Novolog gets to work about as quickly as Humalog, if not a touch faster, and peaks relatively soon. Those who find Humalog peaks very fast for them may feel like Novolog works too slow. But those who find Humalog too slow will likely see better results from Novolog. It has a similar duration to Humalog and takes a bit of time to bring blood sugars all the way back down to baseline.

Also much like Humalog, it’s hard to know how well this insulin will work for you without trying it. If you like how Humalog works overall but feel there could still be some improvement, Novolog may be the better choice. If, on the other hand, you really need something that works faster, you’ll want to check out the super-fast insulins below.

Fiasp

After looking at the above table, you might be shocked to learn that Fiasp is marketed as “super-fast” insulin. It’s uptake time is similar to older, more popular insulins on the market, and it stays active in the body for a surprisingly long time. So how exactly is it supposed to be faster acting?

Fiasp is actually the same insulin as Novolog. The difference is that they’ve added niacinamide–a B vitamin–to the solution, which allows the insulin to move through the fat layer and into the bloodstream faster than Novolog or Humalog.

On average, Fiasp does have a faster onset in many patients than other insulins, but where it truly differs is how intensely it works in the beginning.

Compared to Novolog, this insulin will work 50% harder in the first 30 minutes. This translates to a much smaller glucose peak after meals.

The duration of this insulin can be a bit deceiving, too. While it stays in the system longer overall, the amount left after 2.5 hours is minuscule.

If you frequently experience high glucose spikes immediately after meals or have difficulties pre-bolusing for meals, then this insulin might be beneficial for you. It also works extremely fast to correct down wandering highs and is a good option for people who get impatient with BGs that don’t come down right away.

Apidra

Apidra was the original super-fast insulin on the market. Much like Fiasp, this product works rapidly to drive blood sugars down as soon as your meal starts to digest. But unlike Fiasp, this insulin has an especially short duration. A meal bolus will be completely out of your system after about 2.5 hours.

This short duration can be beneficial for people who frequently suffer from hypos caused by overlapping boluses. 

The action of this insulin also mirrors more closely the action of high glycemic index meals. It may be a better option for people who typically see their blood sugars spike fast and then take a long time to return to normal when using other insulins.

On the other hand, if you tend to eat meals with low GI or lots of fat, this insulin could cause problems by pumping too much insulin into your system before enough glucose has been absorbed. And, since Apidra leaves the body so quickly, you would be more likely to suffer from delayed highs in cases like this. Using a square or dual bolus for these kinds of meals would be necessary with Apidra.

Your Lifestyle, Your Insulin

In the end, there is no one answer to what insulin works best in an insulin pump.

Each one of the options above is likely to affect every individual differently, but that doesn’t mean you should settle for whatever insulin you’re on now. Especially if you aren’t happy with the control it’s giving you.

Most doctors stock samples of all the major insulins. If they believe one might work better for you, most will let you test drive a vile. Don’t get too attached to a new insulin right away, though, as many insurance companies only cover one of the major brands. But, if you can prove that the new insulin works better for you (using CGM data, handwritten records, or A1C changes), your doctor may be able to convince your provider to make an exception.

Even if there are a few hoops to jump through, finding the best insulin to fit your needs and lifestyle is worth it. After all, this is a condition you have to deal with day in and day out, why not make it as easy as possible?

The post What’s in Your Pump? How to Choose the Right Insulin first appeared on Insulin Nation.

First and foremost, there are hormones. 

These pesky chemicals influence blood sugars in ways that are often unpredictable. And, because they change throughout the month and throughout a woman’s life, it can feel impossible to get ahead of their effects.

Beyond the typical ebb and flow of monthly hormones are the especially potent ones that come with pregnancy. A constantly changing mix of chemicals combined with ever-increasing insulin resistance will challenge the sanity of even the most experienced diabetic. Pregnancy presents problems even for women who do not intend to have children. The fear of an accident and the stress of how diabetes might affect the unborn are enough to cause blood sugars to spike on their own.

Beyond physical differences, women with diabetes also have to deal with the unique challenges presented by cultural and social expectations. Raising children, climbing the corporate ladder, and even dating are all hard enough by themselves, and made even more complicated by the addition of diabetes.

Despite all these unique challenges faced by so many, diabetes care is often treated with a ‘one size fits all’ approach. This can leave a lot of people, particularly women, feeling overlooked.

It was this issue that led Brandy Barnes to establish the first American non-profit with the single focus of helping women with diabetes. In the 11 years since its conception, DiabetesSisters has helped thousands of prediabetic, type 1, and type 2 women learn how to better control their condition while building community connections for lifelong support.

Sisterhood for Women Living with Diabetes

DiabetesSisters aims to educate, empower, and encourage all women with diabetes to live a better life. They accomplish this through a number of programs.

One of the simplest, yet most effective of these programs is called Between the Lines. Through their website, DiabetesSisters shares first-person accounts of the trials and tribulations of living with diabetes. These stories are submitted by women with diabetes from around the nation and focus on a number of topics from trying to find healthy, affordable groceries on the island of Hawaii to diagnosis tales we can all relate to.

Whatever the content, these stories all have one thing in common: they inspire. 

To hear another person verbalize the same emotions, frustrations, and hardships you are dealing with immediately takes you from a place of isolation to seeing yourself as part of a community. And knowing that others have made it through that struggle can help motivate you to take the first step yourself.

But the support provided by this organization doesn’t stop with stories of inspiration. They also provide in-person meetups around the country.

PODS Meetups

Part of DiabetesSisters, or PODS, is a program led by a group of volunteers who host monthly meetups for women living with diabetes in their community. Whether you are type 1, 2, or prediabetic, joining these meetups is free of charge.

These meetups are loosely structured with rotating topics to encourage discussion. The goal is to provide a safe environment where women can discuss their struggles and learn from others with similar experiences. The intention is always to create an educational, respectful space where women can learn to take better care of themselves and their condition.

Currently, PODS Meetups exist in 35 locations across 20 states. For those who don’t live near a current meetup group, there is a viral meetup held on the third Thursday of every month.

In addition to creating a sense of community, DiabetesSisters also strives to educate and advocate. In 2016 they launched their minority initiative to increase awareness, peer support, and resources for minority women living with diabetes. These communities are often disproportionately affected by diabetes yet receive fewer resources to educate and support those living with the condition.

Get Involved

DiabetesSisters is a nonprofit organization run by a small group of women living with diabetes. At the heart of the great work they do is a growing number of dedicated volunteers.

If you are interested in hosting a PODS Meetup in your town, you can fill out an application to become a PODS Leader on the organization’s website. In addition to providing resources to help you advertise and run the monthly meetings, the organization also hosts Leadership Institutes throughout the country. These in-person training programs are meant to build and enhance better leadership skills, share experiences, and create welcoming atmospheres to encourage honest discussion.

If you want to contribute to this great organization but don’t have a lot of time to dedicate, you can always submit your own personal story of diabetes struggles and successes. DiabetesSisters is continually looking for new stories from any woman living with diabetes or prediabetes. For more information on how to get involved, send an email to info@diabetessisters.org.

Of course, the sole reason this organization exists is to provide support to the women who need it. Check out their website today — diabetessisters.org — for a host of resources to help you live a healthier, happier diabetic life. While you’re there, make sure to check out the list of current PODS Meetup groups and the schedule of upcoming meetings so you can find and connect to the sisters with diabetes in your community.

The post DiabetesSisters: Women Supporting Women with Diabetes first appeared on Insulin Nation.

Stranger still, women living with type 1 experience heart disease at rates greater than men with type 1 and both men and women with type 2.

So why is it that type 1 women’s hearts seem so vulnerable to the damage caused by this specific condition?

To understand this surprising phenomenon, we first need to take a step back and look at how T1D, in general, affects cardiovascular health.

Why T1D People Face Greater Risk of Heart Disease

People living with T1D come in all shapes, sizes, and ages. Some are athletes, some are overweight. Some have been treating the condition with great success for decades, while others struggle.

Despite these differences, every person with T1 diabetes shares an increased risk of cardiovascular complications.

While many aspects of lifestyle and general health play into an individual’s risk for heart disease, there are certain risks associated with T1D that you just can’t escape. No matter your BMI, A1C, or HDL.

High Blood Sugars

One of the most widely accepted reasons for diabetes increasing cardiovascular disease (CVD) risk, is the damaging effects of high blood sugar. 

High glucose levels cause stronger contraction of blood vessels. In turn, this forces the heart to work harder to pump blood to the organs and extremities. Additionally, frequent high blood sugars can lead to hardening of the blood vessels and damage to the heart itself.

Widely Varying Blood Sugars

If high blood sugar alone was responsible for increased CVD risk, then T1Ds with lower A1Cs would show a comparable decreased risk in this area. But we don’t see that kind of consistent linear association in the data. One explanation may be related to oxidative damage to blood vessels caused by wide swings in blood sugar.

When sugars go high quickly after a meal and then fall low a few hours later, it causes oxidative stress to your cardiovascular system. But, because A1C is only an average of blood sugar levels, it tells us nothing about how often we experience these swings. It is possible that people with lower A1Cs who still suffer from CVD have experienced this type of oxidative stress.

Autoimmune Response

While blood sugars do tend to go higher and swing more dramatically in type 1s versus type 2s, these differences alone aren’t enough to explain the huge variation in risk between the two conditions. But one major difference between these two common types of diabetes might.

T1D is an autoimmune disease in which the immune system attacks insulin-producing cells in the pancreas. But this type of damage may not be limited to just that one organ. A study published in 2018 found a similar autoimmune attack of the heart muscle in some T1Ds. While this process appears to be made worse by poor control, there seem to be a number of factors that influence who is most affected.

Complication Feedback

In addition to the heart, T1D has a number of associated complications including nerve damage, eye problems, and kidney disease. Many of these complications have a direct or indirect effect on a person’s heart health.

For instance, kidney failure can cause high blood pressure. While a person suffering from neuropathy may find it too painful to exercise regularly. Even if a person is not physically limited, any complication can affect mental health, leading to a more sedentary lifestyle, poor diet choices, and worsening blood sugar control. Even something as simple as avoiding carb-heavy plant foods in favor of low-carb meats and cheeses can have a negative impact on heart health.

Why Women Living with Diabetes Have the Greatest CVD Risk

Everything about type 1 diabetes seems to have a negative effect on a person’s heart. But, so far, all the issues we’ve looked at would appear to affect males and females equally. So where does the increased risk for women come from?

First, we have to consider that not all the reasons listed above are, in fact, gender-neutral. 

Multiple studies of the healthcare industry have shown that women routinely receive lower quality and less acute care than men. For a diabetic, less quality and less frequent care often mean higher and less consistent blood sugars. Both things we know lead to a greater risk of heart disease.

It’s also worth considering that women living with T1D might be more prone to autoimmune attacks on the heart muscle. Unfortunately, the study that demonstrated the existence of autoimmune heart damage did not give their results by gender.

Non-diabetic men suffer from heart disease more often than non-diabetic women. But the opposite is true of diabetics. Some theorize that this might have something to do with abdominal fat. Women, in general, carry more weight around their midsection than men. It’s possible that this specific type of fat has a cumulative effect when combined with diabetes.

Despite the fact that more non-diabetic men than women have CVD, some studies suggest that women actually have less control of CVD risk factors like blood pressure and smoking status. Women even appear to more commonly have high cholesterol than men. 

Usually, all of these factors are negated by the heart-protecting qualities of estrogen. But in diabetic women, that protection appears to be negated.

Protecting the T1 Woman’s Heart

While we may only be able to speculate on the exact cause of T1D women’s increased risk of CVD, that doesn’t mean we are powerless to fight it.

Over the next few articles in this series, I will be taking an in-depth look at how you, as a woman living with diabetes, can reduce your risk of developing heart disease. For those out there who already have cardiovascular complications, we will dive into what it takes to manage the condition and your best shot at improving your heart health.

The post The T1 Female Heart: Why Women’s Hearts Are at Greater Risk first appeared on Insulin Nation.

If you took the fat out of cupcakes or lasagna or Chinese chicken fingers or pizza, your taste-buds would riot and protest! 

If you’ve lived with diabetes long enough, you’ve probably had your share of blood sugar battles with high-fat meals. We discussed an approach to dosing your insulin for those heavy, indulgent meals in this article — but there’s another aspect to dietary fat we haven’t covered yet.

Why and how dietary fat makes you more insulin resistant actually has a lot to do with your liver, not just the rate of digesting the sugar you ate in two cupcakes.

Let’s take a closer look.

Yes, dietary fat can delay digestion by 1 or 2 hours

“When you eat a large amount of fat — over 15 or 20 grams in one meal or snack — this will significantly delay the rate of ‘gastric emptying,’” explains Gary Scheiner, MS, CDE, and owner of Integrated Diabetes Services. 

But fat cannot be converted into glucose the way protein can.

Instead, dosing insulin for that high-fat meal comes down to either extending your insulin dose over the course of several hours rather than dosing it all upfront or splitting your dose in half: taking the first half when you start eating and the second half 1 to 2 hours after you finished eating.

Again, you can read more about this in our earlier article on dosing insulin for high-fat, high-carb meals.

But you may notice that even high-fat, low-carb meals leave you with stubborn blood sugar levels, too. This is about your liver.

How large amounts of dietary fat affect your liver’s production of glucose…

The other tricky part of dietary fat comes down to its impact on your liver.

24 hours a day, your liver is producing a small amount of glucose to meet your body’s fuel needs between meals. 

Your liver can produce large amounts of glucose from its glycogen stores, however, during certain situations, like during stressful or adrenaline-inducing moments or during dawn phenomenon.

And lastly, your liver will produce more glucose in response to large amounts of dietary fat, explains Scheiner, also the author of Think Like a Pancreas.

“When you eat a high-fat meal, your triglyceride levels go up and your liver becomes temporarily insulin resistant,” adds Scheiner.

Ordinarily, your liver’s output of glucose is suppressed by insulin. 

“But if your insulin isn’t working as effectively as usual because of the large quantity of dietary fat, your liver responds by producing more glucose, too.”

The same thing happens when you’re battling a cold or flu or infection, or when you’re taking steroids like prednisone. 

This can occur with or without large amounts of carbohydrates in that meal, too, which means that following a high-fat meal, you may see a prolonged rise in blood sugar that requires additional insulin.  

In other words: your digestive system and how your body manages what you eat is a complicated beast!

To manage the increased glucose production from your liver, Scheiner suggests three different options:

For insulin pumps: 

• Set a temporary basal rate increase by 50% for 8 hours after the meal
• Use a small dose of old-school slower “NPH” or “Regular” insulins after the meal with guidance from your doctor. NPH works in your body for 8 to 10 hours, Regular works for 4 to 6 hours.
• In addition to splitting your meal dose as described above, give a little extra 2 to 4 hours after the meal.

As always, discuss any major changes in your insulin dosing regimen with your healthcare team! Or work with Gary and his awesome team of diabetes management experts via video or phone at IntegratedDiabetes.com!

The post Dosing Insulin for Dietary Fat: When it Matters & Why first appeared on Insulin Nation.

As a young or newly diagnosed woman with type 1, it can be disheartening to look at the stats associated with T1D and cardiovascular disease (CVD). The fact that so many people with diabetes end up with heart disease despite stellar blood sugar control only adds to that feeling of powerlessness.

But before you throw up your hands and accept what seems inevitable, know that there are steps you can take today to reduce your risk of heart-related complications.

Find an Exercise Routine That You Can Stick With

Reducing heart disease risk with exercise is a concept that goes way back. This advice is still useful even though T1D women are at a far greater risk than the general population. In fact, that difference in risk should be enough to convince you to go above and beyond the recommended daily activity set down by the American Heart Association (AHA).

Staying physically active will help decrease blood pressure, bad cholesterol, and help you maintain optimal weight. All of these factors work together to reduce your risk of heart problems. 

How much exercise you need will depend on your health status, age, and BMI. The AHA recommends 30 minutes of moderate exercise a day. This is equal to about a two-mile walk at a brisk pace. If light, anaerobic exercise is more your thing, you can still attain better heart health by toning your muscles. Start with longer weight lifting sessions and work toward shorter, more intense sessions that get your heart beating.

Since consistent exercise is key to reducing heart disease risk, it is important to set yourself up for long term success.

Here are some tips that can make daily exercise more achievable for the long haul.

• Mix it up. Instead of doing the same one mile run each day, add some variety. Consider breaking up the routine with a weekly yoga class, a hike with the dogs, a sunset bike ride, and other activities that you enjoy that will also get your heart pumping.
• Involve the family. While your husband or significant other may not have the same CVD risk factors that you do, just about everyone will benefit from more exercise. Join a gym together and challenge one another to reach new milestones. Take your children outside for a long game of tag or chase them while they ride their bikes up and down the street.
• Make exercise time your time. We all want an excuse to have more time to ourselves, and exercising to decrease your CVD risk is one of the best excuses there is. Own your work out by putting on a mix of your favorite songs and enjoying some quality time away from the house.
• Join a rec league. Think sports are just for kids? Joining an adult rec soccer, flag football, or frisbee league is a great way to add activity to your life. Not only does playing games not feel like exercise, but these leagues are a great way to meet new people in a low-pressure environment.

Of course, if you are unfamiliar with how your diabetes or your body handles increased activity, make sure you start out slow and work with your doctor to set your limitations.

Find the Right Food to Feed Your Heart Health

As a diabetic, you already experience a lot of limitations when it comes to food. And, more than likely, you aren’t looking for a reason to add to those limitations. Unfortunately, a restricted diet may be the number one most important factor in reducing your heart disease risk.

A 2017 study found that almost half of all heart disease deaths were linked to a poor diet. If eating processed food and sugary-sweet treats can have that kind of impact on the general population, just imagine what it will do to your type 1 diabetic heart.

While most people with type 1 work hard to reduce their sugary food intake, many still consume too many other red flag heart foods. Items like meat, salt, and fatty dairy products often find their way into the diabetic diet. After all, these are all foods that require little to no insulin, making them more blood sugar friendly. But this “diet” is suspected to be one of the reasons T1Ds are even at a greater risk of heart problems than people with type 2 diabetes.

So how do you eat for your heart without sacrificing your blood sugar control?

Luckily, even though many heart-healthy foods are higher in carbs, they actually work to improve your insulin sensitivity and reduce inflammation in the body, both things that lead to tighter blood sugar control. Additionally, most whole foods have a lower glycemic index than their processed counterparts. So while you may need to bolus more at the beginning of a meal, you are less likely to experience a blood sugar spike with these foods.

To help your heart and improve your blood sugar control, try to incorporate as many of these heart-healthy foods as possible into your diet:

• Veggies, especially leafy greens
• Fruits
• Whole grains
• Legumes
• Nuts
• Heart-healthy fats from flaxseed, olive oil, and fish

Try replacing some of the red flag foods you consume with one of the options above. Each week strive to replace more meals with heart-healthy options. Eventually, you will find yourself on a nutritious diet that is better for you and your heart.

Find a Better Way to Cope with Stress

So many of us today deal with a constant stream of stress, but women, in particular, seem to get more than their fair share. Between taking care of the home and family, building a career, and carrying the emotional burden of the world, it’s amazing we don’t just crumble under the weight of it all. 

But one part of you that is succumbing to all this stress is your heart.

Frequent exercise and eating right can only do so much for you if your blood pressure is constantly spiking at the sight of your coworkers or you’re regularly tearing your hair out over your children’s behavior. In order to protect your heart from all this stress, you have to find a positive way to manage it.

What technique works best varies depending on the individual. The important thing is to figure out what will work for you and find a way to put it into practice.

Here are some of the best methods of dealing with stress:

• Meditation
• Exercise
• Relaxation techniques
• Talk therapy
• Reducing your caffeine use
• Making positive changes in your life
• Getting a better night’s sleep
• Changing your outlook

For some, removing stress from your life may not be as easy as meditating or changing how you view the world. You may need to make some drastic changes to remove constant stressors like a bad relationship or a frustrating job. While breaking up with a boyfriend or quitting might seem like an extreme reaction, putting your own well being first may save you from premature death due to CVD.

Only You Can Reduce Your Risk

Sometimes it’s easier to throw your hands in the air and accept being helpless than it is to make major life changes. But if you want to avoid ending up like the 44% of T1D women who will die of heart disease, you have to put your heart health before just about everything else.

While it may take some extra work to exercise more frequently, eat well, and avoid stressors, you will feel a lot better once you are on a new path. In fact, after a while, you may find you’re doing these things more for how they make you feel than how much they help your heart.

The post The T1 Female Heart: Avoiding Heart Disease in Your Life first appeared on Insulin Nation.

“Most people ignore fat and protein’s effects on their blood sugar,” says Gary Scheiner, MS, CDE, and owner of Integrated Diabetes Services. “And most of the time, you don’t have to pay attention to it, but there are conditions when protein and fat play a major role.

Let’s take a closer look at how protein can affect your insulin needs.

The amount of carbohydrates you eat every day makes a big difference

Protein can be broken down during digestion and converted into glucose if your body isn’t getting enough glucose through the carbohydrates in your diet.

If you’re eating a reasonable amount of carbohydrates, you don’t have to worry about protein being converted into glucose,” explains Scheiner, also the author of Think Like a Pancreas.

When the human body gets a moderate amount of carbohydrates spread evenly through the day — it has no reason to convert protein into glucose. But the human body does need glucose in order to function. 

While many believe the body can “run on ketones” during a ketogenic diet, your brain, in particular, cannot function without glucose. 

This means that a person following a strict low-carb or ketogenic diet is inevitably going to be converting some of the protein they eat into glucose to meet your body’s glucose needs.

“If you’re eating a low-carb meal, you can expect that roughly half of the protein grams in your meal will be converted to glucose,” explains Scheiner.

For example, a dinner of steak and salad may contain 5 grams of carbohydrate and 40 grams of protein. That means you would dose insulin for 5 + 20 (half of 40) grams of “total carbohydrate.”

This can also be the case if you don’t normally follow a strict low-carb diet, but you happened to eat very few carbs that day or you had several low-carb meals before eating a higher carb meal.

If you eat an “enormous” amount of protein in one sitting…

The human body can only make use of so many amino acids from the protein you within one meal. This means that when you eat an enormous amount of protein in one sitting — even with a moderate amount of carbohydrates, too — some of that protein will be converted into glucose.

“More than 60 grams of protein in a meal will absolutely raise your blood sugar more than just the carbohydrate content in that meal would have on its own,” explains Scheiner.

For example: 

• • 3 chicken breasts
  • A very large steak 
  • A dozen eggs 
  • 3 or 4 scoops of protein powder
    (Read more about protein powder and insulin here…)

Bodybuilders, powerlifters, and other types of athletes are most likely to run into this.

“Not only will you want to account for the carbohydrates, but also dose for an additional 20g due to protein being converted into glucose,” explains Scheiner, “but you’ll also want to bolus insulin for that protein after eating because the rate of digestion for that much protein will be much slower than a normal-sized meal.”

What about vegan protein sources?

The difference between the protein in a vegan (non-animal) food and an animal source is that the vegan protein generally comes with carbohydrates, too, explains Scheiner.

Beans, for example, contain a great deal of starch which provides your body with the glucose it wants and needs, and the protein can be digested as simply protein.

Eating a low-carb vegan diet is certainly possible, but is likely and almost inevitably higher in carbs than the typical animal-based ketogenic or very-low-carb diet.

As always, discuss any major changes in your insulin dosing regimen with your healthcare team! Or work with Gary and his awesome team of diabetes management experts via phone or video at Integrated Diabetes.!

The post Dosing Insulin for Protein: When it Matters & Why first appeared on Insulin Nation.

That is just over 12% of the adult population. 

And if you are also living with type 1 diabetes, you have even more company.

About 40% of T1Ds have cardiovascular disease (CVD) by the age of 60, with women being at the greatest risk for developing it at an early age.

Despite these grim statistics, if you are a woman living with type 1 and heart disease, there are still a number of things you can do to reduce the amount of damage being done to your heart and possibly even reverse the damage that is already there.

Aim for Fewer Hyperglycemic Episodes

When it comes to managing diabetes for long term health, there is one thing we have always been taught: Keep your sugars down. While hypoglycemia can cause quick, life-threatening emergencies, the damage done by hyperglycemia is often slow to show itself.

But, rest assured, the damage is being done.

It’s not just your kidneys, eyes, and nerves that suffer from this damage either. Your vascular system and your heart, in particular, carry the brunt of this destruction. 

When your blood sugar is high, it causes your vessels to constrict, forcing your heart to work harder and increasing the odds that blockages will form. Hyperglycemic nerve damage also has a negative effect on how well your heart functions.

If you are already suffering from heart disease, you can reduce future damage to your heart and vessels by working hard to keep your blood sugars from spiking. This means working closely with your doctor to build an intensive treatment plan aimed at keeping your sugars low and reducing your A1C to well below the recommended 7%.

Increase Your Time in Range

For decades, doctors believed that hyperglycemia was one of the biggest contributors to diabetic heart disease, but more recent research has found the story to be more complicated.

Many types of heart diseases seem to be present in those living with diabetes regardless of their A1C. This is especially true of coronary heart disease. One reason behind this phenomenon has to do with the oxidative damage that occurs during blood sugar swings.

Studies have shown that widely varying blood sugars can cause just as much damage to vascular tissue as consistently high blood sugars. This damage is due to an oxidative stress response that occurs when blood sugar changes too rapidly.

For this reason, getting your A1C down into the healthy range may not be enough to prevent future heart damage. Instead of focusing just on that number, it is also important to focus on the amount of time you spend in range. 

Someone who is swinging wildly between 50 mmol/l and 250 mmol/l may show an average BG of 130 mmol/l, but they are still suffering a lot of oxidative damage. 

In contrast, if you focus on bringing your time-in-range up (your time between 70 mmol/l and 180 mmol/l) you’ll suffer less damage from both oxidation stress and from hyperglycemia.

Commit to a Lipid-Reducing Lifestyle

Of course, diabetes isn’t the only thing contributing to your heart damage. To really get control of your health and reduce or reverse your CVD, you have to make changes to your lifestyle as well.

Stay Active

Exercise has long been touted as one of the best ways to decrease your risk of heart disease, but getting active can be equally effective at fighting heart disease.

When you have artery blockages, less blood than normal is delivered to parts of your heart. This oxygen and nutrient deprivation can lead to more severe complications. Ironically, though, one way to avoid some of these complications is to increase that blood deprivation during exercise.

According to cardiologist Dr. Meagan Wasfy, when areas of the heart are starved of blood during short bouts of exercise, those areas develop adaptations to deal with that deprivation. Once you finish exercising, your heart will be better equipped to deal with the less intense blood flow decrease caused by blockages.

Beyond getting your heart used to a low oxygen environment, exercise can help you lose weight and normalize your blood lipid levels.

This is important even if you are not overweight. The most damaging type of fat, when it comes to heart disease, exists around your waist. For women, this fat is often present even if you have a normal BMI. To reduce the effects of heart disease, most women should aim for a waist size of 35 inches or less.

Eat Well

While exercise can help prevent future heart damage, it can’t typically reverse the condition on its own. For that, you are going to need to commit to an even more drastic lifestyle change.

One of the only doctors to show consistent success in reversing heart disease is an MD named Dean Ornish. 

For five years in the late 1980s, he subjected one group of heart disease patients to intense lifestyle modification while the other group underwent traditional heart care. While the intensive care group received a variety of lifestyle modifications, including increased aerobic exercise, stress management, and group peer support, the biggest change they were forced to undergo was switching to a whole-food, vegetarian diet made up of only 10% fat.

After five years, those patients on the intensive care regimen had an average percent diameter stenosis decrease of 3.1% while the control group’s arteries showed increased stenosis of 11%, for a 27.7% relative worsening condition. So while those on the low-fat vegetarian diet saw a reversal in artery blockage, those on the traditional treatment actually suffered more severely clogged arteries.

While many doctors and hospitals are still hesitant to recommend such a strict diet change to their patients, Dr. Ornish’s vegetarian diet method remains one of the only programs that have successfully reversed heart disease.

It is hard to say if this diet and exercise regimen would have the same effect on a woman living with type 1, but it would certainly be worth exploring further for anyone serious about taking back control of their heart health.

Take the Necessary Medications

Of course, one of the hallmarks of traditional heart disease treatment is the use of medications to control blood pressure, cholesterol, and to thin the blood. While your goal should be to get to a point where you no longer need these meds, that doesn’t mean you should avoid them altogether.

In general, women are undertreated for all sorts of conditions, with diabetes and heart disease being at the top of the list. That’s why it is so important to talk to your doctor to obtain and use the right medications and treatments to protect your health.

It is time to find a new doctor if you ever feel like you are being ignored, your concerns aren’t being taken seriously, or you aren’t being treated as intensely as your male counterparts.

Know That It Isn’t Too Late

Having two chronic and, oftentimes, debilitating conditions can make it seem like a bright future is impossible. But that doesn’t have to be the case.

Even for women with diabetes, who seem so unfairly targeted by heart disease, there is hope. With dedicated blood sugar management, consistent exercise, an intensive diet change, and the support of the right doctor, it is possible to protect your heart and live a full life.

The post The T1 Female Heart: Managing Your Heart Disease first appeared on Insulin Nation.

With ketones becoming a very trendy word across mainstream media and mainstream dieting, it’s easy to confuse the two. And it’s very common to wonder: is a ketogenic diet safe for a person with diabetes if diabetic ketoacidosis is extremely unsafe?

Let’s take a closer look.

What are ketones?

In short, ketones are an acid that is produced when the body burns fatty tissue and breaks it down into fatty acids and amino acids to use for energy.

How to measure ketones

Ketones can be measured with urine ketone strips or with a blood ketone meter. A blood ketone meter is, of course, more accurate, because it measures your ketones in real-time. Urine ketone strips provide a more vague measurement of what your ketone levels were 2 or 3 hours ago because they’re now being expelled through your urine.

Situations that cause the body to produce ketones

There are actually four circumstances during which the human body will produce ketones.

• Nutritional ketosis: A diet containing less than 20 grams of “net” carbohydrates per day can cause your body to begin burning body fat primarily for energy, which results in the production of ketone acids.
• Diabetic ketoacidosis (DKA): When the body has too little insulin (primarily in those with type 1 diabetes), it is forced to burn body fat for energy because it cannot make use of glucose in the bloodstream for energy. (Severe alcoholism can also lead to toxic levels of ketones — classified as “ketoacidosis — similar to DKA but not directly related to insulin production.)
• Starvation ketones: If you have not eaten a meal in a significant number of hours — that 10 to 12-hour mark is a rough estimate for most people — your body can produce small amounts of ketones when it shifts to burning body fat for energy, known as “starvation ketones.” This is common in intermittent fasting and is generally as safe as nutritional ketosis provided you do eventually eat a meal.
• Illness-induced ketones: When you are sick with a severe cold, stomach virus, infection, or flu, for example, the stress, lack of nutrition, infection, and work your body is doing to combat the illness can result in “illness-induced ketones.” In a person with diabetes, this should be managed with your healthcare team’s support by increasing your insulin dosages to eliminate the presence of ketones. 

Diabetic Ketoacidosis vs. Nutritional Ketosis

The biggest difference between healthy ketones and dangerous ketones is simply the volume of ketones in your bloodstream or urine.

Ketones themselves are not dangerous, but in a healthy body, the role of insulin and glucose is designed to prevent them from accumulating.

In a ketogenic diet (below 20 grams of carbohydrates per day), ketone levels generally accumulate to very low levels between 1 and 3 mmol/L. The fewer carbohydrates consumed, the closer to 3 mmol/L a person could achieve. But simply eating a serving of carbohydrates — even a big bowl of broccoli — can knock some people out of ketosis.

Yes, a person with type 1 or type 2 diabetes can follow a ketogenic diet. As always, however, it’s important to ensure you’re getting adequate insulin and achieving healthy blood sugar levels. 

Some people find their insulin needs increase significantly on ketogenic diets due to the high-fat intake. See this article. This approach to nutrition and weight-loss is not always a fit for everyone.

In diabetic ketoacidosis, ketone levels accumulate either gradually (in someone in the early onset of diabetes) or extremely quickly (in someone with type 1 diabetes who isn’t getting enough insulin or is extremely sick). 

When there isn’t enough insulin to stop the production of ketones, the accumulation of ketones can build up to 20 mmol/L, which is extremely toxic for the human body, and easily fatal if left untreated.

Symptoms of diabetic ketoacidosis include:

• Vomiting
• Nausea
• Extreme thirst
• Increased need to urinate
• Abdominal pain
• Shortness of breath
• Sour-fruit smelling breath
• Confusion and exhaustion

Treating DKA: If you are experiencing nausea and vomiting, the only way to treat full-blown diabetic ketoacidosis is to visit an emergency room immediately to receive IV fluids and increased insulin doses to restabilize. 

If a person with type 1 diabetes becomes very sick (with the flu, stomach virus, and vomiting, or an infection), ketone levels can become dangerously high and lead to DKA. The usual treatment plan for the earlier stages of these ketones is to drink plenty of fluids and increase your background insulin doses. 

While your blood sugars may appear in range, the extra insulin will eliminate the ketones without dropping your blood sugar while your body continues to fight the illness or infection. 

People with type 1 diabetes who pursue marathons and triathlons may experience ketones similarly to this due to the stress and starvation. And again, they will likely find they can increase their insulin during the intense athletic event to eliminate the ketones without dropping their blood sugars.

As always, be sure to discuss any insulin dosing changes with your healthcare team — especially if you are experiencing symptoms of DKA or illness-induced symptoms.

The post Diabetic Ketoacidosis vs. Nutritional Ketosis? first appeared on Insulin Nation.

Water is the transport mechanism for swallowing, digesting, and moving nutrients to and within cells, regulating body temperature, and flushing waste.

 Let’s take a closer at how your water intake affects your blood sugar levels and overall health.

Not enough water = more concentrated blood

More than half of the human body is made up of water, according to research from the US Geological Survey (USGS). 

When you don’t drink enough water as a person with diabetes, your blood becomes more concentrated which means there are more milligrams of glucose per deciliter of blood. 

Daily Mild Dehydration

Daily mild dehydration can easily cause a slight increase in your blood sugar levels, but even 25 mg/dL higher than if you were normally hydrated can add up when it comes to your overall diabetes health and HbA1c goals.

Tip: Take a look at how much actual water you’re drinking every day.

Too often, we’re sipping coffee or diet soda all day long. While there’s plenty of water in both of those beverages, there are several reasons why they aren’t an even replacement for pure water.

• Coffee’s caffeine content, in particular, will easily increase insulin resistance if you’re drinking more than a couple of cups per day.
• And traditional diet sodas sweetened with aspartame are loaded with chemicals and found in research to contribute to insulin resistance.

On the other hand, unsweetened/caffeine-free tea and seltzer are decent ways to stay hydrated, but that doesn’t mean you should skip the clear stuff altogether. 

If you don’t already have a decent water-drinking habit, find yourself a reusable container and vow to drink at least 1 full serving of water from the container each day. Eventually, you might find you’re craving the pure stuff instead of more coffee!

Sudden Severe Dehydration

Severe dehydration, however — like during an athletic event or watching the July 4th parade in 95-degree heat — can cause very sudden and significant spikes in your blood sugar, from 100 mg/dL to 250 mg/dL, for example.

This type of spike in your blood sugar can happen very easily and very quickly. 

Tip: As people with diabetes taking insulin, we need to anticipate dehydration on those super hot summer days by drinking a lot more water than usual.

If you do find that you’ve suddenly spiked to 250 mg/dL and dehydration is likely the culprit, treat this high with your “correction factor” insulin dose along with…a few tall glasses of water!

It’s also important to keep an eye on your ketone levels when blood sugars spike this high. If your blood sugar doesn’t come down within 2 to 3 hours of taking a correction dose and drinking water, be sure to test your ketones and call your healthcare team if you test positive for moderate-to-large ketones. 

Dehydration during severe stomach virus & vomiting

There’s no quicker way to become dehydrated than when you get a nasty stomach virus or flu and find yourself vomiting every last bit of water from your body.

A bout of sick-day puking in a person with type 1 diabetes can become a true crisis if it isn’t handled quickly. 

A stomach bug can quickly and easily spike your blood sugar from 100 mg/dL to over 250 mg/dL because of the immediate dehydration it creates. If you can’t keep fluids down, your dehydration will escalate your ketone levels so severely that you could find yourself in DKA – diabetic ketoacidosis. 

And with DKA comes very stubborn high blood sugars that extra insulin doses at home will not budge.

Tip: Don’t wait. If you have a stomach virus or flu that leaves you unable to consume water or food, you should visit the nearest emergency department to receive intravenous fluids. 

Gong sooner than later means a much shorter visit — just a few hours strung up and then they’ll send you back home once your blood sugars and hydration levels are restabilized.

If you wait, and try to tough it out at home, your eventual trip to the ER will be much longer because they’ll be treating DKA, not just dehydration.

Water, water, water!

Give that body of yours more water! There’s just no way around it — the more you drink, the better you’ll feel. (And geez, more and more research continues to demonstrate waters impact on weight-loss efforts, too!)

Drinking at least 8 glasses (8 ounces) per day is the goal, but if you’re currently drinking none, just start small! One glass before every meal is a simple place to start.

The Harvard School of Public Health emphasizes that water is actually essential for many of your body’s daily functions — things we don’t often associate with water at all!

• Transporting nutrients and oxygen to all the cells in your body
• Flushing bacteria from your bladder through your urine
• Helping to digest meals properly
• Preventing constipation
• Maintaining healthy blood pressure and heartbeat
• Keeping your joints healthy
• General protection for your organs
• Maintaining a healthy body temperature
• Maintaining healthy electrolyte and sodium levels

If you have any of the following conditions, talk to your doctor about how much water you can safely drink:

• Any types of kidney disease
• Thyroid disease
• Any type of issues with your liver
• Some heart conditions
• Medications with a side-effect water retention
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Some types of antidepressants
• All opiate pain medications

You need water. Make drinking it a bigger priority in your life.  Water will improve your blood sugars…and a whole lot more!

