Insulin Nation Technology. Science. Therapy. Mon, 23 Nov 2015 19:41:26 +0000 en-US hourly 1 The Nude Diabetes Calendar is Back Mon, 23 Nov 2015 19:31:57 +0000 The second annual T1D Exposed Nude Diabetes Advocacy Calendar launches in time for the holiday season.

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Chris_T1D Exposed 2016_300pxTara Layman and Kat Reed first met at a diabetes camp in northern California. Layman, a photographer, was working on her Master’s thesis photographing families touched by diabetes. As she worked, she was struck by the invisibility of the condition, so she and Reed joked that they should create a calendar showcasing people with Type 1 in tasteful, nude silhouettes, clad only in CGMs and exposed sensor sites.

Now, after the successful release of a 2015 T1D Exposed Nude Diabetes Advocacy Calendar, and an immediate outpouring of support from the diabetes community, the project is back with a new calendar and a fresh batch of body acceptance.

For this year’s model recruitment, the pair conducted Skype calls of potential subjects. They had plenty of people from which to choose. Layman and Reed enjoyed being able to have a bigger pool of models for the 2015 calendar, as it was important to them to show more diversity in age, body type, and ethnicity in the calendar’s second edition.

“I was just amazed at the people willing to fly in from out of state,” said Reed, a health care professional who works as the calendar’s project manager.

After putting themselves in front of the camera for the 2015 calendar, Reed and Layman had newfound respect for people willing to expose themselves and share their stories. The two wanted pieces of those stories to come through in the 2016 portraits, so they allowed models to pose with props reflecting their passions. Models posed with swimming gear, a bowling ball, or a musical instrument, for example. Model Kiana McCourt says she was proud to be part of the calendar.

“This project literally strips us down, no photoshop,” said McCourt. “I think it’s cool to have something so real and authentic out there.”

Lai_T1D Exposed 2016_300pxMcCourt is currently a senior philosophy student at the University of California Berkeley and also helped with the T1D Exposed Instagram account (@t1d.ex) to increase social media presence. She jumped on board shortly after hearing about the first calendar.

“I feel their project is really empowering for everybody with Type 1,” McCourt said.

Reed and Layman were ecstatic about the increased production value this year, as well. Thanks to sponsorship from Rebel Sun, a camera and lighting rental company, the two were able to host shoots in a studio, unlike last year when they created a makeshift studio in a house. However, they did decide to stick with the black and white portraits of 2015. They believe minimalism is what makes the photos so eye-catching and empowering.

“It’s about the person and their body,” Layman said. “[Black and white] feels more powerful and the emotion comes out more.”

During a phone interview, the bond between Layman and Reed became very evident, especially when they finished each other’s sentences. Layman says the pair play off each other’s strengths.

“I think the way that you get a beautiful project is by having a little bit of structure and also letting what naturally happens create what it’s going to create,” Layman explained. “I think we balance each other out. Kat is very organized and I’m very…”

“Artistic,” Reed finished while laughing.

“Artistic,” Layman echoed, not missing a beat. “[Kat] keeps me to a schedule and I keep her on her toes.” Reed burst into more laughter in the background, and it seems that volumes were spoken without words between the two during this exchange.

Jerry_T1D Exposed 2016_300pxThe two say they never set out with the intention of creating an annual calendar, it was just a cool idea to try. But since releasing the calendar last year, they’ve received messages of support from around the world and requests from people who want to model for the next year’s calendar. They’ve already compiled a list of 40 models to pick from for 2017. The duo is expecting to donate an estimated $10,000-$15,000 to several diabetes organizations with the projected sales of the 2016 calendars, more than five times the amount they raised the previous year.

To purchase a calendar, you can visit the official T1D Exposed website. If you live in the San Francisco area, you can purchase one at the free launch event on December 4th at the Institute of Possibility.

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A Love Letter During a Blood Sugar Swing Mon, 23 Nov 2015 14:50:55 +0000 Paul Cathcart describes to his love what it’s like to communicate during a high or low, and asks for understanding.

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It’s not easy being in a relationship when you have Type 1 diabetes, especially during a blood sugar swing. In this edited excerpt from Persona Non Grata with Diabetes, Paul Cathcart asks for his love’s understanding with the many communication breakdowns during highs and lows.

shutterstock_242631049_couple_in_love_300pxYou see, the difficulty in being diabetic is in the living, and how blood sugar changes you. Cheekbones and back along the ridge of my brow furrow, skin pales, eyes narrow. A piercing fault as I usher aside clouding thought. I’m trying to concentrate on what you’re saying, but instead I become frustrated. I’m shaking my hands and I’m trying to follow and focus.

Then, I saw, sharp of tongue, “What?”, not because I want to snap at you, nor because what you are saying has little substance or I’m disinterested. My “What?” is because I can’t think, because I’m trying to understand. I’m trying to relate to you, to empathize with you.

I am like this because my head is clouded and agitated and buzzing and I’m trying to communicate with you at the same time and it’s smothering me. I want to be there for you, I am there for you; I am here for you always. And I’m not ill-tempered, especially not ill-tempered towards you. What should be clear and simple between us becomes disagreement, repetition, and frustration.

I want to be a better person for you and I’m only four points of sugar away. My life is run by this simple biological block of not being able to cope with glucose on its own. I won’t let it continue to hurt me and I won’t continue to hurt you. I won’t allow it to stop me from becoming a great husband and a great father.

I know now why I’m writing this. Because I’m ready to settle down and I can’t be living like this or behaving like this anymore.

My love.

To buy Persona Non Grata with Diabetes, go to

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How to Get Fired with Diabetes Fri, 20 Nov 2015 14:46:55 +0000 Paul Cathcart describes what it feels like to be pushed out of a job by an insidious HR department.

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shutterstock_287367206_push_back_business_hand_300pxIt’s fairly well established in U.S. and UK law that people with diabetes have some protection against job discrimination. In the case of those already on the job, employers are expected to make reasonable accommodations for issues that arise from a diabetes diagnosis.

Unfortunately, job discrimination is not always a clear-cut issue. Too often, people with diabetes will be fired or forced out for other alleged reasons, including poor job performance. It gets hard to define what is caused by diabetes and what isn’t, especially when an employer wants to believe the latter over the former.

In this edited excerpt from the book Persona Non Grata With Diabetes, Paul Cathcart describes the experience of being nudged out of a job while dealing with a long-term diabetes-related illness:

HR brings me in for the talk – to see how I am doing. “Is there anything we can do to help? Adjust your working hours? Just let us know. We are here to offer you all the help and support we can. The door is always open.”

HR brings me in for the talk – “Will you ever be ill again? If so, do you know when and for exactly how long? It’s affecting the team; they are managing to cover for now, but it’s getting a bit much for them. In the meantime we are extending your three-month probationary period by another three months.”

HR brings me in for the talk – My boss has come along to make this a more formal affair. No one is happy when I request to be paid for the prearranged work from home I did while I was ill. I am informed that “this will no longer be an acceptable procedure.”

HR brings me in for the talk – they send me to see the company doctor to get to the bottom of this. Someone reported back they had seen me drink a full pint of Guinness on Friday after work as I tried to socialise on some level with the team who have been so patient in covering for me.

Fortunately their doctor is supportive, telling me that I have a legally recognized disability and that he can see I am doing everything I can to get better. He shakes my hand as I leave his office on Wimpole St., and I wish he was my doctor.

HR brings me in for the talk – they have read the doctor’s report and he says I’m fine, so they can’t understand why I have been taking time off to see my own doctor again. We debate what the doctor has actually said.

HR sends me an email – they want a second opinion and arrange an appointment with a company nurse for…pretty much now. She happens to be an ex-diabetes specialist nurse who takes one look at me and says, “You need to go home.” I explain that I can’t because I have so much to do, and I’m under so much pressure to do it.

HR brings me in for the talk – requesting that I give their doctor full access to all previous medical health records and to sign the consent waiver form. The form is prepared in front of me with a pen on top; all I need to do is sign. I demur. My doctor informs me this is a common strongarm tactic implemented by HR departments who don’t know their boundaries. He tells me not to sign it, and that I am protected by law.

I have a toothache, and a piece of tooth falls out. I pop over to the emergency dentist. The root of my recent diabetes problems is revealed, so to speak – a hidden gum infection. Tooth extracted and it feels like someone has lifted a blanket from over my head.

I pass on the dentist’s explanation that this is what was causing me to be ill for the past months on end. This is backed up by their private doctor. Every time I was getting better the hidden infection would rear back up and set me back.

In the midst of this, my sister calls to let me know my gran is passing away. During her last days, I get calls from clients of the company that I can’t field adequately. Then all email communication drops, my calls are not returned.

Train back to London and I receive a call from my boss. HR wants to bring me in for a talk. I know from the silence that she is calling me from a meeting room, and I know what this means.

To buy Persona Non Grata with Diabetes, go to

Read our five-part series on U.S. law and discrimination against people with diabetes in the workplace here:

1. Barred from Work for Diabetes Ignorance
2. Unsettled Diabetes Discrimination Law
3. Protection from Diabetes Workplace Discrimination
4. Prepping for Job Medical Screenings with Type 1
5. 3 More Diabetes Anti-Discrimination Laws

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Diabetes Makes a Cameo in The Walking Dead Tue, 17 Nov 2015 16:27:19 +0000 Insulin becomes a major plot point in a recent episode of the zombie-filled show.

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Photo Credit: Gene Page/AMC

Photo Credit: Gene Page/AMC

Last Halloween, we wrote a tongue-in-cheek story on how people with Type 1 diabetes could survive a zombie apocalypse. Now, the show The Walking Dead has provided proof that someone on insulin did survive an outbreak of zombieism…if only brief

SMALL SPOILER ALERT. This article will talk about a minor character in Season 6 of The Walking Dead, and a possible future plot point.

It would be lovely if the show featured a zombie-killing character with Type 1 who carefully manages her blood sugars while dispatching zombies with an axe. Too often in movies and television, a character with diabetes is part of a plot either to be saved or to die so all the other characters can be sad. Unfortunately, The Walking Dead decided to combine both cliches in one short episode.

In the episode of “Always Accountable”, one of the main protagonists, Daryl, encounters a new trio of survivors in the woods. The three carry a duffel bag between them. Daryl and the new group get off on the wrong foot, as the trio assume he is a bad guy and tie him up as their prisoner.

One of the three is a young woman named Tina, who appears weak and flush. Snippets of conversation reveal the three are on the run from a brutal community of survivors. It’s a bit unclear, but it sounds as if they had gotten away from said community once, but had to double back on Tina’s behalf.

At one point, the trio become distracted and Tina passes out. Daryl grabs the duffel bag and runs into the woods. After dispatching a zombie with his trusty crossbow, he looks into the bag to discover a cooler with insulin.

Photo Credit: Gene Page/AMC

Photo Credit: Gene Page/AMC

Evidently, Tina has passed out from very high blood sugar levels (luckily no one mentions hypoglycemia, so we can assume the writers know the difference between a high and a low). Although the show never clarifies whether she has Type 1 diabetes or insulin-dependent Type 2 diabetes, her young age and relative health points to it being more likely the former.

Daryl, apparently feeling some moral qualms, retraces his steps to give the insulin back to the group. The four make their way through the woods, only to have to hide from another group of survivors; these are apparently the group that the trio originally fled. While hiding, Tina is given her insulin.

And here we have to stop for a moment and examine whether that insulin would do any good. It’s the zombie apocalypse and we are in Virginia – could insulin have survived long enough to be any use for Tina? The answer is possibly, but everything would have to go right.

Here’s why that insulin could….and I mean could….be good: we first see the insulin in a cooler, so we know it’s cool at the moment. The next problem is whether, even if it’s cool, it still would have gone bad by this point; we are in Season 6 of this show, after all. Again, maybe, and only if everything goes right.

To piece this together, we have to assume that all the insulin factories shut down within a month of zombies coming around and eating the factory workers. This vial of insulin would have to have been made pre-zombie outbreak.

Next, we have to establish how long it’s been since the zombies started shuffling around. Luckily, there are superfans of The Walking Dead who have tried their best to account for every day on the show. The well-established fan site,, came up with an estimate that we are on Day 553 post-outbreak; other sites have adopted roughly the same count. However, a WetPaint article quoted a character talking about the last two years of his life being a lie, so 553 days might be a bit short or that character might have lost track of time.

In either case, let’s safely say we’re talking about somewhere between 550 days and 730 days. Insulin expiration dates for refrigerated insulin generally stretch one to two years after date of manufacture. While insulin loses effectiveness as it gets older, if Tina’s insulin had somehow been kept cool all this time, it’s possible that the shot would have done her some good.

But wait, how could this straggly trio have kept that insulin cool all this time? Here again, we have a possible out, albeit a highly unlikely one. There is some speculation from casting moves for the show that we are about to be introduced to a group called the Saviors. If the show follows the comic book on which it’s based, the Saviors have survived the zombie outbreak by holing up in …..wait for it…. a factory. Could it have been an insulin factory? And could the Saviors have kept the power on all this time, without interruption?

Probably not, but if we can believe corpses are walking around eating people, we can believe that this group of survivors somehow kept the insulin cool, at least until we are proven wrong when we see the Saviors’ living conditions.

Of course, Tina would still be in trouble if her blood sugar was so high that she was in diabetic ketoacidosis, but that’s another problem we’ll ignore. The point, it turns out, will be moot.

That’s because poor Tina is going to have a very short life expectancy after being used as a plot device to prove the moral worth of the other four protagonists. The group comes across a glass greenhouse that melted in a massive fire and two corpses of people that apparently were trapped there during the fire. The trio realizes that the two corpses were friends of theirs, and Tina unwisely decides to lay down flowers at their resting place. Bad move, Tina, as the corpses choose that moment to reanimate, break out of the glass, and eat her. She’s buried in the next scene.

So once again, people with insulin-dependent diabetes are either there to be saved or there to provide a sad death. Thanks, The Walking Dead, thanks a lot.

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The 7 Best Ways to Publicize Your Diabetes Event Mon, 16 Nov 2015 18:05:40 +0000 A diabetes news editor shares what works.

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shutterstock_137469248_little_boy_extra_paper_300pxDuring Diabetes Awareness Month, there are many events and fundraisers about Type 1 diabetes vying for attention from the news media. Unfortunately, many worthy stories don’t get the coverage they deserve each year because of an error in publicity strategy. Maybe the press release comes to an editor’s attention too late, or maybe a publicity email doesn’t grab an editor’s attention.

Most every news editor I know is working with limited resources and has to make hard choices of what to cover. With this in mind, I’ve made a list of seven ways you can help an editor take a second look at an email about your event or product:

1. Send your first email at least a month in advance. I receive many emails about World Diabetes Day events just a few days before the big day itself. Many publications, especially the smaller ones, plan their editorial calendars weeks or months in advance. Even if you don’t have everything planned out for your event, you can still send a preliminary email with what you do know and include a link for more information.

2. Send polite follow-up emails. Although I try to juggle many different story ideas at once, I always drop a few balls along the way. As long as you don’t expect an editor to respond, it isn’t rude to send two or three more emails in the weeks leading up to an event.

3. Don’t shoehorn your subject into an existing event. No, Diabetes Awareness Month is not a reason I need to write about the product you want to sell. If you want to drum up publicity for a business venture, just say so; don’t mask it in altruism.

4. Less is more. I will often spend less than 10 seconds skimming an introductory email. Make my job easier by putting your main point towards the top and keep the email short.

5. Take “no” gracefully. There may be many reasons a suggested story doesn’t get covered. If you make a good impression, however, it’s more likely an editor will give your event or product a second look in future emails.

6. Be ready to assist. If an editor wants to write about a subject you suggest, do what you can to be available to provide for whatever she or he needs. Editors wake up at night in a cold sweat about deadlines; whatever you can do to keep things rolling will be appreciated.

7. Choose your battles. Editors want to get things right, but accidents happen. If there is a factual error or a point taken way out of context, politely point it out and ask that it be fixed. However, if you wish things could be worded differently to put your organization in a more flattering light, it might be best to just let it go until the next story. An editor might avoid doing a follow-up story if you’re too forceful in trying to get the most positive news coverage for your organization.

I hope this peek behind the curtain helps you get the word out!

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Diabetes Drives MMA Athlete Dessi Zaharieva Fri, 13 Nov 2015 20:52:58 +0000 The taekwondo medal-winner says Type 1 gave her a desire to have no limits in life.

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Dessi_Zaharieva_Lab_300pxDessi Zaharieva, a 26-year-old PhD student at York University, is sitting in a lab at school in Ontario, Canada as I ask her questions over the phone in the living room of my apartment. When she says that the Black Sea coastline in Bulgaria is where she feels most at home, I struggle to picture the scene.

“It’s where we would always go to relax as a family when I was growing up,” Zaharieva explains. “The food, the salty sea water, the beautiful sunsets. The Black Sea is my ‘happy place’.”

When Zaharieva was four years old, her parents decided to move the family to Canada. Three years later, she was diagnosed with Type 1 diabetes. Looking back, she realizes she probably was symptomatic much earlier than that.

“I was always really active, so it took a little bit longer for my parents to realize what was wrong,” she says.

All of the symptoms were there: drinking tons of water, excessive trips to the bathroom, but her parents didn’t have the knowledge to identify the issue. Or the language for that matter. Literally.

“It’s not like you can go to [a Canadian] hospital and get a Bulgarian translator,” she says.

Although she wasn’t fluent in English at the time, she was better off with the language than her parents. Zaharieva was only seven and it was a lot to handle – coming to terms with her illness and trying to facilitate communication about the medical condition with her parents.

“It was a lot for someone in Grade Three, but I actually think [having diabetes] is like a blessing,” Zaharieva reflects. “I’m very in tune with my body.”

Dessi_Zaharieva_300pxAs she should be, considering she’s spent the better part of her life studying taekwondo. When she was 16 years old, Zaharieva earned a spot on Team Canada for the World Championships, a biennial athletic competition. For three consecutive seasons, she wore the flag of her adopted country on her back. Her proudest moment was in 2013 when she won a bronze medal in sparring for Team Canada at competitions hosted in Bulgaria.

For many summers before this, Zaharieva had returned to her native country to train with the Bulgarian National Team at Kiten Beach, a stretch of sand that welcomes both tourists and locals. Whether she was sprinting up stairs at seven in the morning or running drills in the water, she felt at home. And when she came back for the 2013 games, she felt like she was representing both Bulgaria and Canada. Up on the winner’s platform that year, Dessi stood on the third place perch while just a few feet away in the spot for silver was a Bulgarian girl with whom she had trained.

“It was really special to have both of us on the podium,” Zaharieva says. “For me, no moment can beat that.”

Dessi_Zaharieva_Kick_300pxLast year, Zaharieva switched to Mixed Martial Arts and she now spends hours rigorously training, sometimes twice a day. She’s had a torn meniscus and two torn ACLs, one of which she sustained in 2010 and the other earlier in 2015. After the 2010 injury, her surgeon said she would never compete again; not only did she power through rehab, she also managed to medal for Team Canada that same year. This is typical of her attitude, says Dr. Mike Riddell, a kinesiology professor who supervises her training.

“She will never give up,” Dr. Riddell says. “She believes in herself and seeks the support of others when needed to help reach her goals.”

And she’s got more than her fair share of goals and projects to complete. Not only is Zaharieva a part of the I Challenge Diabetes team, a group dedicated to testing the limits of people living with diabetes to inspire the diabetes community, she’s also spoken at Medtronic events to medical professionals, parents, and kids with Type 1, sharing her personal experiences living with diabetes and emphasizing the importance of living without limitations.

“I think diabetes drives much of her motivations and successes,” Dr. Riddell says. “She uses it as a constant reminder that much more needs to be discovered to help people.”

In addition to her graduate school course load, Dessi has worked for York University’s Diabetes Sports Camp, a program that Dr. Riddell founded to educate kids and teens with Type 1 to better manage diabetes while still remaining active. Despite her crammed schedule (up at six in the morning and not home until midnight many days), the 26-year-old says she doesn’t like to take breaks and admits that she can’t even enjoy a day off from work.

“The busier I am, the more productive I am. I always feel like I’m not doing enough,” Zaharieva chuckles.

The MMA fighter was recently hired to promote Bayer’s Powered by Accuracy campaign in support of the Contour Next meter. She had already been using the device when Bayer contacted her about supporting the product. As part of this, a camera crew filmed a short video for the campaign at an MMA gym in Toronto:

For now, Zaharieva has three more years of work to do until she gets her PhD. One study she conducted for her master’s thesis at York demonstrated that consuming caffeine has no adverse effects on athletes with Type 1; it was a study she describes as very close to her heart.