The post How Drinking Plenty of Water Improves Your Diabetes Health first appeared on Insulin Nation.

But skin is the one area that too often gets left out of that extra-care equation.

Skin is the largest organ of the body. And, just like your vascular and renal systems, it is negatively affected by high blood sugars. As a person with diabetes, if you don’t take extra time to care for your skin you can suffer some pretty severe consequences.

Luckily, a new line of clinical skincare products is here to make caring for your skin as simple and effective as possible. We recently gave VitalFitSR a try and we’re excited to share our review and take some time to discuss the importance of diabetic skincare with you.

Why Your Skin Needs Extra Care

As a person living with diabetes, you are probably well aware of the effect high blood sugars have on your blood vessels. Whenever your blood sugar creeps up too high or stays high longer than normal, it can cause your veins to contract and harden. Over time this atherosclerosis can lead to heart, kidney, and nerve problems.

Sustained high blood sugar also greatly effects your skin.

When your vessels narrow, they can’t transport blood as efficiently. This is especially true of the tiny capillary fields that feed your skin. Because blood is carrying nutrients and oxygen that your skin cells need to stay healthy, vessel constricting caused by high blood sugar often leads to skin problems.

Many people with diabetes suffer from annoying but less severe skin issues like dry skin, dermopathy, and sclerosis. 

But nutrients aren’t the only thing that restricted blood flow effects. White blood cells also struggle to travel through these narrowed blood vessels.

That means if you suffer an injury to your skin, like a cut or a scrape, your body is less capable of defending itself. If not caught and treated early, even minor issues can become major infections.

Combine this with the fact that restricted blood flow also affects your nervous system and how well you sense pain, and a small cut can quickly turn into a big problem.

Even if you are diligent about checking your feet and limbs for cuts, your restricted immune response also leaves you more vulnerable to fungal and bacterial infections.

For so long, the only way to stay ahead of these types of skin infections was to keep an eye out for trouble and react accordingly. But a new product may help you prevent these problems before they even start.

Our Review of the VitalFitSR Skin Care Line 

Despite a clear need for diabetic specific skincare, few options exist that are tailored to meet those needs. But a new clinical skincare system called VitalFitSR (website) is hoping to fill that gap.

The system is made up of four products.

The first is a daily cleanser that not only cleans and rejuvenates but actually works to reduce inflammation and kill bacteria. The cleanser is soap-free and gentle enough for even the most sensitive skin.

The full care line also comes with two different moisturizers. 

1. The first is a day moisturizer meant to replenish dry and cracked skin. Like the cleanser, it also contains a unique set of ingredients that actively fight inflammation and infection.
2. The second moisturizer is meant to be used overnight. This heavier lotion is designed to rejuvenate the skin by supplying antioxidants and replenish your skin’s natural defenses.

The last product is specially tailored for patients who wear prosthetics or braces. Liquid-to-Powder Plus is applied to the skin where it contacts the prosthesis or brace. The lotion forms a friction-free barrier that reduces rubbing, irritation, and sores. It also helps to control odor and kill bacteria.

The premise behind this skincare line sounds promising, but how well does it actually work?

I have been putting the lotions and cleanser to the test over the last month, and I have to say, I am impressed.

None of the products give off a lot of odor and all are mild and easy on the skin. While I am lucky in that I don’t suffer from any major diabetes-related skin conditions, I am hyper-aware of the importance of taking care of my feet.

After only a few days of using the products, I saw a noticeable difference in how my feet looked. They were no longer ashen and flaky as they typically are during the dry Colorado winter. Instead, they looked refreshed and hydrated.

They felt better too. The itching a redness between my toes caused by dry skin went away completely after about a week. Even the thick callouses on my heels looked less chalky and cracked, something that no regular lotion has ever been able to accomplish.

Overall, I am really excited about this product line. As a person who is only a decade into living with diabetes, I feel more confident in my long term foot health when using a preventative product like VitalFitSR.

And for those who do suffer for more severe conditions or amputations, I’m excited to see someone has finally put together a skincare line that has the potential to fight diabetic skin conditions and ease the discomfort associated with prosthetics and braces. 

The post New Skin Care Line Brings Relief for Diabetic Skin Conditions first appeared on Insulin Nation.

This new automated glycemic control algorithm is just the second hybrid closed-loop system available to patients with an FDA clearance. And it promises tighter control, easier usability, and more customization than the current 670g automated system from Medtronic.

How Control IQ Works

Like other automated pump systems, Tandem’s new algorithm works by pairing an insulin pump with a continuous glucose monitor (CGM) to allow for automatic insulin adjustments based on predicted glucose values. In this case, Tandem’s t:slim X2 pump and Dexcom’s G6 CGM will work together to keep blood sugars within the ADA recommended range of 70 to 180.

This is accomplished by multiple pathways.

To help avoid hyperglycemia, the automated system will increase basal insulin when blood sugar is predicted to rise above 160 within 30 minutes. If blood sugar rises above 180 the system can deliver a correction dose to quickly bring sugars back in range.

On the other end, Control IQ will automatically reduce basal insulin if blood sugar is predicted to drop below 112.5. If sugars are predicted to drop even lower, below 70, the system will suspend insulin delivery altogether until sugars begin to rise again.

The system also allows the user to set temporary glucose goals for times of increased activity to help avoid lows.

In a study published in the NE Journal of Medicine, this combination of control factors led to an 11% increase in time spent in range and a 2.6-hour daily decrease in high blood sugar, on average. These types of positive results were seen across a wide range of ages and baseline A1Cs.

What Sets This New System Apart

Control IQ is a huge improvement over Tandem’s current automated system, Basal IQ. This current option automatically suspends basal insulin in the event of a predicted low but does not include any of the new measures to reduce hyperglycemia.

While there are a few systems that integrate this type of semi-automated glucose control, Medtronic’s 670g system is currently the only other hybrid closed-loop system approved for use by the FDA.

While the 670g and new Control IQ share many of the same features, there are some key differences that clearly give Tandem the edge.

First, and likely most important to those using the system, Control IQ works with the Dexcom G6 CGM and requires no finger pricks to function in auto mode. Compared to the 670g, which requires a minimum of two blood meter calibrations every day, this is a major advantage.

Beyond a reduced need for finger pokes, Control IQ also has the capability of auto-dosing correction boluses for high blood sugar. If sugars rise above 180 and active insulin levels allow, the system will automatically give 60% of a normal correction dose with the goal of bringing glucose levels down to 110. This is something that Medtronic’s hybrid closed-loop system cannot do. 

Overall, the Tandem system is much more aggressive than Medtronic’s. 

While the 670g shoots for a blood sugar of 120 throughout the day and night, Control IQ works toward a goal of 110 during the day and works more aggressively overnight to keep your sugars tightly between 112.5 and 120.

Despite the more aggressive algorithm, neither auto-mode enabled system is right for everyone.

While both systems set goal blood sugars that would equate to an A1C in the 5’s, the actual blood sugar averages tend to be much higher. Medtronic’s original study reported an average A1C of 6.9 while Tendem’s trial showed an average A1C of 7.1 after six months.

For people living with diabetes who currently have A1Cs lower than 6.5, it is unlikely either system will provide much of a benefit in terms of control. But for those struggling with their numbers either option is likely to improve your management. And given the extra capabilities and apparent ease of use, Tandem’s Control IQ has the potential to do even more than the current hybrid loop option.

Looking Beyond the Numbers

Despite all the potential packed into the new Tandem system, the true excitement behind this launch may have less to do with the system itself and more to do with how Tandem plans to utilize it.

Control IQ is the first automated glucose control device that has been designated as “interoperable,” meaning it can be used for multiple devices without undergoing the full FDA approval process. While the upcoming launch of Control IQ includes only use with the Dexcom G6, Tandem is currently working with Abbott to make Control IQ pumps that will work with their FreeStyle Libre CGM. 

By making this algorithm available across multiple device types through various companies, Tandem assures more people with diabetes can take advantage of their technology. According to Aaron Kowalski, President and CEO of JDRF, this type of open protocol system is important because “people with different devices could use the algorithm and manage their glucose levels in a way that works best for them.”

For those who already have a t:slim X2 pump, Tandem is offering a free software download to upgrade your system to Control IQ once it is available. 

They also plan to make all future software upgrades immediately available the same way your cell phone can be updated without purchasing a new device. This is a big change from traditional software updates that require patients to purchase the newest model, something that most insurances will only allow once every four years.

It is impossible to say if this new hybrid closed-loop device will live up to our expectations.

It is fair to say that the release of Control IQ and the measures Tandem is taking to make the system more widely available are steps in the right direction for all of us in the diabetic community.

Note: On January 15, 2020, Tandem Diabetes Care Announced Commercial Launch of the t:slim X2 Insulin Pump with Control-IQ Technology in the United States.

The post In-depth on Tandem’s Advanced Hybrid Closed-Loop System first appeared on Insulin Nation.

In fact, many argue that your thoughts are the first and most important factor in determining whether you struggle or thrive as a person with diabetes. 

“Your thoughts guide your behavior,” explains Alexis Elliott, LCSW, LISW-CP, CDE, a health coach with specialties in diabetes, eating disorders, and nutrition.

“We know that managing your health is based on behavior — which means that if you’re thinking negatively, you’re probably going to struggle with following through on healthy behaviors and healthy choices.”

In psychology speak, Elliott says the acronym “ANTS” is important to identify.

Automatic Negative Thoughts (ANTS)

“There’s never just one ant at a picnic,” says Elliott, “and negative thoughts are the same way.

It’s important to recognize that negative thoughts can become a runaway train, and you walk around with this cloud over your head and you project it on every part of your health.”

Habitual negative thinking could be something you’re doing constantly and yet you’re unaware of it because you’ve convinced yourself of the many negative things you keep thinking. 

“I’m never gonna lose weight” versus “I can keep trying, making gradual progress bit by bit.”

One thought comes to a dead-end. The other challenges you to keep trying, keep learning, keep experimenting and evolving and starting over when things don’t go perfectly.

The same is true when it comes to diabetes management. 

“I’ll never get my A1c down” vs. “Let me just try one new thing that might improve my A1c.”

This self-defeating, glass-half-full negative thinking is probably present in nearly every part of your life, not just your health. 

“It casts a shadow over everything you look at it,” says Elliott.

But it’s not permanent, it’s just a habit, like everything else. And in some instances, it’s realistic.

“It’s normal as humans to think negatively sometimes,” explains Elliott. “It’s part of our survival — we have to think about the worst-case scenario for our physical safety or running out of food!”

But day-to-day negative thinking affects every choice and can quickly become your dominant way of thinking,” says Elliott.

That path of negative thinking becomes the easiest, most familiar path. The one you instinctively reach for every time you’re challenged with a behavior choice. It becomes your shortcut.

Creating new thinking habits is like creating a new trail in the woods

Just like walking in the woods where there is no trail, the more you walk that route, the more you create a visible path. Over time, it becomes easier to choose and easier to follow. 

But creating a new thinking habit isn’t easy at first, because — well — there’s no trail to follow yet.

Here are a few tips Elliott suggests for getting started.

Acknowledge your current thinking habits

How often do you tell yourself, “Diabetes sucks, and I suck at managing it”?

How often do you tell yourself that you’ll never succeed in losing weight or quitting smoking or exercising more often? 

If you can’t start with honesty about your own habits, you’ve got nowhere to go. Hold-up a mirror and take a closer look at you. Take responsibility for the thoughts you keep putting in your own head, and for indulging them every time they knock on your door instead of turning them away and replacing them with something more positive.

So much of your thinking comes down to choosing which thoughts you let in. Which thoughts you indulge and embrace. 

Question if your negative thinking habit is even true

Do you really “suck at managing diabetes” or is diabetes difficult for everyone and you just happen to beat yourself up more often for imperfect blood sugar levels? 

The more you beat yourself up, the less encouraged you feel for the next zillion diabetes-related choices you have to make that day. A self-sabotaging pattern. 

Check your environment

Friends, family, Instagram — these are just a few of the environmental factors that can have a huge impact on how you think.

• Do you have a mother who always tries to knock you down a peg when you’re feeling good?
• Do you have friends who embrace negativity and self-pity?
• Do you have friends who try to sabotage your personal success in eating less sugar or drinking less alcohol? 
• Does looking at certain Instagram profiles (or social media in general) trigger insecurity and negativity for you?

Take a good honest look at places in your life that heavily influence how you think. Surrounding yourself with positive people will inevitably change how you see your own world!

Create positivity around you

If you’re struggling to remember positive thoughts and ideas, put them right in front of you in writing so they’re easy to grab when you need them! 

• Maybe it’s inspiring quotes on index cards taped to your fridge or a playlist that makes you feel energetic and alive. 
• Put them in your car, at your desk, in your diabetes kit, on the inside of your arm (with a marker, of course).

Create things that encourage positivity and help you train your brain!

Start a gratitude journal

 It sounds overly simple, but simply writing down one thing every day that you are grateful for can really remind your brain that you have many good things in your life. It can help you realize the more stressful parts of life are manageable, too.

Simply acknowledging your good fortune to have a roof over your head and plenty of water to drink can lift your brain from that negative place with too little light.

Take more responsibility for what you feed your brain

If you’re eating crappy, processed junk every day, it’s no wonder your brain comes up with crappy, junky thoughts, too.

What you feed your body — and how often you exercise to give that same body more energy and healthy blood flow — absolutely impacts how you think and how you feel about yourself and your life.

This is so simple and yet so often ignored. But you don’t have to eat perfectly or exercise every day! Choose one part of the day to start making healthier choices and choose a few days next week that you’ll make sure to exercise for 20 minutes.

Start small. Acknowledge those small steps. Give your body good things so it can produce more good thoughts. 

The post How to Break Your Habit of Negative Thinking Patterns first appeared on Insulin Nation.

Early last year, we brought you the exciting story of PKvitality’s K’Watch–A CGM device unlike anything else on the market. (Read our original coverage

In the last few months, the company has made some major moves to bring the concept of the pain-free glucose monitor into reality.

Why another CGM?

There are currently a variety of CGM devices available to people with diabetes.

There is the frontrunner, Dexcom G6, which requires no fingerstick calibrations and will soon be available for use with Tandem’s Control IQ hybrid closed loop system, which has had such positive outcomes in trials.

Then there is Medtronic’s Guardian CGM which currently works with their hybrid closed loop 670g pump system.

Beyond these traditional CGM types, there are options like Libre’s Freestyle which allows you to scan the sensor for realtime glucose updates, and Eversense’s 90-day implanted glucose sensor.

While it may seem like there’s a little something for everybody on the market right now, all of these options share the same basic flaws.

• All of these CGMs require the insertion of a large needle to implant the sensor deep into the interstitial fluid. 
• Once implanted, you must attach a transmitter and secure the entire apparatus with bulky, and often faulty, adhesive tape.
• You must constantly rotate sites to avoid building up scar tissue that will affect readings and further irritating the skin with additional tape.

Why the K’Watch CGM Is Different and Needed

The K’Watch CGM has these features:

• There no need for site rotation because the CGM works by “tasting” glucose levels just under the surface of the skin
• This means no giant insertion needles and no pain
• This system is more discrete than any other on the market
• It almost completely reduces the need for adhesive tape. 

Instead, the sensor consists of multiple micro points that just barely penetrate the skin. In fact, the contact with your flesh is so shallow that the tiny needles won’t even cause bleeding or scarring. A small, soft adhesive pad is required and fits under the watch face. 

Best of all, the transmitter and receiver are integrated into one device, all in a watch with a band that holds it over the sensor. 

And, like most continuous monitoring systems, the watch provides you with continuous glucose readings as well as alarms for predicted high and low blood sugars.

Big Moves to Advance CGM Tech

PKvitality is just wrapping up its preclinical trial phase and hopes to begin human trials on its new CGM system by mid-2020. 

While it may seem like a market launch is still far off, the company has made some moves in the last few months that not only show they are gearing up for a viable product, but that hint at a product that may just live up to the hype.

The company recently created an advisory board consisting of John Brooks and Alexandre Richard.

• Brooks was the co-founder of Insulet and helped create the tubeless insulin pump, Omnipod. He once also served as the President and CEO of the Joslin Diabetes Center. He will no doubt be vital in preparing the French company for launch in the US market.

• 

  Richard is VP Corporate M&A at Sanofi, a global biopharmaceutical company focusing on diabetes and other healthcare industries.

Combine this knowledgeable advisory panel with the fact that PKvitality recently joined Dassault Systèmes’ 3DEXPERIENCE Lab partnership program, and it would seem all the pieces are falling into place for a successful product launch. This program will give them access to industry-leading software as well as a wider network of potential partners and investors.

Even more exciting, PKvitality recently won the EIT European Health Catapult in the MedTech category for their work on the K’Watch. The company won over 200 other health industry start-ups to get this award from over 1,000 stakeholders, innovators, and opinion leaders in the MedTech sector.

While there is still a long way to go between now and FDA approval, the resources the company has gained since November have given them the confidence to set a launch window of early 2022.

It is impossible to say right now how this CGM will compare to others currently on the market in terms of accuracy and ease of use. But, given the novelty of the design and discrete, pain-free application, it is certainly a product we plan to keep a close eye on over the next couple of years. 

The post CGM Watch Closer to Reality first appeared on Insulin Nation.

Also referred to as “vulvovaginal candidiasis,” a vaginal yeast infection is essentially an overgrowth of yeast, according to the Office of Women’s Health. While your vagina does need some yeast to maintain a healthy environment, too much yeast becomes very uncomfortable very quickly.

Yeast infections are technically “fungal infections” because yeast is a type of fungus. Again, it’s a good fungus when it’s present in healthy amounts. There is such a thing as a “bacterial” yeast infection but those are rare.

You may have heard of yeast infections by the name of “thrush” — which is the term used for the overgrowth of yeast in your mouth, tongue, and throat.

While this is primarily an issue for women, men with diabetes can also develop a yeast infection within their urinary tract. 

Symptoms of a yeast infection

Yeast infections can be subtle at first but they will quickly become very uncomfortable and impossible to ignore if left untreated. It only takes a couple of days for an overgrowth of yeast to go from mild overgrowth to severe overgrowth.

Here are the most common signs and symptoms of a yeast infection from the Office of Women’s Health: 

• Itching on the outside and inside of the vagina
• Burning and stinging outside and inside the vagina
• Creamy, white discharge (in the earlier stages)
• Clumpy, white discharge (as the infection worsens)
• Overall inflammation and redness of your labia and vagina
• Stinging and burning when you pee
• Stinging and burning during intercourse

The following symptoms indicate you should contact your doctor immediately:

• Yellow discharge
• Bloody discharge
• Strong-smelling odor
• Fever
• Vomiting
• Pain in your stomach or back
• Excessive urination

What causes a yeast infection?

Fortunately, yeast infections are very treatable, but in people with diabetes, they can become recurring if your blood sugars are persistently high.

Sugar feeds the growth of yeast. 

When your blood sugar levels are high on a daily basis (generally above 250 mg/dL will do the trick), you’re excreting a lot of sugar through your urine. The presence of this sugar in your urine changes the chemical balance in your vagina and leads to an overgrowth of yeast. 

Blood sugars persistently over 300 mg/dL (in those engaging in diabulimia, for example, or prior to your diagnosis) is almost a guarantee for recurring yeast infections.

Of course, yeast infections can develop in those with or without diabetes unrelated to your blood sugar levels, too. According to the Office of Women’s Health, other causes of yeast infections include:

• High blood sugar levels
• Severe stress
• Changes in hormone levels
• Cortisone injections
• Scented tampons
• Scented lotions, shaving creams, etc.
• Weakened immune system
• Antibiotics
• Birth-control
• Chemotherapy
• HIV/Aids treatments
• Anabolic steroids
• Douching products (you should never douche!) 
• Excessive moisture in the vaginal area from damp underwear, menstrual pads, wet swimsuit, etc.
• Having sex with someone who has a yeast infection (especially between two women)
• Your sexual partner’s physical chemistry or semen (your body will likely adjust over time)
• Men can contract yeast with their penis from a woman, but this is rare.

As a person with diabetes, the combination of one of these factors along with elevated blood sugars can make you far more susceptible to developing a yeast infection. Some of these factors are out of our control, which means it’s essential that you work with your healthcare team to address the yeast overgrowth.

When diabetes medications cause yeast infections

There is one category of diabetes medications in particular that have been known to cause yeast infections if your blood sugars are persistently higher than normal or your diet is very high in carbohydrates.

“SGLT2 inhibitors” (or Sodium-glucose Cotransporter-2 Inhibitors) are also known as “gliflozins.” They help to lower your daily blood sugar levels by preventing your kidneys from absorbing excess glucose in the plasma in your blood, and instead, passing that sugar through your urine.

This excess sugar in your urine caused by SGLT2 inhibitors can stimulate the overgrowth of yeast.

Widely prescribed SGLT2 inhibitors include:

• Farxiga (dapagliflozin) 
• Invokana (canagliflozin)
• Jardiance (empagliflozin)

All these SGLT2 medications share common side-effects of yeast infections, urinary tract infections, increased need to urinate, back pain, nausea, increased cholesterol levels.

These drugs can be very helpful in lowering blood sugar, reducing your insulin needs, and even helping you lose a little bit of weight — so the risk of yeast infections shouldn’t stop you from taking them.

However, if you are taking one of these drugs, there are a few things you should do to reduce your risk of yeast infections.

• Drink a lot of water every day — this gives your body adequate fluid to flush out the excessive sugar in your system.
• Reduce your carbohydrate intake — if you’re taking these drugs and still consuming more than 300+ grams of carbohydrate per day, you’ll likely struggle with yeast infections.
• Combine your SGLT2 with another diabetes medication to help reduce your blood sugar levels.

Treating a yeast infection when you have diabetes

Warning: if you purchase any type of yeast infection treatment product without addressing your persistently high blood sugar levels, you will continue to develop yeast infections.

A critical part of treating a yeast infection must include improving your blood sugar levels and/or your diet. Work with your healthcare team to get the help you need! Diabetes management is complicated — it’s okay to ask for help!

Over-the-counter treatment options

When it comes to over-the-counter anti-fungal infections, you’ll see a lot of options on the shelf. There are a few types, so if one didn’t work for you with quick relief of your symptoms, your body may respond better to another kind.

• Miconazole (Monistat 3, Monistat 5, Monistat 7, Micon 7)
• Tioconazole (Monistat 1, Vagistat 1)
• Butoconazole (Gynazole 1)
• Clotrimazole (Mycelex-G, Femcare, Gyne-Lotrimin)
• Nystatin (Mycostatin) 
• Terconazole (Terazol 3, Terazol 7)

For example, if miconazole doesn’t relieve your symptoms within a couple of days, you may find tioconazole does — and vice versa. 

Be Careful with ‘Itch Relief’ Products

There are “itch relief” products sold to help alleviate the symptoms but these will not treat the growth of yeast. 

The following products should be used in conjunction with an anti-fungal treatment:

• AZO
• Vagisil (wipes or cream)
• Vagicaine

Prescription-strength treatment options

If over-the-counter options do not relieve your symptoms within a few days, contact your healthcare team immediately for a prescription-strength antifungal medication.  One example is Fluconazole (Diflucan). 

Preventing yeast infections

There are several steps and habits you can apply to your daily life to reduce your risk of developing a yeast infection. Most women will develop at least one or two yeast infections at some point in their life, but women with diabetes will likely experience more than just a few. 

For example, just one week of stubborn high blood sugars along with a stressful life event can trigger than yeast overgrowth. 

Here are a few things you can do to prevent yeast infections:

• Address persistently high blood sugar levels quickly
• Avoid long-term moisture in the vaginal area
• Wipe from front-to-back after going to the bathroom
• Do not hang out for long in a wet swimsuit or towel 
• Avoid tight underwear
• Do not douche (ever!)
• Do not use “home-remedies” like apple cider or yogurt inside the vagina
• Avoid scented tampons
• Change your tampon brand if this is a possible factor
• Change your shaving cream brand if this is a possible factor

Yeast infections can be truly unbearable — take good care of your vaginal health with these daily habits. 

The post Why Diabetes Increases Your Risk of Yeast Infections first appeared on Insulin Nation.

If you ate 30 grams of carbohydrate from a sweet potato compared to 30 grams of carbohydrate from the bowl of cereal, you’ll likely notice a significantly bigger (and faster) spike in your blood sugar after eating the cereal.

The sweet potato is a whole food that contains merely one ingredient.

Breakfasts Cereal is as Wholesome as White Flour

Cereal, on the other hand, is about as processed as “food” can get. In fact, most of today’s mainstream cereals are so heavily processed that your body doesn’t have to do much work to break it down into glucose. 

This means that 30 grams of carbohydrate listed on the breakfast cereal nutrition panel will likely impact your blood sugar as though you ate 60 grams. 

And again, the reason is simple: the bowl of “grains” you are eating is so heavily processed and broken down that it almost instantly digests into glucose because there isn’t much work left for your stomach to do. 

Most “whole grain” breakfast cereals have been turned into pure starch, not much healthier than eating a bowl of white flour.

What ingredients are in the cereal you eat?

Let’s take a look at the ingredients’ list? 

Even cereals touted as “whole grain” and loaded with fiber and vitamins that come with a laundry list of ingredients, many of which reveal that the vitamins and fiber in your cereal don’t actually come from those “whole grains” because the grains are so overly processed, there isn’t much nutrition left.

Fiber and vitamins are often added to your cereal, along with some type of brown coloring so it appears wholesome and real. 

Kashi 7 Whole Grain Flakes Cereal, for example, is considered a “healthy” cereal thanks to well-designed marketing, but the ingredients in a bowl of Kashi cereal includes:

SEVEN WHOLE GRAINS AND SESAME BLEND (WHOLE: HARD RED WHEAT, BROWN RICE, BARLEY, TRITICALE, OATS, RYE, BUCKWHEAT, SESAME SEEDS), SOY FLAKES, BROWN RICE SYRUP, DRIED CANE SYRUP, CHICORY ROOT FIBER, WHOLE GRAIN OATS, EXPELLER PRESSED CANOLA OIL, HONEY, SALT, CINNAMON, MIXED TOCOPHEROLS FOR FRESHNESS.

I spy three different ingredients used to sweeten this cereal: brown rice syrup, dried cane syrup (ie: cane sugar), and honey. 

I spy supplemented fiber: chicory root fiber. This means they had to add fiber to make it look more wholesome and healthy for you the consumer, due to the tremendous processing those seven grains go through. 

And what about those seven different grains? At first glance, that sounds like a good thing, but did you ever wonder just how much they have to breakdown all of those grains to them mash them together into a cereal shape?

You’d be better off eating a bowl of actual oatmeal with a little stevia and cinnamon! 

Cereal options for people with diabetes

Fortunately, there are a few options out there you could choose from if you just really love having cereal for breakfast.

One thing you’ll notice about nearly all of the low-carb options on this list is the addition of chicory root fiber. This is because every cereal is heavily processed even if it’s made with non-grain ingredients, and grain-free ingredients (like coconut) likely don’t contain much fiber!

Puffins Original: very few ingredients and very little added sugars

Julian’s Bakery: Coconut Flakes: grain-free and very low-carb (after subtracting dietary fiber)

Wheat-Free Market’s Slow Toasted Flakes: grain-free and very low-carb (after subtracting dietary fiber)

Thrive Market Coconut Flakes: grain-free and very low-carb (after subtracting dietary fiber)

Julian’s Bakery ProGranola: grain-free and very low-carb (after subtracting dietary fiber)

Ditch Boxed Cereal Altogether

Personally, eating grains for breakfast makes me want to sleep for the rest of the day. I prefer some protein and fat (turkey breakfast sausage) paired with some veggies, like frozen vegetable medley that I pop easily into the microwave before heading out the door!

Who said breakfast has to include starchy grains? If cereal isn’t helping your health, try something different! Ditch the toast, the cereal, etc. And try some whole food options like vegetables or actual whole grains like oat bran or oatmeal. 

You might just find you feel better when you don’t eat that bowl of cereal. 

The post The Problem with Breakfast Cereal if You Have Diabetes first appeared on Insulin Nation.

By administering the correct amount of insulin based on your personal insulin-to-carb ratio for a given meal, you should theoretically be able to produce an optimal blood sugar reading around two hours after the meal. Of course, like so many other things in the diabetes world, this is far easier said than done.

But the first step to attaining these illusive optimal blood sugar readings is to be able to accurately calculate how many carbs you are eating at each meal. 

This skill takes time to master, but with a lot of practice and the right tips, even the most novice carb-counter can find their way to post-meal blood sugar bliss.

Carb Counting 101

While counting carbs may seem like it should be as easy as looking up a single amount, there are actually a number of items you need to take into account, with some meal calculations being far more complex than others.

Reading Nutrition Labels

The first step to accurate carb counting means being able to read and understand nutrition labels. 

For a diabetic, the most important information on these labels is the serving size and how many grams of carbohydrates are included in each serving. Protein and fat are good numbers to scan as well, but we’ll talk more about those in a minute.

Figuring out exactly how much food equates to one serving can be tricky. Most labels list amounts in the number of items (such as “5 crackers”) or in a fraction of the total (such as “half a bottle”). But some companies like to get extra tricky and list amounts only in cups or grams. 

For these occasions, it is nice to have a scale and a set of measuring cups at home. As you become more familiar with different food types, you will find it easier to guess what 30g of potato chips or half a cup of berries look like.

Next, you’ll want to look at the total number of carbs per serving. If you plan to have two or three servings, make sure to multiply the number of carbs accordingly. Similarly, if you plan to have only half a serving, make sure you cut the carb total in half as well.

Once you know how many carbs you’ll be eating, you can use the carb-to-insulin ratio your doctor gave you to figure out how much insulin to take. 

For instance, if my carb-to-insulin ratio is 1 unit of insulin for every 15g of carbs and I plan to eat 30g of carbs, I would take 2 units of insulin.

If you have a pump, it will most likely do this math for you. If not, or if you are on shots, you’ll have to rely on your brain (or phone). If the numbers don’t work out nicely, try to adjust how much you will eat to align with a dose of insulin that you can actually give.

That means if you only have a pen that gives whole units of insulin, you may have to up the 25g of carb you wanted to eat to 30g to better fit your 1 to 15 ratio. If you have the ability to dose in half units, you would have the option to decrease from 25g to 22.5g or jump up to 30g.

While looking at the total carbs listed on the label will be accurate enough for most foods, there are times when you will need to look a little further.

Sugar Alcohols

Sugar alcohols are included in the total amount of carbs in many “sugar-free” or “sugar-reduced” foods but they don’t digest completely in the body. If you are eating one of these foods, subtract half of the amount of sugar alcohol from the total carbs and dose for that number instead.

The Role of Fiber 

Fiber, fats, and protein can also complicate things in some cases.

Dietary fiber isn’t digestible by the body and technically doesn’t need to be counted into the total carb calculation. However, since most foods only contain a few grams of fiber, you usually don’t need to make special considerations for it. The exception to this rule would be if the serving you are eating contains more than 5g of dietary fiber.

In this case, you would want to subtract the entire amount of fiber from the carb total. For example, a high fiber cereal may have 30g of carbs per serving but within that contain 7g of fiber. So you would only want to bolus for a total of 23g of carbohydrates.

The Role of Protein Fat

While fiber is technically a carb, protein and fat are completely separate macronutrients. They can, however, play their own unique role in how much insulin you need for a meal.

Under the right circumstances, protein can be converted into glucose and raise blood sugars. For the typical person eating the typical meal containing over 30g of carbs, there isn’t usually a reason to dose for protein. 

If, however, you are on a carb-restricted diet or eating a low-carb, high-protein meal, you may need to consider adding a few units of insulin to cover that protein conversion. Typically, counting half of the grams of protein as carbohydrates will cover you, but it varies person to person and by the specific makeup of your meals that day.

You can learn more about dosing for protein here.

The Role of Fat

While fat cannot be turned into glucose, it can still change how you want to dose.

Fat slows down the digestion of carbs, making it possible for your insulin to peak before your blood sugar does. To avoid this, when you are eating high-fat meals (over 15g of fat) you should utilize your dual wave bolus on your insulin pump. 

You’ll want to take around half your carb dose upfront and spread the rest over the next two or three hours.

If you don’t have a pump, you can simulate a dual wave bolus by taking half your dose upfront and the other half after about two hours.

Really high-fat meals can also cause your liver to dump glucose into your bloodstream, causing a need for more insulin than carbs alone would account for. 

You can learn more about how to account for this phenomenon here.

Estimates for Common Foods

While it’s always nice to have a nutrition label handy to tell you exactly how many carbohydrates, and grams of fat and protein are in your food, that rarely happens, especially for prepared meals. Instead, it is a good idea to memorize the carb load of a few common foods so you can easily estimate your meal dosage.

Here are some of the more common carb-containing foods you’re likely to find on your plate and their approximate carb value.

• 1 slice of bread = 17g carbs
• 1 cup of oatmeal = 30g carbs
• 1 cup of pasta or rice = 45g carbs
• 1 large tortilla = 30g carb
• ½ cup of beans = 20g carb
• 1 baked potato = 40g carb
• 1 cup milk = 12g carb
• 1 cup plain yogurt = 15g carb
• 1 apple or orange = 15g carb
• 1 banana = 30g carb
• ½ cup of berries or grapes = 10g carb
• 1 small order of fries = 30g carb
• 2 tbsp sweet sauces like barbeque, ketchup, and sweet and sour = 10 to 15g carb

Keep in mind that meat, cheese, eggs, nuts, and fibrous veggies don’t have a lot of carbs if any. But animal products can be heavy on fat and protein and may require you to adjust your dose.

The idea of memorizing this list and remembering how to dose appropriately for fats, protein, fiber, and everything else may seem like an impossible task. But there will be a day when the basics of carb counting seem like second nature to you.

For now, make a cheat sheet, download a carb counting app on your phone, and start practicing your carnival-style portion size guessing skills.

You’ve got this!

The post Newly Diagnosed: Carb Counting Basics first appeared on Insulin Nation.

Simply put, cow’s milk contains about 10 more grams of sugar per 8 ounces than the best-unsweetened alternatives.

Let’s take a look.

The highest-carb milk options: 12 to 25 grams per 8 oz

If you purchase the “unsweetened” forms of cow’s milk, oat milk, and rice milk, you’ll be getting anywhere from 12 to 25 grams of carbohydrates in one glass. 

Cow milk (2%) — 12 grams carbohydrate

Goat milk (whole) — 11 grams carbohydrate

Rice milk (regular) — 23 grams carbohydrate

Oat milk (original) — 25 grams carbohydrate

The lowest-carb milk options: 1 to 2 grams per 8 oz

If you purchase the unsweetened forms of coconut milk, flax milk, cashew milk, and almond milk, you’ll get only 1 to 2 grams of carbohydrates in an entire glass! When it comes to your blood sugar, that’s pretty insignificant.

Almond milk (unsweetened, plain or vanilla) — 2 grams carbohydrate

Cashew/Almond milk (unsweetened, plain or vanilla) — 1 gram carbohydrate

Flax milk (unsweetened, vanilla) — 1 gram carbohydrate

Coconut milk (unsweetened, original or vanilla) — 1 gram carbohydrate

By switching your milk choice to one of these low-carb options, you could easily cut your daily carbohydrate consumption by at least 15 to 30 grams per day depending on how much milk you drink!

Other reasons to ditch cow’s milk as your source of calcium

There is an ongoing debate about whether calcium from cow’s milk helps or harms your bone health, the nutrition content in cow’s milk compared to today’s best milk alternatives makes it a pretty obvious choice. 

It’s not clear that we need as much calcium as is generally recommended, and it’s also not clear that dairy products are really the best source of calcium for most people,” explains the Harvard School of Public Health.

“While calcium and dairy can lower the risk of osteoporosis and colon cancer, high intake can increase the risk of prostate cancer and possibly ovarian cancer.”

The Physicians Committee for Responsible Medicine echoed similar and additional concerns.

Research shows that dairy products have little or no benefit for bones. A 2005 review published in Pediatrics showed that drinking milk does not improve bone strength in children,” reported the PCRM. 

“In a more recent study, researchers tracked the diets, exercise, and stress fracture rates of adolescent girls and concluded that dairy products and calcium do not prevent stress fractures.”   

(Take a look at this list for better sources of calcium than cow’s milk!)

Low-Carb Yogurts to Consider

Yogurt can be a bit of a conundrum for those of us with diabetes. While good quality yogurt is loaded with probiotics (beneficial for your gut health), it’s often also loaded with sugar. 

Dairy-based yogurts inevitably contain some lactose (milk sugar) even if they haven’t been sweetened with additional sugar. And the non-dairy options like coconut or soy desperately need some sugar to give it more flavor.

But if you don’t want sugar, you’re left with yogurts containing a whole lotta artificial sweeteners which could contribute negatively to your gut health — defeating one of the biggest points of eating yogurt!

Any yogurt containing any of the following ingredients isn’t any good for you:

• Candy, cookies, pretzels, etc. — this is processed dessert!
• high fructose corn syrup — well, duh!
• aspartame, saccharin, sucralose — these are chemicals, not food
• Food coloring — yogurt should be mostly white until you stir in real fruit 

A problem with many of today’s commercial yogurts is that they are so over-processed they don’t actually contain any natural probiotics. Instead, manufactured probiotics have to be added in.

Don’t judge your yogurt’s health content based on simply the fat or carb-count, look at the bigger picture of what else is (or isn’t) in that yogurt to make sure it’s actually providing what it should. 

These 3 yogurts are not only made with high-quality ingredients, but they also contain zero fake sweeteners and plenty of beneficial probiotics.

Siggi’s Strained Whole-Milk Yogurt: Plain: 6 grams net carbs (5.3 oz) or Fruit-flavors: 7 to 14 grams (5.3 oz)

It’s hard to beat Siggi’s. Made from whole milk, which means it comes with satisfying fat, even their fruit-flavored options contain fewer carbs than most plain yogurts. They also have some “no sugar added” flavors that contain just fruit. No matter which one you pick, you can trust you’re getting high-quality yogurt with genuine probiotics.

Fage Greek Yogurt: Plain: 7 grams net carbs (6 oz) or Fruit-flavored: 10 to 14 grams (6 oz)

Fage’s plain yogurt is pretty darn low-carb! But unless you have the world’s most sophisticated tastebuds ever, you’ll probably want to add a little flavor to it with nuts, berries, or a pinch of stevia. Regardless, Fage is proud to state that their yogurt is free of artificial sweeteners or other cheap filler ingredients that take away from the benefits of real yogurt. 

GTS’ Cocoyo Living Coconut Yogurt: All flavors: 5 to 6 grams net carb (4 oz) 

Sweetened with stevia — which is a plant-based no-calorie sweetener rather than a manufactured artificial sweetener — this vegan yogurt is by far touts the lowest carb-count on in the yogurt aisle. Even though it doesn’t contain the traditional probiotics of dairy-based yogurt, it comes with 25 million probiotics per serving, and you can trust those are legit probiotics because it’s made by the same brand that makes GTS Kombucha! 

The post Milk: These Options Are Better for You Than Cow’s Milk first appeared on Insulin Nation.

It’s this fact that leads so many people with diabetes, especially those who have just recently been diagnosed, to undertreat the condition and aim for higher blood sugar goals. 

While higher blood sugar levels may be easier to live with, in the present, they can lead to debilitating complications down the road.

What Causes Low Blood Sugar?

In a person without diabetes

Low blood sugars occur during bouts of intense activity or fasting. As glucose levels in the blood drop, the body stops producing insulin. The reduced insulin levels then trigger the liver to release stored glucose to raise blood sugar.

In a person living with diabetes

Low blood sugar is the result of too much insulin in the system compared to how much glucose is currently being used. Activity combined with too much (or even a normal) basal insulin can cause glucose to be uptaken more rapidly. 

Too much insulin alone, such as when a meal bolus is miscalculated or basal insulin is too high, can also cause lows. Learn more about how to carb counting accurately here.

In people with T1D, low blood sugars are always combined with excess insulin, so the liver never releases its glucose stores. 

The only way to reverse low blood sugar is to cut off the flow of insulin or intake glucose manually.

What Happens When Your Blood Sugar Is Too Low?

Most organs in the body have their own backup supply of glucose that can be used when sugars get too low. Unfortunately, the brain does not have this ability.

If blood sugar continues to drop without adequate treatment, it can become too low for the brain to properly function. 

This can result in confusion, visual disturbances, seizures, and loss of consciousness.  If levels continue to drop, it is possible to slip into a diabetic coma.

In extreme cases like this, you will not be able to treat yourself and you will need assistance. 

Having a glucagon emergency kit on hand is a good idea. Just make sure you teach those around you how to use it.

Different Types of Lows Require Different Treatments

As terrifying as the consequences of low blood sugars are, it is important to recognize that not all lows you experience are this dangerous. 

In most cases, you will have time to treat yourself without experiencing any major problems.

How dangerous a particular low is and how best you should treat it depends on how fast your blood sugar is falling. 

You can break up lows into three categories based on this idea:

• Crashing lows – These are low blood sugars that are dropping very quickly. They typically produce more severe symptoms like blurred vision, trouble focusing, sweating, and trembling. If sugars are crashing fast enough, you may even experience these symptoms before blood sugars drop below 70. These types of lows are typically caused by intense activity or overcalculated insulin doses and need to be treated quickly and aggressively.
• Dropping lows – These kinds of lows are also falling but in a much less dramatic fashion. They typically produce less intense symptoms and may even result in symptoms that are more emotion-based like anxiety, feeling suddenly depressed, or feeling very sleepy. These lows are usually caused by increased activity or miscalculated insulin doses and need to be treated right away, but will not require as much glucose to reverse.
• Stable lows – These are numbers that are sitting below 70 but are not dropping or rising. They tend to produce less noticeable symptoms, though you may feel more fatigued or lightheaded than normal. While these types of lows are not typically dangerous, they can turn into dropping lows with any increased activity. Stable lows are usually caused by a basal rate that is too high. They should be treated with a small amount of glucose followed by a snack or meal after sugars begin to rise.

Treating Low Blood Sugars the Right Way

No matter which type of low you are experiencing, there are certain foods you should use to treat them. 

What will differ, is how much sugar you take to treat your low.

Foods to Avoid During Lows

When picking your go-to low treatment you want to find foods that will deliver glucose to your bloodstream as quickly as possible. This means you need to avoid foods that contain any protein, fat, or fiber as all of these slow digestion down.

Foods like candy bars, cookies, and chocolate may be loaded with sugar, but they are also bogged down with fat. Using these to treat lows will result in blood sugar remaining low for an extended period and then rising quickly. And by that time, you are likely to have already eaten more food in an attempt to bring your levels up, causing an even higher swing when sugars do finally rise.

Eating meals to treat lows is a bad idea due to the mix of macronutrients and the length of time it will take for blood sugars to rise.

Even fruits contain too much fiber and too low of a glycemic index to be used to treat lows.

Fast Acting Glucose Sources

Instead of jumping on the blood sugar rollercoaster caused by improperly treating lows, then being forced to correct highs, only to end up with another low, you need to treat your lows with food that contains only simple carbohydrates.

A good low treatment food will contain:

• No protein, fat, or fiber
• Little to no starch
• No sugar-alcohols or calorie-free sweeteners
• And will come in servings that are easy to divide up so each part contains about 2 to 4 grams of sugar

Treatments that meet these criteria are foods like juice, nonsugar-free hard candy, nonsugar-free gummies or fruit snacks, honey, glucose tabs, glucose gel, and glucose powder. 

Don’t Over Do It

Typically, doctors recommend 15 grams of simple carbs to bring up lows, but this can vary from person to person. It will also vary based on the type of low you are having.

• Crashing lows may need twice as much treatment as normal, or one dose to stabilize sugars followed by a second dose after ten minutes to bring them up to normal. 
• Dropping lows will typically only need a single treatment but may need to be followed by a meal or snack within the hour to prevent repeat lows. 
• Stable lows usually only require half a normal treatment to prop levels back up over 70. You can then use a snack with a reduced bolus to prevent the extra basal insulin from pulling levels back down.

No matter what type of low you have, it is important to not overdo things.

This can be a hard rule to follow when your body is screaming for you to feed it. But, you need to remember that it takes time for sugars to come back up. 

Take your needed dose of carbs, then wait ten to fifteen minutes and check your blood sugar again. Repeat your dose only if sugars are still under 70.

Preventing Low Blood Sugar

While adjusting insulin doses to treat a low will take much longer to have an effect than food, adjusting them to prevent lows is a skill you should practice.

If you are on a pump, you have the option to reduce basal insulin in preparation for activity and exercise. Just remember, it takes some time for insulin to peak, so you need to lower your basal rate at least 30 minutes before activity begins.

You can use preemptive eating to prevent lows. A protein shake before a workout or an underdosed meal before a shopping excursion can help keep you stable. 

Watch for Patterns, Improve Understanding and Control

If you are having repeated lows, especially if they seem to be around the same time of day, you should talk to your doctor about adjusting your basal dose or your carb ratios.

In the end, everyone reacts differently to low blood sugars and treatments for those lows. The best thing you can do is start experimenting to find out what works for you and what doesn’t. Don’t be afraid to treat lows differently based on how quickly you are falling or the severity of your symptoms. And always remember to stay prepared by stashing low treatments in your bedroom, car, and bag.

Lows might be scary but once you gain a greater understanding of how they affect you and how you can properly treat them, you’ll be better able to set your control to a tighter window to avoid complications down the road.

The post Newly Diagnosed: Understanding and Treating Low Blood Sugars first appeared on Insulin Nation.

While it is true that exercise can increase your chances of experiencing low blood sugars (or, in some cases, cause you to go high), the benefits of activity far outweigh the risks.

You must know how to approach exercise in a way that will keep your sugars stable. The first step is to understand how increased activity will affect your body.

How Your Body Reacts to Exercise

While you might think that anything that gets your heart pumping is likely to have a similar effect on your body, the truth is that different types of exercise affect you in different ways.

As a person living with diabetes, it is important to understand the physiological processes going on beneath the surface so you can better predict how your blood sugars will react.

Aerobic Exercise Burns Glucose

For the average person, exercise revolves around the idea of getting the heart pumping and keeping your heart rate elevated for a prolonged period. Things like jogging, cycling, swimming, and even taking a brisk walk all have this effect on the heart.

These are all examples of aerobic exercise.

During these types of exercises, your body relies on glucose to fuel it. And it uses that glucose at a much higher rate than it does during periods of inactivity.

For a diabetic, that means after experiencing a consistently elevated heart rate for a period of time, your blood sugar will start to crash. If you fail to provide your body with additional glucose or reduce the amount of insulin present, your blood sugar levels will continue to drop and could become dangerously low.

(If you have questions about the best way to treat your low blood sugars, this article will help.)

Anaerobic Exercise Burns Muscle

On the other side of the exercise spectrum are anaerobic activities. These include exercises like weight lifting, sprints, rock climbing, and high-intensity interval training. 

Any activity that causes your body to use more oxygen than your heart can supply via blood flow will use glycogen stored in muscle as a fuel to support this intense activity.  

This is considered an anaerobic exercise.

During this type of exercise, muscle glycogen provides energy without the need for oxygen. Your body may also produce adrenaline during anaerobic activity. 

Both glycogen and adrenaline are hormones that stimulate the liver to dump stored glucose into the blood, further raising your blood sugar. (Check out this article to learn more about how anaerobic exercise affects blood sugar.)

How to Approach Exercise to Keep Your Sugars Stable

One very important rule to follow when it comes to exercising as a person with T1D is to make sure your blood sugar is in-range before you begin. 

Start in Range

You want to shoot for a BG between 80 and 180 before you even consider exercising.

How your blood sugar reacts once you begin your activity depends on whether you are doing aerobic or anaerobic exercises and how you prepared for your workout.

Use Food or Insulin to Prepare

For aerobic exercises, you will likely need to consume some carbs before you begin to avoid lows. 

Conversely, for anaerobic exercises, you will likely need some insulin when you start to keep blood sugars down.

Here are some exercise prep ideas you may want to consider depending on your situation and how your body tends to react to activity:

Aerobic Exercise

• If you are doing a short aerobic activity such as a quick run around the neighborhood, consider eating or drinking some fast-acting carbs before you begin. If your blood sugar is on the higher end when you start, you may not need any carbs at all.
• If you are doing a longer cardio activity such as swimming laps for an hour, you will want to boost your sugars up to a higher level (if they’re not already there) before you start by consuming some simple carbs. Then, before you begin, you may want to consume something with few carbs and a lot of protein, such as a protein shake. Your body will slowly metabolize the protein into glucose as you exercise to keep blood sugars stable.
• For very long aerobic exercises, such as a difficult hike, you may have to repeat high protein or mixed carb and protein snacks throughout your workout to keep your blood sugars where you want them.
• If you are a pump user, you also have the option of raising blood sugars by utilizing a lower temporary basal. A drop in basal by 25 to 75% may be needed, based on how intense and how long the workout will be.
  Just keep in mind, it takes time for insulin to peak, so always start your lower basal rate at least a half-hour before your workout.

Anaerobic Exercise

• For anaerobic activities, you may need to give yourself a unit or two of insulin before you begin to keep sugars from rising as your body releases its own glucose.
• If your sugars are on the higher end before you begin an anaerobic exercise, you may need to give a correction as well as an extra unit or two.
• Pump users can also utilize a raised temporary bolus to cover any peaks during weight lifting and other anaerobic activities. Just make sure to start this temp basal ahead of time.

Schedule Your Workouts

Because your starting blood sugar will play a lot into how your sugars look while you exercise, scheduling your workouts for periods when you are typically higher or lower can be a great approach.

• If you often struggle with high blood sugars in the morning, timing your two-mile run for right after you hop out of bed can help stabilize your sugars without the need for extra insulin.
• Likewise, if you are always going low at certain points of the day, try scheduling your gym time right before that period. Use weight lifting and high-intensity workouts to keep your sugars up.

Expect Your Blood Sugars to Change After Workouts

Exercise doesn’t just affect your blood sugars during your workouts. It can also cause changes immediately after exercise, many hours later, and in general.

Aerobic exercise is likely to send you low both right after you finish exercising and hours after your workout, often in the middle of the night. To help fight this, you’ll want to eat a decent-sized snack or meal after you’re done. You’ll also want to consider lowering your basal a few hours after your workout or overnight or eating a high-protein snack before bed.

Anaerobic exercise, in contrast, is likely to cause higher blood sugars after you complete your workout. Surprisingly, the best way to fight this is to also eat a snack or meal right after you complete your workout. That’s because the natural rise in blood sugar after anaerobic activity comes from your liver releasing more glucose to help your body replenish it’s glycogen stores. By eating a meal of mixed carbs and protein, you can feed your cells directly and stop your liver from raising your sugars on its own.

(If you need help calculating your insulin dose for complex meals, you’ll want to read this.)

Combining anaerobic and aerobic exercises in one workout is another ingenious way to keep your sugars stable. 

• Ending a cardio workout with a few reps on the weight machine or a few sprints can actually activate your liver to dump glucose and help you avoid post-workout lows.
• Alternatively, ending a weight session with an extended jog around the track can help your body utilize any excess sugar in the blood. Though, you may still need a substantial snack after you’re done to replenish all the calories your body spent and avoid additional highs.

No matter how you work out, if you work out consistently, you can expect your body to become more sensitive to insulin over time. Because of this, you may see that your basal rates or bolus ratios, or both, need to be reduced.

Continue to Adapt and Change Your Approach

As much as these guidelines can help you develop a safe approach to exercise, it is important to remember that everyone is different. Your best bet is to try some of these tips and adjust them to figure out what works best for you. Keep a written or digital record and make sure to stop and check your sugars periodically during your workout.  This will help you pinpoint what works and what doesn’t.

As long as you go into your workout knowing what your blood sugars are likely to do and why you’ll be able to stay one step ahead of any dangerous highs or lows while keeping your health in better check for the short and long term.

The post Newly Diagnosed: How to Approach Exercise and Activity first appeared on Insulin Nation.

The reality is that diabetes — both type 1 and type 2 — can absolutely affect and interfere with your ability to enjoy sex as a woman.

More specifically, there are three ways diabetes can impact your body’s sexual function and well-being:

• Nerve damage in the clitoris
• When low blood sugars prevent orgasms
• Overall lack of lubrication 

Diabetes can affect nearly every single part of your body — including the parts that make sex happy and make sex feel good!

Let’s take a closer look.

Nerve damage in the clitoris

Chances are if you’ve developed nerve damage in your fingers and toes (neuropathy) or your eyes (retinopathy, you may have nerve damage in other nerve-laden areas of your body, too — like your clitoris. 

Also referred to as “the pleasure center” by PlannedParenthood, the clitoris’ only purpose is that physical “feel good” sensation when you’re aroused. 

The clitoris also contains thousands of nerve endings — “more than any other part of the human body” according to PlannedParenthood!

More than any part of the human body. And we know that two ways persistently high blood sugars can create long-term damage in the human body is through damaging blood vessels and nerve endings. 

• If you’ve experienced nerve damage in your clitoris, you may struggle to feel as much pleasure when you’re engaged in sexual activity. 
• You may also struggle to achieve an orgasm when your clitoris is being stimulated (by you or your partner) because the damaged nerves mean you’re going to feel less overall.
• And high blood sugars can also mean less blood flow (poor circulation). Just like a man’s erection relies on blood flow, a stimulated clitoris also relies on blood flow. 

Unfortunately, there isn’t a way to repair the damaged nerves, but improving your blood sugars will ensure you don’t succumb to further damage. 

• Since there are thousands of nerves in your clitoris, there’s plenty of them worth saving by working with your healthcare team to bring your blood sugars down to a healthier, safer range. 
• And healthier blood sugars also mean healthier blood flow — which means more fun for you between the sheets.

When low blood sugars prevent orgasms

You can likely recall how weak your arms or legs or brain feels when your blood sugar is low — right? And the explanation is pretty simple: when your blood sugar is low, your body will struggle to function at full-steam. 

Your brain is going to become first priority, and guess what? Your clitoris is likely near the bottom of the priority list when glucose is scarce.

• That means a low blood sugar with poor timing — like when you’re engaged in an activity that would normally lead to a mind-blowing orgasm — could very easily keep you from orgasming.
• If your heart is already pounding from all the fun activity and you’re already a little sweaty, it might be hard to notice the usual symptoms of low blood sugar during sex. Instead, you’re fully engaged in the shenanigans and working towards an orgasm that just doesn’t seem like it will ever arrive.
• You may realize mid-shag, and grab some glucose tabs from your nearby nightstand, or you may not notice until all the fun has stopped, you stand up, and realize you’re extremely dizzy from good ol’ fashioned hypoglycemia.

Either way, it’s annoying. Sometimes really frustrating or even embarrassing. And it’s not always preventable.

• What you can do, on some occasions, is to anticipate that a half-hour of sex is like a 15 to 20 minutes of power walking, in terms of how it might impact your blood sugar. Or three hours of sex is like an hour of power walking.
• Now, certainly, sex is never the same experience or physical intensity every time and it’s remarkably impossible to anticipate, but if you know it’s on your upcoming agenda, you may consider cutting back the insulin dose for dinner that night or popping a bit of glucose (via candy, juice, tabs, etc.) before things get too wild, to prevent hypoglycemia.
• It’s a tricky game, with no one-size-fits-all approach.

Check often. Keep glucose nearby. Tell your partner what’s up so they can support you. And of course, have fun. 

Overall lack of lubrication

Well, yeah, if you’ve experienced nerve damage in your clitoris from persistently high blood sugars, this also means you’ve probably experienced blood vessel damage, too, and you likely struggle with overall blood circulation.

The vagina produces its own lubrication in response to arousal. 

• If your body is struggling with blood circulation due to high blood sugars, nerve damage, and blood vessel damage, your vagina isn’t going to get all the cues it needs in order to self-lubricate during sexual activity.
• This can lead to regular vaginal dryness which can make sex pretty uncomfortable, and downright painful for some women.
• There are certainly other causes of vaginal dryness, including breastfeeding, menopause, and medications. 
• For women with diabetes struggling to maintain healthy blood sugar levels, vaginal dryness is unfortunately just another way diabetes impacts your overall health.

The first thing you can do is talk to your healthcare team ASAP and work together to improve your blood sugars. This may be through an increase in your insulin or other diabetes medications, changes in your diet, or adding exercise to your daily routine.

The second thing you can do is talk to your gynecologist about different approaches to treating persistent vaginal dryness. 

While there is a slurry of lubricants available on the shelf at any pharmacy, there are also prescription lubricants that can be applied every few days that will ensure more moisture for a couple of days after it’s been applied. This means you don’t have to sneak to the bathroom right before having sex or deal with the embarrassment of asking for more lubricant to be applied. 

Sexual health is not an easy topic to talk about. It can come with a lot of embarrassment, shame, and confusion.

If you think your diabetes is having a major impact on your sexual wellbeing, talk to your doctor. That’s what they are there for — and you can be sure that you aren’t the first patient they’ve had who needed help on this topic. 

The post The Female Orgasm & Your Diabetes first appeared on Insulin Nation.

But diabetes doesn’t just change how you have to live. It can also have a huge impact on your physical and emotional self.

Weight gain is a common phenomenon in T1D people just starting insulin treatment. And the same swings in blood sugar that come with those treatments can also cause emotional changes including a tendency toward anxiety and depression.

You also need to know why these symptoms occur and how best to counteract them without putting your blood sugar management at risk.

The first step, however, in living well with T1D is becoming aware that you have joined a community of many other people who have had to deal with these same issues. 

Insulin and Weight Gain

The first major hurdle many newly diagnosed people with diabetes have to deal with is the connection between insulin and weight gain. 

This can be especially difficult for teenage girls and other adolescents.

Why new T1Ds often experience weight gain isn’t as straightforward as some like to think. Dealing with it is certainly not as simple as reducing your insulin dose. 

Here are the most common reasons for weight gain after diagnosis and how you can approach each in the safest way possible.

You May Have Been Underweight When You Were Diagnosed

For so many of us, diagnosis comes only after weeks or even months of unexplained symptoms. One of the most common being weight loss.

Once insulin treatment begins and blood sugars come down, your body will work hard to replace all those fat deposits that were spent while you were ill. The natural effect of this is weight gain.

But it’s important to remember that this weight gain is necessary to get you back to health. While you may have enjoyed your thinner frame, it was the result of sickness and not something that should be idealized. 

Your weight may fluctuate for some time as you get the hang of insulin dosing and your body recovers and enters into the honeymoon phase. As your sugars and insulin need level out, so too will your weight. And once you feel comfortable with your new treatment, you’ll be better able to tackle exercising and getting active which will allow you to achieve a more ideal weight in a healthy way if you still feel that’s necessary.

Hyperphagia May Still Be Playing a Role

Another common symptom in undiagnosed T1Ds is hyperphagia or extreme and constant hunger. In your body’s bid to provide your cells with the energy they don’t have access to, your hunger hormones go into overdrive, even when your stomach is full.

For some, the hormone pathways that control hunger get so worn out that they continue to misfire even after insulin treatment has begun. This can lead to a constant feeling of hunger that results in overeating and weight gain.

Eventually, your appetite will return to normal, but it can take time. The best way to combat this phenomenon is to focus on following your carb goals for meals while limiting fat intake and to choose healthy snack options to quell your hunger in between meals.

Insulin Facilitates Fat Storage

In addition to helping cells use glucose, insulin also helps the body store fat. Insulin can also prevent the body from breaking down fat when excess insulin is circulating in the blood.

Both of these factors contribute to weight gain in insulin-dependent diabetics. For many who are desperate to lose weight, cutting down on insulin seems the best course of action. Not only is this unsafe because it can lead to high blood sugars that will damage your heart and kidneys, but it will only set you up for a rollercoaster of weight loss followed again by weight gain.

Instead of cutting down on the insulin your body needs to maintain normal blood sugars, focus instead on increasing your body’s insulin sensitivity. 

By eating a clean diet free from processed foods and saturated fat and staying active, your body will naturally need less insulin to achieve normal blood sugar numbers.

This natural drop in insulin will, in turn, lead to less fat being stored and more healthy weight loss.

Blood Sugar and Emotions

Beyond the physical changes, your body may see after diagnosis, you may also experience a range of mental and emotional shifts. 

While some of these changes are the natural result of being diagnosed with a life-altering condition, others actually have their roots in the physiological processes that come with fluctuating blood sugar.

How Highs and Lows Affect Your Mood

Most of the cells in your body rely on insulin in order to utilize glucose. But the brain does not. That sets this particularly valuable organ up to be highly affected by swings in blood sugar.

• When blood sugars are high, the amount of glutamate, a chemical linked to depression, increases in the area of the brain associated with emotional regulation. 
• When sugars are low, neurotransmitters that control functions like breathing and heart rate are affected. As glucose levels continue to drop, areas of the brain begin to shut down in order to preserve vital functions. This can lead to confusion and the inability to recall memories. 

One area that continues to fire, is the amygdala, the part of the brain responsible for fight or flight reactions. This is one reason you may feel anxious or angry during lows.

There is no way to predict or control how your emotions will change during high and low blood sugars. But you can take steps to reduce how often you feel these uncontrollable emotions by working closely with your team to reduce blood sugar swings.

While your emotions are likely to level out as your blood sugar becomes more stable, you can experience some long term emotional changes if you continue to have frequent bouts of high and low blood sugars. 

How These Emotions Play Into Diabetes Burnout

Every person with diabetes, at some point in their journey, will experience some degree of burnout.

Type 1 diabetes is a full-time condition that requires almost constant attention and work. It makes sense that at some point you will want to throw your hands in the air and take a break from it.

But diabetes burnout can also be driven by the natural chemical reactions that occur in the brain during uncontrolled blood sugars. If you are constantly feeling depressed or anxious or overwhelmed because you are experiencing emotional lows and highs, you are more likely to struggle to care for yourself. And you may even give up diabetes management altogether.

Feelings of depression only tend to worsen with prolonged high blood sugars, so taking a break from diabetes management is likely to exacerbate those feelings of hopelessness.

If you are overwhelmed by feelings that make it difficult to take care of yourself, you need to seek help. There are steps you can take to work through burnout. You may even need to find a safe way to take a vacation from diabetes to give yourself a break and get back on track. But the last thing you want to do is give up on taking care of your diabetes altogether.

Change Is Inevitable

When you receive a type 1 diagnosis, it’s almost as if the old you has died. It’s okay to take a moment to mourn that version of yourself. And it’s okay to be upset with the changes the new you has to deal with.

• Accepting the limitations of how much you can control these changes is key to living well with this condition long term. 
• You may gain some weight. 
• You may not act like yourself or even feel like yourself some of the time. 
• All of this is not just okay, it’s expected.

By taking time to understand why these changes occur, you can better prepare yourself to deal with them in a way that is both healthy and productive over the long term.

The post Newly Diagnosed: How T1D Changes Your Body and Mind first appeared on Insulin Nation.

And that is why the announcement that a new insulin compound that does not fibrillate is such a big deal. This newly synthesized insulin analog called ‘glycoinsulin’ has shown the same glucose-lowering effects of native insulin but without the complications caused by fibrils.

Before we can understand the impact such a development could have on the diabetic community, we first need to gain a better understanding of what insulin fibrillation is and how it affects the usefulness of current insulin products on the market.

What Is Insulin Fibrillation?

While the concept might seem foreign, insulin fibrillation is actually the main cause of pump sites “going bad.” 

Occlusions, site rotation, three-day reservoir changes, and even insulin allergies all owe their existence largely to the effects of fibrillation.

So what is it?

Insulin molecules naturally exist in a helical formation with multiple stabilizing connections, resembling a tight circle. But when insulin is exposed to heat or acid conditions, these molecules unfold and elongate. Once in an unfolded state, these elongated molecules tend to aggregate with one another, forming large clumps. These clumps are known as fibrils.

Not only are these large clumps of insulin more likely to clog your pump set and cause occlusions at your site, but they also become inactive and thus don’t have any effect on blood sugar. Worse still, these elongated fibrils also tend to trigger unwanted immune responses and can lead to site swelling and redness and potentially even insulin allergies.

But fibrils aren’t just a problem for insulin in our bodies.

Insulin vials or pens that are stored improperly and exposed to heat become inactive due to the effects of fibrillation.

Elongation of insulin molecules is also accelerated when insulin is transferred from inert glass vials into the plastic reservoir of a pump. 

This is the reason you are supposed to change your reservoir out at least every three days.

While there are additional complicating factors that affect your pump site, the accumulation of fibrils is one of the main reasons you need to change your site every three days as well. It is also a driving factor behind the importance of site rotation. 

How Does Fibrillation Affect Current Insulin Options?

The effects of fibrillation have been well documented in human and synthetic insulins for some time. And manufacturers and scientists are always balancing its effects with the need to produce faster-acting, more precise insulins.

For instance, insulin lispro, frequently sold as Humalog, utilizes hexameric stabilized insulin molecules that work much faster than traditional options. But, that same molecule shape that expediates utilization by the body is also more likely  than normal human insulin to aggregate into fibrils.

And aspart and glulisine insulins aren’t much better.

To counteract fibrillation, manufacturers add preservatives to their insulins. While these tend to be powerful in fending off fibrillation under the right circumstances, they do not stop the process altogether. Worse still, it is possible to have a negative reaction to these preservatives and they could be another driving force behind insulin allergies and site reactions.

The Potential Benefits of this New Insulin Compound

An insulin that effectively lowers blood sugar that also doesn’t form fibrils or require preservatives has been the dream of scientists for decades. But any progress in reducing fibrillation was counteracted with lowered effectiveness for reducing blood sugar.

That is, until an international group of researchers based out of the Florey Institute of Neuroscience and Mental Health in Australia were able to synthesize the first non fibrillating form of human insulin that demonstrates the same blood sugar-lowering effects as current products on the market.

The insulin, known as glycoinsulin, has shown promising results in preclinical trials.

It appear to impede fibril formation under normal circumstances and it also remains stable and active even after being exposed to high temperatures.

This could have huge ramifications for pump users as well as any person on insulin treatment.

For those who rely on insulin pumps, a non fibrillating insulin would likely mean you could double the time between reservoir changes. It’s also likely that many patients would even find that their sites continued to work well beyond three days. 

But more importantly, glycoinsulin could significantly reduce the occurrence of occlusions. Since pump users rely solely on the insulin being delivered to them through their infusion sets, any blockage within the pump system quickly drops the insulin levels in the body. If not caught early, this phenomenon typically leads to DKA. Reduced occurrences of occlusions would equate to a much lower risk of pump-failure driven hyperglycemia and DKA.

Even for those that don’t rely on pumps, having a more stable form of insulin could make everything from travel to power outages easier to deal with. As it is now, insulin in vials or pens can only be exposed to room temperature for a restricted amount of time before fibrillation occurs. And if it is exceptionally hot out, insulin can become completely inactivated relatively quickly.

A non fibrillating insulin, on the other hand, would be much more stable under these conditions, making the need for ice packs during travel a thing of the past. And in the case of an emergency or power outage, this type of insulin could theoretically be stored at room temperature for an extended period without the negative effects.

While human trials for glycoinsulin may still be a way off, every indication thus far is that this new insulin will be a game-changer for diabetes management. And it is certainly one product we will be keeping a close eye on.

The post New Non Fibrillating Insulin To Be a Game-Changer for Pump Users first appeared on Insulin Nation.

It is this phenomenon — this inability to see beyond everything you need to do just to get through today — that makes it so hard to look at the big picture of living with diabetes. But as you move out of the newly diagnosed phase, you slowly begin to see things in a new light. As your years as a T1D pile-up, you’ll be amazed at how your outlook and perception of the condition will change.

If you are lucky enough to have a strong community of other T1Ds around you, you may even have the opportunity to learn some of these “truths” about the condition long before you have become a veteran diabetic yourself.

For everyone who isn’t so lucky, here are the top 10 diabetes lessons that seasoned diabetics wish they had known in the beginning.

1. You’ll Have to Educate Everyone You Meet

Even if you have only been living with diabetes for a short time, odds are you’ve started to pick up on the fact that few people really understand what T1D is. We live in a world dominated by type 2 diabetes, a condition surrounded by misunderstanding in its own right. As a type 1, you will constantly have people confusing your condition with one that shares the same name but is altogether different.

It’s best to be prepared for this eventuality now so you aren’t caught off-guard when someone asks if you should really be eating that or tells you exercise and cinnamon can cure you. Try to remember that there was probably a time when you shared a similar misunderstanding.

While educating people is always the optimal course of action, it isn’t always possible or worth your energy. Try not to let these people get under your skin and hold tight to the fact that you know this disease better than 99% of people out there.

2. It Could Be Worse

It’s easy to get caught up in your own pity party during those first few months (or years) as a person living with T1D. In some aspects, it’s your right. Your life has just changed forever, you should be allowed to mourn it. But it is always good to keep a level view of things.

Diabetes is not fun, but there are a lot of conditions out there that are a lot more debilitating, life-altering, and deadly. Not to mention that you have been diagnosed in a time when CGMs, pumps, and diabetes tech has made caring for this condition easier than ever. Consider that not too long ago diabetics had to hand sharpen the needle on their glass syringe while peeing in a cup so they could estimate their blood sugar.

3. The Only Constant Is Change

When I was first diagnosed, I remember thinking how nice things would be when I was finally done honeymooning and my blood sugars would level out. Turns out this isn’t a thing. Your insulin needs, your reactions to certain foods, and how exercise affects you will continuously change throughout your life.

Even if you dedicate yourself to eating the same meals, doing the same activities, and being on the exact same schedule every day, you will still find that at times your blood sugar is unpredictable. This is just one fact about T1D that no one can run from. It’s best to expect this now and work on your techniques for moving with the flow and adjusting your ratios and basal rates on the fly.

4. Perfect Isn’t An Option

There will be a lot of people in your life (you, possibly being one of them) who will expect you to have perfect control over this condition. There are about 20 million T1Ds out there who will tell you that this is impossible. And that one diabetic in your Facebook group who says they have achieved perfection is definitely lying.

If you reach for perfection you only stand to be disappointed in yourself. Instead, create healthy goals and strive to improve those areas that you struggle in the most. If you have a doctor or a parent that expects perfection, take the time to explain to them what you are hoping to achieve (a better A1C, more time in range, etc.) but that their expectations are too lofty and only serve to make things less perfect for you in the long run.

5.  You’ll Do Better If You Can See the Silver Lining

Everything about being diabetic can seem negative if that’s the only way you look at it. For me, I know that living with this condition has forced me to focus on my health and become more aware of what my body is telling me. These are lessons most people don’t learn until they are much older and already suffering the effects of a life lived without this mindfulness.

Consider this the silver lining of your diagnosis. 

It may be hard to see now, but as you live with this condition the benefits of increasing your mindfulness will start to become obvious. Focus on them and keep them at the front of your mind. Especially when the other aspects of the condition are making it impossible to stay positive.

6. Quitting Only Makes It Harder

There will come a time in your diabetic life when you will burnout. It is inevitable with a condition that takes this much continuous energy to manage. For those of us who have already been there and already played that game, let me tell you, quitting does not make things easier.

As hard as the daily grind of T1D is, recovering from a few weeks or years of not taking care of yourself is infinitely harder. And on top of that, you could be suffering the effects of that choice in the form of complications for the rest of your life. When you feel like giving up, know that the simplicity that comes with not managing your condition is painfully short-lived and the consequences will only make everything more difficult in the future.

7. Community Can Make a Huge Difference

Whether you feel like giving up or are on top of your diabetes game, having a supportive group of other diabetics around you is one of the best things you can do for yourself. There are few people in this world who will understand what you are going through, but all those who do are living with T1D themselves.

Reach out to other diabetics through organizations like Diabetes Sisters, T1D camps, and local meetups. Utilize Facebook groups and informative forums like this one here at Insulin Nation to stay connected to others who understand your struggles and can share advice. Just knowing that others have been where you are can make a world of difference.

8. Keep Learning to Keep Fighting

No matter how long you have lived with this condition, there is always something new to learn. Even some of the information you received during those first few confusing months as a diabetic you’ll come to find out was wrong or has since been replaced by better information.

Continue reading and talking to other people living with T1D. You will come across a lot of things that may not apply to you as well as plenty of fad diets and misinformation that you need to learn to ignore. But there will also be plenty of useful information coming out of new studies as well as announcements on new technology that could improve your management. Don’t rely on your doctor to bring all of this to your attention, take the time to seek it out on your own.

9. Find Balance to Truly Thrive

Everything about diabetes involves balance. You balance your carb intake with your bolus amount. You balance your basal dose with the hormones that increase your blood sugar. And this same balance applies to how you should live your life.

Some diabetics spend the first few decades of their lives so focused on managing their diabetes that they forget to live until it’s too late to do so. Others go wild as a teen and then are so bogged down by complications as an adult that they can barely function. Finding a balance between these two extremes is the only way to truly live with diabetes for the long run. 

Take care of yourself, but don’t skip out on opportunities just because they might negatively impact blood sugars for a brief period. 

10. You’re Strongest When You Feel Weakest

No matter how well you take care of yourself or how many of the truths on this list you commit to live by, there will still be times when you feel like you can’t go on. It is in these moments that you are truly the strongest.

Every day you get out of bed and do more to keep yourself alive than any non-diabetic could ever understand. That takes strength. But pulling yourself up when you are at your absolute lowest? There is nothing in this world that demonstrates your power quite like this. When the storm has passed and you are back on your own two feet, don’t focus on how broken or hopeless you felt. Focus on how strong you were to turn it all around.

And know that as you move forward on your diabetic journey, you will suffer through more periods of weakness. But also know that you have shown the strength to move past these moments before and there is no reason you can’t find your way through again.

The post Newly Diagnosed: 10 Diabetes Truths Veteran T1Ds Want You to Know first appeared on Insulin Nation.

Most of the time, though, I stayed silent. I kept a supply of candy at my desk. I learned to order medical supplies directly to the office so I wouldn’t find myself with an empty cartridge or an insufficient infusion set. I planned my meals ahead of time so I would know the exact number of carbohydrates that I was consuming, and therefore could take the proper dosage.

Diabetes is a time-consuming condition with real and deadly implications if it’s not treated properly.  It is never NOT on my mind. Insulin is a treatment, not a cure. Given in the right amounts, it will keep me alive. Not enough insulin will kill me. Too much insulin will kill me faster.

I was diagnosed with type-1 diabetes in 2005. In spring 2019, I celebrated my ‘half-way diaversary.’ For the first time, I had lived with diabetes longer than I had lived without. 

One might think that with 15 years of life experience with diabetes, I’d get the hang of it. And sometimes, I do.  Once in a while, I have the small satisfaction of seeing that straight line on my CGM device, indicating optimal blood glucose levels for a period of time. It’s a short-lived success. 

Most days though, I see peaks and valleys. I treat over-night low blood sugars with fast-acting sugar that I have around the house: juice, strawberry jam, maple syrup. Add on my consumption of crackers, biscuits or anything sugary – anything to get rid of that dreaded ‘low’ feeling – my blood sugar rebounds by spiking to an above-normal level. I spend the rest of the day filling up my water bottle and taking multiple trips to the bathroom. I’m tired, too, because of the lack of sleep that often comes with treating middle-of-the-night highs or lows.