In the future she hopes to open her own research lab. It could be in Canada, the United States, or Europe. She also has no intention of slowing down with the MMA training, either. Limits are like a dirty word to her.

“Don’t limit yourself,” Dessi implores; it sounds like her mantra. “Be free to do what you want to do.”

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5 Reasons People Ditch the Pump Fri, 13 Nov 2015 17:16:38 +0000 We hear a lot about the pros of insulin pump therapy. A diabetes educator shares some of the cons.

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Integrated Diabetes Services (IDS)Questions_Vector_Edited_300px provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community.

Q – I see studies show that people with Type 1 do better on insulin pump therapy, but I sometimes hear of people stopping pump therapy to return to multiple daily injections. Can you tell me why it might be better for some people to stop using a pump?

A There are many more choices for insulin pumps than in the past, and many of these new pumps come with new and powerful technological options to help you with blood sugar management. Many clinicians promote pump use as the best way to achieve optimal control.

But is it really the end-all-be-all of diabetes management? As with everything in life, it comes down to personal choice and what works for you. It’s best to do your homework to evaluate if a pump is best for your lifestyle and blood sugar management needs.

There are plenty of articles discussing the pros of pump therapy, but few that discuss the cons. To offer some balance, here are some downsides to pump use that have caused people to switch back to multiple daily injections:

1) Mechanical Failure
Insulin pens and syringes don’t have mechanical parts – they will not malfunction or have errors. The more technology that is used to deliver insulin, the higher the chance that something can go wrong in a mechanical sense. It doesn’t happen often, but it does happen.

I have had several pump failures in 15 years of pump use; all were detected by the pump. Pump problems can include internal errors in the mechanics, air bubbles in the tubing, and kinks in the cannula. With pump therapy, diabetic ketoacidosis can set in if insulin delivery is interrupted and blood sugar levels aren’t being monitored.

2) Skin sensitivity
If you’ve used a pump in the past and have developed scar tissue or have skin sensitivity to the adhesive tape, it might prompt you to go back to injections. There are ways to avoid these problems, like adequately rotating the infusion site and employing barriers, but these don’t always work.

Pump_and_Accessories_300px3) Visibility
Diabetes is for the most part an invisible condition that we can hide, if we choose. With an insulin pump, it’s harder to hide. Also, being attached to the pump via tubing or pod is a 24/7 thing and for some this makes a pump a constant reminder of diabetes. This might be beneficial for some, but a psychological downer for others.

4) Expense
With pumps, cost is surely a consideration. Pumps and pump supplies cost significantly more than syringes and pens. Insurance companies vary in coverage, so the cost for out-of-pocket expenses might be what makes some turn back to the syringe.

If you can achieve the same level of blood sugar management and A1C scores without a pump, it may provide great savings. However, if you’ve done injections in the past, and can’t get your A1C below 7.0, you might want to consider the expense of an insulin pump worthwhile, as it could save you money down the road in prevented diabetes complications.

5) Personal Preference
A pump has the ability to fine-tune insulin doses down to the 0.025 unit, and that can make an enormous difference in control. Injections can only be delivered in 0.50 unit increments. This might mean you have to take a lot of little injections throughout the day, but some people like that kind of hands-on approach, and don’t mind the amount of effort it takes to achieve good blood glucose control.

The important thing is to take the time to explore the options available and see what works for you. Get the pros and cons to all the pumps on the market; we came up with a list that you can access here. If possible, work with a certified diabetes educator to road-test an insulin pump. While insulin therapy is not optional for people with Type 1, any option for achieving good blood glucose control should fit your lifestyle and needs.

Integrated Diabetes Services provides one-on-one education and glucose regulation for people who use insulin. Diabetes “coaching” services are available in-person and remotely via phone and online for children and adults. Integrated Diabetes Services offers specialized services for insulin pump and continuous glucose monitor users, athletes, pregnancy & Type 1 diabetes, and those with Type 2 diabetes who require insulin. For more information, call 1-610-642-6055, go to or write

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Diabetes Awareness Month – The Year of the Selfie Wed, 11 Nov 2015 18:47:01 +0000 Blue self-portraits and diabetes-related hashtags have taken over social media. Is it enough?

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Insulin4All_300pxType 1 diabetes is inherently a lonely condition, one that makes you look inward to maintain your health. It doesn’t help that few people understand what Type 1 diabetes really is, and many make tasteless jokes at its expense. Campaigns for Diabetes Awareness Month are focused on raising the visibility of Type 1 diabetes to make those who endure the roller coaster ride of blood sugar management feel more visible.

This year for Diabetes Awareness Month, there is a distinct theme emerging – that of the selfie. JDRF has perhaps the most visible selfie campaign of the year, using the tagline of “T1D Looks Like Me”. The organization is encouraging people to have a blue overlay on one’s Facebook profile with said tagline. It also has a giant billboard up on Times Square. Many in the Type 1 community have taken the cue and have altered their profiles accordingly. There has been a good amount of “duckface” portraits, along with at least one glamour underwear shot.

JDRF is not alone. There has been another Facebook profile overlay that has been making the rounds called #TypeNoType, for example; the hashtag calls into question divisions between the Type 1 community and the Type 2 community. Some Type 2 activists have made a convincing argument that they feel socially isolated from the Type 1 community, and wish the bonds between the two groups could be strengthened.

Other charities and nonprofits also have employed selfies in their campaigns. T1International has once again undertaken the #insulin4all campaign, which asks people around the world to post a photo of them holding the sign saying “We are the WORLD in World Diabetes Day”. Also, the Children’s Diabetes Foundation asks supporters to take a picture of family and friends with a Children’s Diabetes Foundation sign that says “I Support Diabetes Awareness Month”.

It’s hard to gauge whether or not these campaigns will have more visibility than last year’s efforts for Diabetes Awareness Month. I can only say they appear more visible in my social media feeds; of course, maybe it’s just because I have gotten more immersed in diabetes community social media than last year. Certainly, the selfies are making sure that the month has a significant blue tinge to it. And it certainly makes me feel better to see them than all the promotional emails I’ve received this month that say, in essence, “It’s Diabetes Awareness Month, so buy my diabetes-related stuff!”

At the same time….and here’s where I’m probably going to show my age…I worry that all these diabetes selfies might make one feel, weirdly, alone. You take the photo, you apply the filter, you post it and…then what? Selfies are great, but they shouldn’t overshadow face-to-face events that these nonprofits and others are hosting to mark the month and create community.

I would advocate for something a bit more hands-on for Diabetes Awareness Month next year. Perhaps one could be offered basic blue profiles for Facebook, and augmented features to the profile only if they could show they had participated in a fundraiser or community event. I think it would be great if the selfies submitted were taken after a day of raising the frame of a house for Habitat for Humanity or lobbying at the statehouse with your local diabetes group.

I have nothing against selfies. I just want people with diabetes to be more than visible in the community; I want them to be a force.

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Pennsylvania Lawmakers Call for Type 1 Education Tue, 10 Nov 2015 19:46:49 +0000 It marks the second time that state legislators have called for enhanced diabetes screening.

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shutterstock_145281661_lawmakers_300pxLast month, North Carolina lawmakers passed the first state legislation to boost screening for Type 1 diabetes. Now, Pennsylvania state house members have passed a unanimous resolution to encourage “all health care practitioners in this Commonwealth to educate and discuss the warning signs and symptoms of Type 1 diabetes with the parents or guardians of each child under their care.” While the resolution does not have the force of law, it is another step in raising awareness among medical professionals and lawmakers of the dangers of undiagnosed Type 1 diabetes.

As with most successful diabetes advocacy campaigns, this resolution was championed by concerned parents. Debbie Healy is a diabetes mom and an honor roll supporter of the Lehigh Valley’s American Diabetes Association walk-a-thon event. It was her son’s brush with near fatal diabetic ketoacidosis (DKA) that got her into the fight. One evening while she was out working, she checked in with her then 17-year old via text, since he’d stayed out of school with what was thought to have been a sinus infection. She described what happened next on a Facebook post:

“My son responded to my text by saying: ‘I’m in the basement.’ So when I got home, I went down to the basement. The lights were off. I told him that he needed to come upstairs so I could see and talk to him. He came upstairs, and … that’s when I knew we had a medical emergency! How did I know? He did not look like my son. He had a sunken-in look to him. … We took him to Lehigh Valley Hospital…while in the ER, a nurse did a finger-prick blood test. The glucometer measured 600.”

That was as high as the particular glucometer could measure. Her son was admitted and given an IV for dehydration, as well as another blood test. This time, his blood sugar levels measured at 1400 mg/dL, again the highest the device could read. He was in a DKA state:

“If we had waited one more day or even just an hour longer to seek medical treatment, we might have lost our son,” she wrote.

She and another mom, Karen Lantz, started a Facebook group, PA Residents for Diabetes Legislative Reform, and began to contact legislators. They focused on five initiatives:

  • better parent education about Type 1 diabetes
  • a required urine or finger-prick blood glucose test for every child who presents to a care provider with a complaint of illness, as diabetes can mimic other conditions that send children to the emergency room
  • better education for school children about Type 1 diabetes
  • strengthened clinical and continuing education requirements for medical personnel about diabetes and DKA
  • required screening for islet cell autoimmunity of children who appear symptomatic or have diabetes in their ancestry

The resolution provides forward progress on the first part of the five-part plan; Healy’s next step is to pass the same type of legislation in the state senate and convince the governor to make the proclamation, as well. In an interview with Insulin Nation, Healy has pledged to push for legislation that addresses the other four parts of the plan, as well.

While neither the North Carolina legislation nor the Pennsylvania legislation mandate testing for Type 1 diabetes, both are hailed by diabetes advocates as a good start to addressing the grave threat of undiagnosed Type 1 diabetes.

This article has been corrected. An editorial error misidentified the other state to pass diabetes legislation as Florida; it was North Carolina.

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Why Celebrities with Diabetes Matter Mon, 09 Nov 2015 17:18:58 +0000 A rebuttal to our story “This is Not a Nick Jonas Article.”

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image4_300pxAs parents, we wanted my daughter Evelyn, who has Type 1, to know that anything was possible, so we decided to have her meet extraordinary people with Type 1. The celebrities we have met and talked with have managed to follow their passion with diabetes in tow. As parents, we decided that if we were asking her to believe in what she thought was impossible at the time – that she could manage her diabetes and have a full life – then it was best to show her in a way that would grab her attention.

We had no special connections; we didn’t “know” anyone that could get us “in” with any of these people. Instead, I tweeted, messaged, emailed, and searched-engined my way into every meet-and-greet. Some were easier than others to meet, with Nick Jonas being the most difficult, as he is in high demand.

We also have met with rock stars Bret Michaels and Crystal Bowersox, baseball players Sam Fuld and Brandon Morrow, race car drivers Ryan Reed and Miguel Paludo, up-and-coming tennis star Elizabeth Profit, and Amazing Race winner Dr. Natalie Strand, among others. Each had a story to tell, and each has helped draw attention to issues of life with diabetes through advocacy or just by sharing their personal stories.

Deciding to meet each celebrity creates a tangible goal to go alongside the less tangible and constant goals that come with diabetes self-care. We studied up on each celebrity and their diabetes stories before we met them so we could talk diabetes shop in person. We wanted to provide parallels between our story and theirs to show Evelyn that she’s not alone, and that she can accomplish much.

In the coming months, we’re set to meet Carolina Panthers football player Kyle Love and snowboarder Sean Busby. This isn’t all we do to stay inspired – Evelyn has been a youth ambassador for the American Diabetes Association, for example – but our little project has kept us busy and energized. And that’s one way celebrities with diabetes matter.



This article is in response to our recent post – “This is Not a Nick Jonas Article”.

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How to Detect Type 1 Years in Advance Thu, 05 Nov 2015 18:42:09 +0000 Researchers find many children with Type 1 had biological markers for the condition years before they became symptomatic.

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shutterstock_111168947_baby_grip_300pxThere has been a push to catch Type 1 diabetes before diabetic ketoacidosis sets in, but some researchers wonder if we should be catching Type 1 years before symptoms appear.

That was the focus of a recent JDRF webinar led by the organization’s chief scientific officer, Dr. Richard Insel. Dr. Insel shared the findings of a large study published in Diabetes Care which found that biomarkers for Type 1 diabetes often could be found years before those with Type 1 showed symptoms.

“For childhood onset Type 1 diabetes, the autoimmune process…begins very early in life,” he said.

The international study screened some 400,000 children for having a genetic disposition towards developing Type 1 diabetes. The study tracked children for 15 years, and 650 of the study participants eventually developed Type 1.

By tracking the children for so long, researchers were able to find evidence that those who developed Type 1 had shown physiological signs long before they showed symptoms – including the development of antibodies against beta cells. One study of Finnish children with Type 1 found that 95% of those who developed Type 1 by fifteen years of age showed signs of these antibodies by age 5, for example. It’s also important for researchers to get good at detecting these precursor biomarkers because beta cell destruction progresses more quickly in children with Type 1 than adults with Type 1, so any intervention has to happen as soon as possible in the process.

“If we’re going to prevent Type 1 diabetes, we’re going to have to intervene very early,” Insel said.

Detecting early biomarkers of Type 1 diabetes helps researchers think of how to formulate early intervention treatments, including giving high doses of oral insulin to children showing physiological signs of the condition. Such early intervention is already being tried in some studies, but it’s too early to tell if this will lead to better glucose control or fewer complications in the long run, he said.

Unfortunately, there will be increased demand for such interventions, as research shows that rates of Type 1 diagnosis are climbing. A recent large-scale study, the SEARCH study, found that there will be a threefold increase of Type 1 diabetes diagnoses among all children, with a more than sixfold increase in Type 1 diabetes among Hispanic youth, according to Insel.

The increase “reflects some environmental issues that we don’t really understand,” he said.

The study was a joint effort involving many major diabetes organizations, including the American Diabetes Association, the Endocrine Society, and the Helmsley Charitable Trust.

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Dr. Ben Carson’s Dietary Supplement Troubles Wed, 04 Nov 2015 15:24:28 +0000 The presidential candidate is quizzed about endorsing Ambrotose, a sugar pill that has been falsely touted to cure diabetes and other conditions.

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This campaign cycle is shaping up to be an interesting one when it comes to dietary supplements, fake diabetes cures, and presidential candidates.

In May 2015, former Governor Mike Huckabee had to take time out of his candidacy to defend his 2014 involvement with a dietary supplement that was a supposed cure for diabetes. During an October 2015 primary debate, it was frontrunning candidate Dr. Ben Carson’s turn on the hot seat, as the neurosurgeon was quizzed about his involvement with a different supplement that also has been falsely touted by its salespeople for curing or improving many serious conditions, including Type 1 and Type 2 diabetes.

Dr. Carson was asked by CNN moderator Carl Quintanilla about his 10-year involvement with Mannatech, a nutritional supplement company that once paid $7 million in 2009 to settle a lawsuit by the Texas Attorney General for false claims made about the health benefit of its product, Ambrotose. Carson first denied having any relationship with the company, and then finished his statement by saying he gave speeches for the company and took the product. You can view the exchange here.

While officially Mannatech says it has never made any claims that Ambrotose should be used as a treatment for any disease or condition, its independent sales force has been caught saying that the product cures many of the worst illnesses, including diabetes.

Court documents filed by the Texas Attorney General’s office under Greg Abbott (now the Republican governor of Texas) and a separate class-action lawsuit reveal multiple instances of claims made that Ambrotose could regulate or cure Type 1 and Type 2 diabetes. The complaint also said the product was promoted as something that could cure or treat cancer, Down’s Syndrome, and many other serious conditions.

In the class action suit, there were multiple allegations of veteran sales associates training new salespeople to say that the product could cure Type 1 and Type 2 diabetes. Sometimes, they would include personal anecdotes of how their diabetes was cured or vastly improved. Materials for a 2003 sales seminar included one such example:

Judy Allen- a Mannatech Presidential (editor’s note, a ranking salesperson) – used to take $1400 of medications a month and even had a double kidney transplant, as she was such a brittle Type 1 Diabetic. Her insulin need has gone down 70%, and her transplant meds to suppress her immune system have now been stopped, which is unheard of!

Mannatech settled the class action suit in 2008 by agreeing to pay $11.25 million to investors. In the 2009 settlement with the Texas Attorney General, the company promised to make sure its sales force wouldn’t make false claims about the product. Even so, it’s clear that Ambrotose is still being marketed by many as a treatment to regulate blood sugar levels or cure diabetes. Here’s an example of a 2014 video put out by one of Mannatech’s independent salesmen – it’s an interview with someone claiming to use Ambrotose to take control of his diabetes:

The man in the video, identified only as “Rob”, describes how his diabetes was out of control until a friend gave him Ambrotose to take:

“So I took it, and I went back for my normal blood work three to four months later. My doctor, he goes, ‘I don’t know what you’re doing, but whatever you’re doing, keep doing it,’” Rob says.

The supposed selling point of Ambrotose is that it helps those who take it maintain adequate levels of so-called glyconutrients, but experts who have studied these nutrients say adding more to your body will only, at most, cause an increase in flatulence. Those experts were interviewed as part of a 20/20 investigation into Mannatech.

It is not surprising that as Carson has climbed in the polls his involvement with Mannatech would be given closer scrutiny. What might be surprising is that he didn’t have a better answer prepared at the debate. It wasn’t as if he didn’t have clear warning this would come up. Earlier in 2015, he and a campaign official were asked by two conservative news outlets, National Review and NewsmaxTV, to defend his involvement with the company.

Even before the October debate was over, fact-checkers were finding ample evidence that Dr. Carson wasn’t being completely forthcoming on his relationship with Mannatech. For example, he took part in a 2013 Mannatech promotional video to talk about Ambrotose. In the video, he gave a careful endorsement-which-is-not-an-endorsement of the product’s effectiveness.

“I can’t say that’s the reason that I feel so healthy, but I can say that it made me feel different, and that’s why I continue to use it 10 years later,” Carson says.

According to PolitiFact, Carson did give four speeches paid for by Mannatech, and they included moments where he touted his personal experience with the product. In total, he has been found to have appeared in two Mannatech videos, as well as a PBS documentary on glyconutrients; his participation in the PBS video was sponsored by independent Mannatech sales people. The evidence was enough for the fact-checking website to decide that while Carson was not a paid employee of Mannatech, his claim that he had no ties to the company was false.

Since the debate, an advisor to Carson has attempted to explain away at least one connection to the company – Carson’s appearance in the 2013 video. The advisor claimed that the candidate had been tricked into giving his endorsement of Ambrotose because he thought the video would help the company’s charitable efforts to distribute the supplement in Africa.

The 2016 presidential election cycle is still in its beginning stages, and it remains to be seen whether Carson will maintain a competitive position as a presidential candidate. If he does, it may very well be that “Mannatech” becomes an election year buzzword that will be much discussed in the coming months.

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My Lost Year with Diabetes Burnout Mon, 02 Nov 2015 20:27:54 +0000 How a decent A1C score and a mask of a positive attitude hide feelings of despair for one young woman with Type 1.

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shutterstock_139730596_flaky_eyes_300pxI thought the term “diabetes burnout” would never apply to me. I had been caring for my diabetes since age 9, and I determined at an early age to always stay positive about it. I wouldn’t acknowledge any downside to my condition, and I was constantly striving to lower my A1C every chance I got.

Then came my junior year of college, and my days were way too full. Between class, my job, and volunteer involvement, I was on the go from seven a.m. to midnight seven days a week. Sometime during the year, my positive attitude evaporated. I began to hate diabetes, not just those moments when my blood sugar levels were out of control, but every moment I was awake. I began checking my blood sugar less and not keeping track of patterns for possible changes, rotating and changing my pump sites less, and canceling doctor’s appointments.

A part of my identity that I used to celebrate, I now detested. I felt like a hypocrite. To cover this up, I put on a mask of positivity and didn’t breathe a word about how I felt for months. I was able to keep up this facade because my A1C barely went up and I somehow avoided any extreme highs or lows.

In the movies, many characters escape burnout with a eureka moment, that shining beat when everything becomes clear and they decide to make a big change. For me, it was a long, drawn-out process. I switched my health care team, which helped, but it took me a while to even hint to them that I was feeling burned out. Instead, I slowly climbed out of the pit of my emotions through internal retrospection.

I eventually realized that I had been skimping on my own self-care. Even though I was doing all the right things to keep my blood sugar levels basically in range, I wasn’t doing enough self-care to feel whole and stable. To combat this, I made a commitment to carve time out of my schedule to do something good for myself each day. I also learned I was being my own worst critic; now I make sure to pat myself on the back when I do the little things I need to do to stay healthy.

Here’s the thing, though – I know diabetes burnout isn’t necessarily a one-time thing. If it comes again, I know I need to let myself feel it, and I need to speak up about my feelings. I have to remember that acknowledging burnout is a sign of strength, not weakness. Accepting that is an important part of taking care of myself.

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Yoga Allowed Me to Give Up on Diabetes Perfection Fri, 30 Oct 2015 18:14:41 +0000 How yoga helped one woman to embrace the unknowns that come with daily blood sugar management.

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shutterstock_186330251_Diabetes_perfection_300pxWhen I started practicing yoga at 17, I couldn’t budge this nagging feeling that something wasn’t quite right, but it took decades until I could put my finger on it.

At first the doctors thought I was pre-diabetic because my levels were just out of range. I just assumed that if I worked to change my diet and adopted a positive attitude everything would change. But pre-diabetes wasn’t the only problem. I had anemia, B12 deficiency, borderline thyroid disease and elevated levels of prolactin, which suggested a possible tumor in my pituitary gland. I can remember driving home from the doctors office in shock.

I was determined to beat it. If I worked to change my diet and adopted a positive attitude, I assumed I could avoid Type 2. The physical practice of yoga was a haven for me after that initial diagnosis and I was sure I could use the practice to stem the tide. I found that yoga helped draw my mind away from thoughts that could be deeply stressful.

But yoga wasn’t the cure-all I was hoping for. It became evident that the changes in my diet and lifestyle weren’t working. Tests taken when I was 42 eventually revealed I had Latent Autoimmune Diabetes in Adults (LADA); my beta cells were dying, and no matter how much yoga I practiced, I could not regenerate them. I had to alter my beliefs about the power of yoga, and the only way to do that was to…give up.

This may sound counterintuitive, but let me explain. When I tried yoga for the first time I had a certain expectation that I would progress with practice. Like a gymnast, you try and get a 10 out of 10 every time you step on the mat. But yoga isn’t a competition; the point is to surrender, breathe, and be one with all that breathes. Acceptance is key.

Now, with every pose, and after every yoga session, I remind myself, “You’re doing your best, that’s enough.” I have also stopped beating myself up when my blood sugar levels aren’t perfect. I accept them, take a breath, and let go.

Practicing yoga has helped me deal with my fears about the complications associated with diabetes. To accomplish this, I’ve had to slow down be mindful that every emotion is like a wave that comes as easily as it goes. Fear is an emotion that arises out of uncertainty, but uncertainty isn’t a bad thing once you can accept it. It can breed enthusiasm for the unknown and bring an unpredictable freshness.

In hindsight, the key step I needed to take was to start listening to my body instead of telling it what to do. I know my body responds differently to yoga practice on different days, and I now allow myself to accept the daily ups and downs of diabetes management. Some days when my levels are high I will respond by being more active. On low days, I have to slow down and make mindfulness a priority over physical activity.

Yoga is an integral cornerstone to my diabetes management. It encourages me to stay disciplined and to accept myself just as I am. It only works, however, because I choose to use it as a tool to accept myself and the unknowns that comes with diabetes.

This article has been re-edited at the author’s request to correct the timeline of her diagnosis and to clarify a few points in the story. Due to an editorial error, an earlier version misidentified her time of diagnosis at age 17.

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This is Not a Nick Jonas Article Thu, 29 Oct 2015 14:02:51 +0000 An argument for not getting too attached to celebrities with diabetes.

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November is National Diabetes Awareness Month, a good time to take stock of the past year.

If there is one indelible face that has become the symbol of Type 1 diabetes in 2015, it’s Nick Jonas, he of the dark hair, foxy gaze, and washboard abs. Never one to hide his diabetes, the pop star has put his Type 1 at the forefront, attaching a Dexcom CGM on said washboard abs for an advertising campaign, helping to create a Type 1 website (Beyond Type 1), and speaking out against a stupid CrossFit tweet making fun of diabetes. Not a bad year’s work.

But we need to stop fixating on him so much, and here’s why:

The diabetes online community is still very much a work in progress. As we’ve matured, we’ve become hungry to find a focus for a condition endured mainly in silence. That hunger creates the need for the BIG moment when FINALLY the world will see why it should take Type 1 diabetes seriously. We look to celebrities to carry the torch.

And sometimes it works. In 2014, Sierra Sandison, Miss Idaho, made jaws drop when she strode on the stage in a bikini with an insulin pump attached; her actions inspired the #showmeyourpump hashtag. There were a lot of great headlines generated for a few news cycles. Other times, the results are muddied. Jay Cutler is perhaps the most well-known athlete with Type 1, and he’s been very active in diabetes charity work. At times, he’s performed brilliantly and at other times he’s made rookie-like mistakes – and he has gained a reputation along the way, fairly or unfairly, of being a sourpuss of a teammate. And then there’s the confusing issue of Halle Berry, who seemed to suggest that she had Type 1 in 2007 and reversed it with diet; the consensus is that she probably had Type 2 and was initially misdiagnosed.

What do Jonas, Sandison, Cutler, and Berry all have in common besides being celebrities? They are all human, and therefore prone to doing great things and not-so-great things. They can get divorced, have substance abuse problems, and even not keep their blood sugar levels in check, just like anyone else. The problem is that when we put them on a pedestal as the standard bearers of the Type 1 diabetes community, any mistakes they make can have an outsized effect on our identity as a community.

It’s natural, and frankly fun, to focus on celebrities. My web browser history has way too many urls leading to articles on the Kardashians than I am comfortable admitting, and Insulin Nation writes probably half a dozen articles each year about big-name folks with Type 1. It’s just that we have to be careful that their stories don’t dominate the diabetes community conversation.

There are limits to the power of a celebrity. Celebrity culture won’t persuade your school district to enact policies to keep kids with Type 1 safe during the school day. Celebrity culture won’t get state laws changed to get better Type 1 screening for infants and toddlers. Celebrity culture won’t provide hand-holding, shoulder-to-cry-on support for a family confronting a new Type 1 diagnosis. That takes everyday people deciding to make a difference. We need to discuss those people just as much, if not more so, than stars with Type 1. Nick Jonas has done a service to the Type 1 diabetes community by being open about his diagnosis and supportive of the diabetes community, but he’s just one of thousands.

Each month this year, Insulin Nation will feature an everyday hero, someone who has taken it upon himself or herself to make a difference at the local level for people with diabetes. If you know of someone who we should consider, please email me at


Nick Jonas Image: Jaguar PS /
Halle Berry Image: DFree /

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Could Formoterol be the New Glucagon? Wed, 28 Oct 2015 13:22:53 +0000 A small study finds the inhaled asthma drug helped combat hypoglycemia.

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shutterstock_286001543_little_inhaler_300pxNearly 100 years ago, researchers discovered a new drug that changed diabetes care forever. Unfortunately, after the discovery of insulin, there hasn’t been that many other drug breakthroughs to report on in the last century. Scientists are now testing existing drugs to see if they might provide effective treatments for Type 1 diabetes. Recently, it was reported that scientists were testing the hypertension drug methyldopa to see if it could delay the onset of Type 1. Now, researchers have explored whether a common asthma medication might be the next treatment for hypoglycemia.

A study published in the journal Diabetes Care found that inhaled formoterol has the potential to help treat hypoglycemia in people with Type 1 diabetes. The study involved 14 participants, half of whom had Type 1 diabetes and half of whom did not. They were treated with either inhaled formoterol, which is traditionally used to treat asthma, or a placebo.

In a phone interview with Insulin Nation, lead researcher, Dr. Renata Belfort de Aguilar, a professor of endocrinology at Yale University School of Medicine, says that formoterol was observed in past clinical trials to stimulate data receptors in the brain, causing glucose levels to rise. This sparked the idea to test its preventative capabilities on hypoglycemia.

For the first part of the hypoglycemia study, 14 participants fasted overnight for 10 hours and then were given either formoterol or a placebo. Next, participants were given a hyperinsulinemic-hypoglycemic clamp, which helps measure insulin resistance in the body through intravenous (IV) methods. Blood-glucose levels were allowed to fall for an hour, with vital signs checked twice for safety. In those given formoterol, glucose infusion rates that kept blood-glucose in range dropped at a rate that was 45-50% slower than those given the placebo.

In a second part of the study, five participants with Type 1 were given formoterol to see if it could prevent insulin-induced hypoglycemia, while others were given a placebo. After they doubled the basal insulin infusion rate, with blood-glucose levels checked every five to 10 minutes, the researchers found that placebo patients fell down to about 58 mg/dL, well into hypoglycemic range; those given formoterol avoided hypoglycemia.

“We prevented hypoglycemia, which was more than we expected,” says Dr. Belfort de Aguilar.

This doesn’t mean formoterol will be replacing glucagon anytime soon. This study would be just the first step to proving the drug controlled hypoglycemia as well as glucagon. As she explains, the results of the study were positive, but the drug would need to be tested in larger studies and in real-world conditions. It would also need to be tested against glucagon in head-to-head trials. Still, Dr. Belfort de Aguilar believes the drug has potential, if she or other researchers could have the funding to prove it.

“I think it would perform well,” she says. “The issue is more time and cost.”

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Shameless and the Disappearing Diabetes Tue, 27 Oct 2015 19:16:29 +0000 A character on the hit show has Type 1 diabetes for all of a few seconds of screen time during Season 5. Why this is a problem.

The post Shameless and the Disappearing Diabetes appeared first on Insulin Nation.



Do you know what’s worse than a character’s Type 1 diabetes being used as an excuse for heroism in an action film? It might be when Type 1 diabetes is brought up once in a television show’s season and then largely ignored for the rest of the episodes.

Shameless is a sprawling and funny show that follows the misadventures of a severely dysfunctional family, the Gallaghers. The show is based off a U.K. show of the same name. One of the central focal points of the show is the fraught love life of Fiona Gallagher, the young and sometimes unwilling matriarch of the family.

At times, there are so many characters that it seems hard for the writers to keep track of all the plot points. That seems to be the case in the most recent season, Season 5, when a character with Type 1 diabetes is introduced as the latest love interest of Fiona. Gus is an earnest musician who helps Fiona save face when she is made a fool of by a member of Gus’s band. The two hit if off, and he spends time hanging around the diner where she works. Fiona is prone to diving into relationships way too quickly, and the two fool around (a lot) and quickly get married in a city hall ceremony.

It is only after this that we learn that Gus has Type 1 diabetes, as Fiona wakes up to find Gus injecting a dose of insulin one morning (poor Fiona is so used to drug abuse in her family that she fears he is doing heroin). The moment is clearly used by the writers to underline how little these two know about each other.

It’s at this point that the writers could begin to incorporate Gus’ diabetes more into the plot, especially since, you know, the two are married and all. Except that they don’t. In fact, Type 1 doesn’t seem to get much of a mention at all. Fiona and Gus begin to, predictably, fall apart, and while they may have 99 problems in their relationship, Type 1 diabetes ain’t one.

And this absence of a discussion about Type 1 causes the viewer, or at least this viewer, to look back and cry foul over its absence in the earlygoing of the courtship. It’s bad enough that Gus hangs out all hours at Fiona’s diner without once having to test his blood sugar or dose for the greasy spoon food that he eats (maybe he just tests and doses in the bathroom a lot?), but then there’s the issue of sex. You see, Gus and Fiona have a lot of it before they are married, a marathon amount actually. It seems to strain credulity that he didn’t need to test his blood sugar or treat a low once all those times. And if there was a pump in use, I think Fiona would have found it before the morning after their wedding day.

Season 6 of Shameless is set to launch in January 2016. My concern is that Gus’ Type 1 will be employed as a plot point, probably involving a hospital, after largely being kept on the shelf during Season 5. It’s not that I want Type 1 diabetes to define Gus, any more than I want it to define anyone who has it; it’s just that it seems annoying that the writers have the ability to take Gus’ diabetes out of a box when needed. If only everyone with Type 1 had the same ability.

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Reegan’s Mom Reflects on Reegan’s Rule Mon, 26 Oct 2015 20:26:59 +0000 Dee Oxendine sees the North Carolina law to strengthen Type 1 screening as a good first step.

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shutterstock_177051005_baby_finger_prick_300pxReegan’s Rule, signed into law in North Carolina, is considered the first legislative action taken in the country to improve pediatric screening for Type 1 diabetes. While it is considered a victory, it also shows the incremental progress of the legislative process. What began as a bill to mandate screening for Type 1 diabetes morphed into a bill that encouraged doctors to talk to parents of children under the age of five about the symptoms and risks of Type 1 diabetes. It was hailed as groundbreaking legislation by some diabetes activists and a missed opportunity by others.

But what does it mean for the parents who lost their child to undiagnosed diabetes?

Reegan Karice Oxendine died at 16 months of age from complications to untreated Type 1 diabetes. Her parents started the social media campaign and lobbying effort that led to this legislation to honor their child and make sure other parents don’t have to experience the same kind of tragedy.

Reegan’s mom, Dee Oxendine, agreed to a phone interview with Insulin Nation after the family contacted our publication to correct an error in a previous article. She is a middle school teacher who earned her degree and teaching credentials after her children were born. While the postings on the Facebook page dedicated to Reegan’s Rule were celebratory when the bill became law, Dee knows it was an imperfect victory.

“Yes, we’d have liked to have more done,” she said.

She said that consulting with legislative counsel at the American Diabetes Association prepared her for the compromise that was likely to come. Rather than view the result as a loss, she and her family, friends, and neighbors see it as a successful first step. Now, she’s begun researching other legislative efforts in the other 49 state houses. She also says she will be back in Raleigh, too, to continue the lobbying effort.

“We’ve got a good start,” she said.

Currently, there are efforts to draft bills to enhance Type 1 diabetes screening in Florida and Pennsylvania, as well as a bill to improve insulin access in Ohio. Whatever comes next will build on the efforts of the family and friends of Reegan Karice Oxendine.

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Here’s The Carb Count of the Top Halloween Candy Fri, 23 Oct 2015 17:40:25 +0000 We share a JDRF chart, and highlight the carb count of the best-selling candy.

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shutterstock_307902323_Candy_300pxThough the true intention of Halloween is to scare ourselves silly, many suggest that candy is responsible for our nation’s fixation on the spooky holiday.

In 2012, Americans spent $12.6 billion on chocolate alone, a USA Today article reported, and by 2019 that number will jump to $25 billion. But for those kids (or adult children) with Type 1 diabetes who go out trick-or-treating, it’s not about what sells; it’s about what you “can” and “can’t” eat, and how much. Throw in Halloween-themed “Fun Sizes,” and counting carbs becomes a confusing nightmare.

So here’s a candy carb chart from JDRF that you can print out:


(Chart is Fun Sized. Click on it to make it full sized.)

With this chart in mind, here are the 5 top-selling candies that you’re likely to come across this year, and their carb counts:

5. Kit Kats, which total 10 grams of carbs per Fun Size. If you do as their jingle suggests and “give it a break” into two pieces, it’s only 5 grams of carbs per chocolate wafer stick.

4. With over $300 million in sales, you’ll likely scrounge up some Hershey’s Mini chocolate bars, which contain about 5 grams of carbs each, on the door-to-door rounds.

3. Snickers are sure to make an appearance in the candy haul. With 10 grams of carbs, the Fun Size peanut-and-caramel chocolate bars are something to indulge in carefully.

2. With $500 million in sales, M&Ms, will surely be dropped into many a plastic orange pumpkin. The Fun Size chocolate packs contain 10 grams of carbs and the Fun Size peanut ones have 11.

1. Is it true that the peanut butter-to-chocolate ratio is better in the bigger pumpkin-shaped Reese’s cups than the regular-shaped ones? Hard to say, but the Hershey company raked in over half a billion dollars in Reese’s products overall. With a staggering carb count of 17 grams for the peanut butter pumpkin cups, it may be better to opt for a single cup of the standard-shaped ones, a 10-gram-carb alternative.

Happy Halloween! Trick-or-treat responsibly.

P.S. For the haters giving out Dots or Hot Tamales, my question is: Who you mad at? I’m sorry you weren’t held or loved as a child, but don’t take your rage out on the children.

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Tom Brady’s Business Partner’s False Diabetes Claims Thu, 22 Oct 2015 12:38:27 +0000 Alex Guerrero, Brady's fitness guru, sold fake diabetes supplements and allegedly advised that kids with Type 1 didn't need insulin.

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Photo Source: Keith Allison – Creative Commons

Court documents and news reports reveal that a business partner of New England Patriots quarterback Tom Brady has been investigated twice and sanctioned once by federal officials for making false claims of supplements to treat chronic conditions. One of the supplements under investigation was falsely billed as a treatment and cure for Type 1 diabetes and Type 2 diabetes.

Alex Guerrero has been profiled by the New York Times and Sports Illustrated as a fitness guru for Brady, and Brady has credited Guerrero’s training for his health and ability to dominate as a quarterback at an age when most NFL players have retired. According to a report in Boston Magazine, Brady, Guerrero and another business partner have established a fitness and nutrition business called TB12.

Guerrero’s past, however, includes a history of court complaints, bankruptcy filings, and a lawsuit concerning past nutritional supplement companies, including ones that touted diabetes cures and treatments. The Federal Trade Commission has taken action against Guerrero (referred to in official documents as “Alejandro Guerrero”) for making false claims of the therapeutic benefits of his supplements.

Guerrero has made several eyebrow-raising claims about diabetes treatments, including:

-His endorsement of a Dia-Balance Pack that claims to stabilize blood sugars for people with Type 1 and Type 2 diabetes. In promotional material, Guerrero claimed that the product allowed people to discontinue insulin therapy within 18 months to 3 years, according to a Daily report. According to the website of the group producing the Dia-Balance Pack, the supplement “energetically supports and aids in the regeneration of the Pancreas (sic), and helps to maintain the body’s proper blood sugar levels.”

-His claim that parents of children with Type 1 should not use insulin. He made this claim when calling himself a doctor, a position for which he has admitted in court filings he lacks credentials. According to the Daily Mail report, he backed up this claim by using aura photography.

-His endorsement, while again using the title of doctor, of Supreme Greens, a supplement to treat chronic conditions, including diabetes, according to FTC documents. The FTC found that he made multiple unsubstantiated claims about Supreme Greens and practiced deceptive advertising and business practices while selling the product.

Guerrero entered into a 2005 consent decree with the FTC for his role pushing Supreme Greens. He was fined; he also agreed to no longer refer to himself as a doctor and to no longer make false claims about Supreme Greens or future products.

However, by 2011 he had created a new nutritional company, 6 Degree Nutrition, that was making questionable health claims, according to the Boston Magazine report. In 2012, the FTC sent a letter to Guerrero’s lawyer about the company’s marketing material for a supplement, NeuroSafe, that was purported to protect against concussions. NeuroSafe appeared to have the endorsement of a handful of big-name NFL players, including Brady. However, the FTC warned that Guerrero had no scientific evidence to back the company’s claims about the product’s effectiveness. The commission took no action since the product had already been voluntarily pulled from market.

It was after this that Guerrero became known as the prime trainer of Brady, once claiming that he knew Brady’s body better than Brady’s wife, supermodel Gisele Bündchen. After the Boston Magazine article, Brady was asked on WEEI, a Boston sports radio station, about his business partner, and he defended Guerrero. Brady claims he and Guerrero had discussed some aspects of Guerrero’s checkered business past, but not all of it, and that he’s satisfied with Guerrero’s explanations.

“He dealt with that,” Brady said in the interview.

Brady has been mired in controversy since the 2014 NFL football season, when he was accused of being part of a scheme to use underinflated footballs during last season’s playoffs. He has, so far, successfully fought off a four-game suspension for his alleged role in that scheme. Both he and his team, the New England Patriots, have been under a microscope in recent years for multiple controversies. While Brady swears by Guerrero’s training and nutrition techniques, it seems an impolitic time for the quarterback to have a business partner who has been a lightning rod of controversy in the nutritional supplement world. At the very least, the move may not help the quarterback’s standing in the diabetes community.

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Diabetes Refugees Wed, 21 Oct 2015 18:41:32 +0000 A look at the tribulations of those with Type 1 who are displaced by war and chaos in the Middle East and Africa.