“What can we do to accommodate?” my manager asked me in my first week of a new job. I had never been asked that before, and the question took me off guard. “Nothing!” I responded, and at the time, that seemed like the right answer. How can someone else accommodate a self-managed condition that does different things every day and isn’t at all predictable? 

It’s my burden. See Life When Every Day can be a Medical Emergency. 

It’s impossible for me not to feel guilt. Or shame. 

I often ask myself “what could I have done differently?” and then replay that day’s events – every meal I ate or didn’t eat, every coffee, all the exercise I did or did not do, the amount of insulin I did or didn’t take – that led me to that point. “Why isn’t my blood sugar coming down?” I ask myself for the tenth time in as many minutes, frustrated that it’s plateaued at a point much higher than the normal range. I self-blame. I feel like it’s my fault. I often feel sad, angry, ashamed…

I also feel jealous. Every team potluck. Every time someone brings in Timbits (bite-sized fried-dough confection sold at Tim Hortons restaurants) to a staff meeting. Every time there’s an office birthday party with cake. I recently discovered that I envy those who can eat whatever they want, and how much of whatever they want. Sometimes I find it’s easier to retreat and to isolate myself from the group than to pretend to enjoy myself. 

“You couldn’t have looked less interested in being there,” someone once told me after a team lunch that I actually chose to go to. 

A week prior it was “why didn’t you go to so-and-so’s birthday party?.”

Well, I could have said:

• “My blood sugars are high.” 
• “It’s too early for me to eat.” 
• “I feel anxious / stressed / sad / worried / scared / tired and fucking defeated because of my diabetes today.”

Instead, I didn’t say that, because nobody wants to hear it. Nobody cares if I’m having a ‘bad diabetes day,’ or if I was up half the night going to the toilet because I was hyperglycemic and didn’t get enough sleep. 

Had this person asked, “are you feeling alright?” I might have even answered ‘yes’ when in my head I was screaming “no,” because diabetes isn’t a sickness. I wasn’t throwing up, so yes, of course, I was alright. Right?

I was terminated from that position a month later. 

Maybe that was the wake-up call I needed. 

It made me accept that: 

• I have diabetes, so I’m not always going to be alright.
• There may be days when I appear bored or uninterested, but that’s almost never the case.
• Human beings are complicated, multi-layered beings, each with a different set of individual needs.

Only now am I really learning how to communicate my needs, because of course I have needs and why shouldn’t they be as important as anyone else’s? 

It’s a strength, not a weakness to be able to talk about chronic illness.  I don’t need to feel shame and embarrassment, because diabetes is real, and it’s hard (like, really hard) to stay in control. 

So here it is: 

• I live with type-1 diabetes
• It’s not my fault
• I did not eat too much sugar; my pancreas just broke for no reason around the time I was starting high school
• I’m self-sufficient and I know my medical needs, but sometimes I may need a bit of patience and compassion to get through the day 

The post Keep it to Yourself, until Someone Asks first appeared on Insulin Nation.

But as you go through the years with this condition, you start to realize that as bad as suffering through those hypo symptoms are, not having them is a heck of a lot worse. If you’ve ever done a routine finger poke only to have the monitor be the first to inform you that your blood sugar is frighteningly low, then you understand what I mean. 

While many long-term diabetics have some idea of what hyperglycemia unawareness is, most don’t have a full grasp of why this condition appears or how you can work to avoid or even reverse it.

What Is Hypoglycemia Unawareness?

As the name implies, hypoglycemia unawareness (HU) is the inability to tell when your blood sugar is low. On a more scientific level, HU is the onset of a shortage of glucose in the brain before autonomic warning symptoms occur.

In someone with normal hypo awareness, lowered blood sugar, usually around 70mmol/l, sets off a chain reaction in the body meant to help increase blood sugar levels while causing physical symptoms that will alert the individual to the problem. 

Unfortunately, the normal channels for automatically increasing blood sugar levels don’t work well in insulin-dependent diabetics. This has to do with changes in hormone pathways as well as the presence of insulin in the bloodstream preventing the release of glucagon.

Because of this, diabetics need to take in glucose manually to increase their blood sugar levels. By responding to symptoms like sweating, shakiness, anxiety, dizziness, and palpitations, people with diabetes can usually normalize their blood sugars before dangerous symptoms set in.

But for someone with HU, the lack of autonomic symptoms can make very difficult to know when blood sugars are plummeting. This can lead to cognitive impairment or loss of consciousness before the person is even aware there is an issue.

While some patients with HU will only get minor symptoms of lows or only show symptoms at very low blood sugars, others may not show any signs until it is too late to help themselves.

What Causes Hypoglycemia Unawareness to Develop?

The exact mechanisms that cause hypoglycemia unawareness to develop are not completely understood. 

There are some studies that support the idea that the brains of diabetics with HU compensate for frequent hypoglycemia by shutting down certain areas when glucose is too low. Some of these areas that are shutdown may be key to triggering symptoms in a healthy patient. 

Others postulate that changes in glucose transport or metabolism in light of frequent lows allows the brain to function better during hypoglycemia, thus reducing the signaling pathways of autonomic symptoms.

There is also some evidence to suggest that the actual chemical makeup of the brain–such as increased levels of Gamma-aminobutyric acid (GABA) during low and normal blood sugars–changes over time as a result of hypoglycemia. These changes cause reduced sensitivity to low blood sugars and a reduction in symptoms.

Regardless of the underlying causes of HU, what we do know is that recurrent episodes of hypoglycemia result in less severe autonomic symptoms over time. In fact, a slight reduction of symptoms can even be seen after just a single episode of low blood sugar. And, as this study points out, you may not even be aware that you have suffered a hypo event, as diabetics are prone to asymptomatic lows during sleep.

But not everyone will react to repeat hypos with the same degree of desensitization. Certain genotypes appear to play a large role in the development of HU and women appear to be more frequently affected than men.

Who Is Most at Risk for Hypoglycemia Unawareness?

About 40% of type 1s have hypoglycemia unawareness.

• Of these, the majority have had diabetes for more than 20 years.
• The occurrence of HU in adolescents, however, is surprisingly high, especially in populations that were diagnosed before the age of six and have experienced severe episodes of hypoglycemia in the past.
• Seniors, as well, appear to be prone to suffering from HU. This has to do with a combination of being more likely to have had diabetes for a long time and the consequences of the natural degradation of cognitive function that comes with age.

Other risk factors for HU include lower A1C and past episodes of severe hypoglycemia that resulted in coma or hospitalization.

Can You Reverse Hypoglycemia Unawareness?

If you are someone who already suffers from HU, it is possible to improve your sensitivity to lows and even start feeling those autonomic symptoms again.

In one study, a group of insulin-dependent diabetics showing almost no autonomic symptoms during hypoglycemia were subjected to intense blood sugar management centered around the “scrupulous avoidance” of lows. After three days, all subjects showed improved symptoms, with completely normal autonomic reactions to lows after four weeks. 

For people living with diabetes who aren’t part of a rigorous scientific study, completely avoiding lows can be close to impossible. After all, high blood sugars carry their own risks and can be much more difficult to avoid if your focus is only on not dropping too low.

Improvements in diabetes tech are making it more possible to reduce the occurrence of hypos without sacrificing tight control over blood sugars.

One of the best defenses against lows is the use of ever-advancing continuous glucose monitors (CGMs). Many of the CGMs on the market today can predict impending lows and alarm in advance to allow the patient to consume sugar or reduce insulin to avoid dropping below 70mmol/l.

CGMs combined with insulin pumps that are integrated and outfitted with ‘auto mode’ is also proving to be an excellent tool in reducing lows by constantly adjusting insulin levels in response to real-time CGM readings. See In-depth on Tandem’s Advanced Hybrid Closed-Loop System.

Of course, even with the best tools, no one perfectly manages their diabetes (nor should they expect to). Lows will happen. But with a focus on reducing the amount and severity of the hypos you suffer, you can reduce your risk of hypoglycemia unawareness and increase the odds that you continue to live a healthy, happy life as a type 1 diabetic.

The post Hypoglycemia Unawareness: Why It Occurs and What to Do About It first appeared on Insulin Nation.

But before you give in to the pandemic hysteria, it’s worth taking a moment to understand this new disease, why it is causing so many headlines, and how it has the potential to affect you as a person living with diabetes.

Should I Be Concerned About Coronavirus?

Whether you are reading through your Facebook feed or watching the local news, it can be hard to determine just how concerned you should be about this new coronavirus. While it is unlikely that the world will descend into some type of post-apocalyptic dystopia anytime soon, it’s also not a great idea to take this recent outbreak too lightly.

So just how bad is it?

Current statistics put the death rate for COVID-19 at around 2.3%. To put this in perspective, the death rate of MERS, a novel coronavirus that struck the Middle East in 2012, was about 34%, the death rate of SARS was about 10%, and the death rate for the flu in the United States is around 0.1%.

Despite the relatively low death rate, the coronavirus has killed almost twice as many people as SARS and MERS combined since it first popped up two months ago. 

This large number of deaths has less to do with how deadly the disease is and almost everything to do with how deadly it’s not.

Around 80% of people infected with COVID-19 show only minor symptoms. Because of this, the disease spreads much easier and much faster than previous deadly coronaviruses, like SARS and MERS that tended to cause more severe symptoms.

The vast majority of people infected with this new coronavirus show symptoms like low fever, a dry cough, and occasionally, trouble breathing. Only in severe cases, do people develop respiratory issues, pneumonia, or organ failure.

Because of these typically minor, generalized symptoms, it is more likely someone infected with COVID-19 will assume their symptoms are just that of the common cold and continue to go to work, school, and out in public. Since the virus spreads easily through physical contact and through contact with respiratory droplets in the air and on surfaces, anyone who is not isolated is likely to infect dozens of other people.

Are Diabetics At Higher Risk for Coronavirus?

As with most contagious illnesses, having an autoimmune disease such as type 1 diabetes does likely increase your risk of falling ill due to the new coronavirus. But just how much that risk is increased and if it also increases your risk of death is hard to say at this point.

Healthy people without preexisting conditions appear to succumb to COVID-19 at a rate of less than 1%, while those with cardiovascular disease have the highest rate of death, outside of the elderly, at 10.5%. Diabetics are reported to succumb to the disease at a rate of about 7.3%, but that number is most likely reflective of the rate of death in type 2 diabetics and not specific to those with T1D.

Type 1s are at a higher risk for heart disease and respiratory disease which are both risk factors for increased mortality with COVID-19.

As for type 1s who do not suffer other complications and have their condition well managed, it is impossible to know exactly what your risk is.

How to Protect Yourself

Regardless of how much your risk is increased as a person living with diabetes, it is always a good idea to take precautions to keep yourself safe from infection and to be prepared in the case of emergency or illness.

Take Steps to Avoid Infection

Protecting yourself and your family from COVID-19 is similar to the steps you should take to avoid exposure to any respiratory illness, and include measures such as:

• Wash your hands frequently, especially before and after you enter a public space.
• Use hand sanitizer when soap and water are not available.
• Don’t touch your mouth, nose, or eyes, especially while in public.
• Clean commonly touched surfaces frequently with soap and water or cleaning products.
• Keep your blood sugars in range and pay extra attention to your diabetes management to keep your body strong.

The CDC and WHO do not recommend the use of facemasks for people who are not currently sick as these are unlikely to offer much protection and should be reserved for infected patients to prevent further spread of the disease.

 Prepare for Potential Outbreak in Your Area 

The likelihood that COVID-19 will continue to spread is incredibly high. Currently, there are confirmed cases on every inhabited continent. And, every day, there are more reports of “community spread,” a term for when an infected person cannot be directly connected to another with the illness.

As the number of infected individuals rises, the odds of your community being affected over the next year or two are almost certain.

While there is no indication that this pandemic will cause massive disruptions to infrastructure, it is likely to disrupt the availability of certain products, including medications and food.

But, more importantly, if there are infected people within your community, you’ll want to do everything you can to avoid public places until the risk of infection has passed.

Here are some measures to consider to make sure you are ready should COVID-19 pop up in your town:

• Load up on non-perishables to avoid having to make a supermarket run in the middle of an outbreak.
• Make sure you are well stocked up on diabetes-related supplies, including treatments for lows, batteries, ketone-strips, and other non-prescription goods.
• Make sure you have plenty of sick day supplies on hand in case you do become ill.
• Stockpile prescriptions if possible by ordering or picking up your next supply as soon as you are able to; Assure your prescriptions are written for the high end of your average use and that you are taking advantage of 90-day supplies when possible will also help you create a stockpile for emergencies.
• Talk to your doctor today about how to manage your blood sugar during illness and what signs might indicate you need to seek medical attention.

As bad as the current coronavirus pandemic seems, it is important to remember that the vast majority of infected people will recover without incident.

By preparing yourself for a potential outbreak in your town, you can help reduce your risk of exposure while also keeping others in your community safe.

The post Coronavirus and T1D: What You Need to Know and How to Prepare first appeared on Insulin Nation.

But it wasn’t much later that Betty started to feel a pain in her chest. She was aware that her heart health was not at its best. Her cholesterol and triglycerides had both been off the charts at her cardiologist appointment the year before and her job as a medical social worker for the elderly came with boatloads of stress.

It was these facts combined with the incessant chest pain and continuing high blood sugar that convinced her that she needed to get ahold of her cardiologist. Her doctor agreed that the situation sounded serious and Betty followed his instructions to take two aspirin and call 911.

But once at the hospital, the emergency room staff struggled to look past her diabetes and see her heart symptoms for what they really were. They were about to send her home with the simple instructions to “take better care of your diabetes” when another doctor intervened and had her sent to the PICU to be evaluated overnight.

The next morning, Betty got the news that she had indeed had a heart attack. In fact, she had a 90% blockage in her right artery and a 70% blockage in her left.

After having a stent put in, Betty was sent home with very little information on how to reduce her odds of suffering the often fatal second heart attack to which so many type 1 women succumb. Luckily, Betty’s neighbor had recently embarked on a vegan diet and Betty had already noticed that he was dropping weight and looking healthier.

She immediately approached her neighbor for advice on how to dramatically change her diet to get some control over her heart health. Her neighbor recommended that she visit the nearby Barnard Medical Center.

Learning to Reverse Heart Disease at Barnard

Barnard Medical Center — website — is a medical care facility located in Washington DC that was established by the nonprofit Physicians Committee for Responsible Medicine. Both the group and the facility emphasize nutrition-based treatments to help reverse conditions such as heart disease, type 2 diabetes, and high blood pressure. 

While traditional medications and care are sometimes used, the focus is always on treating the cause of these symptoms rather than the symptoms themselves.

At Barnard, Betty learned about the possibility of reversing her heart disease using a diet that has been championed by heart specialists like Dr. Dean Ornish, Dr. Caldwell Esselstein, and Dr. Neal Barnard.

The focus of the Barnard diet is whole-food, plant-based nutrition with an emphasis on reducing fat, salt, and processed sugar. 

The diet is the only one in the world that has consistently shown the ability to reverse heart disease in a wide range of patients with moderate to severe blockages.

But for Betty, the diet wasn’t just a way to improve her heart health. For the first time, she felt like she had the tools to truly take control of her diabetes and of her life.

Controlling What Seems Uncontrollable

Betty had spent her entire life with a condition she knew could likely kill her one day. She understood that diabetics, and diabetic women especially, are likely to suffer from heart disease and that many die from the condition. It was knowledge she accepted and because of that, she felt powerless to avoid it.

For most of her life, she had taken care of her diabetes but had never really put the energy she should have into her blood sugar management. Similarly, she took some steps to improve her heart health by trying to exercise and occasionally dabbling in diet trends. But she could never quite shake the idea that if heart disease and other complications of diabetes were inevitable, what was the point of trying?

Compounding this negative thought process was the fact that Betty was incapable of putting herself first. Her patients, many of them also suffering from the complications of diabetes and heart disease, were always her number one priority. And that meant that self-care always took a back seat and stress levels ran high.

It wasn’t until her time at the Barnard Center that Betty realized the complications of diabetes don’t have to be a given. 

Instead, it is possible to take control of your life by putting yourself first and making changes that will help you feel better and live healthier.

Life After Heart Disease

In the four years since her heart attack, Betty has become a huge proponent for the transformative power of the plant-based diet.

She volunteers as a community advocate for the Barnard Center and has helped many others use the diet to improve their conditions, including her own husband who suffers from kidney disease.

While she has encountered some resistance from others who find it too difficult to imagine giving up their favorite meats and cheeses, it is hard for Betty to deny the proof. After just nine months on the plant-based diet, her cholesterol dropped from 257 to 115 and her triglycerides dropped from 154 to 94.

And now, after four years of eating the Barnard vegan diet, Betty continues to thrive. She has more energy than ever, has dropped to a healthier weight, and, for the first time in her life, has achieved an A1C below 7.

Despite all of her personal success, Betty says she tries very hard not to be “preachy” about how people should eat or choose to live. She believes very strongly in the power of this diet to reduce inflammation and influence heart health, but she knows you can’t force anyone to make changes if they aren’t ready.

But for those out there who are prepared to take the steps necessary to achieve better heart health and control over their diabetes, she can’t stress enough the importance of getting support to help with this kind of transition. For Betty, the support she got from Barnard as well as the community empowerment she received from others during cardiac rehab, all helped her find success with this new way of life.

Whether you are ready to make changes right now or are still struggling to see your way past diabetes, Betty says there is one thing that always remains true: 

You do have control over your life. 

If you can keep this one quintessential truth at the forefront of your thought process then there is nothing diabetes can stop you from achieving.

The post How a T1D of 43 Years Reversed Her Heart Disease and Took Back Control first appeared on Insulin Nation.

While a true cure isn’t exactly just a few years away, there are several remarkable efforts towards eliminating the need for ‘exogenous’ insulin in people with type 1 diabetes.

One of the most notable efforts is ViaCyte’s Encaptra “cell delivery system.” This is different from the islet transplantation you have read about where keeping the islets healthy is difficult.  Instead, ViaCyte transplants pancreatic beta-cell ‘precursors’ that mature in place as needed into islets.

What needs to be ‘fixed’ in your body to be ‘cured’?

To understand a ‘cure’ for type 1 diabetes, it’s important to first understand what beta-cells are. While we often blame our pancreas for not doing its job of producing insulin, the real issue is that your pancreas tries to produce insulin every day but your immune system continues to attack and destroy the beta-cells secreted by your pancreas that also produce insulin.

If you simply received a pancreas transplant, your immune system would just attack and destroy those beta-cells, too, without tremendous immunosuppression drugs that come with a slurry of other issues and truly isn’t a practical or safe approach for the average patient.

This means that today’s approaches towards a cure need to either reprogram your immune system to specifically stop attacking your beta-cells or you need beta-cells introduced in a way that protects them from your immune system altogether.

That’s where ViaCyte’s research comes in.

What is ViaCyte’s Encaptra ‘cell delivery system’?

ViaCyte — based in San Diego, CA — has developed a device that is implanted in a person with Type 1 Diabetes. There are actually two devices — PEC-Encap and PEC-Direct — that work very similarly. Both contain pancreatic beta-cell ‘precursors.’

Beta-cell precursor cells are basically like the newborn baby of a fully functioning beta-cell. These young beta-cells develop into mature islet cells that are able to produce insulin, amylin, and other endocrine hormones.

ViaCyte’s technology is one of the leading approaches to ‘curing’ type 1 diabetes and has proven effective in over 1000 rodents with type 1 diabetes along with many ongoing human patient trials. 

Let’s take a closer look.

The PEC-Encap

This is a device that is completely encapsulated which means it doesn’t require suppressing your immune system. Instead, it contains beta-cell precursors that are fully protected from being attacked and destroyed.

The device is implanted within the subcutaneous layer of your skin — which means its fortunately very small, the process of implanting it is minimally invasive, and the recovery period is very short. Over the course of several months, the surface of the device becomes gradually ‘vascularized’ which means that glucose, oxygen and other nutrients can pass into the device and insulin and other hormones can pass back into the blood vessels on the device surface.

This vascularizing triggers those beta-cell precursor cells to mature into insulin-producing cells. So, even though your immune system cannot breach the device and destroy the cells, your blood glucose can flow through it and insulin and amylin can be returned to the rest of your body.

Of course, the supply of beta-cell precursors isn’t endless. At this point, ViaCyte’s device requires a routine implant every year to provide more cells. Overtime, ViaCyte’s goal is to extend the time between implants.

Another overarching goal is to make the implant process itself faster, easier, and less invasive, without any additional cell implants at all.

The PEC-Direct

Very similar to the PEC-Encap, PED-Direct technology from ViaCyte is intended only for those with higher-risk type 1 diabetes, like patients with severe hypoglycemia unawareness and consistently unpredictable swings in blood sugar levels, often referred to as “brittle diabetes.”

This device enables blood to flow into it and intermingle with the contained cells rather than remaining on the surface.  Thus, this technology requires a constant suppression of the immune system.

• Suppressing your immune system to protect beta-cells inevitably means also suppressing your immune system’s ability to protect you from other things like the common cold and the flu. 
• We underestimate just how much our immune system does for us on a daily basis until it’s suddenly been put on vacation and we become very vulnerable.
• It simply isn’t ideal to suppress the immune system without a life or death reason to do so.

PEC-Direct is being tested for those people whose situation requires it. 

ViaCyte’s FDA Journey

When can I sign-up for a ViaCyte implant?

You can’t rush awesome things — including the cure for type 1 diabetes. ViaCyte’s cure technology has come a very long way in the required research process but it still has a ways to go. 

How long until ViaCyte’s cure treatment is widely available?

There are 4 phases any medical technology must go through before it becomes approved by the Food & Drug Administration and available to the general public. Fortunately, ViaCyte is already halfway through this journey.

• Phase I: Safety & Tolerability
• Phase II: Efficacy & Side-Effects
• Phase III: Efficacy, Superiority & Monitoring of Adverse Reactions
• Phase IV: Submit for FDA approval

Phase II is Still Recruiting

Begun in July 2017 with an estimated end in September 2020 ViaCyte’s Phase II trial is still recruiting additional patients for this research.  This is an exciting phase where the technology is demonstrated on humans instead of rodents. 

Participants must meet all of these details in order to qualify:

• Men and non-pregnant women of non-childbearing potential
• Diagnosis of T1DM for a minimum of five (5) years
• At least one (1) severe hypoglycemic event in the previous 12 months
• Hypoglycemia unawareness or significant glycemic lability
• Stable diabetic treatment
• Willingness to use a continuous glucose meter
• Acceptable candidate for implantation

Patients with any of the following issues cannot participate in the study (however, that doesn’t mean they wouldn’t be able to receive the technology once it’s FDA-approved!):

• History of islet cell, kidney, and/or pancreas transplant
• Six (6) or more severe, unexplained hypoglycemic events within six (6) months of enrollment
• Uncontrolled or untreated thyroid disease or adrenal insufficiency
• Diabetic complications such as severe kidney disease or renal dysfunction, proliferative retinopathy, diabetic foot ulcers, amputations attributable to diabetes, and/or severe peripheral neuropathy
• Non-compliance with the patient’s current anti-diabetic regimen

Overall Timing

It’s exciting and stressful all at the same time because naturally, we want it to be available right now. It’s possible that we may see FDA-approval for ViaCyte’s technology in 10 years, around 2030. In the meantime, please keep taking your insulin and checking the ol’ blood sugar!

The post Will ViaCyte’s Encaptra Cell Delivery System ‘Cure’ Type 1 Diabetes? first appeared on Insulin Nation.

Wide swings in blood sugar are now believed to increase your risk for heart disease and other common T1D complications.  

Focusing on the amount of time you spend in your normal range rather than just looking at your average blood sugar seems to provide a clearer picture of your risk factors.

By improving your time in range, usually defined as the amount of time you spend between 70 and 180mmol/l, you can decrease your risk for complications like heart disease, kidney problems, neuropathy, and eye damage. Focusing on this number instead of your A1C also makes it easier to keep your diabetes management at the forefront of your mind because it is something you can calculate on your own at the end of every day or every week. 

Of course, measuring your time in range is only the beginning. Once you know that number, you’ll likely want to make strides to improve it. And that’s where most of the work comes in. 

Here are a few tricks that you can easily put into practice to help improve the amount of time your blood sugars stay in range.

1. Reduce Post-Meal Spikes

Because not eating is not an option, dealing with post-meal blood sugar spikes is just a fact of life when living with T1D. But there are a few things you can do to help avoid spikes that can so easily push your blood sugars above your target range.

• • Pre-Bolus – Because insulin typically peaks after blood sugars do, taking your insulin before you eat can help quell those pesky spikes. Experiment with taking your insulin anywhere from fifteen to forty-five minutes before a meal to figure out what works best for your body and for different meal types.
  • Eat Low Glycemic Meals – Foods that are high in processed starch and sugar tend to peak much more quickly than foods that are loaded with fiber and complex sugars. Replace high glycemic foods like white rice, white bread, and white sugar with their lower glycemic counterparts like brown rice, whole grain bread, and agave sweetener.
• Eat Fat With Carbs – Fat slows down digestion and can help slow the release of sugar into your bloodstream. That’s why adding more fat to your meals can help you avoid spikes right after you eat. But you do need to be aware that sugars may rise later, so utilizing a dual bolus or taking a second shot a while after you eat can help. Also, keep in mind that while fat may be helpful for blood sugars, it isn’t great for your heart health, so always use this trick in moderation.

2. Utilize Different Blood Sugar Lowering Techniques

If your sugars do wander above your upper limit, it can be a frustrating and painful process waiting for them to come back in range. Luckily, there are some tools you can use to help stubborn sugars come back down more quickly so they don’t have such a large impact on your time in range stat.

• Exercise – If your insulin correction just isn’t working well to decrease blood sugars, or you’d rather save a little of that precious liquid, opting for a quick bout of exercise can help bring sugars down with or without extra insulin on board. Just make sure you choose an aerobic activity like jogging, hiking, biking, or swimming since anaerobic exercises are more likely to raise sugars than lower them. And always use caution if you are shedding ketones.
• Hydrate – Drinking a lot of water when your blood sugars are elevated can help dilute the amount of glucose in your bloodstream and aid your kidneys in flushing it out of your system. While you still need insulin to help lower sugars back to a normal level, drinking extra water can help speed the process.

3. Don’t Overtreat Lows

One of the easiest ways to get on the blood sugar roller coaster is to let your stomach do the thinking while you’re suffering from a low. If you consume too many carbs when your sugars have dipped, they are likely to rise too high later on. Instead of treating your lows with any sugar in available, follow these tips to bring your sugars back into range quickly without overdoing it.

• Treat With Only Simple Sugars – Using foods that contain fat, protein, and fiber when treating lows will slow the time it takes for your blood sugar to react, making it more likely that your will overtreat with a second or even third dose. Instead opt for simple carbs that are largely sugar like hard candies, juice, fruit snacks, or honey.
• Treat Based On The Severity Of The Low – For most diabetics, 15g of simple carbs is enough to reverse the average low. But a mild low that is dropping very slowly will require fewer carbs to treat than a plummeting low that is already well below 70 mmol/l.  You can avoid overtreating (and undertreating) by choosing the number of carbs you need to treat based on the severity of the low and your symptoms.
• Wait 10 To 15 Minutes Between Treatments – When you are low, your appetite hormones go into overdrive. By setting a strict time limit to wait between treatments, you can help avoid overtreating a low by putting your brain, instead of your stomach, in the driver’s seat. After ten or fifteen minutes, check your sugars and only treat again if they are still below your low limit.

4. Tighten High and Low Alarms

If you have a CGM, you have a huge advantage in improving your time in range by utilizing high and low alarm functions. These obnoxious alerts and vibrations will force you to think about when your blood sugars are going out of range and find the reason why. 

Setting your alarms to 70 and 180, may not be the best approach.

If you struggle to keep your sugars in that tight of a range, it is better to start with a higher upper limit. Otherwise, you will hear your alarm so often you’ll learn to ignore it. Instead, start with an upper limit that makes more sense for your sugars and lower it slowly as you gain better and better control.

On the other hand, if you already have pretty good control, tightening up your limits can help you attain even better in-range stats by alerting you well before your numbers go too high or low. Lowering your high limit can be an especially good idea at night when your sugars are more likely to be stable and therefore, easier to keep within a tighter range.

5. Keep Good Records

Finally, whether you are looking at your A1C or your time in range, there is no better way to tighten your control than by keeping detailed records. Even if you have a CGM that logs your blood sugars for you, having a written record of what you ate, when you exercised, and other important events, will help you understand where you need to make changes.

Once you see an established pattern in your sugars, having this record will allow you to determine what might be responsible for them falling below or above your target range. As you implement the changes necessary to correct the issue, all the above tips can help you reduce the impact of those out of range sugars and get you back to where you want to be.

The post Five Tips to Increase Your Time In Range first appeared on Insulin Nation.

Recent research from the JAMA Internal Medicine Journal, published by Harvard, continues to prove that the quality of your carbohydrate choices matters most.

The study included about 35,000 adults in the United States ages 20 and older. Researchers focused on determining how certain diets affected a person’s overall longevity and rates or mortality.

What they found was that low-carbohydrate diets that are low in fat can be very healthy, but the quality of the carbohydrates and overall food selection matters most.

• “In this study, overall low-carbohydrate-diet and low-fat-diet scores were not associated with total mortality,” 
• “Unhealthy low-carbohydrate-diet and low-fat-diet scores were associated with higher total mortality
• “Healthy low-carbohydrate-diet and low-fat-diet scores were associated with lower total mortality.

Researchers also felt the same about low-fat diets. 

A low-fat diet was once touted as the optimal approach to health, but even a low-fat diet consisting of low-quality food can be detrimental to your health.

In the battle of quality vs. quantity, quality wins.

But Quality Claims are Confusing

If you listen to society’s conversation about nutrition, it can be very overwhelming and confusing to determine what you should eat and on which macronutrients (fat, protein or carbs) you should focus or limit.

Food marketers are making an increasing number of food claims on packaging and other marketing to respond to consumers’ growing interest in health and well-being.  Many of these claims are gimmicks designed to sway your decisions. 

In 2019, The Journal of Public Policy & Marketing (JPPM) exposed food product marketing by identifying 4 “smoke and mirror” tactics commonly used to confuse and sway consumers.

1. Claims about “removing negatives.”
2. Claims about “adding positives.”
3. Claims about “not adding negatives.”
4. Claims about “not removing positives.”

The JPPM used breakfast cereals to demonstrate their point because cereal is a category of food in which actual nutritional quality varies dramatically but every box usually contains at least one or two firm health claims. 

Health statements on cereal boxes aren’t based on actual nutrition quality of the product but consistently make claims regarding taste, health, and achieving goals within common dieting fads.

Carbs are not Inherently Evil

Meanwhile, Harvard’s coverage of JAMA’s carb-quality research reminds consumers that carbohydrates themselves are not evil. 

“Carbohydrates give us energy. However, if the energy isn’t used after consumption they’re stored in our muscles and liver for later. Eventually, if unused for long enough, they turn into fat.

When adhered to based on healthy choices, low-carb diets do result in weight-loss but are difficult to sustain long-term.”

There’s no arguing that a low-carbohydrate diet does result in quicker weight-loss when adhered to strictly. 

There are many studies and conflicting findings.

• Low-carbohydrate diets that focus on eating more animal protein have been linked to higher cancer rates and a shorter lifespan. 
• Other studies reporting low-carbohydrate diets as beneficial for weight-loss and even for those with kidney disease. 
• Other research indicates these diets haven’t existed long enough for research to fully determine the effects on your metabolism and endocrine system.

Diet Guidelines Vary

If you’re following the Food and Drug Administration’s nutritional guidelines, it’s recommended that you consume between 45% to 65% of your daily calories from carbohydrates. That equates to 225 grams per day for women and 325 grams per day for men. 

A “low-carb” diet would amount to under 100 grams per day or less.

A ketogenic diet is intended to consist of no more than 20 grams of carbohydrate per day (after subtracting dietary fiber) to put a person into a state of “nutritional ketosis.”

Quality of Food is Most Important

JAMA’s researcher emphasized that both low-fat and low-carbohydrate diets are linked with a lower mortality rate when those diets consist mostly of healthy, whole foods. 

“Our findings show clearly that the quality rather than the quantity of macronutrients in our diet has an important impact on our health,” explained Harvard’s report.  

The debate on the health consequences of low-fat or low-carbohydrate diets is largely moot unless the food sources of fats or carbohydrates are clearly defined.”

Harvard researchers recommend focusing your diet on fruits, vegetables, milk, grains, seeds, and nuts, adding that people who eat fruit at least 5 times per day actually live a little longer than those who don’t — combatting mainstream society’s fear of fruit because of its carbohydrate content. Presumably, one could assume that a person eating that much fruit daily may also be making other whole-food choices daily, too.

Determining the right “diet” for you isn’t easy. It comes down to a variety of factors including religion, culture, tastebuds, health issues, lifestyle, and how your body actually feels when you eat a higher amount of carbohydrates versus fewer carbohydrates. Some people simply don’t feel good when they eat larger amounts of starchy carbohydrate — even if those carbohydrates come from whole sources like oats, beans, and sweet potato.

Every individual responds differently which means the best place to start is by looking at how you feel after eating certain foods or meals and conducting your own small experiments. Consider it a science experiment with the goal of simply improving your health and improving how you feel on a daily basis with an inevitable focus on whole foods, despite the macronutrient quantity. 

The post Carb Quality vs. Carb Quantity: Which is Healthiest? first appeared on Insulin Nation.

A cabin in the middle of nowhere is the last place any diabetic wants to suffer a hypoglycemic emergency. But Tim, a 40-year T1D veteran, had no reason to be concerned when he laid down to sleep on the old, sagging cabin mattress. He was well in control of his diabetes and was an old pro at managing the condition on camping trips, during travel, and any other environment you could throw at him.

But Tim’s expertise was about to be put to the test.

That night, he awoke suddenly to the sound of his Dexcom alarm. His blood sugar was dropping rapidly. He assumed his CGM was acting up but decided to double-check it with his meter anyway. 

On the way to get it, he glanced at his pump. According to his Medtronic pump, he had about 15 units of insulin on board. His initial thought was that his pump must be acting up, too. Fifteen units was an unreasonable amount of insulin for him for any time of day, but it was especially unbelievable for the middle of the night.

Groggily, he scrolled through his bolus history. According to his pump, not long before his Dexcom had alarmed, he had received a massive bolus of insulin. Tim, suddenly very awake, didn’t bother taking the time to understand how it had happened. Instead, he ran straight for the kitchen and began chugging root beers and feverishly eating cookies to offset the flood of insulin now coursing through his veins.

By the time he got around to pricking his finger and testing himself with his meter, his blood sugar was dangerously low but slowly rising.

The veteran diabetic had managed to stave off a serious emergency and live to see another day. 

Medtronic’s outrageous explanation of the event, however, truly left its mark on Tim and started him on a fifteen-month-long battle with his insurance company.

Looking for a Better Option

When Tim returned to civilization, his first phone call was to Medtronic to tell them what had happened. 

He realized, through some expert detective work of his own, that somehow he had managed to roll over onto his pump in the middle of the night. The pressure from being pinned between him and the sagging cabin mattress was enough to trigger the right pattern of buttons to input a 300 carb meal and deliver his maximum insulin bolus while he slept.

As hard as the explanation was to believe, the response from Medtronic was even harder: They knew that this flaw existed in their firmware. In fact, they had fixed the issue in their newest pump model. But Tim, like so many others still waiting for their warranty to expire, was stuck with the older, defective pump.

It was this experience that convinced Tim to look into other pump options after his warranty was finally up. He decided he wanted to switch to a Tandem pump. Not only were the newer Tandem pumps generally well-liked by users and compatible with his Dexcom CGM, but they had one important feature that Medtronic pumps do not. 

Tandem’s firmware can be updated straight to the device similar to how cell phone firmware is updated.

For Tim, this was everything. 

By restricting updates to new models, Medtronic and other manufacturers force their users to use outdated products.

Diabetes tech advances in waves, with huge innovations hitting the market at least every two years. But the average pump warranty is four years long. Meaning that Medtronic users will be stuck with outdated tech for at least two years before insurance will cover an update. And Tim had seen firsthand how this issue can cause serious problems.

The UHC Appeals Process

There was just one problem. Tim had UnitedHealthcare insurance through his employer, and UHC had an exclusive contract with Medtronic to only provide their pumps to members.

If Tim wanted a Tandem pump, he was going to have to get it through an appeals process with UHC.

In October 2018, Tim requested an exception and asked that he receive a Tandem pump covered at an in-network rate by his health insurance. He used his near-death experience with the Medtronic pump and Tandem’s ability to update their firmware in the field as his reasons for the switch.

Months later, he received a letter from UHC letting him know his request did not qualify as an appeal, but he never received an explanation as to why.

Eventually, he learned that his UHC insurance did not accept appeals of any form for durable medical equipment (DME) which includes insulin pumps. He spent hours on the phone with UHC looking for an explanation for this policy but never got one. In June 2019, he did, however, receive approval from UHC to file another appeal to get a Tandem pump.

Not surprisingly, this appeal ended in denial. This time, they did provide an explanation, stating that they could not say for certain that his current pump couldn’t be repaired and that his doctor failed to provide proof that a new Medtronic pump would not work for him.

The problem was, Medtronic, like many pump companies, does not, for liability avoidance purposes, repair pumps beyond sending replacement battery caps and reservoir rings. As for his doctor not providing enough information, his appeal letter had requested a peer to peer review be completed with his doctor, but no one from UHC ever talked to Tim’s doctor.

Armed with these arguments, Tim began the escalated appeals process only to receive another denial in January of 2020 with no reason given. He immediately requested an independent review of his appeal. But, not long after, he received a phone call telling him this appeal was also denied.

Finally (Some) Success

With an out-of-country trip upcoming and exhausted by the fifteen-month process, Tim decided to take matters into his own hands. He called Tandem and asked to buy a pump with cash without involving insurance. They told him it would cost $4,995 dollars to pay out of pocket or that he could use his insurance prescription coverage to order a Tandem pump through ExpressRx that would be fully covered.

At about the same time, Tim received a letter from UHC. Apparently, his independent review had been successful after all and Byram Healthcare, who handles many of UHC’s DME orders, would be sending him a new Tandem pump for the in-network price.

Jaded by his year-plus long battle, Tim decided to go through with both orders, assuming at least one would end up being rejected by UHC in another sudden reversal of position.

But, to his surprise, both pumps arrived at his door within a day of each other. Unfortunately, and less surprisingly, Tim also received an explanation of benefits from UHC saying they would not cover the pump they approved through his appeals process. And now, the pump that would have cost him $4,995 if he paid Tandem directly in cash, would cost him $8,322 according to the UHC letter, a 66% upcharge by UHC.

The Problem with Exclusive Contracts

While his fight with UnitedHealthcare is far from over, Tim has already learned an extraordinary amount about the flaws in today’s healthcare system, especially with exclusive contracts.

Because UHC and Medtronic have an exclusive contract, members like Tim are stuck without the ability to choose the medical devices that their doctors believe will work the best for them. And because UHC is one of the largest providers of medical coverage in the US, Tim is not alone. Millions of Americans are stuck without the ability to choose their doctors, drugs, and devices–the supposed hallmark of the free market system.

When it comes to diabetes tech, a field that is advancing at an extremely rapid pace, forcing members to patronize a single company is forcing them to choose tech that may not be the most advanced or the right fit for their lifestyles.  

UHC’s restricting choice is especially difficult now because Medtronic is clearly behind Tandem and Dexcom in its technology.

So why, if exclusive contracts are so bad for members, do insurance companies enter into them? Tim’s experience with trying to buy his new pump out of pocket sheds a little light on this subject.

• The cash price for his new pump from Tandem was significantly less than the price charged by UHC for the same pump. And this isn’t unusual.  
• Insurance firms negotiate higher prices with suppliers of products and drugs that have bundled rebates to make up the difference later on.  
• The consumer, supposedly the customer of UHC, does not see any benefit and is often the victim of this double-dipping. 

If your plan dictates you pay a 20% copay for a DME like an insulin pump, then you will pay 20% of the inflated price of the product, not the true price after the rebate is factored in.  In this case, the $3,327 UHC upcharge ($8,322 – $4,995) would mean that a 20% co-pay is actually a 33% co-pay on the true price.

Consumer Abuse

When insurance companies enter into exclusive provider deals, such as the one UHC has with Medtronic, they are typically not interested in partnering with companies that offer the lowest cost to the consumer. In fact, it is more profitable for UHC to partner with companies that will charge more upfront and then reimburse UHC with higher rebates later on. 

Both Medtronic and UHC win while members get stuck paying much higher copays or out of network costs than they should.

Even outside of the cost to the consumer, these types of contracts can easily stifle innovation within the medical field by forcing patients to buy from larger rather than more innovative companies. Meanwhile, smaller companies with better tech don’t have access to enough consumers to continue to develop newer, better products.

Fighting for Your Right to Choose

Despite the rather large bill Tim expects to receive from Byram, he did manage, in the end, to get one Tanden pump covered by his insurance. And he did so using a workaround that allows some pumps, like Tandems and Omnipods, to be purchased through prescription benefits instead of DME.

For others who are looking to shop for diabetes equipment outside of what is normally covered by their provider, Tim has these tips.

• “It is worth looking at the prescription workaround by talking to the pump manufacturer. The company can usually tell you if this trick will work with your particular plan and their particular product.
• “File an appeal, making sure you record all case numbers, names of people you’ve talked to and dates calls took place.” He also recommends asking for direct phone numbers and writing down the exact words and phrases your insurance company wants you to include in your appeal letters.
• “Be prepared for an extended battle that will include a lot of time on hold and trying to track down the right people to talk to. 
• “Don’t get discouraged. The more of us who are willing to push back against these exclusive policies, the more attention they will start to receive. And hopefully, someday, these policies will be thrown out in favor of ones that are actually meant to benefit the consumer.”

The post Are Exclusive Insurance Contracts Consumer Abuse? first appeared on Insulin Nation.

Sure, insulin is something we truly cannot live without, but those of us with type 1 diabetes aren’t producing amylin either and it’s also extremely important!

Well, more accurately: you’re likely producing as little amylin as you are producing insulin. Some people with type 1 diabetes may still produce some insulin, which means they probably still produce some amylin, too.

Let’s take a deep dive into yet another obnoxious thing our hijacked immune-system is messing with.

What is Amylin?

Amylin is a “37-amino acid peptide hormone” that wasn’t discovered until 1987 — which could explain why compensating for its absence is so far behind our options to replace insulin.

Amylin is actually “co-secreted” with insulin, produced by the same beta-cells that produce insulin, stimulated by the presence of food, like insulin. 

In people with type 1 diabetes, the beta-cells are being destroyed which means — as you already know — they are no longer producing insulin. But they are also no longer producing amylin.

(In people with type 2 diabetes, there can be significant “amylin intolerance” much like insulin resistance and a lack of amylin produced.)

When it comes to managing post-meal blood sugar levels, amylin is pretty crucial.

How amylin works

Amylin works in two ways to help manage your blood sugar levels after you eat or drink calories. 

#1 — Amylin slows down the rate at which your stomach empties the food you eat into your small intestine. 

• When food enters the small intestine, the glucose is absorbed into your bloodstream. 
• By delaying this entire process, it slows down the rate at which your blood sugar rises after eating or drinking.   
• Without adequate amylin present, the glucose produced from the food you eat is hitting your bloodstream much sooner than compared to a non-diabetic.

#2 — Amylin helps manage your blood sugar after eating is by suppressing your pancreas’s production of glucagon.

• Glucagon is a hormone that signals your liver to release glycogen. 
• Glycogen is glucose that’s been stored in your liver and your muscle tissue. 
• Your body depends on this glucagon/glycogen/glucose relationship in order to get the fuel it needs between meals and while you’re sleeping. 

Amylin’s Role in Glucagon (Dys)Regulation

Glucagon also triggers your appetite, which means that by suppressing your body’s glucagon production, amylin is suppressing your appetite. 

Thus, people with diabetes who don’t have sufficient amylin present, tend to experience a delay in feeling satisfied or full after eating.  

Your lack of sufficient Amylin is why you are hungry all the time.

Your brain, in particular, depends upon that second-by-second delivery of glucose in order to function, and your body’s glycogen stores provide that essential fuel.

For those of us with type 1 diabetes, we live with “glucagon dysregulation,” and the reason is that we do not produce amylin properly.

The overall result of a shortage of amylin is both higher post-meal blood sugar levels and higher insulin needs overall.

No wonder it is hard to achieve non-diabetic blood sugar levels even you follow all the rules since we’re only given one of the two hormones essential to blood sugar regulation. 

And yet, while “insulin replacement therapy” is vital to staying alive, “amylin replacement therapy” has been neglected because it is not vital to staying alive.

What about Synthetic Amylin?

One of the biggest obstacles in creating synthetic amylin is that it contains “physicochemical properties” that can form “amyloid fibers” which are known as a potential threat to beta-cells in people with type 2 diabetes.

For this reason, pharmacology developed a more stable form of amylin, known as “pramlintide” that is sold under the brand name, Symlin.  It became available in 2005 and is an injectable medication taken daily designed to mimic natural amylin.

The most common side-effect is nausea and a reduced appetite which leads to another common side-effect of weight-loss. While weight-loss isn’t drastic, most patients report an average weight-loss of about 6 pounds within the first few months on the drug.

Should you take Symlin?

“It took more than 80 years after the discovery in insulin for another medical treatment for type 1 diabetes to finally come along,” Gary Scheiner, MS, CDE, and author of Think Like a Pancreas told Diatribe in 2010. 

You would think that everyone with type 1 would have jumped on the Symlin bandwagon, but that just hasn’t happened. Fewer than 5% of all type 1s in the US are using Symlin.”

Scheiner says one of the biggest reasons most people with type 1 diabetes don’t even know about amylin is because health insurance providers are reluctant to provide coverage — in fact, most won’t.

Nausea that comes with taking Symlin is mild and short-term, said Scheiner, but he feels it also deters patients from trying it or sticking to it. 

And of course, it’s yet another medication to keep track of, another injection, another expense — and it’s not vital to staying alive. 

Lastly, Scheiner theorized that many physicians aren’t comfortable prescribing Symlin — likely due to a lack of experience and a fear of patients experiencing severe hypoglycemia after starting the drug. There is certainly a period of adjustment that comes with taking any new hormone — and that includes Symlin. You would need to work closely with your diabetes healthcare team and keep a close eye on your blood sugars. 

If you’re struggling to improve your A1c and with overall blood sugar management despite making efforts in your lifestyle habits and taking insulin properly with meals, synthetic amylin might be a worthwhile option — particularly if you can get your healthcare team to advocate for you and get health insurance to cover it. 

The post Amylin: The Other Hormone Affected by Type 1 Diabetes first appeared on Insulin Nation.

Why no Generic Insulins?

A long-standing issue with insulin is the lack of a “generic.” Just like you can buy generic metformin instead of Glucophage, or your grocery store’s brand of acetaminophen instead of Tylenol, we ought to be able to buy a generic version of long-acting and rapid-acting insulin that may not be as awesome of Fiasp or Novolog or Tresiba, but it still gets the job done.

Sanofi, NovoNordisk, and Lilly have created huge and profitable businesses by filing hundreds of patents for every type of insulin in order to prevent generics from being legally possible.

The FDA is finally changing that.

FDA Changes

“On March 23, 2020, an application for a biological product approved under the Federal Food, Drug, and Cosmetic Act (FD&C Act), including applications for insulins and other biological products, will be deemed to be a license for the product under the Public Health Service (PHS) Act,” explains a recent report from the FDA.

“This will, for the first time, enable submission of applications for products that are proposed as biosimilar to, or interchangeable with, the transitioned products. As such, the transition of insulin products from approved drug applications to deemed biological product licenses will open up those products to potential biosimilar and interchangeable competition.”

In other words: any pharmaceutical companies will be legally allowed to produce more affordable versions of today’s most advanced insulins.

“The availability of approved biosimilar and interchangeable insulin products is expected to increase patient access, adding more choices and potentially reducing costs of insulin products,” adds the report.

FDA Goals for New Regulatory Framework

The FDA Commissioner, Stephen M. Hahn, M.D., acknowledges that today’s patent laws around biologic drugs like insulin have resulted in little competition in the marketplace and more expensive drugs.

The only people who pay the true price for the current system are the patients who desperately rely on those drugs in order to stay alive.

“This transition will open new pathways for manufacturers to bring biosimilar and interchangeable versions of insulin and other transitioning products to market, facilitating greater competition in the marketplace,” explained the commissioner. 

“These critical therapies often carry a heavy price tag; the cost of insulin has risen over the past decade. Opening these products to increased competition is expected to bring down prices and help patients have access to more choices for these life-saving drugs. We will continue to communicate relevant information, including the resources we’ve issued today, to make the transition from one statutory framework to another as seamless as possible.”

While it’s certainly felt like the FDA has done very little to actually improve the outrageously rising prices of insulin until now, they’ve apparently been establishing the legal framework for this to become possible since 2018.

The “Biosimilars Action Plan (BAP)” was issued in 2018 to improve the overall regulatory process of biosimilar and “interchangeable product development” — also known as more affordable generic versions!

Of course, this isn’t just to improve the affordability of insulin, but of many other drugs for which there is little competition due to a ridiculous number of patents, even on older insulins like Lantus.

Lantus Example

The price of Lantus insulin has increased by 49 percent over the last 20 years — an increase that cannot be justified by inflation alone — according to a study from the University of Pittsburgh.

While the original patent for Lantus expired in 2015, dozens of “secondary patents” prevent competitive alternatives from being developed and marketed to the public. 

This web of secondary patents is the work of powerful legal teams behind every pharmaceutical giant.  This results in extending by years and years the high profits of protected products.

This secondary patent strategy is used by all pharmaceutical companies.

For example, the generic version of metformin is actually inadequate because it doesn’t offer an “extended-release” version which ameliorates its harshest side-effect: digestive discomfort and diarrhea. 

But Glumetza, an extended-release version covered by secondary patents, will cost a patient as much as $600 a month versus the few dollars a month they’d pay for metformin.

Biosimilar Drugs ‘Interchangeable Products’

The FDA’s most recent effort will change the finer details of the laws surrounding biosimilar drugs like insulin and make “interchangeable products” more easily available because other pharmaceutical companies will be more easily able to develop and market them.

“The FDA’s interpretation of the transition provision of the BPCI Act is intended to balance innovation and competition and facilitate the development and approval of biosimilar and interchangeable products,” explains the FDA’s report. 

“Getting safe and effective biosimilar and interchangeable products approved will help ensure that the market is competitive, and patients may have more affordable access to the treatments they need.”

The FDA also emphasized that when generic, more affordable options become available, they shall be managed in a way that minimizes any noticeable interruption or differences for the patient in how they receive or take their medications.

As people with diabetes, we know that no two insulins are exactly alike, even if they exist in the same category — like Humalog vs. Novolog vs. Fiasp. Yes, they’re close, but for some, the differences are noticeable.  Personally, I’ve been on Fiasp for just a few weeks and I absolutely need far less of it to correct a high blood sugar (for example) than I need of Novolog.

We’ll have to wait and see what this approach to more generic “interchangeable” insulin really looks like when it truly arrives on the market.

The post FDA Enables Generic Insulins with Lower Prices first appeared on Insulin Nation.

Not only does Medtronic have a slew of improvements and advanced features planned for their next-generation AID system, but Tandem just launched its first hybrid-closed loop system, Control IQ, in partnership with Dexcom last month.

Now, Dexcom is making headlines again for their most recent partnership with Insulet, the company behind the trusted tubeless system, Omnipod.

In this article, we’ll take an in-depth look at the features available in this newest AID system as well as some other big reveals Insulet has planned for 2020.

Next Generation Omnipod AID System

Like Tandem’s Control IQ, the new Omnipod system will work by integrating the highly popular Pod with the Dexcom G6 CGM.

At the time of market release, which is expected in early 2021, the system will work exclusively with the current G6 Dexcom sensor which provides highly accurate glucose readings without the need for fingersticks. But the system will also be fully compatible with Dexcom’s next generations sensor–the G7–which should be released at the end of 2020 with a wider commercial release in early 2021.

Expected Features and Benefits

The system will include a number of features that we have come to expect from newer AID systems, including:

• Automated basal rate adjustment using micro boluses to increase time in range.
• Automatic corrections to avoid hyperglycemia and for missed mealtime boluses.
• Adjustable settings for times of increased activity or when hypoglycemia or hyperglycemia is more likely.

Advanced and Unique Features

The Omnipod system will also include a number of advanced and unique features that we haven’t seen in current products on the market, including:

• Customizable blood sugar targets.
• Full control over the system through an optional smartphone app.
• Direct communication between the sensor and pod that does not require a control device or smartphone to be within range for automated insulin delivery.

And of course, this will be the first AID system available on a tubeless pump device.

This feature, along with the fact that it has been approved for ages as young as 6, makes it an especially great choice for children living with type 1 diabetes.

Insulet’s Tidepool Partnership Expands Choices

If you prefer a more hands-on approach to your diabetes, you still may have a chance to benefit from the advanced features of an Omnipod AID system.

Currently, Insulet is working with Tidepool, a non-profit that is developing an open-source IOS phone app and algorithm, in the hopes of extending looping capabilities to more of their Omnipod users.

This new system would allow users to link the Dexcom CGM to their Omnipod using the app. The Loop algorithm contained in the app allows customization and automation of insulin basal rates and correction boluses similar to other AID Systems.

In addition to the Tidepool partnership, Insulet has recently announced a partnership with Abbott that will integrate the next generation Freestyle Libre CGM with the new Omnipod AID system.  This integrated system is still a way off, but it is certainly something to look forward to.

Tidepool Features

Unlike other DIY looping apps, Tidepool is seeking FDA approval for its algorithm so it can be downloaded through the App Store and work with newer, in-warranty pumps and CGM devices. 

Also, unlike the current Loop algorithm, this one will come with a tutorial and certain safeguards within the app.

Other Tidepool Partnerships

In addition to Insulet, Tidepool has also entered into partnerships with Medtronic and Dexcom. As of now, there is no clear timeline on when the FDA might approve the algorithm or when the app may be available for download.

While we may need to wait a bit longer for truly flexible AID systems that provide choices to the consumer, it is always a positive to see companies, such as Insulet, add to the field of advanced diabetes management tech.

The post Insulet’s Omnipod to Join Hybrid Closed Loop Pump Market first appeared on Insulin Nation.

What you are probably not picturing is a small, disposable, Nicorette-style patch full of insulin.

But this cheap little device, about the size of a quarter and meant to be discarded each morning, might be the key to a future free of diabetes management for millions of people around the world living with type 1.

What Is the Insulin Patch?

We had a chance to talk with Jingqiang Wang and Professor Zhen Gu of UCLA Engineering last June about their efforts to synthesize glucose-responsive insulin analogs.

In the intervening short period, they have come a long way in developing the first “insulin patch” that uses tiny microneedles to release insulin into the system based on current glucose levels. 

Unlike most glucose-dependent systems we have today, notably the Medtronic hybrid-closed loop and the newer Tandem AID system, this little device does not require a lot of extra tech or the use of a CGM in order to automatically adjust insulin dose based on current glucose levels.

It is this simplicity that really makes this little device such a standout among the increasingly tech-heavy field of diabetes management. Not only would this patch simplify diabetes management for millions with T1D and for those with advanced type 2 diabetes, but it could do so at a fraction of the cost of what most patients spend on management tools today.

How Does Insulin Patch Work?

The patch is able to adjust insulin output based on current glucose levels in the body through the use of a glucose-sensing polymer that is enclosed with insulin. When glucose rates rise, microneedles in the patch open to allow insulin to diffuse into the subcutaneous area under the skin. 

As glucose levels drop, the polymers close and reduce insulin flow into the body.

Not only does this automatic feedback allow for more stable blood sugars, but it does so without the need for blood sugar monitoring, carb counting, or manual insulin injection.

It may even be possible to combine this technology with the newly synthesized non-fibrillating glycoinsulin to greatly increase the patch’s effectiveness. Because this new type of insulin does not form inactive fibrils it is less likely to cause occultations within the tiny microneedles, thus keeping the insulin flow predictable and avoiding site rotation issues.

The goal is to design a patch that can be worn for 24 hours and then replaced each morning.

Because these materials are relatively inexpensive to manufacture compared to insulin pumps, CGM sensors, and other current diabetes management tech, the patch could significantly reduce the financial burden of managing diabetes.

And, if the patch works as well as the researchers at UCLA hope it will, it may significantly reduce how much time and effort a person with diabetes will have to put into keeping their sugars within a healthy range.

When Will the Insulin Patch Be Available?

The researchers behind the insulin patch recently concluded animal studies in mice and pig populations with impressive results. The patch was able to keep blood sugars stable in type 1 mice and pig models for over 20 hours at a time.

Currently, Zhen Gu and his associates are in the process of applying for FDA approval to begin human clinical trials. Once approved, human trials would allow researchers the opportunity to formulate patches specifically for use in people with T1D and advanced T2D. 

Ideally, this cheap, disposable device could normalize blood sugar levels without the need for additional insulin injections or even finger sticks.

There is also a possibility that this tech could be adapted for other medical conditions requiring medication infusion based on physiological parameters.

While the insulin patch is likely still a few years off from being available to the general public, it is exciting to see this device entering the next phase of scientific study. If successful, it could completely change the vision for diabetes management and what an eventual cure may look like.

In the more immediate future, the insulin patch promises a simple and affordable method for controlling blood sugar for so many living with T1D, including millions worldwide who cannot afford the current, more advanced methods that many of us enjoy today.

The post Insulin Patch Could Provide Cheap, Simple, and Effective “Cure” for T1D first appeared on Insulin Nation.

And to make matters worse, you have to wake up to this fight every morning for the rest of your life.

No one will argue that there aren’t many reasons why this disease sucks or that it can take a toll on your life. 

I believe that there are also some positives that come with this condition; some of them even powerful enough to rival all those negatives.

Here are eight ways T1D has the power to change your life for the better.

1. It Forces You to Live Healthier

As a person living with diabetes, you don’t have the luxury of making poor choices when it comes to your health. While the person next to you might be able to load up on unhealthy food or skip the gym without suffering the consequences for decades, you have the unique ability to see the effects of those decisions in real-time.

• When you eat poorly your blood sugars immediately suffer. 
• When you fail to stay active, your insulin resistance goes through the roof. 

Every day this condition gives you a real-time look at how well you’re treating yourself and what more you need to do to live healthier.

While the condition itself may make you feel less healthy than those around you, the truth is, you probably take better care of yourself than most of the people you know.

2. It Makes You More Self Aware

When paying attention to how you feel can literally be the difference between life and death, you become pretty well acquainted with how your body works and what your feelings mean. 

• You know that stress can have a major impact on your sugars, so you are hyper aware of the signs of tension and anxiety. 
• You know how important it is to catch a low blood sugar before it becomes dangerous, so you are always checking in with your body for those subtle hints that something might be wrong.

While others may have the luxury of ignoring the barely perceptible signals their body employs, you don’t. And that means you are less likely to miss important warning signs that may signal a problem, whether diabetes-related or not.

3. It Allows You to Feel More Connected to Others

There is nothing quite like the excitement of being out in public and spotting a CGM, pump, or BG meter from across the room. 

• No matter who that person is, you immediately have a connection to them.
• It’s a connection that’s built on the fact that there is no one in the world who quite understands your diabetic struggles as well as another diabetic. 
• It’s what brings thousands of strangers together for deep conversations on T1D Facebook group pages. 
• And what makes it possible to sit down with a group of strangers at your local T1D meetup and feel like you aren’t alone.

Few people in the world can share such an immediate connection with people they don’t know. And that in itself is something to be celebrated.

4. It Makes You More Empathetic

But those connections don’t stop with others who share your condition. Your intimate knowledge of the struggles and emotional hardships that come from suffering an often invisible illness give you a sense of empathy that most lack.

• You may not suffer from depression or anxiety or some other invisible disease, but you do know what it feels like to suffer in silence. 
• It’s easy to relate to others who have their conditions questioned because they show few outward signs when so many of the immediate difficulties that come with diabetes are impossible to see.

It’s not always easy to view the negatives of T1D in a positive light, but when those negatives make you a more empathetic person, it does have a positive impact on you and those around you.

5. It Makes You Value Your Life More

As hard as it is for those around us to accept this, living with diabetes means becoming overly comfortable with your own mortality. 

• As much as you try to stay healthy and thriving, it’s hard to ignore how easily things can go wrong.
• It’s this acceptance of life’s fragility that allows you to put more value on your life. 
• You no longer have the luxury of putting things off or counting on the ability to enjoy something in the future. 
• If you feel well enough, you have to seize the day, because you never know what tomorrow will bring.

It’s a dark notion, but one that truly has the capacity to make your life better if you look at it in the right light.

6. It Forces You to Appreciate the Small Things

Few things can make a person with diabetes happier than looking at their monitor or CGM screen and seeing that highly sought after “100” staring back at them. This “diabetes unicorn” is a simple thing, but that doesn’t make it any less important.

• When you spend every moment of your day fighting for better blood sugars and better control, it’s these little things that make the fight worth it. 
• Learning to celebrate these simple accomplishments can help you see your condition in a more positive light.

And, once you find that power to appreciate small things, it is easy to extend it to other aspects of your day, making your life as a whole, a more rewarding experience.

7. It Makes You More Humble

There is no “perfect” when it comes to T1D. 

• No matter how diligent you are, how well you take care of yourself, or how many books you read on the subject, maintaining perfect blood sugars just simply isn’t possible.
• For some, admitting this fact can be difficult. 
• But for everyone, eventually, the time comes when you have to humbly accept that you are not perfect. 
• And that’s okay.

The ability to learn to live with imperfection and to forgive yourself for mistakes has positive ramifications far beyond your diabetes. That humility will allow you to more readily find happiness and make you a better person overall.

8. It Makes You Stronger

Lastly, but potentially most importantly, diabetes makes you stronger. 

• Adversity forces us to grow into more powerful, more capable people. 
• There are few things that spark such a continuous stream of adversity as a condition that requires never-ending commitment. 
• Even when diabetes has you crying on the floor, it is still making you better. 
• Because, eventually, you have to get up and you simply can’t do that without getting stronger.

While it’s true no one would choose to live with this condition if they had the choice, it’s also true that having T1D forced upon us has the potential to make us stronger than we would have been without it. 

At the end of a long, hard day, when you think there is no way you could possibly live another second with this condition, it’s worth reflecting on this and all the other powerful ways diabetes has changed your life for the better.

The post 8 Ways T1D Can Change Your Life for the Better first appeared on Insulin Nation.

This simple, yet necessary hormone has transformed what was once a sure death sentence into a condition that can be managed well into old age. Without insulin, none of us T1Ds would be here right now.

But with insulin, every single one of us is forced to endure the annoying, sometimes even crippling effects of low blood sugar.

While many innovations in the diabetes field center on better insulins, better ways to deliver insulin, and advances in CGM tech, very little attention is paid to the treatment of hypoglycemia.

University of Toronto doctor creating revolutionary glucagon delivery system meant to stop low blood sugars before they start.

Most Important Unmet Need

At best, low blood sugars are annoying, life interrupting occurrences that require treatment with sugary, often unhealthy foods. At worst, they are the cause of death for as many as 10% of type 1 diabetics.

While advances in continuous glucose monitoring and automated pump systems are helping reduce the time diabetics spend in hypoglycemia, lows will always be a risk for anyone on insulin therapy due to the very nature of how insulin functions.

It was this fact that led Dr. Shirley X. Y. Wu to start development on a glucagon delivery system with the potential to reverse lows before they occur.

How the Glucagon Patch Works

Dr. Wu and her team created a smart patch, similar to the insulin patch, that detects falling blood sugar levels and reacts by releasing glucagon into the bloodstream to prevent lows from happening.

The patch is made of an array of “smart” composite microneedles filled with microgels and glucagon. The microgels react to changes in glucose volume in the blood and automatically release glucagon when sugars fall below a certain threshold. 

Positive results have been seen in both in vitro studies and in T1D rat models, though, it will likely be some time before the patch enters into human trials and even longer before it is available for sale.

Glucagon Patch Applications

If successful, the glucagon patch has the potential to greatly improve the quality of life for many diabetics, including those with brittle diabetes, hypoglycemia unawareness, and fear of hypoglycemia. 

Even for those living with T1D who are less at risk for dangerous lows, this patch would greatly reduce management burden by abolishing the need to treat lows manually using food, juice, or, in severe cases, inhalable or injectable glucagon.

Depending on the final design of the patch, it would likely be applied to the skin in the morning and worn throughout the day. If the user’s blood sugar was to drop, the patch would react by releasing glucagon and preventing hypoglycemia from occurring without input from the user.

If set up like the insulin patch, a single glucagon patch could treat multiple low blood sugars throughout the day and night or longer.

The patch could be used alongside a wide range of insulin therapies from pumps to pens to injections. It may even be possible to use the insulin patch and glucagon patch together to stabilize blood sugars in much the same way a non-diabetic’s body automatically does.

While it may sound like a simple product, the implications of such a device are far-reaching. A fact that is easy to see for any person living with diabetes who refuses to leave the house without a well-stocked supply of glucose tabs, gummy bears, or juice boxes.

The post Glucagon Patch Promises to Stop Low Blood Sugars Before They Happen first appeared on Insulin Nation.

For diabetics, this anxiety doesn’t just come with feelings of dread, sleepless nights, and high blood pressure. It often also comes with a hefty dose of elevated blood sugars.

To have a fighting chance at keeping your blood sugars within a healthy range you have to lower your stress hormones. Here are ten proven methods for fighting your anxiety that you can do from the safety of your home.

1. Exercise

Not only is exercise an effective way to reduce cortisol and increase endorphins, but it is one of the simplest ways to lower blood sugars without using up valuable insulin.

If your area’s isolation restrictions allow it, try going out for a run. Shoot for early morning or dinner time when crowds aren’t likely. Otherwise, youtube has an almost unlimited number of free cardio and anaerobic workout videos to follow along with.

Just make sure your blood sugars are in the appropriate range before you start. If you aren’t sure what that means, check out this article first.

2. Stay Connected

Today’s communications technology provides a unique aid compared to the true isolation people experienced historically when they suffered through pandemics. While we may be physically isolated from family and friends, saying hello or even seeing their faces is only a click away.

If you feel anxious or lonely, schedule a call with someone close to you. Or better yet, set up a video chat happy hour with all of your friends or family.  House Party is a great app for doing this with your whole family or group of friends. 

Studies have shown that depression levels are directly tied to perceived social support. If you feel you’re missing that vital support, take the first step and reach out. If that’s not an option or not enough, there are many counselors available to chat over the phone.

3. Limit Your Social Media and News Exposure

While it’s important to stay informed during this time, it is easy to overdo it. In your endless search for information, you can quickly become overwhelmed by the number of negative stories you see. And yet, it can be difficult to turn off the TV or close your social media app.

Instead of letting your drive for information lead you down a rabbit hole that will most likely ruin your day, set limits for yourself. Allow yourself ten minutes to check your Facebook feed or read your news notifications during lunch or while you take a break in the afternoon. Once your time is up, engage in one of the other stress-relieving activities on this list to assure that negativity doesn’t spiral.

Try to avoid watching the news right before bed and don’t be afraid to use screen time limiting apps or the do-not-disturb setting on your phone to force yourself out of stress-inducing habits.

4. Utilize Stress Reducers

If you find that your blood sugars or your anxiety are out of control, don’t be afraid to reach out to your doctor for help. While medications may be necessary for some, others can find relief in the form of non-pharmaceuticals.

Many studies have found that omega-3 fatty acid supplements can have a profound impact on anxiety levels. Herbs like chamomile, lemon balm, and valerian can also help reduce stress and improve sleep.

Aromatherapy can be another great avenue to explore, especially while you are stuck in the house. Scented candles and essential oils have been shown to reduce heart rate and stress hormones in the blood. Even the smell of rain can have a positive impact on mood and reduce anxiety.

5. Find Time to Laugh

Laughter is the best stress reducer and it does not need to be ingested or inhaled. A good, hearty laugh is one of the simplest ways to make yourself feel better.  

Laughing not only reduces stress hormones but can also relieve the physical symptoms of tension and make you feel physically and mentally more relaxed. Both of these effects can have a profound impact on your blood sugars and your overall BG control.

Choosing a classic comedy, binging on episodes or your favorite sitcom, or even calling that friend you share endless inside jokes with are all great ways to induce a belly-busting laugh session. Sometimes I ask Alexa to tell me a joke — they are lame but it helps.

6. Get Your Oxytocin Fix

Oxytocin, commonly known as the love or cuddle hormone, can help reduce stress and make you feel less lonely. And, research shows it has the power to make people more insulin sensitive. 

This connection hormone may be the answer to all your isolation woes, but how do you get it?

Oxytocin is readily produced in the body during physical contact with people you like. So, if you happen to be holed up with a significant other and both of you are healthy, it’s time to cuddle! But don’t worry if you’re the only human in your house, because even the act of petting a pet can release oxytocin. If you don’t have your own pup to pamper, consider fostering an animal from your local shelter.

Other simple ways to activate oxytocin in your body are to take a warm bath, do something nice for someone else, meditate, and to go for a walk.

7. Breathe

This might seem obvious, but how you breathe is almost as important as breathing itself when it comes to lowering your stress levels.

When we experience anxiety, we tend to take quick, shallow breaths. This breathing pattern can continue long after the initial stressor has gone away. If you feel tense or are in the process of battling a stubborn high blood sugar, try taking a few deep, long breaths.

According to the American Institute of Stress, deep breaths increase the amount of oxygen in the brain and stimulate the parasympathetic nervous system which, in turn, promotes a state of calmness.

8. Get Outside

Unless you are under a strict lockdown or are experiencing symptoms of COVID-19, you likely have the opportunity to get out of the house at least once a day. Take advantage of that opportunity to take a long walk or just sit in the sun while doing some breathing exercises.

Getting some fresh air and moving around decreases stress and can help you feel less isolated. Even just spending time on your balcony and hearing other people can help you feel connected to the world and increase that valuable oxytocin hormone.

9. Focus on the Positives

It can feel weird to laugh or enjoy yourself during a time when so many are suffering and the future is so uncertain, but the truth is, there will be some positives that come out of this situation. While we may not know what those are on a large scale, it can be easier and even beneficial to focus on the positive things happening in your own life.

Maybe you get to spend more time with your family, finally have an opportunity to start a new hobby, or just catch up on some much-needed rest.  By focusing on these things instead of the many negatives, you can quickly improve your mood.

As a person living with diabetes, you already have to make the best out of a bad situation every day so you should be well equipped for such an exercise.

10. Give Your Diabetes Some Love

Lastly, consider spending this extra time focusing on your diabetes management. While this might not directly lower your stress levels, it can certainly help you better manage those elevated BGs.

And, once your new focused management starts to show results, the stress you’ve always had around diabetes will start to decrease. This, along with your stress management techniques from above will help you feel better overall.

We are currently experiencing an unprecedented global situation that should have you feeling a little nervous. But it’s important to keep those nerves in check so that you can maintain healthy blood sugars and keep yourself strong.

If you are wondering what other steps you should be taking to keep yourself healthy and safe as the coronavirus pandemic intensifies, you can learn more here.

The post Stressed by COVID Isolation? Tips to Keep Anxiety & Blood Sugars in Check first appeared on Insulin Nation.

“Back in 1996, when Eli Lilly’s Humalog first came out, the price for a 1-month supply of insulin was $21. As of 2001, that exact vial’s price increased by $14 to $35. Now, in 2019, that vial is said to be around $275,” explains one of many articles aimed at the increasing greed of BigParma. 

Novo Nordisk, Sanofi, and Eli Lilly manufacture today’s best insulin options, including Novolog, Humalog, Fiasp, Levemir, Lantus, Tresiba, and Toujeo. 

One by one, thanks to pressure from patients and supporters across the globe, these pharmaceutical giants are offering copay price-cap programs for people with or without insurance, regardless of your personal monthly income which is a typical obstacle in their previous savings programs.

Lilly’s $35 copay: The “Lilly Insulin Value Program”

Lilly announced a “price-cap” program on insulin several months after receiving criticism in late 2019 for still failing to lower prices as they had previously promised.

“Anyone who has commercial insurance, or no insurance, can purchase their monthly prescription of Lilly insulin for $35 through the Lilly Insulin Value Program,” explains the press release.

The program is effective immediately and covers most Lilly insulins, including Humalog and non-branded insulins.

Mike Mason, the President of Lilly Diabetes, said they increased effort to lower insulin prices due to the COVID-19 crisis. 

“Too many people in the U.S. have lost their jobs because of the COVID-19 crisis, and we want to make sure no one goes without their Lilly insulin,” Mason said in a statement in early March.

“We’ve been providing affordability solutions for a long time, but more is needed to help people during this unprecedented period. People with commercial insurance, as well as those without insurance at all, are eligible, and the process is quick and simple. We want people who need help to call us,” he added.

You are eligible if:

• You have commercial insurance
• You do NOT have commercial insurance

You are not eligible if:

• You are currently enrolled in Medicare Part D

If you are not eligible, you should still call the program phone number to learn if you may qualify for other Lilly financial assistance programs.

How to enroll in Lilly’s Insulin Value Program:

• Call the Lilly Diabetes Solution Center at 833-808-1234 
• Open Monday through Friday, 8 a.m. to 8 p.m.

“The calls are simple, the average time on the phone is about 10 minutes, and there’s no paperwork to fill out,” explains DeShong Perry-Smitherman, communications manager for Lilly Diabetes. “We have operators who can take calls in Spanish and we can translate information into about 40 languages.”

You will give them information including your name, address, and insurance details if applicable.

Lilly Diabetes will then send a copay card to your address that you should bring with you to the pharmacy when you fill your next insulin prescription.

If you are enrolled in Medicare Part D

Fortunately, even though this new copay program isn’t applicable for those on Medicare Part D, there are other programs in development to help you cut insulin costs in a similar fashion.

The Trump administration also announced a program for Medicare Part D enrollees to pay no more than $35 per month for insulin regardless of their deductible, coverage or a gap in coverage.

Other insulins…

Mannkind manufactures Afrezza, an inhaled insulin that can serve as a worthwhile alternative for some or all of a person’s fast-acting insulin needs. Afrezza also offers a savings program but tends to be far less expensive than traditional insulin in the first place.

Afrezza has continued to be one of the more affordable options but not necessarily an ideal alternative for everyone. 

You should try Afrezza for yourself and see. Some folks love it, some don’t.

Walmart also sells archaic yet affordable insulins “Regular” and “NPH,” which sell without a prescription for only $25, but they are cheap for a reason, and certainly not considered the standard of care those of us with diabetes expect today for the sake of our longterm health.

Hopefully, other insulin manufacturers will follow suit and the overall out-of-pocket cost of insulin will lower as patients continue to speak up about the outrageous rising prices. 

Market Share Ploy by Lilly?

For decades, BigPharma and their co-conspirators, Pharmacy Benefit Managers, seem to have played a coordinated shell game of increasing list prices and PBM rebates that cost patients more and more.

The move by Lilly could signal a change in this pattern.  We imagine that Lilly sees an opportunity to switch many patients to its insulin and permanently increase its share if the US insulin market.  If this is their motivation, we should hope for similar programs from Novo Nordisk and Sanofi to protect their US revenues.