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Type 1 diabetes is trying enough for those with access to state-of-the-art medical care; it can be hard to fathom what it must be like for someone caught in a conflict zone.

And yet the suffering of refugees with Type 1 is merely a footnote in the news accounts of the latest refugee crisis, as European governments struggle to offer sanctuary to tens of thousands fleeing conflict and economic hardship in the Middle East and Africa. The world’s humanitarian organizations are being strained to the limits as they try to meet the basic medical needs of these refugees.

And those that make it to the shores of Europe are just a fraction of the total number of refugees during the crisis in the Middle East and Africa; the majority of those displaced don’t leave the borders of their countries. There are hundreds of thousands of these internally displaced refugees in Syria, for example, and they are suffering through a catastrophic disruption to their medical care. It’s reliably reported that Syria’s once-reliable health care delivery apparatus quickly disintegrated into a state of chaos soon after hostilities began between the Assad regime in power, moderate rebels, and the terror group known as ISIS.

The assault on health care delivery comes from multiple directions in conflict zones. Hospitals, pharmaceutical companies, supply warehouses, delivery routes, and delivery trucks are all targeted. Electrical and water utilities are hijacked or obliterated. The goal is to control a country’s infrastructure, or to wreck what you cannot control.

One of ISIS’ methods is to position itself defensively among non-combatants, and garrison its armed personnel in the places where innocent people congregate, like markets and hospitals. A hospital in Kunduz, Afghanistan operated by Doctors Without Borders came under fire from an U.S. HC-130 gun ship on October 3, for causes still under investigation at press time. On October 5, Doctors Without Borders left Kunduz.

Syrian health care workers who haven’t fled are being threatened by both ISIS and the Assad regime with detention and prosecution for treating rebels. Many of those needing medical care are staying away from the facilities where treatment might be available out of fear.

Those who can afford the high costs to flee include doctors and medical technicians. This exodus has grown so pronounced that ISIS has launched a video propaganda campaign to rein in the skilled professionals it needs to keep afloat its de facto government in Syria. In May, the terrorist group issued an ultimatum to doctors, support staff, and pharmacists who left Syria, threatening confiscation of their homes if they did not return to work by a June deadline. Doctors in Mosul have been forced into service as Islamic State soldiers, so that flight becomes desertion punishable by death. Doctors who don’t report to work are rounded up by armed enforcers.

T1International, a London-based diabetes care advocacy organization, has been receiving accounts of the terrors facing people displaced by war and insurrection, particularly in Syria. Elizabeth Rowley, T1International’s founder, said in a telephone interview that when war or insurrection overtakes a region it can hobble her organization’s ability to know how the burden of diabetes care is being met. Her contact with the humanitarian organizations on the ground grows difficult as communications infrastructure continues to be hijacked by terrorists or is destroyed in combat operations.

The day before she spoke with us, she had been in touch with a group that had been operating an underground emergency care facility, but then had to abandon its site due to escalation of air strikes, and fear that it would be discovered.

James Elliott, who has Type 1, has worked on health policy development for the Canadian Diabetes Association and the governments of Canada and Oman. He’s experienced in reporting on medical care delivery and in conducting field need assessments for emergency medical relief. As he wrote on T1International, while on an assignment to Lebanon he ran out of test strips and compensated by going less heavily than usual on his evening insulin dose to get through the night without fear of a low. His shortage lasted just a day. It caused him to think in stark and realistic terms, he writes, about the prospect of being unable to test regularly, or find an adequate supply of clean needles and safe insulin, and having to ration his insulin, scrounge for food suitable for a diabetic diet, or to see a doctor.

The stories of the refugee exodus can blend into a sweeping canvas of horrors, but each is an individual tragedy. There have been multiple reports of a Syrian family who resorted to using a human smuggler to carry them across the Mediterranean to Europe; the family included a girl with Type 1; some news accounts say she was 11, while others say she was 10. Offshore, the family’s belongings were ransacked and the crew sent a bag holding insulin and supplies overboard. She died two days later, her body thrown overboard.

For years the Mediterranean has been the graveyard for desperate people moving in unseaworthy vessels. Fifteen years ago, Doctors without Borders, mobilizing to assist populations of Syrians, Eritreans, and Sub-Saharan Africans seeking asylum put medical staff aboard offshore rescue vessels operated by the the Migrant Offshore Aid Station (MOAS) organization in Malta.

Those fortunate enough to reach a European shore, or to enter Europe over land, have been caught up in a puzzle palace of asylum rules. Refugees coming ashore in the south of Europe face detention not so much for illegal entry as for having no place else to go. The EU Commission appears impotent to get its member nations to cooperate to end the suffering. Displaced people arrive with undiagnosed or untreated diabetes and other chronic conditions, often without medication, and suffering from malnutrition and exposure.

Ultimately, it will require a coordinated effort among nations to stem the tide of refugees and alleviate the suffering. Until then, non-profit organizations are in dire need of donations. If you are in a position to do so, please consider giving to the following organizations:

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Hey McFly, Where’s My Type 1 Cure?! Tue, 20 Oct 2015 19:16:55 +0000 As we reach the date when “Back to the Future II” takes place, it’s time to take stock of how close we are to a future without Type 1 diabetes.

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Hoverboard_Mcfly_300pxThe future is now. October 21, 2015 is the day Marty McFly travels from 1989 to “now” in Back to the Future II. There he confronts the many ways the future has changed, from hoverboards to 3D movie posters. The approach of the date when the future and the present collide has given futurists a good excuse to do some “where’s my jetpack” assessing of how far we’ve advanced and what we’ve fallen short on since the movie was released in 1989. Let’s do the same for Type 1 diabetes care.

There are many in the diabetes community who have managed Type 1 diabetes since 1989. They probably heard plenty about the quest for a Type 1 cure, including how it might have been just around the corner. JDRF (formerly the Juvenile Diabetes Research Foundation) formed in 1970 to fundraise for said cure. While I’m sure they weren’t irresponsible enough to say that a Type 1 cure would be ready to go in a decade, I’m also sure their fundraising literature didn’t emphasize the possibility that it would take more than 45 years.

Why wasn’t there more frank talk about the long timeline for a Type 1 cure? One factor that can impede medical predictions might be what former defense secretary Donald Rumsfeld once called “the known unknowns” and “the unknown unknowns.” We can only predict a future reality based on what we know of the current one. In 1989, there was a lot we didn’t know about how and why the immune system sometimes decides to attack insulin-producing beta cells. (Heck, we still don’t know what all the hormones in the pancreas do.) If we generally thought of Type 1 diabetes as a simpler condition, it would have been easy to confidently predict an erroneous timeline for a cure.

Another problem is that making realistic projections of cure research can be a soul-crushing endeavor. Can you imagine being a mid-career scientist working on diabetes research in 1989 and concluding that a cure wouldn’t come for more than a quarter century, probably long past retirement? Many researchers do that kind of calculation, but that doesn’t mean they would go around advertising such timelines at cocktail parties.

Another carrot that has been dangling before us since the eighties is that of an artificial pancreas which can predict insulin levels and correct them automatically. There has been so much positive buzz about experimental artificial pancreas systems. We’re seeing companies begin to prepare for the commercial launch of such devices. Hackers are creating their own. Still, no one has gotten FDA approval for an artificial pancreas yet.

Don’t get me wrong, we’ve made a lot of progress with pump therapy since McFly’s time. In the eighties, insulin pump therapy was just moving out of the experimental and into mainstream commercial medicine. (If you think it’s hard to get insurance to pay for a pump now, it would have been nearly impossible in 1989.) Also, back then, the concept of the user-friendly interface was just in its infancy in the computer world, and a foreign concept in medical devices. And continuous glucose monitoring? That just meant obsessively pricking and testing your fingers.

In the movie, Doc Brown has undergone a series of medical procedures. Many of the procedures he predicts are either reality now or in process of becoming reality. He has a hair transplant, a rejuvenation procedure that sounds a bit like today’s experimental stem cell therapy, and a couple of organ replacements. Hair replacement is certainly a thing now, and stem cell therapy and research to grow or print 3D organs is progressing. A recent advance in stem cell therapy has led to the most recent wave of erroneous “TYPE 1 DIABETES CURED” headlines in the cheaper newspapers of the world. Sadly, that prediction has not panned out, at least not yet.

Recently, I attended a lecture of Harvard researcher Dr. Doug Melton, who painstakingly crafted that new way to grow stem cells. Dr. Melton described years of experimentation to get embryonic stem cells to grow into insulin-producing beta cells in mice. When he finished, there was a beat, and he commented that he was surprised he wasn’t hearing audible surprise at news of the breakthrough. If you had told him when he was a student that such a procedure was possible, he would have thought you were crazy.

And therein lies the rub of assessing our present through the lens of past predictions from the imagined future. Humans are restless creatures, and it often does us little good to look back at past generations to see how good we have it because we can always dream bigger. In the past 100 years, Type 1 diabetes has gone from being a death sentence to a chance of living well into adulthood to a good chance at a long and relatively healthy life, with a lot of work and anxiety. For those who must constantly manage their blood sugar levels or risk death, that progress simply isn’t good enough. Those with diabetes have long been promised a better future, and they want to get to that future now.

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Lilly Acquires Rights to Nasal Glucagon Fri, 16 Oct 2015 20:39:17 +0000 The deal might be evidence that injectable glucagon is on its way out.

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Locemia Solutions ULC glucagon nasal powder device. June 2, 2015 Locemia Solutions 8505 Chemin Dalton Montreal, QC  H4T 1V5 http://www.locemia.comOne of the biggest pharmaceutical companies is placing a big bet that nasal glucagon is going to get FDA approval in the near future.

Eli Lilly and Co. has acquired the worldwide rights to a nasal glucagon product being developed by Locemia Solutions, according to a recent press release. As is often the case in such announcements, financial terms have not yet been disclosed, and both companies have given generic quotes about how the deal was a good thing for everyone. Lilly, it should be noted, currently has the corner on the market for the standard mix-and-inject glucagon kits.

Lilly’s deal for nasally absorbed glucagon can only be seen as a huge vote of confidence for this treatment, which Locemia officials are hoping will replace injectable glucagon for the treatment of severe hypoglycemia. The announcement of the deal comes after Locemia has enjoyed a series of positive trial results for nasal glucagon in 2015; the most recent study data released showed the treatment proved safe for children, ages 4 to 17, with Type 1. No timeline has been given for seeking FDA approval for the product.

The acquisition is an attempt by Lilly to bolster its troubled drug pipeline. In October, FierceBiotech reported that the company pulled the plug on the development of evacetrapib, a drug meant to ward off heart attacks and strokes, after investing $90 million in costly clinical trials. Lilly has endured a steady string of failed drug development in recent years, according to the report.

With this industry news in mind, the acquisition could be interpreted two ways – either Lilly is desperate enough to take a chance on the nasal glucagon treatment, or it is sufficiently risk averse enough to only bet on a slam dunk. The positive trial data seems to suggest the latter.

With the acquisition, Lilly has essentially co-opted one of its potential future competitors. Xeris Pharmaceuticals is also developing a new glucagon delivery method, one that would still be injectable, but wouldn’t need to be refrigerated or mixed before use. The move puts Lilly in the awkward situation of helping bring a glucagon product to market that could make its current glucagon kit obsolete, but company officials most likely see the writing on the wall for mix-and-inject glucagon.

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Diabetes Takes Halloween Off Fri, 16 Oct 2015 19:38:39 +0000 An imagined interview with Type 1 incarnate as it decides to cut a teen with diabetes a break for the holiday.

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567_shutterstock_160394441_boy carving pumpkin_300pxWhat if you could ask your Type 1 diabetes for a day off, say, on Halloween? In this fanciful flight of fiction, we imagine such a scenario:

News quickly spread throughout the diabetes online community that Type 1 diabetes has decided to give 15-year-old Jimmy Smith of Pougensburg, Pennsylvania all Halloween off to lackadaisically consume candy without counting carbs or needing to bolus. We at Insulin Nation needed to learn more, so we sat down with Jimmy’s diabetes to ask some questions about its decision.

Insulin Nation: How long have you and Jimmy known each other?

Jimmy’s Diabetes: Jimmy and I go way back. I mean, I’ve always been there, but he was 12 years old when he found out about me. It’s been 3 years, total, I guess.

IN: Is it hard for Jimmy, being a 15-year-old high schooler?

JD: Of course it is. He’s got puberty, he’s going to be driving soon, sexuality.

IN: That’s not what I….

JD: It’s a very confusing time. But I like to think I keep him grounded.

IN: How?

JD: No matter what Jimmy’s going through, I’m always there. I’m the one constant thing in his life that he can rely on.

IN: Really? What about his fluctuating glucose levels that shift at random throughout the day?

JD: It’s an evolving consistency, I guess.

IN: Could you share with our readers some of your day-to-day responsibilities?

JD: I just kind of do what I want – there aren’t exactly rules. It’s real fun watching Jimmy’s expression when he checks his blood sugar and realizes he’s way off target. Throwing him a curve is the best part of my day.

IN: Do you always do things that Jimmy hates?

JD: Like I said, there aren’t really any rules.

IN: So why are you being nice and giving him Halloween off?

JD: I’m no saint, but Jimmy deserves this. He’s had a rough year. His girlfriend broke up with him last month, his dog, Dexcom, ran away, and his parents won’t let him hack into his insulin pump to try and make an artificial pancreas. It’s just been tragedy after tragedy. And I’ve been there with him the whole time.

IN: Yeah, you’re pretty chronic.

JD: Yeah. Look, Halloween is the candy holiday. Normally, Jimbo has to be real careful with candy. It’s not impossible for him normally to enjoy Halloween, just a bit more challenging, so I wanted to cut him a break.

IN: So you’re doing this for Jimmy because…

JD: Because he deserves it.

IN: …

JD: I also have some unused vacation time that I needed to get in before it expires.

IN: Vacation time?

JD: Yeah.

IN: What exactly does Type 1 diabetes do on vacation?

JD: Can we skip to the next question?

IN: Ok. What’s Jimmy’s costume this year?

JD: I don’t know, I don’t pay much attention.

IN: Has there been any other time when you tried to help Jimmy?

JD: Yeah, there was this one time that he was taking a math test, and I could tell he was struggling so I just kept forcing him to have to go to the bathroom. And of course the teacher can’t stop him from going. The teacher let him retake the test a different day.

IN: Did he end up passing with the retake?

JD: No, Jimmy sucks at math.

IN: Even with all the carb counting he has to do?

JD: Yeah, he’s terrible. Just awful.

IN: I think we’re all set here.

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U.S. Pays Much More Than UK for Insulin Wed, 14 Oct 2015 16:09:14 +0000 A study finds that U.S. consumers pay between 5.7 times and 7.5 times more for Lantus and NovoRapid than UK consumers.

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shutterstock_311161892_insulin_money_300pxA new study finds that people with diabetes in the U.S. are paying between 5.7 times and 7.5 times more than those in the UK for two popular insulins and a rare drug to treat diabetic retinopathy. U.S. consumers absorb this higher cost despite often not being the first in line to have access to new drugs or medical device treatments.

According to a Reuters report, researchers from the University of Liverpool (UK) analyzed the drug prices for 20 top-selling drugs worldwide, including Sanofi’s Lantus, Novo Nordisk’s NovoRapid insulins, and Roche’s Lucentis, a macular degeneration drug recently approved by the FDA to treat diabetic retinopathy. U.S. consumers ended up paying 5.7 times more for Lantus, 7.5. times more for NovoRapid, and 7.5 times more for Lucentis than their UK counterparts, according to a chart published by the Daily Mail (UK).

The average price difference of the Top 20 drugs sold was 3 times higher in the U.S than in the UK. The gap between drug prices in the U.S. and prices in other industrialized countries is even greater – 6 times higher than in Brazil and 16 times higher than in India, for example. That difference comes mostly because other countries implement price controls, while the U.S. usually allows the market to set prices, according to a Reuters report.

In the report, representatives of the pharmaceutical industry pushed back against the study, saying that the market price for a drug is often not the one paid by the consumer, as many insurers demand a deep discount. In 2014, for example, Sanofi’s then-CEO Chris Viehbacher warned that sales for Lantus might flatline as insurers would demand discounts in 2015 for the popular basal insulin.

A pharmaceutical industry representative pointed out in the Reuters article that some 90 percent of drugs prescribed in the U.S. are cheaper, generic versions of name-brand drugs. However, drug companies will sometimes block the development and sale of generics. Sanofi, for example, has been involved in a protracted legal war to block the sale of generic formulations of Lantus, and only recently settled with Eli Lilly and Co. to allow a generic version of Lantus to be sold at the end of 2016. The court battle and settlement has bought Sanofi time to try to establish its new basal insulin, Toujeo, in the marketplace.

U.S. critics of the pharmaceutical industry contend that U.S. consumers are being forced to subsidize the research and development costs of drugs for the rest of the world, according to the Reuters report. That criticism might resonate with the Type 1 diabetes community in the U.S., as many diabetes advocates have been frustrated with how new diabetes treatments are often available in other parts of the world before they are available in the U.S. For example, Novo Nordisk’s new basal insulin, Tresiba, has been available for months in much of Europe and Japan, but only recently received FDA approval this past month. The flip side to this, however, is that earlier access to new treatments sometimes results in higher risk of injury and death for the end user, and European regulators are even calling for better safety standards for new technological fixes for diabetes.

U.S. drug prices are facing increasing scrutiny by U.S. politicians and regulators following widespread public outrage after a company hiked the price of a 62-year-old drug to treat a parasitic infection. Turing Pharmaceuticals bought up the drug, Daraprim, and immediately raised its price from $13.50 to $750 a tablet. The Reuters report might provide more ammunition for a populist call to regulate drug prices in the coming U.S. presidential election cycle.

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When the Diabetes Honeymoon Ends Fri, 09 Oct 2015 16:51:53 +0000 A D-mom feels guilt over her son’s increased insulin needs.

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shutterstock_9097549_mom_and_son_300pxMy son’s honeymoon phase was like diabetes with training wheels, a seemingly manageable level of uncertainty. His body was still producing some insulin, and that made dosing somewhat of a guessing game, but his A1C was great and I felt like I had gotten the hang of being a D-mom.

Then he caught a cold. It was a year after his diagnosis and he slowly started requiring more insulin. Before, he could go a long time without injections, but now he really needed them to keep his sugars down. He went from using half a unit of long-acting insulin a day to requiring that in one hour.

I felt guilty every time I had to increase his basal rate. No matter how many times his care team told me this would happen, I was still caught off guard. A part of me secretly believed that since his insulin requirements were so minimal and his blood sugars were close to normal, he didn’t really have Type 1 diabetes. When reality set in, I felt like I should have stopped it somehow.

At our next appointment, the endocrinologist noted the increased insulin usage and higher A1C. The honeymoon was over, he said. He asked our son if he knew what the honeymoon period was and why he was using more insulin. Our son said he had no idea. To him, it was just diabetes. While I felt like I was failing him and that he was getting sicker, he hadn’t even noticed. I realized I needed to shift my attitude on diabetes to follow his lead.

The honeymoon was over, insulin therapy has become a big part in daily life, and that is somewhat sad. At the same time, I feel like I’ve learned about the power of resilience and the importance of keeping self-guilt to a minimum. I hope each new challenge we face with Type 1 comes with similar lessons that arm us for how to better handle this frustrating condition in the future.

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Is it Zombieism or a Blood Sugar Swing? Wed, 07 Oct 2015 19:25:10 +0000 A handy chart shows the difference between the flesh-eaters and those experiencing a high or a low.

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People with Type 1 often have trouble communicating with the rest of the world when their blood sugars are high or low. Their behavior can be misinterpreted as rude, or just plain weird.

To combat this and raise awareness of Type 1 diabetes, we’ve created a handy Halloween-themed poster comparing zombies with those experiencing blood sugar swings.

Print this out to hang at work or school (click to enlarge):



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Can an Old Drug Delay Type 1 Diabetes? Tue, 06 Oct 2015 19:20:26 +0000 Can an old blood pressure medication block the genetic triggers for the development of Type 1?

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563_Old_Drug_New_Tricks_for_Type_1_300pxResearchers have long known that diabetes runs in families, but it’s only been about 20 years since they have successfully isolated gene and antibody combinations that serve as reliable genetic predictors of the risk of developing Type 1 diabetes.

A great many people who have Type 1 also have inherited genetic codes for antigens known as DR4 and DQ8; an antigen is any substance that may cause your body to produce antibodies against it. Post-diagnostic genetic testing of patients who have developed Type 1 diabetes has shown that about 90% have one or both of these genetic codes, and 60% have the DQ8 gene alone. The DQ8 gene also has been linked, although less conclusively, to a very small population of people with Type 2 diabetes.