Update

Playing catch-up, Novo Nordisk has quickly come up with their own offering just days after Lilly’s $35 copay price-cap, with the offer of free Novo Nordisk insulin for anyone who has recently lost their health insurance due to COVID-19-related unemployment. This would include Novolog, Fiasp, and Tresiba. The free insulin is available for up to 90 days through their Patient Assistance Program.

Unlike Lilly, the Novo Nordisk program is temporary.

“Applicants are not required to provide documented proof of income,” explains the announcement. “Participants must provide documentation showing loss of healthcare benefits, such as a job termination notice or job status change, or proof that COBRA benefits are being offered. In addition, if Medicaid benefits are denied, assistance for eligible patients can be extended past the 90-day-window until the end of the year. People applying for this program must have a valid prescription for a Novo Nordisk insulin and meet certain eligibility criteria, which can be found on NovoCare.com or by calling 1.844.NOVO4ME (668.6463).”

Here is the press release from Novo Nordisk.

The post Eli Lilly Insulin Price Cap Program first appeared on Insulin Nation.

While current evidence suggests that type 1 diabetics are at no higher risk for contracting or suffering complications from the disease, any illness can have profound and debilitating effects on your blood sugars. For that reason alone, it is a good idea to prepare your immune system just in case you are exposed.

Unfortunately, there is no panacea to strengthening your immune system despite the claims of hundreds of supplements and self-care companies. 

There are, however, a few steps you can take that have been scientifically proven to increase disease resistance and prepare your immune system to effectively fight off viruses. 

Here are five of the most effective ways of boosting your immune system.

5 Proven Ways to Strengthen Your Immune System

Healthy Diet

While there are studies that show the power of certain vitamins and herbs to shorten the duration of viral symptoms, these same supplements will not boost the immune system before infection.

This makes sense considering the complex nature of our immune systems which rely on multiple pathways, cell types, and even the bacteria in our gut to function properly. Trying to strengthen this system with a single vitamin is like replacing the bolts on a rollercoaster and expecting it to run faster.

To support your immune system and give it a fighting chance against COVID-19, you need to provide it with a long list of vitamins, minerals, antioxidants, enzymes, prebiotics, and other micronutrients that naturally exist together.

And the best way to do this is through a healthy diet that consists largely of colorful fruits and veggies as well as some healthy fats.

Dark leafy greens, orange fruits, and other deeply pigmented plant foods are rich in vitamin C, inflammation-reducing antioxidants, and other important nutrients that aid in immune function. Healthy fats like olive and flaxseed oils also play a role in reducing inflammation and providing energy for your immune cells.

As a bonus, a diet rich in healthy plant-based foods also tends to increase insulin sensitivity and can make managing your diabetes easier while reducing your insulin needs.

Regular Exercise

Regular moderate exercise has been shown to have a beneficial effect on the immune system. 

By increasing your heart rate, exercise naturally reduces inflammation that can otherwise impair your immune system’s ability to fight off infection. This same increase in blood flow can also help increase the amount of immunosurveillance happening in your body, allowing your system to detect and fight off invaders before they establish.

The key to using exercise to strengthen your immune system rather than depress it is to keep your activity at a moderate level. Intense or prolonged exercises, such as long-distance running and extreme weight lifting, actually have the opposite effect on immune function and are more likely to make you susceptible to infections like COVID-19.

Focus on regular moderate exercise. According to the Cleveland Clinic, examples of this kind of healthy exercise would be walking or biking for 30 minutes, running for 15 minutes, or walking stairs for 15 minutes.

Not only will doing these types of exercise regularly boost your immune system, but they will also help increase metabolism, help shed excess weight, and decrease insulin resistance.  

Sleep More

If there is one positive to social distancing and being forced to stay in, it’s that you finally have the chance to catch up on your sleep. And, according to research, those extra Z’s can have a huge impact on your immune system’s ability to function properly.

While there are still many mysteries surrounding sleep and why it is so essential, one thing we know for sure is that sleep is restorative. Getting rest allows your immune system to reset. This could be one reason why researchers have found that adults who sleep more than 6 hours per night are less likely to catch colds than those who sleep less.

So, if you find yourself with less to do these days, catching up on your rest is a valuable way to spend your time. But don’t confuse sleep with simply being sedentary. In order to gain the immune-strengthening benefits of sleep, you actually need to be sleeping, not just resting while watching TV or playing video games.

Stress Less

Stress has a lot of negative side effects on the body. Hormones like cortisol increase cravings for unhealthy foods while simultaneously causing your liver to dump glucose into your bloodstream. 

But stress doesn’t just cause issues with blood sugar. 

Stress can also depress your immune system and make you more susceptible to viral infections. One study showed that long-term stress increased inflammation and the odds of the subject developing a cold when exposed to a rhinovirus.

By taking steps to decrease your stress levels and find healthy management techniques for long-term stress, it is possible to strengthen your immune system. And, since stress has a negative impact on diabetes management, focussing on de-stressing can create positive changes all around.

Of course, lowering your stress levels in the middle of a pandemic is much easier said than done. If you are struggling to keep your stress in check, here are some tips to help you relax.

Tame Bad Habits

Sometimes strengthening your immune system has less to do with what you are doing and more to do with what you’re not.

Many habits can have a negative effect on immune function.

Eating junk foods that are high in sugar and saturated fats increase inflammation and offer little in the way of nutrition that is needed for proper immune system function. A sedentary lifestyle has similar negative effects on your body. 

Other bad habits that can negatively affect immune function are drinking and smoking. 

While drinking alcohol in moderation can have a slight positive impact on present stress levels, drinking too much or too frequently can impair the function of immune cells and even allow more pathogens to pass through the gut into the body.

Smoking cigarettes negatively impacts both innate and adaptive immune function. Smoking also appears to put people at an increased risk of COVID-19 and may increase the odds of spreading the virus.

Of course, if you smoke, drink heavily, eat poorly, are inactive, and you have type 1, this is probably not the first time you have been encouraged to change your ways. And now, you have one more very good reason to do so.

Special Considerations for Diabetics

While these tips for boosting your immune system are helpful for everyone, there are additional steps people living with diabetes should take to help keep themselves safe.

Elevated blood sugars cause inflammation in the body which can contribute to a depressed immune system and immune dysfunction.

Keeping your blood sugar levels within the normal range is always important, but during this uncertain time, it is even more so. Frequent blood sugar checks and focused insulin management are the first steps to achieving better diabetes control. 

Following the above tips will also help increase insulin sensitivity and decrease blood sugar fluctuations in addition to boosting the immune system.

The post Diabetes & Coronavirus: How to Boost Your Immune System first appeared on Insulin Nation.

When they launched their automated hybrid-closed loop system a few years later, I was equally excited to upgrade to the more user-friendly, waterproof pump and more advanced CGM. Even though I never planned to use my pump in auto mode, it was exciting to be part of that first wave of truly advanced diabetes tech.

Tandem/Dexcom Now Lead Market

Even as a lifelong Medtronic patron, it is hard for me to feel the same excitement about the company that I did six years ago. 

Not only has Tandem launched its own automated system with better features and a more user-friendly interface, but they were doing it with Dexcom, a calibration-free CGM sensor that is more accurate and longer-lasting than Medtronic’s Guardian sensor.

Tandem isn’t the only one entering the hybrid-closed loop market this year, either. Insulet’s Omnipod Horizon will soon be offering its own automated system that also integrates with Dexcom’s auto mode algorithm.

• Much like the 670g, none of these other looping systems offer tight enough control for diabetics who can achieve an A1C below 6.5 on their own.
• But Dexcom’s superior sensor tech is almost worth switching to in and of itself. And in fact, I was seriously considering it as the year began.

Medtronic Product Pipeline

I have learned that Medtronic is gearing up to launch a series of new products over the next two years.  I am once again feeling a bit excited about what the company has to offer.

Medtronic’s Upcoming 780g Advanced Hybrid Closed Loop System

The first product set to be released is Medtronic’s answer to the superior algorithm used in the Dexcom compatible automated pump systems.

Much like the current 670g system, this advanced hybrid closed loop (AHCL) will use predictive values from the integrated sensor to adjust basal rates to keep blood sugar stable. But unlike the 670g (and much more like the Dexcom loop) this system will also be able to deliver corrections for missed meal boluses or undercalculated carb ratios.

Importantly, and unlike anything currently on the market, the AHCL system will target a goal blood sugar of 100 mmol/l rather than the current 120 mmol/l of the 670g and 110 mmol/l of the Tandem system. 

Medtronic hopes this system will increase time-in-range from about 72% for current systems to 80%.

Both of these factors would seem to make the new 780g system a better choice for people with diabetes who already have fairly tight control on their own.

The AHCL system will also have Bluetooth capabilities, making it possible to read and control the pump via a phone app.

The 780g has just wrapped up clinical trials and results are set to be released in July. Medtronic expects to release this new product in the second half of 2020.

Medtronic’s Upcoming Personalized Closed Loop System

The second product in development is the Personalized Closed Loop (PCL). 

Like all current auto-mode enabled systems, this one will adjust basal rates based on predicted CGM values. 

Unlike anything available on the market today, the Medtronic PCL will also have the capability to give automated boluses for meals, effectively eliminating the need for carb counting.

It will also be able to self-correct for times of high activity without users needing to set a manual temporary basal rate.

With these features, the PCL has the potential to become the first true artificial pancreas system and would likely have a huge impact on the quality of life for millions of people living with type 1 diabetes.

In addition to greatly reducing the burden of diabetes management, the PCL system is set up to achieve greater than 85% time spent in range. 

It will also allow the user to set customizable blood sugar goals. 

Both of these factors mean the PCL has the potential to be useful to all T1Ds, even those who achieve near-normal blood sugar levels on their own.

Like the 780g system, this one will be Bluetooth enabled and compatible with a phone app.

The PCL system has received the FDA’s Breakthrough Device designation, which will allow Medtronic to move the product through the approval process more quickly than traditional devices. The company hopes to have the system available to patients as early as 2021.

Improving Sensor Technology

The success of both of these new automated systems relies heavily on the next generation of Medtronic CGM sensors.

The first to be released will be the GS3 sensor which is currently undergoing FDA approval to be marketed as non-adjunctive, which means that treatment decisions can be made based on the readings given by the CGM. 

• This is a big improvement on the current Guardian sensor which requires users to check their blood sugar on a BG meter before making treatment decisions. 
• The Dexcom G5 received a similar non-adjunctive designation back in 2016.
• The GS3 is expected to be available later this year.

Fewer Daily Calibrations

Like the current generation Guardian sensor, the GS3 will still require multiple daily calibrations. However, Medtronic hopes to reduce this drawback with the release of the Zeus sensor in 2021. 

• The GS3, like Guardian, will be a 7-day wear sensor, but it will only require finger-stick calibrations on the first day of use. 
• While this still does not achieve the “calibration-free” designation of Dexcom’s latest sensor, it is a huge improvement over the current recommended three to four calibrations a day for the Guardian sensor.

Following the release of Zeus, Medtronic hopes to simplify its sensor even further by offering a disposable form that will be released under the name Synergy.

• In addition to only requiring once-per-day calibrations, it will also be half the size, easier to insert, and will not need over-taping such as the current models require.
• The Synergy disposable sensor is expected to be released in 2022.

Increased Infusion Set Wear Time

Looking to the Future

While it is impossible to say if these products will live up to the hype, it is promising to see companies continuing to improve upon current diabetes technology.

And for me, personally, the potential to get to use a true artificial pancreas that eliminates the need to carb count while reducing burdens like finger-sticks is enough to keep me brand-loyal for a few more years. 

Or, at least until the next company comes out with something even better.

The post Can Medtronic Retake Automated Pump Market? first appeared on Insulin Nation.

This newer data appears to be true in cases of people with well-controlled T1D. 

However, type 1 diabetics are at an increased risk of developing cardiovascular disease (CVD) compared to the general population. And statistics continue to show a high correlation between CVD and severe COVID-19 infection.

If you are a person living with type 1 diabetes and cardiovascular disease, it is important to understand how much your risk is increased, how your heart medications might complicate that risk, and what steps you should be taking to protect yourself.

Are People with CVD at Greater Risk for COVID-19?

Current data from the front lines of the COVID-19 pandemic shows that patients over the age of 65 with underlying vascular conditions are not only more likely to be infected with the novel coronavirus but are much more likely to suffer from severe or even fatal COVID-19 symptoms.

The elderly aren’t the only cohort that appears to be at an increased risk.

Patients with preexisting myocardial injury appear to be at the highest risk of severe illness and death associated with COVID-19. But patients suffering from hypertension, previous stroke, and certain respiratory illnesses are also at increased risk of long-term hospitalization and death.

No Direct T1D Link

While type 2 diabetes and obesity may also increase a person’s risk factors, there is no direct link between well-controlled type 1 diabetes and increased COVID-19 risk. However, given the high incidence of heart disease, especially among women with type 1, all T1Ds should be aware of the connections between CVD and coronavirus.

Do Heart Meds Increase Your COVID-19 Risk?

The connection between cardiovascular disease and increased COVID-19 risk is thought to relate largely to the decreased cardiac and respiratory function seen in these individuals. However, there is some additional concern that common heart medications taken by these patients may be at least partially responsible for some of this increased risk. 

Both ACE inhibitors, often prescribed for patients suffering from heart disease, and angiotensin receptor blockers, including “statin” medications, used to treat high blood pressure, upregulate the expression of the same receptor type that SARS-Cov-2 uses to enter human respiratory cells.

There is reason to believe that these medications may increase infection risk by providing more infection points for the virus.

Unfortunately, at this point in time, the full effect of these medications isn’t completely clear. Furthermore, there is some evidence that these meds may actually play a part in reducing lung, heart, and renal damage associated with COVID-19.

Until we know more about the interactions between these drugs and the virus, the AHA and researchers recommend continuing to take your heart and blood pressure medications as prescribed. But do report the use of any of these meds to your doctor right away if you develop symptoms of COVID-19.

Protect Yourself from Coronavirus as High-Risk Person

Whether you are at an increased risk of developing COVID-19 due to cardiovascular disease or poorly controlled diabetes, here are some steps you should take to protect yourself from exposure.

Stay Home

If you want to reduce your odds of getting sick to near zero, you have to stay away from other people and areas where other people visit. The simplest way to do this is to stay home.

Of course, that practice is easier said than done, especially for certain individuals. Still, there are alternatives to many errands and other out of the house activities you should absolutely be utilizing if you are high risk.

Choose grocery delivery, telehealthcare appointments, and mail order medications whenever possible. If there are other essential items you need, try ordering them online or having a friend pick them up for you. 

If you do need to go out in public, make sure to wash your hands before you leave and as soon as you return. Keep a minimum distance of six feet between you and others and consider wearing a facemask to protect those around you.

If you do not live alone and others must leave the house, or you have to leave for work, make a habit of disinfecting high-traffic and high-touch areas throughout the day.

Limit Visitors

Ideally, you should not have anyone visit you during this time. If you do have someone come over, try to avoid having them enter the house and make sure to keep a safe distance while outside. You should also ask any visitors to wear a mask to protect you in case they are sick and don’t know it.

If a visitor does need to enter the house, remember to keep your distance. Once they leave, make sure to disinfect any areas that they touched, including doorknobs and countertops.

If someone brings your groceries, be cautious about touching bag handles and food containers. While the chance of the virus spreading this way is low, it doesn’t hurt to be overly cautious. You can wipe down food containers with disinfecting wipes or simply set them aside for three days. After this period it is very unlikely any virus would be viable.

Practice Good Hygiene

If you live by yourself and are not leaving the home often, then your risk of coming into contact with the virus is very low. Still, it is a great idea to practice good hygiene by washing your hands frequently and avoiding touching your face. If you live with others or do have to leave the home frequently, good hygiene is a must.

Make sure to wash for at least 20 seconds with warm soapy water before eating, upon returning to the home, after sneezing or coughing, and after leaving any public place.

While all these rules are especially important to follow if you are at high risk of coronavirus infection due to cardiovascular disease or poorly controlled diabetes, they are actually good for all of us to keep in mind.

The more of us who abide by stay-at-home policies, limit our interactions with others, and practice good hygiene, the lower the risk of infection to those who are high-risk will be.

The post COVID-19 & Cardiovascular Disease: What You Need to Know first appeared on Insulin Nation.

But something very strange began to happen around 1950. Suddenly, the rate of type 1 diabetes, especially in children, began to increase sharply. Since then, most countries around the world have seen a linear upturn in T1D cases, a trend that has not slowed over the last decade.

Despite seeing this strange 70-year uptick in cases, researchers are still struggling to figure out exactly why this phenomenon is taking place. Some theories, such as the vaccine and cow’s milk connection, appear less plausible than once thought but there are plenty of others that still appear to have some validity.

In this article, we will take a closer look at this worrisome phenomenon and dissect some of the more likely causes behind it.

How T1D Rates Have Changed Over Time

Multiple studies looking into the prevalence of type 1 near the middle of the last century found that rates doubled from around 1950 to about 1965 in the US. Stranger still, this same surge was seen in many European countries around that same time.

More recent research into the prevalence of T1D shows that this worrisome trend continues in most countries around the globe.

The SEARCH for Diabetes in Youth campaign reported that the prevalence of the disease in people under the age of twenty rose by 21% between 2001 and 2009. Globally, the rate of type 1 appears to be increasing at about 3% per year.

What is most astonishing about this data is how it seems to be consistent across countries while simultaneously appearing to effect some nationalities more than others.

Scandinavian countries, the US, the UK, and Saudi Arabia all have the highest incidence of type 1. Still, despite having a much lower occurrence of the disease, countries like China, India, and Brazil are all seeing similar rates of increase.

This appears to indicate that predisposition to the condition is much more similar across different genotypes than we thought. However, one SEARCH study looking at American youth found that the rate of increase in Hispanics was almost four times the rate of increase in non-Hispanic whites.

It would seem that, while rates of T1D are rising in all populations, we are seeing the fastest rise in populations that have traditionally been less affected.

Why Are Type 1 Diabetes Rates Rising?

There is a clear increase in the occurrence of type 1 in all areas of the world, and the rate of that increase also seems to be growing. 

A number of theories have been put forward over the last few decades to try and explain this phenomenon.

The Hygiene Hypothesis

Over the last century or so, we have learned a lot about pathogens and how infectious diseases are spread. Ironically, it maybe this focus on reducing the spread of these types of illnesses that has led to an increase in T1D.

Recent research has shown a strong correlation between infants growing up with pets and a lower rate of childhood asthma and allergies. Scientists believe this connection has something to do with the increased number of pathogens children living in homes with pets are exposed to early on.

This same process of “immune system priming” may be beneficial in helping reduce the risk of autoimmune diseases such as diabetes. This was a theory first brought forward by David Strachan in 1989 and continues to gain support today.

This theory would explain why rates of diabetes are rising in developed countries where sanitation continues to improve and children are less and less likely to be exposed to viruses and bacteria with each generation. 

Where this theory comes up short is in explaining why T1D rates continue to rise in countries where childhood disease and contact with pathogens is still quite prevalent. 

The Viral Hypothesis 

The viral hypothesis represents, in some way, the antithesis of the hygiene hypothesis. Here, scientists have found a connection between increased exposure to certain viruses and the development of type 1 diabetes.

Research shows that some viruses may trigger or accelerate autoimmune activity in a predisposed person. Rubella, mumps, and rotavirus have all been implicated in this phenomenon, but enterovirus seems to have the most concrete connection in recent studies. 

Long term environmental studies following children with type 1 relatives have found that a large number of those that go on to develop diabetes were infected with enterovirus in the months or years before they tested positive for autoantibodies. There even appears to be some connection between pregnant women getting enterovirus and their child having a higher likelihood of getting type 1. 

While there is a huge amount of evidence linking certain viral infections to the development of type 1, this explanation doesn’t quite explain the sudden rise in T1D prevalence. Especially considering that childhood viral infections have become less common in recent decades.

Breastfeeding and Formula Hypothesis

One other hypothesis that continues to hold up, though the exact mechanisms have changed some, is the association between infant feeding methods and the development of type 1.

There have been some connections drawn between early exposure to cow’s milk, especially dairy-based formula and the prevalence of type 1. But more recent research has focused on what tends to be missing when cows milk is fed early instead of breast milk.

Like the first two hypotheses, this one focuses on the development of the early immune system. 

There are many molecules in breast milk that seem to prevent infection and even autoimmunity in infants. Secretory IgA, for instance, plays an important role in both protecting intestinal flora and providing antibodies against specific threats. Even the insulin present in mother’s milk appears to play some role in reducing the odds of developing type 1.

Unfortunately, this theory alone also falls short of explaining the consistent rate of growth in T1D prevalence. While there was a noticeable drop off in breastfeeding rates in the US around the middle of the 20th century, that rate has recovered somewhat since, while the rate of T1D prevalence continues to grow.

“Balance Shift” Might Be the Answer

As a single explanation for the increasing rates of type 1, none of the theories postulated so far appear to provide an answer. However, if we look at all of the plausible explanations as factors that are interconnected, the possibility of building an explanation that does align with current trends is much more likely.

This “Balance Shift Model” as postulated Francesco Maria Egro, describes how a balance between protective and diabetogenic factors must remain in place in order for the prevalence of the disease to stay consistent. 

For example, the protective power of early exposure to pathogens and the immune-supporting benefits of breastmilk might override the diabetes-inducing power of certain viruses. If a child is not breastfed, then that balance may still be maintained through greater protective qualities of pathogen exposure or through another theory, such as higher vitamin D levels.

But, if multiple protective factors are reduced simultaneously, we would expect the rates of type 1 to rise. Similarly, if deleterious factors were increased, we could also expect rates of T1D to go up.

What these decreasing protective factors and increasing diabetogenic factors may be in any given country is likely to be different. But the results–an increase in T1D prevalence–would be the same.

The beauty of the Balance Shift theory is that it doesn’t discount the many other T1D prevalence theories that do appear to have evidence in their favor. Instead, it validates a wide range of correlations by explaining how each plays a part in determining whether a person who is predisposed to diabetes will get the disease or not.

And more importantly, as an answer to why rates are rising, it explains how we are seeing the same trends in most countries despite vastly different cultural practices and health issues. 

While we still don’t know exactly what all the factors that play into this model might be, the model appears to be the most plausible explanation for the increase we continue to see in T1D diagnosis. 

And for now, this might be the most complete answer we will get.

The post Why T1D Diagnosis Rates Continue to Rise Across the Globe first appeared on Insulin Nation.

As exciting as this news seems, it is important to pause anytime these types of announcements are made.

In this article, we take a look at the astonishing results of this new study, how the researchers got there, and take a critical look at what this actually means for people living with this, so far, incurable disease. 

How Was Type 1 Diabetes Cured in Mice?

Results from the study headed up by Jeffery R. Millman, Ph.D. were released in Nature Biotechnology last month.

The article discusses how the researchers were able to improve upon current techniques for transforming human stem cells into insulin-producing beta cells. 

Up to this point, transforming stem cells into a specific target cell always resulted in a wide array of different types of cells in addition to the one being targeted. While these random cell types don’t cause problems when injected into a subject, they do result in a significant decrease in the number of target cells produced.

Millman and his associates were able to refine this process by targeting the cytoskeleton of the stem cells to produce better functioning insulin-producing beta cells without producing as many random cell types.

With a more effective way of producing high-functioning human beta cells, the scientists were then able to transplant islet-sized aggregates, or small groupings, of these cells into mice with preexisting diabetes.

These mice, which were experiencing sustained blood sugars of over 500 at the time of the procedure, began showing normal blood sugars within two weeks of the transplant. These normal blood sugars continued without any other intervention for at least 9 months, with some mice showing normal levels for over a year.

What Does this Cure Mean for People with T1D?

While this study shows a lot of promise for the future of type 1 diabetes treatment and even a potential for a cure, this in no way guarantees humans with T1D will see a day free from their condition anytime soon.

There are a few reasons why we should remain skeptical about an impending cure with the two most important having to do with issues associated with mouse models and the problem of scaling.

The Problem with the Mouse Model

Mice have long been used in scientific research of human diseases. While their rapid life cycles make them perfect subjects, their physiology differs greatly in many respects from humans and what shows promise in a mouse study doesn’t always perform well in human trials.

In fact, according to Dr. Juan Juame, a professor at the University of Toledo who studies mice models for T1D, there have been over 125 proven therapies to cure diabetes in mice but none have held up in human trials.

The reason for this is fairly simple: Mice don’t naturally suffer from the same type 1 diabetes autoimmune disease that humans do. The mice used in these studies are generally “non-obese diabetic mice.” These mice have been specially bred to exhibit similar physiological symptoms as type 1 patients but the pathophysiology of the disease is different.

Because studies like the one out of the Washington University School of Medicine rely on these imperfect mouse models, it is impossible to say how a person suffering from type 1 might react to this same treatment.

The Issues with Scaling

Another problem with these types of “cure” studies is the issue of scaling.

Obviously, mice are much smaller than humans, which means they require fewer beta cells to adequately control their blood sugar. In order to replicate this study in humans, researchers would have to create about 1 billion cells per test subject, something that, at this time, is not yet possible.

But scaling doesn’t just relate to the number of cells needed, it also causes issues when looking at how long this cure may be effective.

The mice in this study were able to maintain normal blood sugars for at least 9 months. Since humans have a significantly longer lifespan than mice, we would expect this amount of time to be much greater in people. However, we also know that the disease-specific actions of the autoimmune system in humans could have a more limiting effect on the curative power of this treatment.

It’s possible that a human treated with a similar stem cell transplant may show normal blood sugars for a decade or maybe only for a few months.

Even if the treatment does last many years, it would still likely fall short of attaining cure status since, eventually, the patient’s immune system will destroy the new beta cells.

More than likely, additional transplants would be needed throughout the patient’s life. It is also possible that immunosuppressors or other common transplant drugs be used to keep the immune system from decimating the new cells. We may even see a completely different approach to this treatment in humans, such as encapsulating the new cells in something similar to a PEC-Encap or SeraGraft device.

What Comes Next?

Answers are still a long way off to how scientists will mass-produce these beta cells and how long the cure will be effective in humans.

For now, Dr. Millman and his team are looking to begin additional animal trials in larger animals such as rats and pigs. Using additional models will give the researchers a better idea of how this treatment may translate to a potential treatment in humans.

In the meantime, they will also be hard at work establishing an easy and cost-effective way to create these beta cells in mass so they will be ready for human trials if and when they are needed.

While we aren’t yet ready to throw our hats in the air in celebration of an impending type 1 diabetes cure, we are still watching this research closely. After all, even if we have already seen over one hundred T1D cures fail in human trials, it only takes one success to change everything.

The post Should We Be Excited About ‘Curing’ T1D in Mice? first appeared on Insulin Nation.

Last year we had the opportunity to talk with Dr. Faustman, an Associate Professor of Medicine at Harvard and the Director of the Immunobiology Laboratory at Massachusetts General Hospital. At the time, Dr. Faustman was studying the effects of the BCG vaccine, a century-old tuberculosis vaccine, as a cure for type 1 diabetes. (You can read more about that exciting research here.)

While her research into T1D is still very much active, the events of 2020 have Dr. Faustman working overtime as she prepares to launch yet another BCG vaccine trial to test this age-old remedy as a preventative treatment against the progression of the coronavirus disease.

I recently had a chance to catch up with Dr. Faustman to find out what it is about this unique vaccine that makes it so versatile and what potential application it has in battling the global COVID-19 pandemic that has already affected so many lives.

How Vaccine Protects Against Infections and Diabetes?

Before we can understand how a vaccine can protect against such a wide array of diseases, we first have to look at what makes the BCG vaccine so unique.

Unlike most directed vaccines we use today, including many of those that are being developed right now as a possible vaccine against COVID-19, the BCG vaccine does not utilize a dead or weakened version of the antigen that causes TB. Instead, it utilizes a weakened strain of bovine bacilli, an ancient organism that humans have coevolved with for millions of years.

While most vaccines rely on the body’s adaptive immunity, or the immune system’s ability to respond to a specific infection based on previous exposure, the BCG vaccine affects your body’s innate immunity or the first line of immune defense that prevents the spread and movement of any foreign pathogens throughout the body.

As Dr. Faustman puts it, “It’s believed that what BCG does is automatically boost your innate immune system so that now when you see an organism you don’t have antibodies to, that you don’t have immunity to, you can have a better cytokine response and a better way to fight that infection at a faster rate because of this chronic synergy you have with the BCG organism. So it’s kind of a way to make a super immune system; to dress up your immune system to make it better.”

We have seen the effects of BCG’s super-immune-boosting powers many times before. Dr. Faustman says there are at least three human trials that have shown that if you get the BCG vaccine you are less likely to get respiratory viral infections. Even the incidents of infectious diseases like malaria and yellow fever decrease when the BCG vaccine is given, according to data from double-blind placebo-controlled clinical trials.

But the power of this amazing vaccine doesn’t stop at infections. Current trials, including Dr. Faustman’s own, have shown that BCG has the power to rewire the immune system to treat autoimmune diseases like type 1 diabetes and multiple sclerosis.

Promising Data on the BCG Vaccine and COVID-19

It is this history as an effective treatment for so many diseases that have had many scientists looking to the BCG vaccine as a potential preventative treatment for COVID-19 since the very beginning of the coronavirus outbreak.

Dr. Faustman says that in the last two months there have been multiple papers published looking at the differences in COVID-19 mortality rates between countries like the US, Italy, and Spain that do not have national BCG vaccination programs and countries like China, South Korea, Russia, and Japan who do.

Each of these epidemiology studies shows the same trend: A marked survival benefit in countries who routinely use the BCG vaccine.

While this does not prove that BCG will reduce the mortality rate or severity of COVID-19, these studies do show a strong correlation between the two, which is part of what is driving the current wave of human clinical trials using this vaccine.

Starting Human Clinical Trials for BCG

Currently, there are active trials in both Europe and Australia testing the efficacy of the BCG vaccine against COVID-19. Dr. Faustman’s human clinical trial would be the first of its kind in the United States. She hopes to begin enrolling participants within a month.

Due to the high prevalence of coronavirus cases within Boston, the city is the perfect location for such a trial. In order to reduce the time needed to see results, this trial will enroll high-risk healthcare workers who are more likely to be exposed to the virus within a relatively short period. Similar to the trials in other countries, Dr. Faustman hopes to enroll between 2,000 and 4,000 people.

Half of these participants will receive the BCG vaccine and half will receive a placebo. The hope is, that within the year, enough of these participants will be exposed to the virus that the researchers will be able to draw conclusions about the effectiveness of BCG.

Given the effect the vaccine has on other respiratory illnesses, the assumption is not that BCG will prevent infection altogether, but that it will greatly reduce the severity of symptoms or eliminate symptoms altogether while also reducing the mortality rate of the disease.

Results from Dr. Faustman’s study along with the current trials underway and the ten or so additional trials set to begin around the world in the coming months should provide more than enough data to help governments and healthcare organizations determine if BCG would be a useful tool in the battle against coronavirus.

Potential for Widespread Large-Scale BCG Treatment

At the very least, Dr. Faustman hopes that the BCG vaccine may be a helpful preventative measure to be utilized by high-risk groups such as healthcare workers and the elderly. 

But given the potential for some low-risk patients to develop severe complications from coronavirus as well as the well-documented safety and the extraordinarily low cost of producing this particular vaccine, it may prove a useful measure for all.

Dr. Faustman explained that right now there are a number of biotech drugs being tested for use in severely ill patients as well as many companies pursuing a true vaccine for COVID-19. But, in terms of what people can do to protect themselves today, there are masks and social distancing, but that’s about it. 

The BCG vaccine has the potential to fill that gap.

Wide-Ranging Benefits of the BCG Vaccine

In addition to the obvious benefits the BCG vaccine could have on fighting COVID-19, there are many other reasons to hope that these trials drive a large-scale BCG vaccination effort. 

For one, getting large companies interested in producing this vaccine again has the potential to increase the supply and quality of the vaccine relied upon to treat vulnerable children in less developed nations around the world.

In addition, many studies have shown that inoculation with BCG actually has the power to make more effective the other vaccinations patients receive. Not only could this have a huge impact on the number of flu cases each year, but it may be the missing piece in creating a COVID-19 vaccine that actually works.

And, of course, for so many type 1 diabetics in the world, the BCG vaccine has the potential to change their lives in a profound way.

I asked if Dr. Faustman believed getting the BCG vaccine as a preventative for COVID-19 would have a positive impact on a diabetic’s blood sugars. 

“Oh yeah,” she said, “we are still very optimistic about type 1 diabetics [and the BCG vaccine]. We fully expect to see a disproportionate number of type 1 diabetic nurses signing up for our Boston COVID trial.”

Previous research has shown that the blood-sugar-lowering effects of BCG take around two to three years to have a full clinical impact. Meanwhile, the effect of BCG on the body’s ability to fight off respiratory viruses happens much faster. Researchers expect trial participants to show increased resistance to severe COVID-19 symptoms within a couple of weeks of inoculation.

This fact combined with the high incidence of coronavirus infection in the COVID-19 trial participants means that results from these more recent BCG studies are likely to be released relatively quickly.

Meaning, that while we may have to wait another two years to see the results of Dr. Faustman’s BCG-diabetes study, access to her potential diabetes treatment could be just a short COVID-19 trial away.

The post Possible T1D Treatment Shows Promise to Reduce COVID-19 Complications first appeared on Insulin Nation.

This is the second piece of tech from Tandem to receive such designation. In December of 2019, Tandem’s Control-IQ also received iAGC status. 

To understand what is so important about these interoperable designations, you need to understand the different types of “i” designations and how they will benefit users.

Tandem’s Basal-IQ

In contrast to Control-IQ, which works to fully automate insulin delivery for the user, Basal-IQ simply works on the lower end of the BG spectrum.

Basal-IQ is similar to Medtronic’s SmartGuard in this regard.  It is a technology that works to reduce hypoglycemia by suspending insulin delivery through an insulin pump anytime a low is predicted based on the values from a connected CGM. 

Specifically for Basal-IQ, if BG levels are predicted to drop below 80 mg/dL within 30 minutes or current levels drop below 70 mg/dL, it instructs the pump to suspend insulin delivery until blood sugars begin to rise.

Right now, this tech is available to be used with the Tandem t:slim X2 insulin pump and the Dexcom G6 CGM.

But, with the new interoperable designation, the Basal-IQ algorithm can now be used with other “i” designated pumps and CGMs without the need for additional FDA approval.

An Interoperable Future?

At this point, there are few interoperable designated devices on the market. But, as this designation is expanded to more and more products, users will gain the ability to mix and match devices to create their own customizable AID systems based on the devices they like best.

But before we dive too deep into the potential benefits of this new designation, lets first look at the three different categories of “i” products that current diabetes tech can fit into.

Interoperable Automated Glycemic Controller (iAGC)

iAGCs, or iControllers, are algorithms used to process values from a CGM and turn them into commands for an insulin pump to follow. This type of tech is the basis for all AID systems.

While multiple companies have developed or are in the stages of developing these types of algorithms, Control-IQ and Basal-IQ are the only ones currently approved to be used with other “i” pumps and CGMs beyond the devices they were originally packaged with.

Tidepool, a non-profit organization, is currently in the process of developing an open-source algorithm and will also be seeking this special FDA designation.

Alternate Control Enabled (ACE) Insulin Pump

Before a pump can be used with an iAGC or CGM that was not part of it’s original makeup, it must first receive the Alternate Control Enabled (ACE) designation. Once it has this designation, the pump can be used with different components to create a customizable AID system without the need for further FDA approval.

The only pump, so far, to receive this ACE  designation is Tandem’s t:slim X2

Interoperable Continuous Glucose Monitor (iCGM)

The last piece of the AID puzzle is the CGM. As you can probably guess by now, interoperable CGMs, or iCGMs, are continuous glucose monitors that can be used alone or in combination with different pump types and algorithms to create an AID system.

Currently, the Dexcom G6 is the only CGM with this iCGM designation.

Why Interoperable Designations are Important?

To understand why these designations are so beneficial to the diabetic community, we have to look at an AID system that lacks the type of flexibility the “i” designation was created to build.

Old School Approach

Medtronic was the first company to develop a fully functional AID algorithm capable of taking readings from a CGM and turning them into commands for an insulin pump to follow. This powerful new tool allowed users to take a step back from their diabetes management. They no longer had to set their own basal rates or work as hard to prevent highs or lows between meals.

Medtronic’s algorithm works exclusively with its MiniMed 670g system. As promising as the tech is, that exclusivity is where this product falls short.

Anyone interested in using the Medtronic hybrid-closed loop system has to use Medtronic’s pump and CGM as well. 

While the Medtronic pump has had many problems of its own, including a recent recall due to a reservoir ring malfunction, it is the CGM that truly discourages many T1Ds from purchasing the product.

Unlike the new Dexcom CGM, the Medtronic CGM requires multiple daily calibrations. It also has a shorter sensor life and is less accurate overall than the G6.

Better User-Friendly Approach

Many users would prefer to use the Medtronic AID system if it used the Dexcom G6 CGM. Other people would likely prefer a different pump, like the Tandem t:slim X2 or Insulet’s tubeless Omnipod. Unfortunately, this kind of mixing and matching is not available with the Medtronic AID system.

It is only possible with devices that have been designated as interoperable.

At the moment, only Tandem’s algorithms and t:slim X2 pump and the Dexcom G6 CGM have interoperable designations and can be mixed and matched this way. 

Insulet’s Omnipod has announced its own AID based on a partnership with Dexcom.  We expect they will seek ACE designation in the next 18 months.

While this doesn’t provide a lot of choices at the moment, things will be different in a few years after companies like Tidepool and Abbott add their tech to the interoperable smorgasbord. And if Medtronic and Insulet get on board, the options for AID customization could truly become endless.

The post Tandem’s Basal-IQ Gets FDA Interoperable Designation first appeared on Insulin Nation.

Deleting this gene caused the beta cells in the mice to de-differentiate or revert to an earlier, less specific functional stage. After a short period of hyperglycemia, these beta cells re-differentiated back into healthy, insulin-producing, mature cells.

Surprisingly, this short reversal in function was enough to prevent immune activation against the cells, thereby preventing autoimmune diabetes from ever developing.

I spoke with Assistant Professor Feyza Engin, the lead author of the study, which was published in Cell Metabolism, and ask her some more in-depth questions about this research.

IN: Your team first expected that deleting this gene would expedite the development of type 1 diabetes, not cure or prevent it. Can you talk about your expectations going into the study and what it was like to stumble upon a finding like this?  

Feyza Engin: We previously published a study where we showed that endoplasmic reticulum (ER) stress and defective unfolded protein response (UPR) existed in pancreatic beta cells of 2 mouse models of type 1 diabetes (T1D) as well as human patients. Treating these mice with a compound called TUDCA mitigated ER stress and prevented T1D. TUDCA is now in Phase I clinical trials for the treatment of T1D. 

Building on this study, we hypothesized that targeting the UPR could affect the disease progression. We initially predicted that deleting a key UPR gene would accelerate the disease. 

Thus, when we observed that IRE1 deleted mice were developing hyperglycemia following weaning (3- 4 weeks of age), we thought we were right in our initial hypothesis, but surprisingly almost all of these mice started to recover from the hyperglycemia. 

Then, our next prediction was that they would still get attacked by immune cells. 

However, even after almost a year of monitoring these mice were still normoglycemic and healthy. At that point, we knew that understanding the mechanisms of this phenomenon would lead to an important discovery.

IN: Did the effects of the genetic modulation last for the entire lives of the mice? Would you expect to see a similar manipulation prevent diabetes in humans using this method?

Feyza Engin: IRE1 deficient mice were normoglycemic for up to 50 weeks of age which roughly corresponds to 40-50 years of age in humans. After this point, we ended monitoring these mice. 

It needs to be tested in a clinical setting whether deleting a single gene from the beta cells of high-risk individuals could lead to a similar protective effect in humans. 

However, we know that a cancer drug, Gleevec, is currently under Phase II clinical trials for the treatment of new-onset T1D patients. Interestingly, studies showed that Gleevec exerts its anti-diabetic effects via inhibiting IRE1.

IN: How long did the hyperglycemia phase last in mice? How long would you expect it to last in humans?

Feyza Engin: The duration of hyperglycemia showed variations in mice, but roughly they were hyperglycemic for about 3-4 weeks. It is hard to predict if the deletion of IRE1 in humans will lead to hyperglycemia as most likely this would depend on when, where, and how it will be inhibited, hence making a duration conversion from mouse to human would be difficult.

IN: Can you explain the process by which the deletion of the target gene is carried out? Would you expect a similar method to be used in humans if this is found to be useful?

Feyza Engin: Since we aimed to delete IRE1 before pancreatic islets were infiltrated by immune cells, we targeted IRE1 deletion in mice early in their life. We injected lactating dams with a drug called tamoxifen. Tamoxifen triggers the deletion of IRE1 in beta cells in pups. While this system worked very well in mice, there are other gene-editing tools that can silence a gene in humans.

IN: You mentioned that this method could be a potential treatment for people at “high risk” for developing type 1. Can you expand on what might make someone a candidate for a treatment like this?

Feyza Engin: Detection of diabetes-relevant islet autoantibodies is essential for predicting and preventing type 1 diabetes (T1D). Directly related to our study, whether islets of autoantibody-positive individuals are already infiltrated with immune cells is a debate in the field and the more we learn about this, the better chance we may have to identify a therapeutic window for prevention.

IN: When would the treatment need to take place to be successful, assuming it works the same way in humans as it did in the mouse model? Would it still be useful after autoantibodies are detected or would it need to be done before that point?

Feyza Engin: Yes. As I stated above, autoantibodies are the best prediction tool and there is a potential to intervene to manipulate stress responses at this point. Prior to this point, it is not possible to identify individuals at high-risk definitely.

IN: In a broader sense, how do you envision this discovery being applied to prevent or treat T1D in humans?

Feyza Engin: We are just unveiling novel preventive and therapeutic strategies against T1D that are focusing/targeting pancreatic beta cells. Our discovery identifies a therapeutic window where beta cell identity and function can be compromised for a short period of time during the early stages of the disease to induce immune tolerance and ultimately prevent the disease. Thus, this opens up exciting new opportunities to explore the right genetic and/or pharmacological tools to modulate ER stress in beta cells to be used alone or in combination with other immune-modulating strategies to prevent or treat T1D in humans.

IN: What are the next steps for this research? Do you have any sense of if/when human trials might become a possibility?

Feyza Engin: Our discovery leads to many important questions that need to be answered. 

• How do beta cells recover from stress and restore their function? 
• How do de-differentiated cells induce immune tolerance? 
• Would manipulation of IRE1 in beta cells later in life exert anti-diabetic effects? 
• What are the functions of other stress response genes in beta cells? 
• Can we generate specific IRE1 inhibitors with minimal toxicity and off-target effects to be used in humans? 
• Using novel genome-editing methods can we manipulate the functions of this gene in beta cells? 

Answering these questions will lay the foundation for the human trials.

The post Deleting Gene in Mice Prevents T1D from Developing first appeared on Insulin Nation.

Today, plenty of patients utilize an insulin pump or a tubeless insulin reservoir for this purpose. Many more turn to insulin pens as a simple and affordable option. And, despite these advances in tech, a huge number of people still choose to inject insulin via the old fashioned method: with a vial and syringe.

There is no shortage of pump cases, pen carrying packs, and other gear for these higher-tech items.

Finding simple and effective options for transporting syringes, especially those preloaded with a day’s worth of insulin, is surprisingly challenging.

It was this hunt for better supplies that led Carlos Sapene, a type 1 diabetic with a background in 3D modeling computer design, to create a user-friendly, stylish, and affordable prefilled insulin syringe carrying case.

I had a chance to talk with Carlos more about his invention and what drove him to pursue this particular unmet diabetic need.

Identifying an Unmet Need

Carlos Sapene was diagnosed with type 1 diabetes seventeen years ago as a young adult. Since then, Carlos has tried almost every available method for insulin injection, including pens and pumps. 

But, even when he was using a more advanced method of diabetes care, Carlos often found himself carrying around extra needles and insulin vials as a backup. And, when the cost and additional work required for these higher-tech solutions became too much, he often found himself relying solely upon this much simpler tactic.

Since carrying a vial of insulin around all day brings with it the inherent risk of breaking the fragile glass bottle and losing an entire month’s supply of this costly drug, Carlos preferred to pre-fill his insulin syringe with what he would need for the day and carry only that with him.

Unfortunately, carrying a full needle around in your pocket or bag comes with problems of its own.

This is how Carlos was first introduced to the very limited and uninspiring world of syringe carrying cases.

What Makes This Product Better?

While Carlos came to rely on the syringe cases currently on the market, he couldn’t help but feel that there was room for improvement.

For one, many of the cheap plastic cases he had to use were prone to breaking. The thin hinges were usually the first to go. Then it would be the pocket clip that would snap off.

But worse than the brittle nature of the cases, was how un-user-friendly they were.

The latch that held the case closed was either too weak to do its job or impossible to open with one hand. And the tracks on the inside of the case meant to keep the syringe in place dictated that the syringe be filled to pre-set amounts, meaning you had to depress the plunger to the right point and waste valuable insulin if you wanted the syringe to fit securely.

Luckily, Carlos had the right skills to identify and tackle the shortcomings of these standard syringe cases. He put his engineering and 3D printing background to the test and began designing a better syringe case.

He designed his new case to not only be stylish and discrete but to actually work for the purpose it was designed. 

Unlike the disappointing cases he had been using for years, Carlos’ case utilizes a wide living hinge built to withstand movement without wear. He also designed an ergonomic latch that can be easily opened with just one hand.

Carlos was also able to fix the issues with the inner design of other cases. His case can fit any size syringe from 1/3cc to 1cc securely no matter how much insulin the syringe is holding. 

The outside of his case also got a much-needed makeover. Unlike other pre-filled syringe carrying cases that tend to be round, bulky, and almost always black, Carlos’ case is compact, with a slimmer profile, a stronger, recessed pocket hook, and it comes in multiple colors.

Making This Prefilled Syringe Carrying Case a Reality

Currently, Carlos’ case is available for discounted pre-sale on his website. He is starting a crowdsourcing campaign to officially launch the product and begin manufacturing. 

“This product was designed by somebody with diabetes for people affected by diabetes,” says Carlos. “[By] purchasing this prefilled syringe case you are not just purchasing a very good quality product, you are also helping to bring new ideas and products to the market that enhance the lives of people with diabetes at an affordable price.”

To learn more about this product, get some helpful tips about living with diabetes, or to pre-order your new pre-filled syringe case, visit https://www.t1d-ignited.com/ or email Carlos directly.

The post Designing a Great Prefilled Insulin Syringe Case first appeared on Insulin Nation.

For parents like me and for others out there who have a type 1 in the family, free screening resources for these types of genetic diseases can help ease much of that worry.

If you’ve ever caught yourself focusing on symptoms in your child that may or may not be there or have yourself wondered if you are at risk of developing T1D, here are some great resources worth looking into.

TrialNet Screening for Relatives of T1Ds

Type 1 Diabetes TrialNet is a group of physicians, scientists, and healthcare professionals who are working to better understand the genetic predisposition, development, prevention, and treatment of type 1 diabetes.

In their quest to better understand how this disease operates and how it can be better treated, they provide free T1D screenings for relatives of people with type 1.

Who Qualifies for TrialNet?

TrialNet’s free screening is available for:

• Anyone from the age of 2.5 (3 for those in the United Kingdom) to 40 years of age who have a direct T1D relative (parent, sibling, or child)
• Anyone from the age of 2.5 (3 for those in the United Kingdom) to 20 years of age who have a more removed relation to someone with diabetes (aunt/uncle, cousin, grandparent, niece/nephew, or half-sibling)

TrialNet has testing facilities available around the world and also provides in-home test kits that can be mailed in. These in-home kits require only ten drops of blood and are generally easy to collect yourself. However, if the results are inconclusive or positive, you will need to visit a testing facility in person for a second test.

What Do Your TrialNet Results Mean?

Once TrialNet has your sample, they will test it for all known T1D autoantibodies.

Those who test negative for all these antibodies are unlikely to develop type 1 and will not need to be tested again. There is still some possibility of developing the condition later on, but this risk is greatly reduced.

For those who test positive for a single autoantibody, their odds of developing type 1 are much greater. If you fall into this category, TrialNet will want to retest you in a year to look for additional autoantibodies. They will also let you know if you qualify for any prevention studies that might decrease your odds of actually developing the disease.

Those who test positive for more than one autoantibody are considered to already have type 1 diabetes. Further diagnostic tests will be performed to determine the stage of the disease and your eligibility for available prevention or treatment studies.

If you are interested in learning more about TrialNet or want a list of testing locations or instructions on how to get your home test kit, you can visit their website here.

Alternative Free T1D Screening Options for Children

While TrialNet continues to be a great resource for type 1 parents and for those with type 1 relatives, it can’t provide peace of mind to everyone.

After my own type 1 diabetes diagnosis, I learned that the only other person in my family who had the condition was my mom’s cousin. Even if we had been aware of the option or need for type 1 screening, I would have never qualified for the free test through TrialNet.

Luckily, for children living in my home state of Colorado, there is a new option for diabetes screening.

ASK Program

ASK—Autoimmune Screening for Kids–is a program run out of the Barbara Davis Center for Diabetes in Aurora, Colorado. The team of doctors behind the new screening initiative is hoping to learn more about the development of common childhood autoimmune disorders by opening up screening to all children ages 1 to 17, regardless of if they have a family history of diabetes.

In addition to testing for type 1 autoantibodies, the ASK program also tests for Celiac’s Disease markers, a disease that affects about 1% of the general population and about 6% of type 1 diabetics.

Anyone who tests positive for autoantibodies of either disease in this study will be provided free follow-up services to help educate parents on identifying symptoms of disease onset and guiding them toward prevention resources.

Screening Tests Save Lives

Currently, the ASK program is only available to Colorado residents. And, unfortunately, it is one of the few free screening services available to children without a type 1 connection.

Because type 1 diabetes is so often diagnosed only after severe symptoms such as DKA are present, screening services like this one and TrialNet are vital in reducing the damage and healthcare costs associated with delayed diagnosis. 

Children, especially, are at risk of being misdiagnosed, a mistake that has led to many unnecessary and preventable deaths. 

Learn more about the benefits of screening your child for T1D here and about some of the trial and study options available here.

For type 1 parents and for people with type 1 relatives, taking advantage of screening options through TrialNet is a great way to reduce this risk. For children living in Colorado, even those with no apparent risk of autoimmune dysfunction, it is still worth taking the time to have this screening done.

Helping Research

Beyond reducing the risk around diagnosis, these types of programs provide valuable data to researchers who are looking for a connection between genetics, environment, and lifestyle and the development of type 1 diabetes. Additionally, these programs provide important opportunities to study prevention and management methods that may reduce the number of those suffering from T1D in the future.

The post Free Type 1 Diabetes Screening for Children Saves Lives and Aids Research first appeared on Insulin Nation.

Her friends and teachers thought type 1 diabetes was contagious, so she wasn’t allowed to play with other children and many teachers didn’t want her in their classroom. 

My high school principal said I couldn’t go on the senior class trip because I was a danger to other children because of my diabetes.”

Debbi is now 69 years old. The doctors were very wrong — about a number of things.

Unable to check blood sugar levels

For the first several decades of Debbi’s life with type 1 diabetes, she was essentially unable to ever actually check her blood sugar levels. 

“Back in those days, the only way to check your glucose levels was by using a urine test strip. The problem was that the results it gave you were from two hours ago, and they were a range, not a specific number,” explains Debbi.

In other words, the methods available for checking your blood sugar were essentially useless. 

Instead, Debbi took insulin NPH and Regular insulin and juggled her blood sugar levels by feeling the symptoms and inevitably experiencing a lot of low blood sugars.

A testament to just how often Debbi struggled with low blood sugars was evident in her HbA1c, which was often as low as 4.9 percent.

Back then, low blood sugars were called ‘insulin reactions’,” explains Debbi. “My mother would get mad at me because she thought I had done something purposefully to mess things up.”

Severe hypoglycemia and seizures became very common for Debbi. Her mother would inject glucagon and call an ambulance at least once a month. The seizures became so frequent that Debbi was eventually misdiagnosed as also having epilepsy.

“The doctors started making me take Dilantin — an epilepsy drug for seizures. But my seizures kept happening,” says Debbi, recalling the frustration. “After going to diabetes camp for the first time and watching other kids have seizures because of low blood sugars, I was sure I didn’t have epilepsy.”

Worse, Debbi felt the epilepsy drugs she’d be forced to take were actually causing further seizures since she wasn’t actually epileptic. 

“I finally convinced a neurologist that I didn’t have epilepsy. He admitted that he was just following other doctors’ notes and finally did his own tests.”

Fortunately, he concluded that Debbi didn’t have epilepsy either and took her off the meds, which immediately reduced the frequency of her seizures!

Using the same syringe for years

“We used the same needle for two or three years, basically until it broke,” Debbi recalls. “They just didn’t believe in changing it.”

Debbi’s syringe was kept in a mason jar that also contained cotton balls and rubbing alcohol to keep it sterile. After each injection, it would also be dipped in boiling water.

When the needle wouldn’t puncture my skin on my thigh, that meant my mother had to remove the burrs that had built up, making it too blunt.”

Debbi and her mother would remove the burrs (which aren’t really visible to the naked eye) by taking a pumice stone to the needle to essentially re-sharpen it.

Transitioning to newer technology in 1985

“I was the first employee at my work to have an insulin pump, but in order to get a pump my doctor said I had to start checking my blood sugar more often,” recalls Debbi.

Having never been able to accurately check her blood sugar for the prior 20 years of her life with type 1 diabetes, Debbi had little understanding of just how useful these newer blood glucose strips and meters would be to her. 

“I was vaguely aware of it but I didn’t understand the purpose of it because I’d lived with type 1 for so long without ever being able to check my blood sugar. My A1c was fine and I went to my regular doctor appointments, I didn’t think I needed or had time to check my blood sugar.”

Motivated by the idea of using an insulin pump, Debbi started using a glucose meter, too.

“I started seeing just how much my blood sugars were truly fluctuating. It was very eye-opening.”

She asked her healthcare team for a prescription to get more test-strips in order to keep up with her very active job as a police officer and eventually working for a security team. 

Eventually, Debbi was asked by her healthcare team to be part of a team that would help other patients learn how to treat their diabetes. While there was little-to-no diabetes education available in the 60s and 70s, the newer technology meant more information which led to more opportunities for education.

Thriving today against the odds

Despite living with type 1 diabetes for decades when technology and insulin were minimal, Debbi is 69 years old today with no diabetes complications.

Debbi has a 47-year old daughter despite being told she would never have children.

She thrived in a career as a police officer and security guard. And watch out, because she was the second-best shot (with her pistol) out of all the officers in her county during her police career.

Debbi was diagnosed with Celiac disease at 50 years old but has used it as merely another motivation to make healthy decisions for her daily life.

With 50 years of type 1 diabetes under her belt, Debbi has spent years helping educate and encourage other patients through health fair events and support groups.

Accolades for Debbi Tally include:

• Diabetes On Target Groups  607-776-4065
• Founder, President, Diabetes Educator & Diabetes Advocate
• 50 Year Joslin and Eli Lilly Medalist
• 2013 Jefferson Award
• Bath Rotarian
• 2016 Paul Harris Award

The post Living with Type 1 Diabetes in 1959 first appeared on Insulin Nation.

While low blood sugar has been known to be mistaken for drunkenness, diet or diabetes-related ketones may mistakenly trigger a false positive on a breath alcohol test.

A study published by the International Journal of Obesity found evidence that ketones can potentially result in a false positive on a breath alcohol test — something especially important for people with diabetes and anyone following a ketogenic diet.

How Breath-Alcohol Tests Work

“These tests are used by police to indirectly measure how much alcohol is in a person’s blood,” explains the National Institute on Drug Abuse for Teens. 

“Alcohol breath-testing devices use the amount of alcohol in exhaled breath to calculate the amount of alcohol in a person’s blood, also known as blood alcohol concentration (BAC).”

When you consume alcohol, it enters your stomach and small intestine and is very quickly absorbed into your bloodstream. Your BAC reaches its highest level about one hour after consuming alcohol, but some of it will show up in a breath alcohol test within minutes of drinking. 

Your liver is responsible for breaking down about 90 percent of the alcohol you drink, because like other toxins, your liver wants to clear the poisonous substance from your system as quickly as possible. (This priority to remove toxins is also why it can interfere with the digestion of food and cause delayed hypoglycemia.)

The rest of the alcohol is eliminated through both your urine and your breath. 

The breath-testing device used most commonly in traffic stops converts the amount of alcohol detected in your breath to a corresponding blood alcohol level.

It is illegal to drive a car if your BAC is over 0.08 percent. (And of course, for those under 21, driving with any alcohol detected on your breath is illegal because it’s illegal for you to drink in the first place.)

Different factors can affect the rate at which alcohol impacts your breath alcohol content include: your weight, gender, time since your last meal, history of drinking, and how much you’ve consumed within any given period of time.

False Positives in Breath Alcohol Tests from Keto Diets

“A 59-year-old man undergoing weight loss with ‘very-low-calorie diets’ (VLCD) attempted to drive a car, which was fitted with an alcohol ignition interlock device, but the vehicle failed to start,” explains the study. 

The driver of the vehicle was surprised by the test results because he was 100 percent sober.

VLCD in research usually consists of approximately 800 calories per day and very few carbohydrates. 

“After a few days of dieting, fat becomes the main source of energy, and VLCD regimens are consequently ketogenic.”

When following a strict low-carb diet, your body burns body fat differently in a way that results in ketones, resulting in “ketonemia,” which is defined simply by a high presence of ketones in the bloodstream. 

Along with ketones, ketonemia also includes high levels of acetone, acetoacetate, and β-hydroxybutyrate.

The breath alcohol testing device measures other types of alcohol beyond alcohol.

“The interlock device determines alcohol (ethanol) in breath by electrochemical oxidation, but acetone does not undergo oxidation with this detector,” explains the study. “However, under certain circumstances, acetone is reduced in the body to isopropanol by hepatic alcohol dehydrogenase (ADH). The ignition interlock device responds to other alcohols (e.g. methanol, n-propanol, and isopropanol), which therefore explains the false-positive result.” 

The science here is a bit overwhelming, but the nutshell version is this: one component of a ketone is acetone and the acetone can be metabolized into “hepatic alcohol dehydrogenase” or ADH, which could then result in a false positive on a breathalyzer test.

“Acetone is a water-soluble volatile product of metabolism and is therefore exhaled in the breath and excreted in the urine,” explains the study.

In fact, measuring a person’s breath is one way a study or medical protocol can be sure a patient is following their VLCD.  

“The elimination half-life of acetone in humans is fairly long,” adds the study, meaning that ketones can persist in your breath up to 15 to 25 hours.  

“During ketonemia, the reduction pathway toward isopropanol becomes a strong possibility and, indeed, this secondary alcohol has been identified in blood tests of patients with hyperglycemia and poorly controlled diabetes.”

“If acetone is reduced to isopropanol during ketonemia, there is a strong possibility of false-positive results when ignition interlocks are used. Indeed, the concentration threshold for a positive test and failure to start the engine is often set fairly low, corresponding to a blood alcohol concentration (BAC) of 0.01–0.02 g/100 ml.”

What happens next?

If you were pulled over and asked to take a breathalyzer test, a false positive due to ketones isn’t the end-all and be-all of your results.

“Suspected drunk drivers first submit to a roadside breath-alcohol screening test and if this is positive they provide either an evidential breath-alcohol test or a blood specimen is taken for laboratory analysis,” explains the study. 

“Breath-alcohol screening tests incorporate electrochemical detectors similar to those used in the ignition interlock device and therefore respond to isopropanol. By contrast, most evidential breath-testing is performed by multifilter infrared analysis, and these are programmed to abort the test if acetone is detected on the suspect’s breath above a certain threshold value.”

In other words: it would likely be revealed in the actual blood test results if the only alcohol present in your body at the time was from acetone.

Accurate testing depends on the type of testing equipment used.

“Evidential breath-alcohol analyzers based on electrochemical oxidation cannot distinguish ethanol from isopropanol and this resulted in a false-positive test after VLCD,” adds the study. 

This means it’s critical that if you were in the situation of taking a breath alcohol test, and you’re either experiencing diabetes-related ketones as a person with type 1 or following a very low-carb ketogenic diet, you need to inform the officials operating the testing equipment of this potential variable.

“We suggest that people on ketogenic diets run the risk of false-positive breath alcohol tests owing to the reduction of acetone to isopropanol,” concludes the study. “People on VLCD need to be warned about this artifact when alcohol ignition interlock devices are used. This possibility also warrants consideration in connection with workplace alcohol testing and screening of drunk drivers with electrochemical sensors.” 

In other words, speak up if you think your ketones may trigger a false positive.

The post Ketones Role in False Positives on Breath Alcohol Tests first appeared on Insulin Nation.

In multiple double-blind, placebo-controlled clinical trials, the company has shown the effectiveness of this drug to preserve beta-cell function in subjects with pre-clinical and new-onset type 1 diabetes.

And now, with this new FDA submission process initiated, it appears teplizumab, the first preventative treatment for type 1 diabetes, may soon be on its way to market.

What is Teplizumab?

In highly technical terms, teplizumab is an anti-CD3 monoclonal antibody that disrupts the immune cell activity responsible for the destruction of beta cells in autoimmune diabetics. Or, more generally, this drug acts to rewire the immune system to increase immune tolerance and reduce or halt the destruction of insulin-producing cells in the pancreas.

When administered to subjects with a high probability of developing type 1–those testing positive for two or more autoantibodies–teplizumab appears to not only delay the onset of the disease but may actually completely prevent it from developing in some people.

In the clinical trial of teplizumab sponsored by the National Institutes of Health, the median time to clinical diagnosis was two years for those on the placebo and four years for those on the drug. 

About 60% of the subjects receiving teplizumab did not develop diabetes at all compared to only 30% on the placebo.

For these subjects, the drug was administered daily for fourteen days at the beginning of the study, and no follow-up treatment was given.

Who Might be a Candidate for Teplizumab?

While the above study looked specifically at the effects of the drug on people who tested positive for multiple T1D markers but had yet to develop hyperglycemia symptoms, other studies have shown promise for use of this drug in newly-diagnosed type 1s already showing clinical symptoms.

Subjects in these studies consistently demonstrated preserved beta-cell function and had a reduced need for exogenous insulin.

There is some potential for this drug to be useful for those with more advanced diabetes, but the main focus of Provention Bio for this exciting new drug is in preventing or delaying the development of diabetes in those with a high predisposition for the disease and in reducing insulin needs and blood sugar management difficulties in those who have just been diagnosed.

Current FDA Designation and Upcoming Market Release

In August of 2019, teplizumab was granted breakthrough therapy designation by the FDA, paving the way for an expedited review process for this one-of-a-kind T1D preventative.

Now, with the initiation of rolling submission of the company’s Biologic License Application for teplizumab, it seems a market launch date could potentially be announced as soon as 2021.

The rolling submission process allows Provention Bio to submit completed modules for the development and use of the drug on an ongoing basis. Currently, the company has already submitted the non-clinical module and hopes to submit the clinic module by the end of Q3 and the chemistry, manufacturing, and controls module by the end of the year.

Once the final module is submitted, the FDA will then make a filing decision. At this point, the company expects to receive a final review of the new drug within six months due to the breakthrough therapy designation. Meaning, it is possible we will see potential market release information for this treatment by the end of next year, assuming it is approved for use by the FDA.

Another Similar Drug Coming

While teplizumab is most likely to be the first type 1 diabetes preventative treatment to hit the market, there are a few similar preventatives in the works, including an oral treatment from ActoBio Therapeutics.

Neither ActoBio and Proventation Bio would have been able to get where they are today without the help of research studies like TrialNet that work to identify early markers of type 1 diabetes and assess risk factors for the development of the disease.

The post Provention Bio Starts Rolling FDA Submissions for T1D Preventative first appeared on Insulin Nation.

These studies came after years of research into the connection between infection with the rotavirus and activation of T-cells against pancreatic cells in those predisposed to type 1.

Due to an increase in the routine administration of the rotavirus vaccine to infants around the world, scientists were finally able to review large scale data on the links between this vaccine and T1D.

But now, despite promising early results, a new study published in March in JAMA Pediatrics shows no link–positive or negative–between this vaccine and the rate of type 1 development.

To understand what this means for the future of type 1 diabetes treatment and prevention, we must take a closer look at the disease’s connection with the rotavirus and the specific studies that have looked at the links between the vaccine and rates of T1D.

The Type 1 Diabetes/Rotavirus Link

It has long been theorized that infection with certain viruses activates beta-cell destruction in people predisposed to type 1 diabetes. One of the viruses most strongly associated with this phenomenon is the rotavirus, which causes millions of cases each year of diarrhea and digestive upset in children under the age of five. 

Mouse studies, including this one published in the Journal of Virology in 2008, show a strong link between rotavirus infection and the acceleration of type 1 diabetes onset.

Even more interesting, many studies have shown a clear correlation between past rotavirus infection and islet cell autoimmunity in children predisposed to type 1. One study, in particular, outlined a significant correlation between rotavirus infection and increased autoantibody load.

It was studies like these that caused many researchers to wonder if the rotavirus vaccine might impact the rates of T1D development.

Encouraging Early Studies on the Rotavirus Vaccine

While some scientists theorized that introducing even a weakened form of the rotavirus to predisposed children might increase the number of T1D diagnoses, others were hopeful that vaccination against the virus might decrease the risk of developing type 1.

Luckily, it was the optimists who seemed to win out as the first papers were published.

In 2019, prominent studies out of both the US and Australia found that the increased rate of rotavirus vaccinations correlated with a decrease in T1D diagnoses in children. The US study even found that getting vaccinated for the virus equated to a 33% reduction in the risk of type 1 diabetes.

The Recent Shift in Perspective

As promising as these initial studies were, there was an inherent flaw in how the data was collected.

In both the US and Australian studies, researchers compared the number of T1D diagnoses before the implementation of routine childhood rotavirus vaccination with the number seen after implementation.

In both countries, the number of children diagnosed with T1D was lower following the widespread use of the vaccine. 

There is no way to determine, however, if this phenomenon was a product of the vaccine or due to some other factor entirely.

While the rate of T1D diagnosis continues to rise, the number of cases in developed countries like the US and Australia has actually begun to plateau over the past couple of decades.

It is very possible that these first studies picked up on the tail end of a trend that was already in progress before the rotavirus vaccine was introduced.

Or, at least, that would seem to be the implication of this most recent study.

Unlike the previous studies, this newer study compared the T1D diagnosis rate of only children born after the implementation of this new vaccination program. The groups were broken down based on whether the children completed the full vaccination series, only part of the series, or remained completely unvaccinated against rotavirus.

In looking at these cohorts, the researchers found that there was no significant difference in the rate of diabetes diagnosis between children who were vaccinated against rotavirus and those who were not.

Finding the Silver Lining

While this most recent study would seem to indicate that the rotavirus vaccine does not protect children from developing T1D, it is still too early to completely count this vaccine out as a potential player in the fight against type 1.

More research and further studies using similar cohort data as this most recent paper will be needed before any true conclusion can be drawn.

In the meantime, there is a silver lining to this most recent information. 

While the vaccine failed to demonstrate any apparent protection against the development of T1D in the children studied, it did not appear to increase the risk of developing T1D either.

This is important to note considering, early on, many scientists thought that the rotavirus vaccine may pose a risk to children predisposed to type 1 diabetes.

For now, all of us T1D parents can breathe a sigh of relief knowing that while the RV vaccine may not be doing any extra good for our children, it is, at least, not doing any extra harm.

The post New Study Questions Rotavirus Vaccine Effect on T1D Development first appeared on Insulin Nation.

That is where a simple but ingenious invention by a student out of the University of Wisconsin-Madison comes in.

Attaching Steady Shot, a small U-shaped plastic device, to the end of an insulin pen allows the user to easily inject with a single hand. And in doing so, it opens up a number of new injection sites to the user.

The Importance of Rotating Injection Sites

Before you can truly understand the brilliance of such a device, you first must understand why site rotation is so important for your diabetes management.

In addition to helping you utilize glucose, insulin also acts as a fat-storage hormone within the body. And, surprisingly, this fact plays a huge role in the importance of site rotation.

When one area of the body is used too frequently to inject insulin, small, fatty lumps can develop under the skin. This condition, known as lipohypertrophy, not only makes injecting painful but can drastically decrease the amount of insulin absorbed into the body. When insulin isn’t utilized fully, it can make maintaining stable blood sugars impossible.

It is estimated that about 65% of insulin users suffer from lipohypertrophy. While this condition is reversible if the affected area is given enough time to heal, this can be difficult to accomplish for many people with diabetes who have limited choices of where to inject.

A Solution for a Common Diabetic Problem

This is where Shawn Michel’s Steady Shot invention comes in. 

Michel was a student at UW-Madison when he was given the task of inventing a new product in one of his entrepreneurial classes. The teacher asked the students to focus on solving a problem that was unique to their own lives. As someone who has been living with diabetes since the age of sixteen, Michel immediately looked to his own daily struggles for inspiration.

It didn’t take long for him to come up with the first prototype for a device he hoped might help him and others avoid the painful and aggravating side effects of lipohypertrophy.

His invention showed such promise that it got him accepted into the Discovery to Product program at the University. Here, Michel received mentorships and help in developing Steady Shot into a marketable product.

From Prototype to Market

By allowing the user to inject insulin with just one hand, Steady Shot enables diabetics to inject in areas that were previously impossible to reach such as the back of the arms, the lower back, and the buttocks.

The U-shaped plastic device acts as a second hand by gently pushing the fatty layer up as the needle inserts, similar to the way you would pinch the skin yourself when injecting.

Not only is Steady Shot helpful, but it is also intuitive and easy to use. You simply slide the device over the top of your pen needle, inject, and then remove the device before recapping and removing the used pen needle.

Michel’s invention has come a long way since he developed his first prototype back in college. In fact, Steady Shot is now available for purchase on the product’s webpage, mysteadyshot.com. 

The current device fits most insulin pen needles, and Michel plans to soon add additional sizes that will fit the new BD Nano Second Gen, NovoTwist, and Owen Mumford pen needles. He also hopes to have the product available at retail pharmacies someday so more people living with diabetes will have a chance to try it out.

While it may seem like just a little piece of plastic to those who don’t understand the everyday struggles faced by diabetics, Steady Shot has the potential to be a lifesaver for those on multiple daily injections who suffer from the complications brought on by site overuse.

The post Student Invention Aims to Improve Control for Diabetics on MDI first appeared on Insulin Nation.

Prices Skyrocket and Shareholders Benefit

The price of insulin in the United States has sky-rocketed more than 1000 percent since the late 1990s. Until recently, there has been no substantial action taken by the U.S. government to put an end to this price gouging. 

Research from the University of Pittsburgh provided evidence that the net price of insulin in the United States had also soared – by 51% between 2008-2017.  This is the price received by Novo Nordisk, Eli Lilly, and Sanofi.

One vial of insulin costs a few dollars to produce, yet costs $320 for a patient in the United States and only $30 for a patient in Canada, explained Marina Tsaplina and Nicole Smith-Holt, both fervent advocates behind the #insulin4all initiative.

“The three insulin manufacturers have raised their prices in lockstep for many years now, prompting a class-action lawsuit and criminal investigations into collusion,” wrote Smith-Holt in her 2018 article for TruthOut. “Additionally, the insurance industry is also complicit in the drug pricing scheme.”

The Institute for New Economic Thinking published a report in April saying ‘Contrary to pharmaceutical company claims, revenue from high insulin prices are going to shareholders, not R&D.’

Will CMS Action Matter?

In March, the Trump Administration announced it was working to lower insulin prices for senior citizens on Medicare.  While seniors are a mere fraction of the population of people with type 1 and type 2 diabetes who depend on insulin, it is a step in the right direction. 

“Today, the biggest payer for medicines — the United States government — is legally prohibited from negotiating for the price of medicines with manufacturers. This means the industry can charge whatever they want,” added Tsaplina, “and they do.”

Breaking News — On May 26, 2020, the Centers for Medicare & Medicaid Services (CMS) announced a Senior Savings Model in which insulin copays will be capped at $35/month beginning in 2021. See the last section of this article for details.

#insulin4all and its work on the price of insulin

First launched by the founder of T1International, Elizabeth Pfiester, #insulin4all is a patient-led movement that doesn’t actually belong to any single organization or person but to everyone on the planet who needs insulin.

“It’s really a global call and cry,” explained Tsaplina, “and has become the tip of the sword of the medical crisis in the United States because the violations of insulin pricing in this country are so egregious and so obvious.”

Before the birth of #insulin4all, T1International operated as an international nonprofit organization committed to helping people across the globe with diabetes get the insulin they need to survive.

Unlike many advocacy organizations that rely on funding from BigPharma to keep their doors open and operations underway, T1International has steadfastly resisted this approach to funding.

“T1International accepts no funding from the pharmaceutical industry,” explained Tsaplina, “and is uncompromised in terms of industry alliance.”

When fighting for access to affordable insulin, this discrepancy in an organization’s source of funding is critical. Tsaplina knows this influence personally. She founded and directed a nonprofit that accepted industry funding. She writes that the influence of industry “is often revealed by what is not said.” 

The #insulin4all initiative has led the way in exposing the pharmaceutical industry’s deceptive and greedy price gouging on insulin — the hormone all people with type 1 diabetes and many of those with type 2 cannot survive without.

The Problem with Insulin Copay Price Caps

The first “insulin copay price cap” bill was announced in Colorado with a $100 maximum expense to the patient no matter how much insulin they needed. Quickly, many patients discovered this new bill didn’t apply to them because of various exemptions in their health insurance plan. 

The three big manufacturers of insulin did not offer their own price cap programs until this bill that they lobbied heavily against was passed in Colorado.

Shortly after national stay-at-home orders due to COVID-19 were issued, Eli Lilly seized the opportunity to appear generous by presenting their own “copay price cap” program that would cap insulin expenses at $35 per month for some patients. 

Novo Nordisk followed shortly after by offering “free insulin for up to 3 months” for anyone who has lost insurance coverage related to COVID-19. 

Over a year ago, Sanofi offered to limit insulin expenses for patients paying with cash to only $99 per month which completely ignores the still outrageous prices patients with health insurance face.

But Tsaplina and Smith-Holt point out that they still haven’t been required to lower the list price of insulin in the United States, which means they still aren’t concerned about a patient’s ability to afford insulin, making these price caps really just one large PR opportunity.

“I asked health insurance companies in Minnesota if premiums for health insurance plans would rise to compensate for the price caps on insulin, and they said it would not result in higher premiums,” explained Smith-Holt. “But we all know they’re going to need to recoup that money somehow in order to continue profiting.”

“Ultimately, these companies are really smart because when they do this, it’s a write-off for them as a charitable contribution and it’s a business loss that they can claim on their taxes,” said Smith-Holt. 

“And they don’t even pay taxes, they actually get refunds of billions of dollars. It’s not a loss to them, they gain positive PR, good samaritan points, they gain a tax write-off, and they turn around profit from it off the federal government.” 

Novo Nordisk, Sanofi, and Eli Lilly aggressively fought ‘Alec Smith Affordable Insulin Act’

In 2016, Smith-Holt’s son began rationing his insulin. No longer eligible to be on his parents’ health insurance plan, Alec died at the age of 26 from diabetic ketoacidosis — just two years after his type 1 diabetes diagnosis.