The DQ8 gene is heavily distributed among people in Central America and northern South America. It’s also found in high frequency among Americans who live near the Gulf of Mexico and in the Mississippi Valley whose lineages go back to Caribbean and indigenous North American peoples. It’s found frequently in northern Europe, Scandinavia, and Japan, as well.

The Barbara Davis Center for Childhood Diabetes, located at the University of Colorado Medical School, is backing research into a link between DQ8 and Type 1 diabetes. Researchers are trying to see if they can block DQ8 to delay or block the progression of Type 1 diabetes.

To do this, they are undertaking a clinical trial of methyldopa, an oral drug which has been long used to alleviate hypertension. Methyldopa, once commonly branded as Aldomet, was developed in the 1960’s as an anti-anxiety and anti-tremor remedy for patients with neurological disorders. It was later shown to work by dilating blood vessels. As a psychoactive drug, it’s fallen out of favor since being replaced by other formulations for long-term use but it’s still prescribed for relief of short-term high blood pressure (think gestational diabetes).

Dr. Aaron Michels, who is chief investigator for the University of Colorado methyldopa clinical study, is co-author of a paper published in the April 2015 edition of World Journal of Diabetes that describes the potential of using methyldopa to treat newly diagnosed Type 1 patients. The hope is that this approach might slow progression of beta cell loss, and possibly delay or prevent onset of cell loss in patients exhibiting signs of prediabetes.

Methyldopa appears to work as a blocker; it neither interacts with the insulin molecule nor the pancreatic beta cell. Rather, it scrambles the signal from the antibody-summoning HLA DQ8 molecule, which might confer protection to islet cells. Further, researchers see no reason to expect that administering methyldopa will interfere with T-cell functions.

Methyldopa emerged as a candidate for inhibiting the fatal attraction between T cells and pancreatic islet beta cells through complicated chemical analyses aided by Dr. Mark Atkinson and Dr. David Ostrov, researchers at the University of Florida. Dr. Ostrov, a structural biologist, employed a supercomputer to perform what were essentially docking simulations of the DQ8 molecule’s receptor with structures of 140,000 existing small molecule medications – a process involving some 560 million permutations. Methyldopa was one of the finalist medicines that docked well with DQ8. Subsequent in vitro (“test tube”) and in vivo (living organism) tests with mice confirmed the likelihood that the drug would be effective.

Dr. Michels then enrolled 20 volunteer patients for a first phase clinical trial. 17 patients have thus far volunteered to receive methyldopa in three dosages at or below the therapeutic dose for high blood pressure. In the coming months, the study volunteers will continue to return for A1C monitoring and blood glucose testing.

Dr. Michels hopes to have this trial phase completed by early 2016, after which he would like to conduct a next-phase clinical trial with a larger group of recently diagnosed children and adults. The results of this broader, placebo-controlled study could lay the foundation for developing a methyldopa “vaccine” to delay onset or progression of beta cell destruction. The possibility of a remission or delay of even four to six years for a young child amounts to a breakthrough, as every year of maturity allows a child’s body to grow without complications of diabetes, and the child to develop skills to cope with the rigors of diabetes self-care.

If you want to contribute to a fundraising effort to support this type of research, you can go to

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Reegan’s Rule Passes in North Carolina Mon, 05 Oct 2015 18:33:09 +0000 Legislation is first to call for improved Type 1 diabetes screening efforts.

The post Reegan’s Rule Passes in North Carolina appeared first on Insulin Nation.


shutterstock_177051014_baby_prick_300pxAfter months of political wrangling, North Carolina legislators succeeded in passing a bill that would promote diabetes screening for infants and toddlers, and parent education about the symptoms of Type 1 diabetes. The legislation, known as Reegan’s Rule, stalled for months, and it took some last-minute heroics on the part of its sponsors for it to pass. It is the first diabetes screening law of of its kind in the nation.

After 16-month-old Reegan Karice Oxendine died from undiagnosed Type 1, her family and neighbors launched a Facebook campaign for legislation that would require Type 1 testing of newborns and children at well-child visits. and other diabetes advocacy organizations joined the cause, and soon two members of the North Carolina General Assembly came onboard.

North Carolina state representative Charles Graham and state senator Jane Smith filed identical bills in the house and senate in January to mandate diabetes screening of newborns and of kids to age three. However, well-child practitioners objected to the mandate, saying they worried they would be held responsible for well-child visit attendance. House committee members crafted a compromise, revising the bill’s language instead to encourage medical professionals to educate parents of children under five about the symptoms and risks of Type 1 diabetes.

Still, there was little progress made. As a summer legislative deadline approached, the senate bill had stalled, but the house version was still alive, with an amendment tacked on to enact an unrelated health insurance market reform. By September, a senate amendment concerning a community hospital system had been added. Still, there was no move to vote on the bill.

Legislators came to the rescue, though, in the wee hours of the morning of the final legislative day. State representative Graham described in an email interview with Insulin Nation how Reegan’s Rule had been added to a bill on pharmacy insurance regulation. That legislation was passed just in time to be signed into law by Governor Pat McCrory.

While the final language of the bill may not be as strong as some might have liked, it’s being hailed by diabetes testing advocates as an important first legislative victory. Already, some advocates are pushing for similar legislation in other states. If such efforts succeed, then Reegan’s Rule will be considered an important milestone in improved screening for Type 1 diabetes.


October 8th, 2015 – An earlier version of this story incorrectly stated that Reegan’s age was 3 years old when she died. Insulin Nation sincerely regrets the error.

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Parent Refuses Insulin for Teen with Type 1 Mon, 05 Oct 2015 12:27:15 +0000 An Irish court intervenes to try and save the child’s life. It’s not the only instance of parental refusal to start insulin therapy.

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shutterstock_253430857_nurse_insulin_needle_300pxThere is a disturbing report out of Ireland of a parent refusing to give her child insulin to treat Type 1 diabetes.

According to a story in the Irish Times, the High Court of Ireland has had to intervene in a medical dispute that took place in a Dublin hospital. On September 30, 2015, a 13-year-old girl was rushed to the hospital because of symptoms of untreated diabetes. Doctors weren’t able to administer insulin at the hospital because the mother had neither given her consent nor refused it. The move left doctors in legal limbo, and the teen’s life in the balance.

A pediatrician told the courts that the mother was waiting out the diabetes in hopes it would go away. She even declared that she would rather her child die at home than be given insulin. On October 2nd, the High Court (the final court of appeal in Ireland) overruled the mother, ordering insulin therapy for the girl.

This is not the only case of parents refusing Type 1 treatment for children. In May 2015, police in Australia opened an investigation into whether a 7-year-old child with Type 1 was taken off insulin and refused food before undergoing controversial alternative treatments that involved slapping and massage. The child died shortly after undergoing the treatment, according to an Australian news service.

And in 2008, two parents in Wisconsin chose to forgo insulin therapy for their 11-year-old daughter, opting only for prayer to treat her Type 1 diabetes; she died of diabetic ketoacidosis from untreated Type 1. Her parents were convicted of reckless homicide, and the conviction was upheld in 2013 by the Wisconsin Supreme Court, according to The Wisconsin Journal-Sentinel.

While such reports are thankfully rare, they underscore the need to combat misinformation found online about false cures for Type 1 diabetes. Common sense isn’t as common as we would like to think.

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Artificial Pancreas Beats Humans in Type 1 Care Fri, 02 Oct 2015 21:40:55 +0000 Two European studies find tech did better than humans at blood sugar control, especially at night.

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We’d like to believe that humans have the problem-solving tools to handle health issues, but a new study shows that it might be best to turn over blood sugar management to the machines.

Researchers in the UK found that an experimental closed-loop artificial pancreas system did better than humans alone at managing Type 1 diabetes, according to a Reuters report. The closed-loop software, which could be turned on and off at will, included a glucose sensor and insulin pump that sent wireless signals every 12 minutes to adjust how much insulin was administered.

The European research effort conducted two studies to come to this conclusion. In a study of 33 English, German, and Austrian adults, trial participants showed better blood sugar management overall when the technology was activated. However, the difference was most pronounced at night – insulin levels stayed within the 70 mg/180 dl range 59% of the time when the artificial pancreas system was used, compared to 29% of the time without it. The second study, involving 25 English adolescents and younger children, focused exclusively on nighttime blood sugar management. Again, the artificial pancreas beat human blood glucose management hands down – in that study, glucose levels stayed in range 60% of the time with the software active in comparison to just 34% when humans were responsible for the testing and insulin dosing.

Unfortunately, such systems aren’t readily available yet in the commercial marketplace, although pump and continuous glucose monitor makers are inching towards creating them. Still, research results like this might make even the most technophobic consider accepting tech help in managing blood sugar levels.

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Readers Share Their Missed Type 1 Diagnoses Fri, 02 Oct 2015 20:56:09 +0000 Sadly, their stories are all too common. New diagnostic strategies are needed to prevent such misery.

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Our story on a missed Type 1 diagnosis, “I Had Type 1 Diabetes and Didn’t Know It”, elicited a long list of comments from readers, many of whom wanted to share their own missed diagnoses. From the several dozen comments, we were able to piece together a non-scientific cross-section of what happens to people with Type 1 when their symptoms are overlooked:

Length May Vary
While a few lucky souls caught their diabetes quickly…

“I saw the symptoms and took my son to the doctor 3 days…after I noticed.”
-Eschelle W.*

…many described not getting the diagnosis for months or, even, years:

“A year…convinced myself I was thirsty and tired because of summer, exercising 6 days a week, and low iron. Went to the doc and they always thought I was pregnant when I brought up my symptoms. Went to an eye doctor when my vision went blurry and was told it wasn’t serious. Finally got to ER and was misdiagnosed with Type 2, but I was back a week later back. Doc finally gets it right – Type 1.”
-Angelica J.

Overlooking the Obvious
As Angelica J.’s comment suggests, many people got diagnosed with other things before their Type 1 diagnosis. Several were given the diagnosis of Type 2 diabetes. One person was misdiagnosed as bipolar. Some people were tested for exotic things before being diagnosed with Type 1:

“It took 4 months before I was diagnosed with Type 1 diabetes. All along I was misdiagnosed – I was told that I had amoeba and typhoid!!”
-Susan G.

Sometimes, lack of information about Type 1 presented a hurdle for parents who were trying to figure out the symptoms of their children:

“I watched my daughter drink and urinate frequently, but since I didn’t see any other symptoms, I didn’t think it was Type 1. I didn’t know you could develop it later in childhood. ‘If she were to have it, it would have happened as an infant,’ I thought. Then she excitedly told me she dropped 10 pounds and I just knew. Checked her at home (dad was Type 2), and her blood glucose was over 500 mg/dl. The doctor told us if we had waited another week, she would have been in bad shape.”
-Sue B.

The Long-Delayed Diagnosis
Sometimes, people faced skepticism, or even hostility, because of their poorly understood symptoms:

“I was applying for a teaching position in 1982 and had to do a urine test as part of a health checkup. The school district doctor accused me of having diabetes and trying to cover it up so I could get insurance. I went to my regular doctor and redid the test, but my blood sugar levels were normal. I was diagnosed 6 months later with Type 1.”
-Kim K.

“I went to the doctor’s four times with classic symptoms only to be turned away. At 23, I suppose I wasn’t a classic case…At the advice of a friend I went to the local pharmacy and had them test my blood sugar, and was promptly sent to the hospital”
-Zoe S.

Because of the delayed Type 1 diagnosis, many readers had dramatic trips to the hospital:

“I had symptoms for a few weeks. I lost a lot of weight, was extremely thirsty with no appetite, and my eyesight deteriorated badly. Then diabetic ketoacidosis hit and I was sick in bed for 3 days, getting weaker and weaker. On the fourth day, I didn’t wake up. My father didn’t want to wait for an ambulance so he drove me to hospital himself. The doctor later told me if I hadn’t been taken to the hospital that morning I would have died.”

-Adrienne E.

Sadly, these kinds of stories are all too common. Worse, sometimes those who endure a missed diagnosis don’t survive to tell their stories. Diabetes advocates are beginning to push for state health laws mandating better screening for Type 1 diabetes. Also, the ADA and JDRF recently advocated for a reclassification of Type 1 diabetes to incorporate earlier symptoms.

It is our hope that fewer of our readers have to go through months of uncertainty before receiving their diagnosis.

*Last names withheld for privacy concerns. Reader comments were edited somewhat for clarity.

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7 Consejos Para Combatir La Ansiedad del Tipo 1 Thu, 01 Oct 2015 14:01:47 +0000 ...Y Apoyar a una Persona Ansiosa con el Tipo 1

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shutterstock_134312588_melancholy_300pxUnos meses antes de graduarme de la Universidad, fui diagnosticada con el Trastorno por Déficit de Atención con Hiperactividad (TDAH), Ansiedad Generalizada y con Trastorno Obsesivo-Compulsivo (TOC). Ahora que tomo medicamentos para el TDAH, que también ayuda con mi ansiedad, he comprendido el impacto que mi salud mental tiene sobre mi diabetes. Cuando note los estimuladores que afectan ambos, traté de trabajar en ellos.

He aquí 7 cosas que apreciaría las personas tuvieran en consideración en respecto a la diabetes y la salud mental, basada en mi experiencia:

  1. Por favor, permítanme explicar el por qué no amo mi Monitor Continuo de Glucosa
    Es complicado. Ser capaz de reconocer los patrones y ver mi glucosa durante me ejercito es maravilloso, pero ver mi número cada cinco minutos incrementa mi ansiedad. No tuve un CGM por mucho tiempo porque sabía que me iba a estresar. También evito de vincularlo con mi celular; no veo que sea bueno para mí.
  2. Por favor no me digan que revisar repetidamente mi glucosa no ayuda
    Sí, sé que 20 minutos no hará la diferencia, pero voy a revisarla de todos modos. El momento que sé que mi nivel de azúcar en la sangre está por arriba de mi objetivo, tengo que revisarla. También empiezo a pensar en el dinero que estoy gastando y luego mi mente se dispara a un millón de distintas direcciones.
  3. Por favor no me digan como sentirme cuando tengo un alta o baja
    Me entra el pánico cuando tengo una baja. Las bajas me asustan, especialmente las bajas en la mitad de la noche. Qué tal si estoy sola o donde las personas no me conocen? Es estresante aún sin padecer de ansiedad. Y cuando mi azúcar en la sangre está por encima del objetivo, pienso lo peor: Qué va a hacerle a mi A1C? Qué tal si entro en Cetoacidosis diabética (DKA, por sus siglas en Inglés)? Cómo impacta mi vida? Hay muchas emociones encontradas, y es realmente difícil moldearlas a la manera como supones que debo sentirme.
  4. Por favor no menciones ese comercial que viste acerca de ojos y pies
    Mi diagnóstico fue captado en un examen de ojos así que estoy lo suficientemente asustada, gracias. No me gusta pensar en complicaciones debido al estrés adicional. Las reconozco, pero las tácticas de pánico no ayudan.
  5. Por favor no me digas que la diabetes y la salud mental no tienen que ver entre sí
    Diabetes es una montaña rusa, lo mismo aplica para la salud mental. Heme aquí en estos dos viajes tratando de estabilizarlos. No sé si ser ansiosa es un síntoma de no tener mi glucosa en objetivo o que mi ansiedad “empeora” cuando estoy fuera del objetivo. Tal vez ambos? Cómo las separo? De cualquier manera, estoy segura que mi diabetes y mi salud mental están comprometidos en una relación de pareja.
  6. Por favor no lo hagas…
    Llámame loca, complusiva, sobrecumplidora, obsesiva o Tipo A. Simplemente no. Una de las principales razones para ser tan intensa con mi cuidado es porque no me gusta mi cerebro cuando mi nivel de azúcar en la sangre está fuera de objetivo. También, yo ya sé todas estas cosas sobre mí, así que recordarlas no me ayuda.
  7. Por favor hazlo…
    Sientate a mi lado. Apoyame. Dame un jugo o agua si ves el número en mi pantalla, pero no me juzgues. Toma en cuenta que voy a reaccionar más a las cosas si mi salud mental y mi diabetes están peleando, pero me excuso. Permíteme sacar mis emociones.

Por favor recuerda que soy una persona primero, pero que la diabetes y la salud mental son una parte muy importante de mi vida y siempre cambiante.


Traducido por Edel Mancina

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Mark Lowe – The Playoffs Pitcher with Type 1 Thu, 01 Oct 2015 13:41:06 +0000 Lowe has bounced back from injuries to have a career year and become a valued member of the Toronto Blue Jays pitching staff.

The post Mark Lowe – The Playoffs Pitcher with Type 1 appeared first on Insulin Nation.


Photo credit: Toronto Blue Jays

Each year, baseball’s playoffs are filled with unlikely heroes. This year’s might be Mark Lowe, and that would be a win for people with Type 1 diabetes everywhere.

Lowe, who was diagnosed with Type 1 diabetes during the 2008 baseball season, has endured a string of injuries and bounced around between various minor league and major league teams in recent years. He was looking to resurrect his career when he signed a minor league contract with the Seattle Mariners, and he started the year with their minor league AAA team, the Tacoma Rainers.

He soon made the big league club and enjoyed a career year, posting great numbers, first for the Mariners and then for the Toronto Blue Jays. He now has become an indispensible member of the Blue Jays’ corp of relief pitchers as the team prepares for its first entry into the playoffs in 22 years.

It’s a great turn of events for the 32-year-old pitcher, who came out of college as a sought-after prospect and moved up to the big leagues in just two years after starting his professional baseball career. Just as Lowe was establishing himself for the first time with a big league club, again the Mariners, he had to confront a diabetes diagnosis. Worse, it was at first an incorrect one.

During spring training in 2008, blood tests showed Lowe had elevated blood glucose levels. He was given a diagnosis of Type 2 diabetes and given medical treatment for that condition. Taking the diagnosis seriously, he watched his diet and dropped weight that he really couldn’t afford to lose. 15 pounds lighter, he still felt weak and dizzy, and his blood sugar levels were out of control. Eventually, his diagnosis was switched to Type 1, and he started insulin therapy.

A late-in-life Type 1 diagnosis is difficult enough, but Lowe had to balance it with a career as a professional athlete. Luckily, along with the support of good medical staff, he had a blood brother in the bullpen in Brandon Morrow, a fellow pitcher with Type 1 who had been dealing with diabetes since he was a senior in high school. According to a 2009 ESPN report, Morrow helped Lowe learn the basics of blood sugar management, and the two even had a friendly competition about who could most correctly guess their blood sugar levels.

Lowe has enjoyed some success since that time, including pitching in two consecutive World Series, but he also has dealt with a series of injuries. He’s had two elbow surgeries in his career, and they have robbed his pitches of triple-digit velocity. Since those surgeries, he has had a hard time sticking with one ballclub, and he was fighting to extend his career as he came into the 2015 season.

All that he has done this season is dominate batters as one of the best relief pitchers in the big leagues. Here’s a prime example:

Baseball observers point to the fact that Lowe has honed his pitching arsenal, which once included five different pitches, to two devastating ones. It can’t be overlooked that he’s been healthy, as well. In either case, Lowe’s performance was good enough that he became a sought-after commodity during the baseball trade deadline. The Seattle Mariners traded him to the Toronto Blue Jays, where he has earned a role as an important reliever for the Blue Jays.

It will be nice to see if Lowe and the Blue Jays can go deep into the playoffs and even reach the World Series. If the team does make the Series, Lowe’s Type 1 diabetes is sure to be a storyline for sports reporters looking for human interest angles leading up to the final games of the season. Certainly, Lowe’s Blue Jays, which also once fielded two other pitchers with Type 1, has become the adopted team of Insulin Nation’s editorial staff for the 2015 playoffs.

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Tresiba Gets FDA Approval Tue, 29 Sep 2015 19:15:38 +0000 Will it offer enough of an improvement over other basal insulins to compete in the basal insulin marketplace?

The post Tresiba Gets FDA Approval appeared first on Insulin Nation.


novonordisk_300pxOn September 25, 2015, the FDA announced it had approved two new insulin products, Tresiba and Ryzodeg, to treat people with Type 1 diabetes and Type 2 diabetes. Both have been developed by Novo Nordisk. Of the two, Tresiba is the bigger deal, as it is a rare new long-acting basal insulin and its development and approval have been a long time coming.

Ryzodeg 70/30 is an insulin product that is a mixture of 70 percent long-acting insulin (Tresiba) and 30 percent rapid-acting insulin.

Novo Nordisk officials emphasized two main selling points of Tresiba – that it is very long lasting and that it offered greater flexibility in dosing time. According to trial data gathered for the approval process, the insulin had a half life of 25 hours and stayed in the bloodstream for 42 hours, making it the longest-lasting basal insulin available. Also, a dose could be administered anytime after 8 hours of the previous dose. This means that Tresiba has the potential to lower overall injections for people with diabetes and could help those with diabetes who accidentally skip their dosing time. Novo Nordisk doesn’t formally recommend flexible dosing times, but variability in dosing or skipped doses happens, according to Robert Clark, vice president of regulatory affairs for the company.

“35 percent of patients miss one or more of their insulin doses, or fail to take them as prescribed. On average, patients miss 3.4 doses every month,” Clark stated during a 2012 FDA scientific advisory panel meeting on Tresiba, according to the meeting’s minutes. “The development of a basal insulin that would allow patients to manage unexpected missed or delayed doses should improve overall treatment adherence to and effectiveness of insulin therapy.”

In theory, that flexibility in dosing time could mean lower rates of hypoglycemia than with other basal insulins, but so far the FDA has not granted Novo Nordisk the right to tout this potential benefit on the Tresiba label. This worried company investors in a recent conference call discussing FDA approval of Tresiba and Ryzodeg. Novo Nordisk’s CEO Lars Rebien Sørensen and Chief Science Officer Mads Krogsgaard Thomsen assured investors that the FDA sets a very high bar for granting a drug company the right to say its insulin causes fewer bouts of hypoglycemia. They also said that trial data seemed to show that Tresiba and Ryzodeg did indeed cause fewer bouts of hypoglycemia, and further testing is being done to strengthen that assertion. Company officials were confident that the benefits that the FDA allows Novo Nordisk to advertise will be enough to attract a market.

“We have a nice label where you can say it’s an insulin with the longest half-life providing the longest duration of action,” said Krogsgaard Thomsen in the conference call.

Such benefits were apparently enough to convince federal regulators to approve Tresiba and Ryzodeg after initially rejecting the two in 2013 over concerns that the insulins caused a slight increased risk of cardiovascular problems. If true, that would be a big concern, as a sizeable amount of people with diabetes, both Type 1 and Type 2, are already at high risk of cardiovascular problems. That was a concern expressed by Dr. Charles Shaefer, a Georgia primary care doctor, during the 2012 FDA advisory panel meeting.

tresiba_mesa_300px“We’ve seen evidence this morning to at least raise the question of whether there may be minor increases in adverse cardiovascular events in actively treated patients with (Tresiba),” Dr. Shaefer said.

Several advocates for the diabetes community asserted at the same meeting that new insulin development was worth the possible slight increase in risks of cardiovascular issues. Kelly Close, editor of diaTribe, pushed back at the possibility that the FDA could ask Novo Nordisk for additional cardiovascular data before granting approval of Tresiba and Ryzodeg; to her, such a move could have a chilling effect on investment in new insulins.

“If FDA is going to require pre-approval cardiovascular outcome trials, it would be the equivalent of changing the goalpost in the middle of the game,” Close said at the meeting.

After the 2013 FDA rejection, Novo Nordisk worked to collect trial data to assuage federal regulators of the cardiovascular safety of Tresiba and Ryzodeg. However, the drug company didn’t wait until its clinical data was complete, instead choosing to resubmit for approval in March. It was seen as a gamble at the time by industry analysts, but it paid off.

Tresiba and Ryzodeg already are available for sale in Japan and much of Europe. However, the rollout has had a few bumps in the road. Most notably, Novo Nordisk pulled Tresiba from the German marketplace in October 2015 after an argument with German health regulators, according to an article in MedScape Speciality. The fight started in 2014, when the the German Institute for Quality and Efficiency in Health Care declared that Tresiba failed to offer any real benefit over existing insulins on the marketplace; this blocked Novo Nordisk from offering their insulin at the price Novo Nordisk wanted. Many diabetes advocates in Germany were frustrated with the move to pull the insulin from the marketplace, saying it caused chaos for some patients already on Tresiba and blocked the availability of an insulin option for people with diabetes.

Tresiba and Ryzodeg will be entering a basal insulin marketplace currently dominated by Sanofi, which enjoyed some $7 billion in sales in 2014 for its flagship basal insulin, Lantus. Sanofi hopes to replicate that success with its new basal insulin, Toujeo, released this past year. It also has fiercely fought in court any attempts to create generic forms of Lantus. This past month, Sanofi settled a longstanding lawsuit with Eli Lilly and Company over Lilly’s attempts to sell a generic formulation of Lantus, according to a FiercePharma report. Under the agreement, Lilly will pay licensing fees to Sanofi for some Sanofi patents and pledge not to roll out a Lantus generic before December 15, 2016. That gives Sanofi a window to establish Toujeo before a generic form of Lantus hits the marketplace.

In the investor conference call, Novo CEO Rebien Sørensen detailed that the company is prepping for a commercial rollout for Tresiba and Ryzodeg in early 2016, while making the insulins available to some medical specialists and pharmacists in the last quarter of 2015. FiercePharma reports that the company has made a significant investment in its sales force in preparation of the Tresiba rollout.

However, Rebien Sørensen said the company will not try and use its entire portfolio of insulin products to try and create exclusive package deals to entice doctors to use Tresiba instead of Lantus or other basal insulins. Novo Nordisk also won’t offer extensive discounts on Tresiba to compete with Lantus or Toujeo. Rebien Sørensen said the drug will be offered at a “premium price” because of its potential to outperform other basal insulins. The company is betting that this will create market demand. Rebien Sørensen told investors they should expect Tresiba to gain a small foothold in the marketplace in the early stages and then increase that marketshare over time.

“We’d rather have a more steady penetration into the marketplace given that we believe we have the premium product,” Rebien Sørensen said in the conference call.

If the company’s basal insulin products get a foothold in the U.S. marketplace, they will provide greater basal insulin choice for people with diabetes. Also, if Novo Nordisk’s new products prove a real threat to Sanofi’s continued dominance of the basal insulin marketplace, that could also create downward pressure on basal insulin prices. With FDA approval, now we get to see if such projections will pan out.

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I Had Type 1 Diabetes and Didn’t Know It Tue, 29 Sep 2015 12:34:40 +0000 A young adult with diabetes describes how easy-to-recognize symptoms went unrecognized.

The post I Had Type 1 Diabetes and Didn’t Know It appeared first on Insulin Nation.


shutterstock_174520502_tired_300pxIn the summer of 2009, I was participating in a summer program for high schoolers at Georgetown University, and I could sense something was a little off. I explained away my insatiable thirst because of the summer heat, but I kept waking up in the middle of the night to use the bathroom. My face looked a little thinner in the photos from the end of the program than the photos from the first day.

As I started my senior year in high school, my friends noticed that my weight had dropped. I figured it was from all the walking I did during the Georgetown program. About a week into classes, I was so weak that I couldn’t carry my backpack up the stairs. I was constantly leaving lectures to get a drink of water and go to the bathroom. My high school prohibited students from carrying water bottles, but I snuck one in my backpack because I was never not thirsty. Meanwhile, I continued to shed weight. I remember one time putting my mouth directly under my fridge’s water dispenser.

I tried complaining to my pediatrician about my thirst, weakness, and constant fatigue. He noticed the weight loss and tested me for mono. When the test came back negative, he said I was just stressed with college applications.

Next, I went to my mom’s general practitioner. By now, my tongue had turned white. She diagnosed me with thrush and sent me home with some tablets to chew. I went back to her a few days later, still feeling terrible, but she didn’t offer a new diagnosis. My nails became yellow and fragile. I stayed home from school because I was too weak to walk from class to class. My friends thought I was anorexic.

In late August, a close family friend came to visit and I managed to peel myself off the couch for a bit. My now-all-too-familiar symptoms were described, and the friend said, “Well, it sounds like diabetes.”

The moment I heard the word “diabetes”, it was like a light clicked in my head. In hindsight, I clearly had Type 1 diabetes, but I didn’t have the language or knowledge to identify it. My dad drove me to my grandparents to test my blood sugar on the meter my grandfather used. I was reading at 465 mg/dL.

We went straight to the ER. The nurses immediately injected me with insulin. They told me if I had waited a few days more to come in, I would have been in the ICU. That night is the only time I’ve ever seen my dad cry.

The next day, I was learning a new language—hypoglycemia, hyperglycemia, insulin, blood glucose. My pediatrician came to visit me. He apologized profusely for missing the diagnosis. I forgave him. I have no doubt that the next time a patient comes in complaining of the symptoms I experienced, he will know to test for Type 1. That makes my near-miss of a missed Type 1 diagnosis somehow easier to bear.

I hope that my story, and others like mine, will be shared to spread awareness of the symptoms of Type 1, so more doctors can see the warning signs in time. No one should have to slowly waste away before being diagnosed.

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10 Consejos Para Mantenerse Saludable con Tipo 1 Tue, 29 Sep 2015 12:20:09 +0000 Consejo de un educador de diabetes.

The post 10 Consejos Para Mantenerse Saludable con Tipo 1 appeared first on Insulin Nation.


shutterstock_122080105_mom_daughter_walking_300Michael J. Fox alguna vez dijo esto acerca de vivir con la enfermedad de Parkinson: “Usualmente digo que ahora no tengo opción alguna sobre si o no tener Parkinson, pero alrededor de esa no-elección hay un millones de otras elecciones que puedo hacer.”

Como alguien que vive con el Tipo 1, argumento que puedo decir lo mismo acerca de vivir con el Tipo 1. No se tiene opción sobre si o no se tiene diabetes Tipo 1, pero se puede hacer “un millón de otras opciones” de cómo vivir con ella.

Mi trabajo es de ayudar a otros con diabetes que tomen la mejores decisiones para sí mismos. Como una terapeuta de comportamiento cognitivo y educadora de diabetes certificada, me especializo en tratar los asuntos emocionales de aceptación de la diabetes. Ayudo a mis pacientes a que examinen sus pensamientos y acciones hacia vivir con diabetes.

La Asociación Americana de Educadores de Diabetes ha desarrollado siete directrices claves para ayudar con el manejo de la diabetes. Llamada la AADE7 Comportamientos de Cuidado Personal, que incluyen:

  • Alimentación saludable – Tener diabetes significa aprender a contar carbohidratos y cómo la comida que se come afecta la azúcar en la sangre. Un plan de comidas saludables también incluye carbohidratos complejos, proteína, fibra (frijoles, granos enteros, frutas y vegetales), mucha verdura de hoja verde y una cantidad limitada de grasas saludables para el corazón.
  • Estar Activo – La actividad física puede ayudar a mantener normales los niveles de azúcar en la sangre y el manejo de la diabetes. Estar activo también ayuda a mejorar el estado de ánimo y reduce los sentimientos de estrés y ansiedad.
  • Monitoreo – Chequear los niveles de azúcar en la sangre regularmente proporciona información acerca del manejo de la diabetes. El monitoreo ayuda a saber cuando los niveles de azúcar están dentro del rango meta y ayuda a tomar decisiones en cuanto a qué comer y qué hacer.
  • Tomar Medicación – Obviamente, es importante que la insulina sea tomada, pero es de vital importancia entender cuánto tomar en ciertas situaciones. Esto viene de un monitoreo cuidadoso de los niveles de azúcar y aprender a saber la causa y efecto entre la terapia de insulina y sus niveles de azúcar en la sangre.
  • Resolución de Problemas – Todos encontramos problema con el control de la diabetes. Si cuando se encuentra un problema, se necesita saber cómo solucionar su cuidado personal. Esto incluye analizar y evaluar la situación y pensar en que fue la diferencia de lo usual que pudo afectar la azúcar en la sangre. También significa encontrar una solución para probar, como también ver lo que funcionó y lo que no. No te enojes, se mejor.
  • Reducir Riesgos – Se pueden tomar medidas ahora para bajar los riesgos de desarrollar problemas de salud en el futuro. Las recomendaciones para reducir los riesgos y prevenir otros problemas incluye: no fumar, visitar al doctor regularmente (para examinar el A1C), visitar el oftalmólogo al menos una vez por semana, lavar los dientes y usar hilo dental diariamente y visitar al dentista, cuidarse los pies y escuchar a su cuerpo.
  • Aceptación saludable – Vivir con diabetes y sus diaria demandas para el cuidado personal puede ser muy estresante y puede impactar negativamente al manejo de ésta. No sólo puede el estrés aumentar los niveles de azúcar en la sangre, pero puede contribuir a tomar malas decisiones. La buena noticia es que hay muchas maneras saludables para afrontar el estrés.

Considero éste último punto de vital importancia, y quiero compartir tres opciones para manejar el estrés de vivir con diabetes:

  • Sea amable con usted mismo. Haga lo mejor que pueda hacer. Es importante sentirse bien acerca de sus éxitos. Dese crédito a usted mismo cuando sea exitoso en el manejo de su azúcar en la sangre y no se critiques de más si no logra su meta.
  • Busque apoyo en una red de familia y amigos con quienes pueda hablar cuando se sienta desanimado. Busque oportunidades de encontrar otras personas con diabetes, tal como asistiendo a grupos de apoyo o participando en foros en línea (tales como podcasts o tweet chats), para que así no se sienta aislado o solitario. Hable con un psicólogo u otro proveedor de salud mental quien pueda proporcionar una terapia enfocada en diabetes si se siente deprimido o sobrecargado.
  • Elija tener una actitud positiva, y cultívela cada día, pero también acepte cuando se sienta deprimido por la diabetes. Tener pensamientos negativos ocasionalmente es normal, investigaciones has comprobado que aceptar estos pensamientos pueden ayudar a las personas a mantener niveles estables de azúcar en la sangre. Reconózcaslos, pero no viva con ellos; vivir con una mente negativa va a limitar su habilidad de aceptación. La forma en que piensa sobre los eventos puede influir en su estado de ánimo, pensamientos y acciones.
    La diabetes Tipo 1 es un reto de salud que no fue su elección, pero haciendo lo que usted pueda para mantenerse saludable es una elección que hace a diario. Es una práctica para toda la vida que debe adoptarla lo mejor que pueda.

El texto ha sido editado por la longitud. Traducido por Edel Mancia.

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Dress Your Pump or CGM for Halloween! Mon, 28 Sep 2015 19:50:02 +0000 Costume up your diabetes gear and share a photo of your creation for our photo contest.

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little_witch_300pxAn insulin pump is often worn as a discreet fashion accessory, but a growing number of pump users have chosen to be more open with the devices. Many people now have chosen to openly display their pumps, including Miss Idaho’s Sierra Sandison during the 2014 Miss America competition.

This Halloween season, we’d like to take the #showmeyourpump movement a step further by inviting you to dress your insulin pump and/or continuous glucose monitor for Halloween. Submit photos to us of your diabetes gear as part of your Halloween costume, or with costumes off their own by October 20th. (It’s okay to use a pump you’re not actively using now.)

Submissions will be shared on our Facebook page, and the winner will receive a copy of Gary Scheiner’s book Think Like a Pancreas – A Practical Guide to Managing Diabetes with Insulin.

You can send in your photos to Be safe, but have fun!

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Having T1D Doesn’t Give You a Monopoly on Suffering Fri, 25 Sep 2015 18:30:22 +0000 An author with diabetes feels kinship with others living with chronic conditions.

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shutterstock_25144681_teddybear_300pxIf someone just met me, they wouldn’t immediately guess I worry about my health several times each day. They have no idea that I fret over every bite of food or swig of a drink that passes my lips. Or that before I go to bed, I measure, check, and create backup plans in case something unexpected goes wrong. They don’t see this. To them, my illness is invisible.

It can feel like I’m the only one who is going through something like this, but I’m not.

A friend of mine lives with chronic pain. She doesn’t even remember what being pain-free feels like. She smiles through it, takes her pills, and hopes she doesn’t become addicted to them. Another friend is manic depressive. She talks excitedly about everything in her life, but then can get severely depressed and despondent, sometimes even agoraphobic. Their conditions are invisible.

Some days I think that every person I encounter might also be battling something not easily seen – PTSD, loss of a family member, migraines. We all soldier on. My worst day could be a ketoacidosis episode, complicated by a bad hospital stay, with little sympathy from my family. My friend’s worst day could be waking up with a incapacitating headache and having to try to go grocery shopping. It’s all a matter of perspective.

Both within the diabetes community and without, some people find it necessary to compare their worst days with the next person. This kind of venting can be used to point out that personal issues can be conquered, but too often it devolves into trying to one-up each other in suffering. This latter process can delegitimize one’s struggles and leave both parties feeling isolated.

In this new age of information overload, let’s share our diabetes stories to gain wisdom. Let’s set aside our need to be the Most, Best, Worst, or Right. Let’s walk alongside each other and pick each other up as we take turns falling down, because we all are going to need a helping hand along the way.

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8 Things I’d Tell My Teenage Self About Our Type 1 Tue, 22 Sep 2015 16:00:35 +0000 After a high school reunion, Chelsey Allen reflects on how she would have done her diabetes care differently.

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shutterstock_182266259_teen_300pxI recently attended my 10-year high school reunion, and while the event caused me to wax nostalgic about my teenagehood, it also made me realize what I didn’t know about Type 1 diabetes self-management at the time.

If I could go back in time, here are 8 tips I would tell my younger self about managing Type 1 diabetes:

1. Listen to your parents
Teenagehood demands more self-sufficiency, but parents really do have your best interests at heart, and (irritatingly) they’re usually right. They make mistakes too, but their broader life experience allows them to boss you around impart their profound wisdom and point your moral compass in the right direction. Plus, they go to bed with the constant worry of your overnight blood sugar levels (your diabetes is no picnic for them, either), so cut them a break.

2. Nothing exciting happens after midnight…or 1a.m.
Let go of your FOMO*! A decent night’s rest far outweighs an extra hour of “hanging out”. Studies even show that lack of sleep can dismantle blood sugar balance, not to mention mood and cognitive function.

3. Prioritize your health
The invincibility of youth starts to wane in your late twenties, as does the ability to bounce back from a blood sugar roller coaster. You may have exams to crunch for and parties to attend, but take time to check in with yourself. When Type 1’s a priority instead of a royal pain, life’s big events (and the future) will go much more smoothly than if you neglect your diabetes care now.

4. Learn to say no
We’ve all succumbed to some form of peer pressure, and the teenage years can be tough. Being an assertive youth will actually make you a more decisive, independent adult. It’s also a really kind gesture to be the designated driver after a night of gallivanting, and you’ll be happier than your peers in the morning when you don’t have to bow to the porcelain god.

5. Go to summer camp
Aka diabetes camp. Even if you’re past the camper age group, register to be a counselor or volunteer. You get to swim, hike, play, camp, and test blood sugar with your bunk mates and a team of diabetes care specialists around the clock. It’s a magical place where diabetes is the norm.

6. Stay open
Being empowered to prick your finger in public or show strangers how your insulin pump works is awesome, until that self-conscious impulse kicks in. Try not to rationalize your compulsive discretion as a shield against showing weakness or scaring needle-phobic peers. Public displays of Type 1 are a great way to raise awareness, your friends and teachers will be supportive, and anyone who can’t handle it needs a lesson in maturity.

7. Make friends with people who care about your well-being
The wise Dr. Seuss once said, “Those who mind don’t matter, and those who matter don’t mind.” This is an apt way to describe friendships when you have diabetes. The ones who truly get the shaky personalities of blood sugar are the ones you’ll still be friends with in 10 years.

8. Enjoy riding the wave of youth
Adulthood means growing up, figuring out your life, and paying bills. I wish I had appreciated the resources and support I had in my teens, from high school counselors to health care coverage to the endocrinology unit at Children’s Hospital. There’s going to be plenty of time to go it alone with your diabetes, too much in fact, so enjoy the support while you can.

Of course, youth is wasted on the young, and we all have to learn some lessons the hard way. I just hope the current crop of teenagers with Type 1 can learn from the experiences of the former teenagers that came before them.

* Note to non-recent former teens, FOMO = fear of missing out

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Acetaminophen Can Affect Meter and CGM Readings Tue, 22 Sep 2015 15:36:38 +0000 The common pain-relief drug does not affect actual glucose concentration in the bloodstream, however.

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shutterstock_228881236_tylenol_300pxThere’s been evidence as far back as 2009 that acetaminophen can cause inaccurate blood sugar readings with meters. Now, a more recent study suggests that the common pain reliever also might interfere with continuous glucose monitor (CGM) readings, as well.