“He didn’t have insurance through his work,” explained Smith-Holt. “They were a small family-owned business that was not required to provide benefits such as insurance. We looked at purchasing insurance through the marketplace for him but based on his income and family size of ‘1’ the premiums were high at $450 a month with a very high deductible, like $7600, so he chose to not purchase the policy.”

As a healthy adult male, Alec would easily need at least 2 or 3 vials of insulin per month to treat his type 1 diabetes. At more than $300 per bottle along with required doctor’s appointments to maintain prescriptions and blood sugar testing supplies, the monthly expenses added up to several thousand dollars just to stay alive.

Alec would not have qualified for any of the patient-assistance programs offered by Novo Nordisk, Sanofi, or Eli Lilly because his income didn’t qualify as living below the poverty line.

These are just a few of the hoops a person with diabetes must jump through to demonstrate eligibility for these programs. 

Had his parents known he was struggling, they would’ve helped him in a heartbeat, but as a newly independent young man, Alec tried to manage the financial burdens of type 1 diabetes on his own.

“Because he’d only had type 1 diabetes for two years and had likely just finished that honeymoon phase [during which your pancreas is still producing some insulin],” explained Smith-Holt, “I think he just did not realize that cutting back his insulin that much was going to become so dangerous so quickly.”

In 2018, Smith-Holt, her husband, and other advocates from #insulin4all began working in Minnesota to pass the Alec Smith Affordable Insulin Bill. If passed, this bill would provide a patient with any type of diabetes a 30-day supply after filling out a short application attesting that they cannot afford the out-of-pocket expenses of the insulin they need in order to stay alive — whether or not they have insulin.

It took two years of showing up over and over and over in court, meeting with the governor and other lawmakers who were all heavily influenced and lobbied by representatives for Novo Nordisk, Sanofi, and Eli Lilly.

“Prior to #insulin4all showing up at the Minnesota capital and working that first year to get the bill passed, there were very few pharmaceutical lobbyists in Minnesota,” explained Smith-Holt. 

“As soon as they were aware of Alec’s bill, we started to notice these lobbyists were showing up in full force, representing every major manufacturer of insulin, meeting with legislators to prevent the bill from passing.”

Smith-Holt recalls one week of working to pass the bill when its success felt imminent.

“And then, all of a sudden, the bill just disappeared. Something happened behind closed doors between legislators and BigPharma’s lobbyists that influenced the decision.”

But Smith-Holt, her husband, and the army of #insulin4all advocates didn’t give up — and Novo Nordisk, Sanofi, and Eli Lilly continued to fight at every opportunity to prevent their efforts to make insulin more accessible and more affordable to the people who depend on it to stay alive.

“During year two, every single time we testified, a lobbyist from one of those ‘big 3’ were there to testify,” explains Smith-Holt. “Their lobbying dollars had doubled in Minnesota in order to come back at us in full force. All three of these insulin manufacturers were writing letters to every legislator involved in potentially passing the bill.”

All three insulin manufacturers were calling the author of the Alec Smith Affordable Insulin Bill asking for special meetings, including their top executives. 

Smith-Holt sat in on just one of those meetings, listening to Novo Nordisk and Eli Lilly saying they already offer patient assistance programs and offered to simply change the wording on their website or tweaking their programs just slightly here and there. 

Smith-Holt and other #insulin4all advocates said no.

“It’s not enough,” said Smith-Holt. “There’s no law forcing them to maintain these programs. They can simply drop them a few months from now.”

Finally, in the Spring of 2020, Smith-Holt, her husband, and their fellow #insulin4all advocates celebrated their success when Minnesota legislators passed the Alec Smith Affordable Insulin Bill. While devastatingly too late for Alec, this groundbreaking stride offers the potential to save thousands of lives for years to come in the state of Minnesota. 

But these advocates know this isn’t enough, and Novo Nordisk, Sanofi, and Eli Lilly are still choosing profits over the lives of the patients who depend on insulin to survive.

Will BigPharma be held accountable for price-gouging?

“The solution to the insulin pricing crisis fundamentally has to happen on the federal level,” said Tsaplina, who was the Strategy and Action Lead for the New York #insulin4all chapter through April of this year. “T1international state chapters can work on important  stop-gap solutions to help bring relief to some families to ensure people get the insulin they need to live, but this isn’t a replacement for national legislation, and doesn’t cover everyone who needs insulin to live.”

Tsaplina points out many flaws in the patient assistance programs touted by Novo Nordisk, Eli Lilly, and Sanofi:

What about patients in low-income environments who cannot afford or don’t have access to a stable internet? Those who receive very little diabetes education and support, and do not know about these programs?

For a patient rationing insulin and enduring daily high blood sugars, how are they expected to have the energy and mental clarity and stamina required to jump through the series of hoops that might eventually lead them to get some version of “patient assistance” in programs that are designed to serve as few people as possible?

Organizations intended to advocate for the benefit of patients with diabetes — the American Diabetes Association and the JDRF — rely heavily on funding from these pharmaceutical giants and have made zero effort to support lowering the list price of insulin. (They, however, tried taking credit for the work of #insulin4all.)

“To date,” explained Tsaplina, “they have lacked meaningful advocacy that supports solutions to permanently lower the list price of insulin so we don’t lose another life to insulin rationing.”

At the end of the day, these patient assistance programs and insulin copay price-caps are an effort to make it seem as though they are doing something when in fact they are still profiting wildly.

Tsaplina, Smith-Holt, and their fellow advocates at #insulin4all aren’t satisfied and continue to fight, for example, for a “comprehensive insulin package” in NY State that would address the criminal actions on the price of insulin in the United States.

Tsaplina said it best when she asked, “Why on earth should we be satisfied with coupons when insulin costs $30 per vial in Canada?”

New CMS $35 Monthly Cap Plan

On May 26, 2020, the Centers for Medicare & Medicaid Services (CMS) announced a Senior Savings Model in which insulin copays will be capped at $35/month beginning in 2021.

Over 1,750 standalone Medicare Part D plans & Medicare Advantage plans with prescription drug coverage have applied to participate in Part D Senior Savings Model, offering coverage in all 50 states, DC, and Puerto Rico.

This is a step in the right direction but important details to be determined include:
Source: Juliette Cubanski (Twitter) of the Kaiser Family Foundation (website)

• What will be the monthly premiums for participating Part D enhanced plans in 2021 relative to other enhanced plans and basic plans?
  1. Currently, enhanced plan premiums are roughly twice the level of premiums for basic plans, on average
  2. Insulin manufacturers seem to bear much of the cost of this enhanced benefit through the 70% coverage gap discount
  3. Plan sponsors were offered additional financial protection through a narrower risk corridor, and costs can be passed on to enrollees in the form of higher premiums
• How many insulin products does each participating Part D plan actually offer at the $35 flat copay? Plans don’t have to cover every insulin product at $35/month, just one of each dosage form (vial, pen) and type (e.g., long-acting, rapid-acting).
• Part D enrollees may have to switch plans (from basic to enhanced or from one enhanced plan to another) and/or switch insulin products in order to see these savings.

The post Why Insulin Coupons & CoPay Caps Aren’t Good Enough first appeared on Insulin Nation.

Unlike MDI, which requires you to take a single dose of long-acting insulin to cover your basal blood sugar throughout the day and night, the variable basal rates of pumps more accurately reflect how a true pancreas works. 

Unfortunately, it is easy to get confused by this added basal rate flexibility. 

• How do I know when my basal rates need to be changed? 
• When do I start this new rate and when should I set it to end? 
• When do multiple basal rates become too many basal rates?

These tips will help you identify when you may need a basal rate adjustment and how to go about changing that rate in a coherent and effective way.

Signs Your Basal Rate Needs to be Adjusted

When you have high or low blood sugar, it can be difficult to determine if the problem was a miscalculated meal bolus, an incorrect carb ratio, or a bad basal rate. 

Here are three signs that usually indicate your basal rate may be to blame.

1) Your Sugars Rise or Fall Overnight

For most people, nighttime is the one stretch of time throughout a day where the only thing affecting your blood sugar is likely to be your basal rate. Typically, your dinner bolus dose will be spent, your food will be digested, and you aren’t likely to be exercising.

This makes identifying basal rate issues much less complicated, but not one-hundred-percent straight forward.

For example, a large dinner, especially one containing a lot of fat, or a late dinner, may continue to affect your sugars well past midnight and cause unexpected highs. Similarly, excessive exercise the morning before or an overly active day may lead to lows while you sleep.

If you are concerned your overnight basal rates aren’t cutting it, but you want to be sure, you’ll need to remove these types of factors from the equation. Eat a light, early dinner to help stabilize your sugars before bed and avoid any major changes in exercise or activity for twenty-four hours beforehand.

If your sugars still fluctuate (rise or drop by 30mg/dL or about 2 mmol/l) for three or more nights in a row, then that is a clear indication your overnight rate or rates need to be adjusted. Keep in mind, if you don’t have a CGM, you will need to wake up at least twice during the night to check your sugars to identify any fluctuations.

2) Your Sugars Rise or Fall with No Active Insulin On Board

One thing that makes nighttime basal rate issues so easy to identify is the lack of bolus insulin interference. If you happen to go for longer periods between meals and snacks, you may also have an easy opportunity to identify basal issues during the day.

If you catch a slow rise or fall during a time when you have no active insulin on board, this is usually a clear sign your basal rate needs to change.

Of course, there are always exceptions to the rule. 

• If you ate a high-fat meal, it may have taken longer to digest than your active insulin time would have covered. 
• If you ate a low carb meal after eating relatively few carbs throughout the day, your body may have resorted to processing some protein into glucose.

These interactions can easily lead to meal-related glucose shifts after your bolus insulin is used up.

If you notice your blood sugar rising or falling with zero insulin left onboard, note the time and keep an eye on it over the next few days. If you notice the same trend despite different meals preceding it, this is a good indication your basal rate is to blame.

3) Your Sugars Rise or Fall Between Meals

Ideally, your bolus insulin should bring your blood sugars back down to premeal levels about two hours after you eat.

There are plenty of issues that can affect this goal, however. Miscalculations, high-fat or high-protein meals, and bad carb ratios can all cause in-between meal fluctuations. 

If your sugars return to normal about two hours after a meal only to continue falling or to slowly rise back up, your basal rate may be the problem.

To confirm this:

• Eat an easy-to-calculate, low-fat meal before the time period in question for a few days in a row.
• See if the trend continues
• If it does, you likely need to switch your basal rate around that time of day.

How to Use Basal Rate Testing to Find the Right Rates

Knowing you have a basal rate problem and knowing how to fix that problem are two different things. 

Even if you have identified that your basal rate is too high or too low during some point of the day or night, it can be hard to know how much to change the rate and whether or not you need to adjust the time period or add a new time period altogether.

The easiest way to clearly identify when your rate needs to change and how drastically is with something called Basal Rate Testing. While the concept may seem a little overwhelming at first, it is really straightforward, but it will take some time commitment.

Here are the basics steps of Basal Rate Testing:

1. Identify the time of day you believe you need to make a basal rate adjustment.
2. Eat your last meal four hours before that time period starts (or, for morning issues, simply eat a late dinner and then skip breakfast). You will also need to avoid exercising during the test period.
3. Your blood sugar will need to be at a healthy level before you begin; If it is below 80mg/dL or over 200mg/dL, treat/correct and try for another day.
4. If you don’t have a CGM, you will need to manually test your sugars every hour.
5. Continue to fast for about six hours or through the night (or at least long enough to cover the time period of concern).
6. If you fall low or rise to an unhealthy level, treat/correct and retest another day.

Test and Confirm

After you complete the fast, review your numbers. If your levels stayed relatively stable (did not wander more than 30mg/dL or 2mmol/l up or down), then your rate is likely correct. If it rose, your rate likely needs to be higher and if it fell, it needs to be lower. Note the time when the rise or fall began. 

Repeat the test two more times over the next few days/weeks to confirm.

Adjustment Size & Timing?

In terms of how much to adjust your basal rate up or down, typically you’ll want to make changes at a rate of about 10% at a time, but more drastic rises or falls will benefit from a more aggressive rate change than moderate rises and falls.

As far as the time period to set the new rate for, that can be tricky as well. Keep in mind that insulin takes time to show an effect, so changes should start one to two hours before the rise or fall was seen.

You want to be careful about creating too many different basal rates throughout the day as this can bring a whole new layer of confusion to your control. Some endocrinologists recommend shooting for only a couple rate changes throughout the day while others see benefits to more.

Since everyone is different, there is no right answer here. But, if you notice multiple periods of high basal rates intermixed with periods of low rates throughout the day, that is a good sign you may be overcomplicating things.

Look for larger trends and try to set average rates to cover longer periods and work with your healthcare team if you continue to struggle to keep things level.

Change How You Think About Basal Rates

Basal insulin is meant simply to cover the amount of glucose your liver trickles into your bloodstream every few minutes. That is why Basal Rate Testing works so well to identify where issues may lie in your set basal rate program. 

But, it is worth keeping in mind that there are a lot of factors that can affect your blood sugar outside of food.

Stress, hormones, exercising, and illness can all change how much glucose your liver dumps into your blood and how well your body utilizes insulin. 

While these factors can make it seem like you need to change your basal rate, try to remember that your basal insulin is only there to cover your basal blood glucose under normal circumstances.

Rather than make permanent changes to your set basal rates in response to these fleeting fluctuations, it’s best to utilize other tools at your disposal. Temporary basal rates, correction boluses, and even secondary basal rate sets are all better ways to handle stress, hormones, and other blood sugar complicating factors.

The post Signs Your Pump Basal Rate Needs Adjusting & How to Get It Right first appeared on Insulin Nation.

Changes in schedule, diet plans, activity levels, stress levels, illnesses, hormones, and even global crises can affect how much insulin your body needs to keep blood sugars stable. And since most people aren’t living in a vacuum, these types of changes occur all the time.

So, if you want to stay on top of blood sugars, you need to be willing to change in response to them.

One area many people living with diabetes are surprised to see changes are in their insulin to carb ratios. But just as with your basal rates, how much insulin you need to take to cover a typical meal will change as your insulin sensitivity changes in response to all the factors listed above.

In this article, we look at some common signs that your carb ratio needs to be adjusted and how to make those adjustments in an effective way.

Signs You Need to Fine-Tune Your Carb Ratios

A person’s carb ratios rarely stay the same for their entire life with diabetes. In fact, most people will get to a point where they need different ratios for different meals eaten at different times. And just about everyone will eventually need to adjust their ratios up or down as their lives and schedules change.

Here are four signs to look for that may signal your carb ratio needs some tweaking or that you need to make some changes to when and how you take your meal-time insulin.

Blood Sugars Rise After Meals and Don’t Come Back Down

Fast-acting, mealtime insulins are made to mimic the slow rise and plateau of glucose in the blood following a meal. Ideally, your blood sugar and insulin will peak at the same time about an hour to ninety minutes after you finish eating. 

Within a few hours after eating, this complimentary process should bring your blood sugar back down to the level it was at before your meal.

If your blood sugar rises after a meal and fails to ever fall back into range, that is a good sign that your carb ratio for that particular meal may not be aggressive enough to properly cover your carb intake.

Unfortunately, there are a lot of factors in addition to a bad carb ratio that can affect this process. High-fat meals, undercalculated carb counts, and even bad insulin can lead to elevated post-meal blood sugars.

Instead of reacting to a single post-meal high by changing your carb ratios, make a note of the problem and consider what other factors could have played into the issue. If a bad carb ratio still seems most likely and the pattern continues multiple days in a row, then it’s time to follow the process outlined in the next section to effectively lower your carb ratio (make it more aggressive).

Blood Sugars Drop Within Three Hours After Meals

Sometimes it’s not about blood sugars rising and staying high, but instead, they rise or stay level only to plummet too low within a few hours after you have eaten.

Typically, if your sugars fall ninety minutes to three hours after you eat, an overly aggressive carb ratio is to blame.

However, just like with post-meal highs, there is always a possibility something else is to blame. In the case of low sugars following a meal, the most likely culprit is an overestimated carb count or too much activity before or after the meal.

Consider what other factors may have affected your blood sugar trend following the meal. If a bad carb ratio seems the most likely cause and the trend repeats over time, then it is time to raise your carb ratio to lower how much insulin you are taking with that particular meal.

Blood Sugars Spike High After Meals Before Returning to Normal

Another disheartening trend some people run into is blood sugar that spikes very high after a meal but still returns to normal after two or three hours. In some cases, you may even find your sugar falls too low after the initial towering spike.

This type of pattern usually has less to do with your carb ratio and more to do with how well your body is utilizing insulin at that particular time of day.

If your body is especially insulin resistant during that meal period, your cells may take longer to uptake the insulin you took with your meal. This delay in insulin activation will cause your blood sugar to spike as your meal digestion peaks. Only once the insulin begins to work will your sugars start to fall, sometimes dramatically and sometimes more slowly.

Instead of changing your carb ratio to battle this problem, it can often be more helpful to take your mealtime bolus in advance of eating. For some people, a fifteen-minute pre-bolus is enough to flatten the peak while others will need to take their bolus closer to thirty-minutes to an hour beforehand.

This type of delayed insulin activation is most common in the mornings and more likely to be seen in those with higher insulin resistance and in pregnant type 1 women.

Of course, there may be other factors at play. High glycemic meals with simple carbs are more likely to spike before insulin peaks as are meals with little to no protein and fat. But, in either of these cases, a pre-bolus will still work to reduce the post-meal spike.

Blood Sugars Drop After Meals Only to Rise Again

One of the most frustrating post-meal blood sugar patterns to deal with is when your sugars return to normal or drop too low two to three hours after a meal only to rise again before your next meal.

The most obvious cause of this issue is a problem with your basal rate for that time of day. However, there are instances when this problem stems from a bolus issue.

If the meal you ate was very high in fat, it may have taken longer than normal to digest, causing a blood sugar spike after most of your meal insulin had already peaked and leveled off. Meals extra-high in protein can also take longer to digest and may require more insulin than your carb ratio accounts for due to some protein being converted to glucose.

In either of these cases, using a prolonged square or dual bolus, or splitting your bolus if on MDI, will be more beneficial than changing your carb ratio.

How to Fine-Tune Your Insulin to Carb Ratio

If you believe that your carb ratio is in need of an adjustment after seeing a similar pattern in post-meal sugars a few days in a row, there is a simple test you can do to make to effectively raise or lower your particular carb ratio.

1. Avoid eating anything for at least three hours before the meal in question and only begin the test if you haven’t taken a correction for at least five hours beforehand. Your sugars should be between 80 mg/dL and 130 mg/dL before your meal.
2. Choose a meal that is low in fat and a good balance of complex carbs and some protein. Make sure it is something you can easily count the carbs for.
3. Calculate your insulin dose based on your current carb ratio and bolus before eating.
4. Check your sugars after two hours and again at three and four hours (if you don’t have a CGM).
5. If at any point your sugars fall below 70mg/dL, treat the low. This may be a sign your ratio is too low or that there was some external factor interfering with the test.
6. After four to five hours, your blood sugar should have returned to about the premeal level. 
7. Repeat this test a few days in a row to assure the accuracy of your results.
8. If your blood sugar after four to five hours is consistently more than 30mg/dL higher than your starting sugar, you need to lower your carb ratio by about 10%. If it is consistently more than 30mg/dL lower than your starting sugar, then you need to raise your carb ratio by about 10%.

You can then use this same procedure to test your new carb ratio. Continue to adjust until you find a ratio that will bring you back into range after your meal.

Do keep in mind, your insulin to carb ratio is meant to bring your sugars back into range following a low-fat, balanced meal. To get the same results from higher-fat, higher-protein, or simple carb meals, you will have to utilize the other tools in your belt, such as dual/square bolusing, split bolusing, and pre-bolusing.

The post Carb Ratios: Signs You Need to Make a Change & How to Do It first appeared on Insulin Nation.

However, the specifics in regard to this trend were not well known. Particularly, how did death rates and risk factors differ between type 1 and type 2 diabetics?

Now, thanks to the information provided by researchers using data from NHS England, we have some concrete numbers on how COVID-19 specifically affects people with type 1  diabetes.

Type 1 Diabetics Have the Highest Risk of Death from COVID-19

Since the beginning of the pandemic, diabetic patients have made up a disproportionate number of those succumbing to the disease.

Early data seemed to indicate that diabetics with complications were the most likely to have an increased risk of death.

Since type 2 diabetics, in general, are more likely to suffer from obesity, high blood pressure, and other known COVID-19 risk factors, the early assumption was that type 2s were at an increased risk compared to type 1s and that healthy type 1s without complications did not suffer a higher risk of hospitalization or death.

However, this most recent data, which looked at the health records of over 60 million individuals in England, found that type 1 diabetics actually have three and a half times the risk of dying in-hospital from COVID-19 compared to non-diabetics. Type 2s, by contrast, are only twice as likely to die.

People with type 1diabetes more 3½ times more likely to die in-hospital from COVID-19 compared to non-diabetics. 

These rates remain true regardless of sex, age, ethnicity, and region. When researchers also accounted for the additional risk associated with a previous hospitalization due to heart attack or cardiovascular disease, the rates dropped somewhat, but type 1s still had a higher risk than type 2s at 2.86 and 1.81, respectively.

Why Are Type 1s at Higher Risk?

Unfortunately, this UK study provided few answers as to why type 1 diabetics are at such a higher risk for mortality due to COVID-19 compared to other diabetics and the general public.

They did pose a few theories, however.

Type 1 differs from type 2 in pathophysiology, specifically in that type 1 is caused by a defective immune system. We already know that type 1s are at an increased risk for infection, especially from bacterial pathogens. But it is possible that similar factors may work against a type 1 who is infected with this strain of coronavirus.

Varying patterns of diabetic complications may also put type 1s at higher risk.

While it is more likely that an older person will have type 2 over type 1, those who are living with type 1 are more likely to have had diabetes for longer. Since diabetic complications increase with the amount of time a person has had the condition and type 1 is most often diagnosed at a young age, elderly people living with type 1 typically have more complications than elderly people with type 2.

The researchers also pose that there may be some unknown effects of conditions like hypoglycemia and type 1 treatment measures that negatively affect our ability to fight off this virus.

While not directly mentioned in the paper, it is also possible that type 1 diabetics may be receiving less than optimal care for their diabetes while in the hospital being treated for COVID-19. 

Poorly managed T1D can quickly interfere with the body’s ability to fight off infection or function normally. Because type 1 diabetes is a more complicated disease to manage than type 2 in terms of insulin dosing, time commitment, and the greatly increased risk of hyper and hypoglycemia, any reduction in the quality of diabetes care a T1D receives is far more likely to impact their ability to recover from COVID-19.

Age is Still the Biggest Risk Factor

While a three and half times greater risk of death seems like a huge number, it is important to remember that this is just one factor to be considered in a person’s overall mortality risk.

Age, by far, still appears to be the greatest factor in determining who is at the highest risk for hospitalization and death. 

While the mortality rates vary from country to country, most models show similar calculations for mortality risk by age:

• Below 30 – under 0.2%
• 30 to 39 – 0.2% to 0.3%
• 40 to 49 – 0.4%
• 50 to 59 – 1% to 1.3%
• 60 to 69 – 3.5%
• 70 to 79 – 8% to 12.8%
• 80 and up – 14.8% to 20.2%

This means that an otherwise healthy 45-year-old has an 0.4% mortality risk and if they have type 1 diabetes this mortality risk increases to 1.4% (3.5 x 0.4%), a number that is still significantly lower than the 3.5% mortality risk of a non-diabetic 60-year-old.

Cardiovascular Risk Most Significant Condition

While diabetes in any form appears to be one of the larger determining factors in COVID-19 mortality, cardiovascular disease still remains the most significant health condition in determining COVID outcomes.

The overall fatality rate of COVID-19 is about 2.3%, however, the mortality rate for those with cardiovascular disease is much higher, at 10.5%. 

How Can You Protect Yourself?

As someone living with type 1 who may or may not have secondary complicating factors (advanced age, heart conditions, etc.) it is important that you take extra precautions to protect yourself, especially in light of these most recent findings.

Here are some steps every diabetic should take to assure the best outcome for themselves:

• Continue social distancing even as cities begin to reopen
• Continue to wash your hands and use a facemask whenever you go out
• Avoid unnecessary trips to crowded locations
• Have family and other members of the household take advanced precautions to avoid bringing germs into the house
• Get familiar with what rights you have to care for your own diabetes in the event that you are hospitalized (these rights vary by region)
• Create contingency plans for diabetes care should you be hospitalized and incapable of caring for your diabetes yourself (your endocrinologist may be a good resource here); Keep in mind that your family will likely not be allowed to stay with you
• Continue to manage your diabetes as well as possible to help your body stay strong and healthy

As disheartening as these new findings are, it is important to keep in mind that you can take steps to reduce your risk of being hospitalized or succumbing to COVID-19 by reducing your overall exposure to the virus.

The post High Covid-19 Death Rates Explained first appeared on Insulin Nation.

Things like retinopathy, kidney disease, and neuropathy are all common problems faced by those with poorly controlled blood sugars and those who have lived with T1D for a long time. 

But did you know that there are other diseases, much less directly related to type 1, that are also more common among those living with diabetes? 

Here are ten of the most common health problems type 1 diabetics are likely to experience. 

It is important to keep in mind that while you may be at an increased risk for certain diseases, there is no guarantee you will suffer from any of these conditions. And, in fact, by focusing on strong blood sugar management and taking care of yourself, you can reduce your risk of developing many of the diseases on this list.

Cardiovascular Disease

Cardiovascular disease is the number one killer of people who have lived a long time with type 1. About 44% of those living with T1D will die from some type of heart disease, with those diagnosed in childhood and women being the most at risk.

There are a lot of factors that increase the risk of vascular damage, stroke, and heart attack in people living with type 1. High blood sugars damage vascular tissue while dramatic swings in blood sugar and aggressive exogenous insulin use cause increased oxidative stress on cardiac tissue.

Strict blood sugar management, a healthy diet, and frequent moderate exercise are the most important steps you can take to decrease your risk.

Thyroid Disorders

According to the ADA up to 30% of diabetics suffer from some type of thyroid disorder, with hypothyroidism being the most common. Many thyroid disorders, such as Hashimoto’s disease, are caused by autoimmune action that results in the death of thyroid cells. People suffering from one autoimmune disease, such as type 1 diabetes, are at an increased risk of developing additional autoimmune conditions.

Signs of hypothyroidism include fatigue, dry skin, weight gain, and muscle weakness. Most endocrinologists test thyroid function in their T1D patients at least once a year. Typically, hypothyroidism is treated with synthetic thyroid hormone.

Celiac Disease

Celiac disease is another autoimmune disease that is more common in type 1 diabetics and occurs in about 8% of patients.

When a person suffering from celiac disease consumes gluten, the protein found in wheat, rye, and barley, their immune system reacts by attacking the cells of the small intestine. Symptoms include digestive upset and irritability, but it is not uncommon for the disease to progress without any symptoms at all. If left unaddressed, celiac disease can lead to intestinal cancer and heart problems.

Addison’s Disease

This rare disease is characterized by reduced function in the adrenal glands which results in insufficient levels of hormones like cortisol and aldosterone. Most cases of Addison’s disease are caused by autoimmune damage to the adrenal glands. The rate of this disease is higher in people living with T1D than in the general population.

Symptoms of Addison’s disease include extreme fatigue, weight loss, abdominal pain, and recurrent hypoglycemia in diabetics. Many people don’t know they have an issue until they experience the acute symptoms of an Addisonian crisis in which a person will suddenly become weak, confused, and experience dangerously low blood pressure. In most cases, emergency intervention is needed.

Sexual Dysfunction

Sexual dysfunction is common in both men and women with type 1 diabetes. 

Diabetic men are more likely than the general population to experience erectile dysfunction due to vascular damage and retrograde ejaculation due to nerve damage. Women also suffer from the effects of vascular and nerve damage in the genitals. It is estimated that up to a quarter of T1D women experience problems with vaginal dryness, pain during intercourse, and difficulty becoming aroused.

Luckily, many of these issues can be avoided or sometimes reversed with tighter blood sugar control and strict diabetes management.

Polycystic Ovary Syndrome

It has long been known that polycystic ovary syndrome (PCOS) can lead to type 2 diabetes, but more recent findings have shown that PCOS appears to be more common in type 1s than the general population.

Signs of PCOS include irregular periods, infertility, weight gain, and excess hair growth. High androgen hormone levels and enlarged ovaries are both clinical symptoms your doctor may check for if you believe you have PCOS.

Treatment usually includes weight loss and medications such as metformin and clomiphene. 

Mastopathy

Mastopathy, or hardened breast tissue, is a condition most commonly seen in women with type 1 or insulin-dependent type 2 diabetes.

It is not clear what exactly causes this condition, but it appears to be highly correlated with poorly controlled blood sugar. Premenopausal women who have lived with diabetes long term are the most likely to suffer from this problem. 

In general, the hard breast lumps that result from mastopathy do not cause any issues and require no treatment. However, the discovery of the initial lump and that of all new lumps that form will require screening and biopsy to rule out breast cancer.

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a condition that causes tingling, pain, and numbness in the arm and hand. While this syndrome occurs frequently in the general population, especially in those that work at a computer for a living, it occurs more often in type 1 diabetics.

T1Ds with diabetic polyneuropathy (DPN) appear to have a higher chance of developing CTS but even in patients without this disorder, there seems to be an increased risk. One study found that while about 2% of the general population has CTS, closer to 14% of diabetics without DPN suffer from it and a high 30% of diabetics with DPN have it.

Treatment of the condition usually involves the use of splints and physical therapy but may require surgery. Diabetics with DPN are less likely to find success in treating the condition with more conventional methods.

Skin Disorders

There are a number of skin disorders that can affect type 1 diabetics at a higher frequency, including bacterial infections, fungal infections, and general dry skin and itching.

There is also a long list of conditions that are found exclusively in diabetics. Diabetic dermopathy causes scaly patches on the skin. Diabetic blisters are burn-like blisters that erupt on the hands and feet. Necrobiosis lipoidica diabeticorum causes raised, dry, shiny patches on the skin. All of these conditions appear to be related to the changes to small vessels during repeated high blood sugars.

In most cases, bringing blood sugars under control can help reduce or eliminate these types of skin conditions. There are also some great products on the market geared toward diabetic skin health.

Dental Problems

People living with diabetes are also at an increased risk of certain dental problems. The combination of dehydrating high blood sugars, neuropathy, and decreased blood flow to the gums increases the odds of gingivitis, mouth infections, and dry mouth.

While keeping your blood sugars under control is the first and most important step to preventing these types of dental issues, regular visits to the dentist are also important. A good dental hygiene routine that includes frequent brushing, flossing, and treatments for dry mouth can also make a big difference in oral health.

The post 10 Health Conditions Common in People with Type 1 Diabetes first appeared on Insulin Nation.

• This remains true despite huge advancements in blood sugar management technology, more effective insulins, and an increased focus on heart health.
• The risk of developing heart disease remains high regardless of the individual’s glycemic control.

Why does the vascular system of diabetics continue to experience damage even after near-normal blood sugar control has been reached?

Researchers in Europe may have found some answers. 

While their initial conclusions are troubling, their research also found a potential treatment for insulin-related vascular damage.

How Insulin Treatment Leads to Vascular Destruction

High blood sugars cause a number of problems in the body. 

They can negatively affect your kidneys, your nervous system, your eyes, your skin, and your heart. 

But focused glycemic control has the power to reverse much of this damage.

With one exception.

For years, research has shown that cardiovascular damage and the risk of heart disease remains high even after a person living with diabetes achieves strict blood sugar control. 

There have been many theories on why this correlation exists, but until now there hasn’t been a lot of hard data on the subject.

A recent paper published in Science Transitional Medicine by researchers from the UK, Greece, and Germany has found that insulin resistance in the vascular system of humans can exist independently of systemic insulin resistance and hyperglycemia, and appears to be aggravated by the use of exogenous insulin.

This explains why even in an otherwise healthy diabetic with good blood sugar control, insulin treatment may cause insulin resistance in the cells of the vascular system. And this insulin resistance can lead to vascular damage over time.

Under normal conditions, insulin acts as an antioxidant to the endothelial layer of the vascular system and exerts vasoprotective actions that help lower blood pressure and support heart health. But when insulin resistance is present in these cells, the protective effects of insulin are reduced.

It appears that treatment with insulin is actually driving this process of vascular insulin resistance.

• For type 1 diabetics who require higher insulin amounts
• For type 2 diabetics on aggressive insulin treatment
• Whether treating with human insulin or insulin analogs

The Catch-22 of Insulin Use

With regard to the treatment of type 2 diabetes, this research could have a profound effect on how and when insulin treatment is used. 

But people with type 1 diabetes, who rely on exogenous insulin to survive, the path forward is less clear.

Without insulin, a person living with T1D would see their blood sugars climb into a dangerous hyperglycemic range within a matter of hours. 

The effect of elevated blood sugars on the heart and vascular system is well known. Not only does hyperglycemia cause hardening of the vessels and increased blood pressure, but it can also damage the nerves that control the heart leading to an increased risk of a heart attack.

But we now know that the use of insulin to keep blood sugars within a normal range appears to be damaging to the heart and vascular system in its own way.

The increased oxidative stress that the cells of the vascular system experience when insulin sensitivity drops due to aggressive insulin treatment can also lead to an increased risk of stroke and heart attack.

Luckily, this greater understanding of how insulin use plays into cellular damage and insulin resistance in this particular system also led these researchers to a potential treatment for insulin-related vascular damage.

Potential Treatment for Diabetic Cardiovascular Disease

By conducting ex vivo experiments with human vessels, the researchers found that treatment with dipeptidyl peptidase 4 inhibitor (DPP-4)  had the power not only to increase insulin sensitivity in vascular cells but also reduced vascular oxidative stress and improved endothelial function.

DPP-4 inhibitors are a class of prescription medicines that are used with diet and exercise to control high blood sugar in adults with type 2 diabetes. Medicines in the DPP-4 inhibitor class include sitagliptin, saxagliptin, linagliptin, and alogliptin.  
Source: FDA Website

Combining exogenous insulin and DPP-4 may prevent the vascular damage caused by aggressive, long-term insulin treatment, thereby reducing the risk of cardiovascular disease in diabetics with tight blood sugar control.

While the original report focused on type 2 diabetics undergoing insulin treatment, there is no reason to believe that this type of combination therapy wouldn’t have similar positive effects on those suffering from type 1.

As of now, the use of DPP-4 in combination with insulin therapy to prevent vascular damage is still completely theoretical. While this drug is currently prescribed to help control blood sugar in some type 2 diabetics, its effect on vascular oxidation in type 1 patients requires further study.

The researchers behind this study are pushing for randomized clinical trials to explore the effects of DPP-4 on cardiovascular outcomes in patients with atherosclerosis and diabetes.

• The initial focus of these trials would be patients with preexisting vascular damage
• Positive results would surely lead to further research into using some combination approach to prevent insulin-related vascular damage from occurring in the first place

The post Insulin’s Role in Vascular Damage first appeared on Insulin Nation.

This often painful, and sometimes dangerous condition can cause tingling and numbness in the extremities, increased rates of amputation, and even heart and bladder problems.

Neuropathy, in general, means the dysfunction of nerves. But there are different types of neuropathy that can affect people living with type 1. 

• Peripheral neuropathy is the most common form, affecting up to half of all diabetics. The peripheral nerves are responsible for motor control and feeling in the arms and legs. Damage to this system can lead to numbness, pain, weakness, and tingling in the feet, legs, or hands.
• Autonomic neuropathy is the second most common form and it affects the nerves responsible for automatic functions in the body such as regulation of the gut, bladder, and heart. Damage to this system can cause incontinence, constipation, impotence, and life-threatening heart problems.

For many living with neuropathy, reducing these painful and life-altering symptoms can only be accomplished by taking one or more of the drugs meant to address the condition.

Drugs aren’t the only treatment for neuropathy. In fact, some of the more unusual treatments for neuropathy seem to be more effective.

Here are four neuropathy treatments that have been scientifically proven to help many of those who suffer from the condition. 

Effective Alternative Treatments for Neuropathy

Topical Capsaicin

Capsaicin is the chemical compound in chili peppers that gives them their spicy flavor. But making your eyes water and your tongue swell isn’t the only thing this naturally occurring chemical is good for.

Multiple scientific studies have looked at the effectiveness of topical capsaicin ointment on the reduction of neuropathy pain and other symptoms. What these scientists found was so promising that one company actually developed a capsaicin patch capable of significantly reducing peripheral neuropathy pain for up to twelve weeks per treatment.

Qutenza, as the patch is now known, was originally tested for use in nondiabetic neuropathy, mostly in patients suffering from HIV-associated neuropathy and nerve pain that exists after shingles flare-ups. But more recent studies have shown the patch to also be effective for peripheral neuropathy caused by high blood sugar.

But you don’t need a prescription to enjoy the pain-relieving benefits of capsaicin. There are multiple brands of capsaicin ointments and creams on the market that may help you find some relief.

Deep Breathing

As painful and difficult as living with peripheral neuropathy is, autonomic neuropathy can be more dangerous, especially when it affects cardiac function.

When the nerves that regulate heart rate, blood pressure, and other aspects of the cardiovascular system are damaged, it can create lasting problems with heart function and even acute issues such as asymptomatic ischemia which can cause arrhythmias and sudden death.

But one new study has found a surprising way to treat this type of neuropathy: With deep breathing.

These researchers found that deep breathing in a 100% oxygen environment at a rate of 15 breaths per minute increased measures of cardiovascular autonomic function by 21%. And breathing at a rate of 6 breaths per minute in a standard oxygen environment (the normal air in your house for example) increased these measures by 32%.

The participants in this study were all older type 1 diabetics who had been living with the condition for a significant portion of their lives.

A Vegan Diet