In July 2009, The Journal of Diabetes Science and Technology published a paper discussing sources of meter errors in measurement of blood glucose levels, including patient use of acetaminophen. Acetaminophen is a mild painkiller and fever reducer that people use as an alternative to aspirin; although it’s been hard for scientists to pin down exactly how acetaminophen works, the drug is believed to moderate the body’s production of prostaglandins, a hormone-like lipid which, among other things, helps regulate sensitivity to pain. Researchers in the 2009 study documented how acetaminophen use seemed to cause errors in blood glucose readings with meters. The paper has found no chemical or metabolic link between acetaminophen and the body’s production of, or sensitivity to, glucose or insulin. The researchers did say older meters were more prone to these erroneous readings than newer meters, but that such fluctuations can be possible with all meters they researched.

Now, a similar inaccuracy has been documented in connection with CGM use. In 2015, clinical investigators published a paper in Diabetes Care describing meter and monitor variations for a group of acetaminophen-using patients who tested both with meters and CGMs. The study, led by Dr. David M. Maahs of the University of Colorado Barbara Davis Center for Childhood Diabetes, was a stress test to predict the reliability of investigational closed-loop artificial pancreas systems relying on CGMs. Study participants took 1,000 milligrams of acetaminophen at breakfast and tested their levels at seven intervals within eight hours using Dexcom G4 monitors and a variety of blood drop test strip meters. Researchers saw the same elevated glucose reading phenomenon as had been found with meters. In some cases CGM variances were recorded of up to 100 mg/dl over meter testing.

Blood drop test strip meters read the electrical current generated by the reaction of blood glucose to a glucose oxidase enzyme impregnated in the test strip. CGM sensors read the electrical current generated by the reaction of blood glucose and glucose oxidase loaded in the sensor tip cannula assembly. It’s believed that one’s own body chemistry can affect the range of inaccuracy exhibited in CGM results, as many CGM users report no elevated blood glucose readings after taking acetaminophen. Also, some CGM users who regularly take acetaminophen have reported that they need to replace their sensor tips more frequently than manufacturer recommendations.

It’s important to identify if this phenomenon is happening regularly in your diabetes self-care, as erroneous readings can lead to dosing more insulin than needed. If you regularly take acetaminophen, it might be important to document whether your blood sugar readings after taking acetaminophen seem incongruous with other readings. As always, consult with your doctor before making any changes in your diabetes self-care or before discontinuing use of a prescribed or doctor-recommended over-the-counter medication.

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¿Puedo Obtener Insulina Sobre el Mostrador? Tue, 22 Sep 2015 13:35:48 +0000 En algunos casos y con algunas insulinas, sí.

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shutterstock_67522636_insulin_over_counter_300pxRecientemente escribimos acerca de Kevin Houdeshell, quien murió de diabetes cetoacidosis después que su receta de insulina expiró. Algunos han cuestionado sobre si Kevin debió haber ido a comprar insulina sobre el mostrador (OTC, por sus siglas en Inglés) a Walmart en vez de no tener insulina en lo absoluto.

Como cualquier persona con diabetes sabe, existen factores complejos y decisiones que pueden llevar a situaciones de emergencia con los niveles de azúcar en la sangre. Nunca sabremos con certeza lo que sucedió en el caso de Kevin. Su padre, Dan Houdeshell, ha preguntado si la insulina OTC es una opción para alguien con una receta vencida.

Hicimos un poco de investigación en línea y encontramos que existe una gran confusión acerca de las insulinas OTC en las salas de chat de diabete, así que decidimos preguntar a Jennifer Smith de Servicios Integrados para la Diabetes (IDS, por sus siglas en Inglés) nos ayude aclarar las cosas. Le preguntamos si ella piensa que las insulinas OTC son un buen plan secundario cuando no se puede obtener la receta regular. He aquí como Jennifer contestó la pregunta:

Hoy en día, la mayoría de recetas para aquellos que usan insulina cubren las más actualizadas tipos de insulina – insulina basal tales como Lantus y Levemir, como también insulinas de rápida acción como Novolog, Humalog y Apidra. Cuando se compra insulina sobre el mostrador (OTC), éstas insulinas de marca no están disponibles.

Es cierto que la insulina de la marca ReliOn de Walmart está disponible sin receta en muchos estados. Sin embargo, incluye un limitado tipo de insulina. Estas son insulinas de una generación anterior, incluyendo insulina R, también llamada Regular (una insulina de acción rápida) e insulina N (una insulina de acción intermedia tomada dos veces al día). Estas insulinas OTC genéricas tienen un muy diferente perfil de acción a las insulinas prescritas. Sin embargo, genérico de ningún modo significa de baja calidad.

Es importante tener un plan secundario de insulina en caso que se encuentre con una receta vencida o corto en fondos. Sin embargo, sería de mucho beneficio dialogar con su proveedor de atención médica sobre el uso de este tipo de insulina genérica OTC antes de que las utilice.

La insulina de acción rápida trabaja rápido y sale del cuerpo rápidamente. Los análogos de insulina basal típicamente trabajan por más tiempo y en una manera más uniforme y sin un pico de acción, a diferencia de la insulina de acción intermedia que tiene que ser tomada dos veces al día. La insulina de tipo R y N requiere que sus usuarios tengan un poco más de estabilidad en sus comidas y actividades diarias debido al tiempo de acción de la insulina.

Debe de enfatizarse que la insulina es un medicamento indispensable para aquellos que están en tratamiento con insulina. Sin ella, la glucosa en la sangre se elevaría a niveles peligrosos y potencialmente mortales. En el caso de una receta, es bueno tener la opción de tener acceso a insulina OTC de forma rápida y a bajo costo. Sin embargo, entender cómo utilizarla en tiempo de necesidad es también importante para asegurar un adecuado manejo del nivel de glucosa en la sangre.

Servicios Integrados para la Diabetes provee educación personalizada y asesoramiento en regulación de glucosa para aquellos que utilizan insulina. Servicios de asesoramiento en diabetes están disponibles en persona y de forma remota vía teléfono o en línea para niños y adultos. Servicios Integrados para la Diabetes ofrece servicios especializados para usuarios de bombas de insulina y monitores continuos de la glucosa, atletas, embarazos y diabetes Tipo 1, y aquellos con diabetes Tipo 2 que requieren insulina. Para más información, llamar al 1-610-642-6055, o entre a o escriba

Acerca del Autor
Jennifer Smith es la Directora de Estilo de Vida y Nutrición en el Servicios Integrados para la Diabetes. Ella tiene una Licenciatura en Nutrición Humana y Biología de la Universidad de Wisconsin. Ella es dietista licenciada y registrada, educadora de diabetes certificada y entrandora certificada en la mayoría de marcas / modelos de bombas de insulina y sistemas de monitorización continua de la glucosa. Ella ha vivido con diabetes Tipo 1 desde que era niña, ha navegado ejercicio, embarazo y vida adulta con diabetes y cuenta con conocimiento de primera mano de eventos del día a día que afectan el manejo de la diabetes.

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I Grapple with Hypoglycemia-Induced Depression Tue, 22 Sep 2015 11:43:32 +0000 A man with Type 1 identifies an emotional pattern with his lows.

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shutterstock_271701236_depression_300pxAs a person with Type 1, I do my best to stay in control of my blood sugar levels; I even use a CGM and pump. Even so, sometimes my body has a mind of its own. It’s frustrating when I do my best to be on track only to realize my glucose levels are way off. These swings in blood sugar levels make me feel out of control and helpless.

Dealing with the mood swings of hypoglycemia is not an easy process, either. I recently discovered that strong emotions come with my blood sugar lows. Sometimes my body reacts physically, but other times I become extremely depressed. Whenever I feel despondent during a low, I dig myself into an emotional pit. I become anxious and avoid seeking help.

It’s almost never immediately clear to me that dropping glucose levels correlate to my emotional state. Not having enough glucose to fuel the brain creates some kind of a chemical reaction and puts me in a state of denial. Even if I do manage to tell myself that the depression will fade once I return to a normal blood sugar, it feels overwhelming. Emotions run wild until my blood sugar levels are brought back under control.

Instances of hypoglycemic depression make me feel isolated, but I’ve recently learned that it’s a lot more common than I thought. Once I started talking about this emotional pattern with others, I learned that many other friends with diabetes experience the same problem with lows. I suspect the more we talk about this, the more we’ll find out this is a common occurrence for people with Type 1.

If you find you also experience emotional valleys with hypoglycemia, it’s important to track how your mental health changes in relation to fluctuations in your diabetes management. It’s also important to have a plan of action in place when hypoglycemia occurs, and to be willing to reach out for help if you can’t take care of your low, or your depression, yourself. We can’t be expected to think straight when a low comes, so it’s best to create an easy-to-follow plan and have some kind of buddy system in place to help you deal with your low, and the emotional toil that accompanies it.

When all else fails, seek professional help, both from your endocrinologist and a qualified mental health counselor.
To learn more about mental health counseling for people with Type 1, go to “Should You Go to a Diabetes Psychologist?”

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Injecting Movies with Type 1 Diabetes Fri, 18 Sep 2015 17:47:55 +0000 What if Hollywood blockbusters included more characters with diabetes?

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Frozen Insulin_300px


Diagnosed with diabetes at a young age, Princess Elsa of Arendelle was taught by her crass father, the king, to keep her hands covered with gloves so nobody would see the small scars from repeated blood glucose tests. Elsa also can make snow come out of her fingertips, but no one really cares about that.

Hearing rumor across the land of a possible cure for diabetes, the king and queen set sail. Months go by, yet the royal parents never return. (Truth to tell, Elsa might be better off without them.)

Eventually crowned queen of Arendelle, Elsa still struggles with displaying her diabetes in public. At the coronation party, a small drop of blood spreads on the fingertip of Elsa’s white glove and guests take notice. Frightened of what they’ll think, Elsa flees, leaving her sister behind, and escapes to the snowy mountains. Free for the first time, Elsa tosses her gloves to the wind, but forgets that her insulin would be unusable if it freezes. It is up to her sister, Anna, to bring Elsa insulin in an insulated pack and try to convince her to return to the kingdom and educate others about Type 1.


After an extraterrestrial is stranded on Earth, he must survive new horrors like child-Drew Barrymore’s cuteness long enough for his alien brethren to rescue him. However, unbeknownst to his newfound human friends, this alien is suffering from diabetes. He attempts to communicate with them, but “E.T. phone home” apparently does not translate to, “Please prick my finger and test my blood sugar, I think I might be running high.” Will his new friends figure out how to work his meter in time?

Titanic Bolus_300px

Titanic Bolus

Young and aristocratic Rose boards the RMS Titanic and falls in love with Jack, a charming, but poor, artist with diabetes. But even within the small confines of the ship, Jack shows Rose a carefree life she never knew possible, teaching her about his condition along the way.

During a midnight stroll on the deck, Rose notices symptoms of Jack experiencing hyperglycemia (remember – he shared a lot about the condition). She rushes off to his room to get his insulin and manages to bring the supplies back to him just as the mammoth boat collides with an iceberg. In the confusion, Jack can’t remember if he counted carbs right for the amount of insulin he injected.

Will Jack’s glucose levels sink like the doomed ship, or will the two escape death?

(Spoiler Alert: Yes they escape the ship and Jack counted his carbs just fine, but Rose selfishly man-spreads herself on a floating wardrobe and lets the supposed love of her life disappear into the abyss.)

Prick PerfectPrick Perfect_300px

A ragtag team of college students comprise the Barden Bellas, an acapella group recovering from an upset at last year’s nationals—one of the female leads, Aubrey, passed out on stage from an untreated low. The judges totally didn’t understand Type 1 diabetes and were jerks about the low, so the Bellas lost the competition.

Now, the team must work extra hard to restore the Bellas to their former glory. Newcomer Beca suggests Aubrey use a CGM to better track her glucose levels. At first reluctant of this, as well as Beca’s other plans to perform nontraditional mashups at competitions, Aubrey eventually decides to stop making up aca-scuses and get on board with the new ideas to make a stronger team. But will her newfound attitude be enough to combat their biggest competition, a crowd pleasing all-boys acapella group that boasts killer vocals, a taste for modern music, and sexual tension?

The Devil Wears Prada and a CGMDevil wears prada_300px

Miranda Priestly, the editor-in-chief of a high fashion New York magazine, takes a young aspiring writer with no concept of fashion (or bangs) under her wing. Despite her flaws, the young girl has potential, and like Ms. Priestly, the girl also has Type 1 diabetes. However, Miranda manages to keep the disease on the down-low by wearing a CGM and a pump while the twentysomething secretary unashamedly pricks her finger at her desk as she pleases.

Tired of living a lie, and sick of being embarrassed by her condition, Miranda soon realizes that while she can impart style and luxury to her new assistant, perhaps the girl can teach her a great deal in return.

(If we’re making up movies to have characters with diabetes, we can just change the ending, too.)

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The Supreme Court Justice with Type 1 Fri, 18 Sep 2015 17:13:23 +0000 Justice Sonia Sotomayor has been very open about her diabetes diagnosis, and how it has shaped her worldview.

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The odds that Associate U.S. Supreme Court Justice Sonia Sotomayor is the first person with diabetes to be seated on the highest court are pretty long. However, Justice Sotomayor is the first to reveal her diabetes diagnosis in a very public way. She let it be known that she has Type 1 in her 2013 memoir, My Beloved World.

Her memoir opens with an account of her frightening emergency trip from Sunday church to the hospital; she was diagnosed with diabetes at age 7. It follows with how she soon learned to self-administer insulin. And she includes how she overcame perceived limits of having Type 1, saying, “I don’t know if they still give diabetic children a list of professions they can’t aspire to, but I’m proud to offer living proof that big dreams are not out of bounds.”

Justice Sotomayor earned a B.A. in history summa cum laude in 1976 at Princeton, where she won the Pyne Prize, the highest general academic honor for undergraduates. She matriculated to Yale Law, where she was an editor of the Law Journal. Justice Sotomayor worked as an Assistant District Attorney in New York and then entered private practice, specializing in international commercial litigation. President George H.W. Bush appointed her to the U.S. District Court for the Southern District of New York in 1992. In 1998, President Clinton elevated her to the Second Circuit Court, and in 2009, President Obama appointed her to the Supreme Court following the retirement of Justice David H. Souter.

In a 2013 Q&A session at an event in Denver, Justice Sotomayor was asked how she was able to surmount the obstacles of diabetes and other challenges to achieve great things in life. She said her diagnosis at an early age framed her mental outlook on life.The prognosis for Type 1 was not good when she was diagnosed 50 years ago, and she was told she wasn’t expected to live past 40. Her diagnosis gave her a sense of urgency to get the most out of life.

“[My diagnosis] taught me the preciousness of life, and it taught me that if I wasted any minute of my life, that it would be criminal. That’s what’s kept me going,” she said.

You can read more on Justice Sotomayor’s life in her memoir My Beloved World, which can be purchased online at Barnes & Noble and Amazon.

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Google and Sanofi Join Forces Fri, 18 Sep 2015 16:25:31 +0000 The two companies hope to create a new diabetes device.

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Sanofi and Google have announced a business partnership to create a device that will gather information to help people with Type 1 diabetes and Type 2 diabetes better manage their blood sugar levels. The partnership will combine Paris-based Sanofi’s knowledge in diabetes care and devices with the analytics, compact electronics, and chip design know-how of Google’s evolving life science division.

It is far too early to have any clear idea of what this device will look like. However, according to the press release, it sounds like it might be CGM-like and combine different components of diabetes management, such as A1C levels, medication regimens, patient-provided feedback, and sensor devices.

If this story sounds familiar, it’s likely because there has recently been news of Google’s recent life science division’s partnership with Dexcom to create a compact and disposable CGM. The internet giant also has undertaken a project to create a contact lens that gauges blood glucose readings, The Verge reports. This stacking of partnership announcements makes one wonder who’ll be next to join forces with Google’s life science division. It certainly seems to indicate that the company is serious about making a splash in diabetes management.

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5 Diabetes Memes You Need to See Thu, 17 Sep 2015 16:11:45 +0000 At least we think you need to see them, but what do we know?

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We’ve come up with a fresh batch of Type 1 diabetes memes, straight out of the ovens of our fevered imaginations. Feel free to pass them around like Groupon offers for Starbucks:

Joker meme

the first year

Anger meme

None of my business

One does not simply

Do you have a Type 1 meme you’d like to share? Email it to our editor at

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Deal With Your Emotions to Improve Your A1C Tue, 15 Sep 2015 18:46:47 +0000 Better blood sugar is not just about the physical, suggests one motivational speaker.

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When it comes to advice on improving one’s A1C score, there are some familiar suggestions that we often hear:

· Check blood glucose more often
· Exercise regularly
· Eat healthy fats and protein and minimize carbs

And, so on. What do these suggestions all have in common? They are all physical solutions.

Here’s the problem: while these tips may be sound advice, physical is only part of the story. The real question is what will it take to overcome an individual’s resistance or unwillingness to carry out these physical recommendations? We need to go beyond the physical and address the emotional, mental, and spiritual needs of people with diabetes, as well.

When Morgan Patton had an A1C of 16, she already knew the recommendations touted in the list above, but she had no reason to change her behavior. She didn’t want to test her blood sugar much, so she didn’t test her blood sugar much.

According to an interview with the College Diabetes Network, that changed when she met Phil Southerland’s Type 1 bike racing team, now Team Novo Nordisk. It was her first exposure to people doing what she wanted to do AND checking their blood sugar, and it was a life-changing experience for her. Suddenly, it occurred to her that it was a great idea to check your blood sugar, especially if you loved to bike as she did.

Within a relatively short period of time after Morgan met Phil, her A1C came sharply down, in inverse proportion to her self esteem and feelings that her life had purpose. Her narrative had shifted from a rebel without a cause to a champion with meaning. Her new story was that it was now imperative to check her blood sugar so she could perform better in something that really mattered to her. She’s now a competitive athlete with diabetes who organizes a cycling team for others with Type 1.

So, in trying to aim lower in A1C targets, the answer does not lie just in the physical. People with diabetes (as well as those who care for them) must uncover what’s emotionally holding them back from taking care of themselves. Once you do this emotional work, physical change is much easier to undertake.

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Not One More Missed Type 1 Diagnosis Tue, 15 Sep 2015 18:28:18 +0000 A new group, UPrising Against DKA, is calling for all children to be screened for Type 1

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shutterstock_150288266_sick_girl_300pxAdvocates calling for earlier Type 1 detection have formed a new group to raise awareness about the dangers of a missed Type 1 diagnosis. The group, UPrising Against DKA (“United Parents Rising Against Diabetic Ketoacidosis,”) has built a membership of more than 1,800 since its creation in July.

Page administrator Cindy Turner, who helped form the advocacy group TestOneDrop, urges others to “unite against the lack of education and complacency that allows unnecessary life-threatening illnesses, permanent handicaps, and even deaths to continue.” Members have been sharing stories of missed Type 1 diagnoses and contacting their congressional representatives to push for new legislation to improve screening efforts for Type 1.

In 1995, Cindy experienced the pain of a late Type 1 diagnosis when doctors overlooked her six-year-old’s symptoms of persistent thirst, irritability, and weight loss over a nine-month period. Cindy’s daughter somehow avoided DKA, but was hospitalized for days after diagnosis. Her daughter is now a nurse who volunteers at diabetes camp.

Hers is not the only story of a missed diagnosis on the Facebook page. One parent shared the story of her son – doctors possibly missed his Type 1 diagnosis for two years. When they did finally diagnose him with Type 1, a lot of damage had been done.

“His sugar was 1277 at onset. A1C of 11.5. He had edema on his brain. Short term memory loss. He couldn’t hold a spoon or a pencil. He couldn’t see to read,” the mother wrote.

The group has formed at a time when legislators are just beginning to take notice of the dangers of DKA. In 2015, North Carolina legislators have been considering legislation, known as Reegan’s Rule, named for a toddler who died from undiagnosed Type 1. As it was first filed in January 2015, this legislation would have required physicians and other licensed medical practitioners offering well-child examinations to perform blood glucose testing of newborns and toddlers annually to age two. Committee amendments enlarged the testing years to six, and then removed the testing mandate for language encouraging practitioners to educate parents about Type 1 diabetes warning signs and symptoms. The bill has been bouncing around the legislature and no action has been taken since July 21st.

UPrising members are busy pushing for similar bills in Ohio and Pennsylvania legislatures. It’s hoped that these efforts will soon pay off in new laws. They make a persuasive argument that a simple and affordable blood test can save lives.

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The Odyssey of a Runaway with Type 1 Mon, 14 Sep 2015 12:52:47 +0000 The diabetes online community worries for days about the fate of a teen who seemingly disappeared without his insulin.

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shutterstock_304871189_stressed_boy_300pxTrance Rodenbough, an insulin-dependent sixteen-year-old with a history of running away, left a rural hospital intensive care unit under his own steam and about 110 miles from his home in Guthrie, Oklahoma on Friday of Labor Day weekend in 2015. He had disappeared the day before from the Lawton Adventure Program, a community-based facility providing counseling, education, and transitional housing services for at-risk youth. There are unconfirmed reports from regional television stations and the Lawton Constitution that he’d said he was 18 when he went to the hospital and that he’d used an alias, that he had been treated for diabetic ketoacidosis (DKA) and released, and that he’d told someone there that he was headed to Florida. There are also reports, also unconfirmed, that he’d been seen on his bicycle near Bowie, Texas on September 3 and that he was making his way on skateboard or bicycle to Florida by way of Shreveport, Louisiana. Bowie is a little more than half the way from Oklahoma City to Dallas.

It’s against federal law for a hospital that receives any form of federal health care payment to refuse emergency services to someone in need who cannot pay. If the news reports are accurate, the hospital that rendered services believed he was 18 and so couldn’t stop him from signing himself out, even against medical advice. And now the hospital can’t reveal what happened, and can’t even accept a HIPPA release from him now, because he’s not old enough to sign one. There was really not much to stop Trance from gaming along underground until the clock ran out on him.

Phone inquiries to the local police departments had gone unreturned by press time, and so what we know, or think we know, has had to come from our trying to dovetail together local news stories and what has been posted on a Help Find Trance Facebook page by family and neighbors. The National Center for Missing and Exploited Children, which with state law enforcement and public health agencies maintains the Amber Alert system, issued an online alert, as did regional public safety agencies, and private sites maintained by volunteers.

If my chart plotting and dead reckoning skill can be transferred to reading a GIS topographical map created on imagery from space, and assuming that public safety officials acted upon the Texas tip (which eventually proved to be erroneous), the search area for the young man extended some 6,375 square miles, halfway between New Jersey and Connecticut in size. If Trance had been moving in Manhattan buses or subway trains instead, the transit police could probably have intercepted him within hours of being alerted of his disappearance. He managed to elude the southwestern Oklahoma law enforcement community for five days.

On the Tuesday evening four days after he checked out of the hospital, the Logan County Sheriff’s Department told Insulin Nation that he had been found by police officers in Ardmore, Oklahoma, about 40 miles east southeast of Lawton. He’d spoken to some patrol officers who thought something about his story just didn’t sound right. On a hunch, they checked the Wanted and Missing Persons fliers and then went back and found him.

The Help Find Trance page is long, and it’s timeline goes back to his 2014 disappearances. Last year, the overnight crew at a Walmart off the interstate in Edmond, 20 miles from his new hometown, had seen him just hanging around outside between two and five in the morning and called the police for a well-person check. Eight months earlier, he’d turned up at a church in Edmond on a Sunday morning after having been gone three days. According to a report of that rescue in the Edmond Sun, he’d been threatening his parents with running away to live with family in Missouri, and he was worried about having to move to a new town and making new friends. And it doesn’t look like he’s ever taken his insulin with him when he’s gone missing.

Trance’s stepmother reports she’s hoping that he’ll be released by the end of the week from the Oklahoma City hospital where he’s being treated. She reported on the Help Find Trance page the morning after his turning up that his blood sugars were back to normal and that “he’s been eating like a horse.”

Trance’s case is an extreme one, and we don’t know all the particulars about his life, but it highlights the need for better mental health support for teens with Type 1. A recent Diabetes Australia survey of 800 teens with Type 1 found that ¼ of them reported moderate to severe anxiety and depression. While the vast majority of teens with Type 1 and anxiety or depression won’t choose to run away like Trance, they still might have just as desperate of feelings and need just as much support.

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How a School 504 Plan Helps a Child with Type 1 Thu, 10 Sep 2015 16:57:38 +0000 A mother of a child with Type 1 shares her experience.

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shutterstock_251924788_childhood_friendship_300pxMy son’s fourth grade teacher encouraged him to create a 504 Plan shortly after his Type 1 diagnosis. I had no idea what it was. I quickly learned how it could be a helpful tool for our son, my husband and me, and the school.

A student does not have to have a learning disability to have a 504 Plan in place. As it turns out, any school that receives federal funds is required to develop a 504 Plan for any student with a mental or physical condition that might limit their ability to function in school.

(A 504 Plan differs from the more widely known IEP Plan in that it has a broader definition of what constitutes a “disability” that impedes learning. If a child with diabetes has no other physical or mental conditions that can impede the learning process, he or she is likely not to qualify for an IEP, but might qualify for a 504 Plan.)

This plan has become a platform to help us communicate any adjustments to normal school rules that our son needed. It ensures that staff implement equal access rules to testing and activities to minimize the impact diabetes has on our son’s learning.

Here are some of the major items that we included in our 504 Plan:

  • Documented awareness that there will be extra absences for sick days and doctor appointments. Prior to diabetes, my son missed about four days of school a year. The year he was diagnosed, he missed 17.
  • Adjusted provisions for classwork, homework, and testing. The first year of his diagnosis, between missing school and battling lows, it wasn’t possible for him to make up all the work. His teacher understood this and was flexible. This understanding helped him, and us, transition to life with diabetes.
  • Permission to eat and drink whenever and wherever. Someone who doesn’t have diabetes might not understand that when my son needs a snack, he needs a snack.
  • Permission to take extra trips to the bathroom. Kids with diabetes can’t always plan their bathroom breaks due to blood sugar spikes. When he runs high, he needs to be excused more often.
  • Permission to carry his supplies and use them anywhere, anytime. If he feels low in class, I want him to check there, not wait to take a flight of stairs to the nurse’s office to do it.

The 504 Plan goes to all of his teachers prior to a new school year. I get a call from the school every new year asking about possible updates, often before I even remember to let them know about them.

It’s great knowing my son’s school has a support system I can trust. It makes sure everyone concerned with my son’s education is on the same page about how to support him as he goes to school with diabetes.

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Pump Maker Deals with Quality Control Fallout Thu, 10 Sep 2015 16:44:10 +0000 Insulet touts improved OmniPod manufacturing standards just as FDA details summer recall notice of the pumps.

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OmniPod_Model_300pxInsulet, known for the OmniPod tubeless insulin pump, recently announced that its manufacturing plant was functioning quite nicely again after a rocky period of quality control issues. This announcement, of course, came just before the FDA released details of a July recall notice that affected over 400,000 OmniPods.

The recall was issued because regulators in March found that the Billerica, Massachusetts-based pump manufacturing facility had “inadequate standards compliance” issues, according to a Fierce Medical Devices article report. There were 90 reported complications with the OmniPod device, 13 of which required medical intervention, the FDA recall notice explained. This included an instance of the device’s cannula retracting or not fully deploying, which means no insulin delivery. The OmniPod recall notice, which Insulet told customers was voluntary, was only for the OmniPod itself and not for the accompanying Personal Diabetes Manager device that wirelessly communicates with the insulin delivery pod.

In response to concerns of quality control, Insulet brought on Michael Spears, giving him the title of vice-president of quality, regulatory and clinical affairs. Spears held a similar position with Covidien, another Massachusetts-located medical device supplier. Insulet has also implemented improved quality control procedures and have received the FDA’s blessing to continue production.

It’s often said that timing is everything in business. It appears Insulet was extremely unlucky in the timing of its public relations moves.

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Donate Your Pancreas to Science…Later Wed, 09 Sep 2015 15:35:04 +0000 The nPOD program seeks to study the pancreases of people with diabetes.

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shutterstock_147096581_enjoying_life_300pxIf you have Type 1 diabetes, you might think your pancreas is worthless, but researchers don’t. They hope you will think of donating your pancreas to research efforts when you shuffle off this mortal coil.

Researchers want to study the human pancreas to learn more about Type 1, but to do so they need organ donors. The Network for Pancreatic Organ Donors with Diabetes (nPOD) was founded to supply researchers with pancreases to study, says Dr. Alberto Pugliese, the program’s co-executive director. Since its founding, nPOD has collected tissues from over 100 donors with diabetes. As a result, those specimens have been examined by about 130 research projects across the globe.

Diabetes researchers often don’t get enough access to human pancreases, and must focus research instead on mouse pancreases. Unfortunately, this can lead to mouse “cures” that don’t work on humans. The pancreas is not normally biopsied, Pugliese explains, and imaging techniques are very limited. While a cure is the ultimate goal, Dr. Pugliese said in an email interview that if “patients with diabetes donate their pancreases to diabetes-focuses research, we could…understand the disease’s cause and discover new therapeutic targets.”

One initiative to come out of the program is the University of Miami nPOD-Transplant study, in which pancreases from diabetic patients who’ve received a transplant are recovered, post-mortem, to be compared with the donor’s native organ.

“It is…important to study the transplanted pancreas because in some cases the autoimmune process that caused diabetes may come back against the transplanted pancreas,” Dr. Pugliese said.

To visit nPOD’s website and learn more about the program, click here. If you or someone you know would like to participate in the nPOD program, you can find the application here.

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NFL Player Misidentifies his Diabetes Wed, 09 Sep 2015 15:27:51 +0000 Patrick Peterson initially says he has reversible Type 1 diabetes, then reverses himself.

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patrickpeterson21_300pxTo make it in the NFL, Patrick Peterson has to remember a bewildering amount of plays, most of which are labeled with random numbers. He apparently is pretty good at it, too, as the former All-Pro cornerback signed a $70 million contract extension with the Arizona Cardinals in 2014.

That makes his momentary slip-up on his diabetes diagnosis all the more strange. In an August 3rd profile with the Arizona Republic, Peterson had some trouble remembering what type of diabetes he had. In that report, he said, “I had Type 1 so it was reversible and as of right now, I’m diabetes free.”

Peterson must have realized or heard about his mistake almost immediately. He quickly tweeted out later that day, “Wanna clear something up from earlier today. I was diagnosed with Type 2 diabetes, not Type 1. Guess that’s why my wife’s a doctor not me…”

For many in the sports world, it was a momentary blip during the early days of training camp. However, Peterson’s momentary misdiagnosis, especially since he used the word “reversible”, is sure to make him memorable to the diabetes online community for years to come.

To dismiss Peterson’s statement as a sign of unintelligence is, of course, unintelligent in itself. One does not master how to defend against complex offensive schemes at the highest level of football without having intelligence.

At the same time, it might be a mistake to dismiss Peterson’s utterance as a misstatement made in the chaos of preseason training. His diagnosis was a key development in his life in the past year. He began to show the ill effects of diabetes shortly after signing for big money, and it showed on the field. He went from being an elite defender to being a subpar one, and he was raked over the coals by football fans and sports radio talking heads for it. This season is meant to be a redemptive one for Peterson, as he now believes he has gotten his diabetes under control and regained his explosive quickness on the field. It would seem strange for a superman to misremember the name of his own personal kryptonite.

Of course it’s possible that Peterson wasn’t given enough information in his initial diagnosis to sear into his brain the difference between Type 1 diabetes and Type 2 diabetes. This is something to which many people who receive a diabetes diagnosis can relate. Often, the diagnosis comes like a sudden thunderclap, and those who receive it must adjust rapidly to a new normal, often without the benefit of enough guidance from busy doctors. If this is the case with Peterson, it goes to show no one is immune; he is married to a physician and has medical staff who monitor his body to make sure he is able to perform at his peak.

Mistakes are opportunities to learn. Hopefully, Peterson’s mistake about his diabetes diagnosis will help to further the discussion between physicians and patients about the need to provide more information and more support on all forms of diabetes after the initial diagnosis.

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Dad with Type 1 Investigated by Child Services Tue, 08 Sep 2015 15:14:14 +0000 A UK man is accused of being an unfit parent after suffering a bout of hypoglycemia.

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shutterstock_196714871_son_holding_onto_father_300pxLate in July the London tabloid the Daily Mirror published a story about a man who had suffered a hypoglycemic episode and collapsed at home. Under a headline which said he was “accused of being unfit parent by paramedic,” the article described how a 27-year old dad, March Le Fey, came to after being administered emergency treatment, only to be upbraided by a paramedic who later reported him to the child protection authorities.

According to the Mirror, social services decided to take no action, but only after a lengthy interval. Le Fey, who was looking after his five-year-old and three-year-old sons on a regular weekend schedule, suffered a low at home. The older son, according to an interview the father had given, had been taught how to respond to a diabetic emergency. The father had been diagnosed at age nine and by all appearances had been taking proper care of himself, and was equipped, and had equipped his loved ones, with knowledge sufficient to help him recover from his low and to prevent risk of harm to his children.

“I have a known complication of diabetes and if the paramedics had bothered to give me a chance I would have told them,” Le Fey says in the article. “We all have a right to live. There are plenty of people with diabetes and other medical conditions who look after their kids perfectly safely.”

A pertinent question is whether someone with diabetes could have their children taken away in the United States. Certainly, a chronic health condition, if it’s debilitative or life-threatening, or pattern of behavior evidencing a reckless approach to anything in life that would put a child at risk, are factors an official may consider when making an order affecting parental rights. But none of the judges I’ve known in my legal career would even think of denying or restricting custody merely on the basis of a parent’s diabetic condition. And a lawyer stupid enough to be making an issue or a negotiating point out of it would be hauled into chambers for a good woodshed talking-to.

However, that isn’t to say such a case as this might not happen here. It’s important to note that all that happened in this case was an accusation by a health official and a nerve-wracking investigation. Sadly, as anyone who has gone through a nasty custody dispute could attest, baseless accusations against fit parents happen all the time. While these cases are hopefully closed before they get to court, or shut down once there, they can be a needless drain on parents and the system.

While it may be impossible to prevent one misinformed first responder from initiating such an investigation, the best methods to prevent such an outcome are to continue to train health officials about hypoglycemia, to keep your family in the loop about your diabetes self-care (as Le Fey has done), and to keep good documentation of your diabetes therapy. Parents who are responsible in their diabetes care shouldn’t have to go through this, but it’s best to be prepared, just in case.

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My Type 1 Outpatient Support Team Tue, 08 Sep 2015 13:45:23 +0000 A young man with diabetes describes how outpatient care made all the difference after a Type 1 diagnosis.

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shutterstock_65755810_diabetes_support_300pxI was nervous when I was told I could go home from the hospital after my initial diagnosis of diabetic ketoacidosis. I had forgotten what life was like without a nurse checking my blood sugar levels every hour or a ham and cheese sandwich delivered at bedtime, just in case. All of those hospital elves I had come to rely on were about to disappear, and I wasn’t ready to deal with this diabetes thing on my own.

I was discharged after five days with the bare essentials: a blood glucose meter, a handful of diabetes supplies, some insulin dose instructions, a few photocopied fact sheets, and a referral to the diabetes outpatient clinic at my hospital.

Luckily, Australia has a government-funded health care system, and one of the benefits is comprehensive outpatient care for people with Type 1. I didn’t know when I left the hospital how valuable such services would be.

On my first visit to the outpatient clinic, I met my diabetes educator, Gwen. She said it was her job to teach me to think like a pancreas and make her role as my diabetes educator redundant. Gwen explained the role of the pancreas. We covered all of the basics, including carbohydrates, hypos, hypers, ketones, sick days, exercise, and travel. After two months, Gwen was confident that I didn’t need to see her anymore. She was, however, always available to me by phone or e-mail if I needed support.

I also had a few sessions with Krystina, my dietician. In these sessions we talked through my diet and found ways I could make improvements. I learned the value of slowly digested Low Glycemic Index foods, which form a big part of my diet today. I also learned about the effects of fiber and fat on my blood glucose levels.

I saw an endocrinologist every three months in the first year of my diagnosis. Unfortunately being a patient at a busy, government-funded clinic meant that I never received the attention I felt I needed. I never saw the same endocrinologist each time in the beginning. I struggled to be open and honest with a complete stranger, afraid I would be judged for imperfect numbers.

Thankfully, the care I received at the outpatient clinic more than made up for the shortcomings in my endocrinology care. Also, a government-funded health care system meant I could monitor for any possible side effects. If I needed my eyes, feet, or anything else checked, I was given a referral to another section of the hospital. I accessed 12 months worth of podiatry treatment on a stubborn foot wart in that first year alone.

Gwen told me that getting through my first year of diabetes would be the biggest hurdle to overcome. Luckily, I didn’t have to go it alone.

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Illegally Fired for Hypoglycemia Wed, 02 Sep 2015 18:12:51 +0000 A jury finds an employer violated the Americans with Disabilities Act when it fired a paramedic with diabetes.

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shutterstock_54474118_torn_contract_300pxThe Americans With Disabilities Act recognizes metabolic and endocrine disorders as disabilities for which employers are required to make reasonable accommodation for potential hires and employees. What concerns employers about diabetes most are complications, such as compromised eyesight, disorientation resulting from a hypoglycemic episode, and the need to reassign employees to give them time to recover from highs or lows.

Early in August, a jury in the U.S. District Court for the Southern District of Indiana rendered a $223,500 damages verdict against a township fire department which had terminated a ambulance paramedic with diabetes. The case isn’t as significant an illustration of the protections afforded employees under the law, as it is of an employer’s failure to work with an employee with diabetes in the process of determining reasonable accommodations.

Kristine Rednour, hired as a paramedic and ambulance driver, suffered four bouts of hypoglycemia in an approximate two-year period – two were serious enough to render her unable to drive during emergencies, and one left her unable to start an IV for a patient she was attending to during an emergency ambulance run. She was granted a light duty assignment period to adjust her treatment plan; she and her doctor were considering whether to adjust her pump’s basal insulin dose and to integrate a continuous glucose monitor (CGM) into her care. During that time, a firing letter came.

It stated:

Your separation of employment is due to unsolicited discovery of medical events caused from your diabetes. The events were on duty, having a direct threat to you, your partner, assisting crews, patient care, and safety of the general public. Under ADA Title II, it is the Wayne Township Fire Department’s position not to cause undue financial and administrative burdens on other employees’ [sic], or the community. By doing so it would fundamentally alter the nature of our service, program, and activity’s [sic] being provided.

The complaint states, and evidence later presented corroborates, that the department’s chief, after having done some independent online research on diabetes, determined that people with Type 1 diabetes should never be hired by the department. Ms. Rednour “must have fallen through the cracks,” according to a statement attributed to the chief by another employee.

Public safety and health care personnel fall into a recognized category of workers who need high levels of physical stamina and mental acuity to properly and reliably carry out their duties. Rednour had begun to exhibit a pattern of performance, by one reading of the facts, indicative of her inability to meet requirements in her job description that she “safely and effectively operate emergency and non-emergency vehicles under all conditions” and be able to attend to patients. So why did her employer lose the case?

The answer, according to a statement given by Rednour’s lawyer to the Indianapolis Star, turns on whether the fire department had engaged in a required “individualized interactive process” to make an accommodation. A physician regularly engaged by the employer examined Ms. Rednour and prepared a report suggesting that a two-to-four week period of light duty, during which Ms. Rednour would adjust her pump to tweak her basal insulin dose, “could be a reasonable accommodation.” Ms. Rednour’s own physician had suggested she try a CGM during her light duty time, and offered to confer with the department’s medical officer, but the employer did not respond to the offer. Then, out of the blue, in apparent disregard of advice from the department’s consulting doctor and a second opinion solicited from an outside doctor, the deputy chief picked up his pen and fired Ms. Rednour.

Attorney Kevin Betz, who represented Radnour at trial, said in a telephone interview with Insulin Nation said that the fact that his client offered a “no-risk accommodation” which her employer dismissed before giving it a chance to work was a focal point in the trial. He added that the termination letter, and the opinion rendered by the department’s physician – suggesting light duty to allow time to adjust his client’s basal insulin dose – were other strong points in his client’s favor. The township’s lawyer did not respond to an invitation to comment on the verdict.

The idea of the individualized interactive process to explore reasonable workplace accommodation has been around in federal courts for at least fifteen years and, according to Mr.Betz, is “at the heart” of the Americans with Disabilities Act. It creates a shifting of the burdens of proof between employers and applicants or hirees. In these cases, it’s first up to an employee or prospective employee to establish evidence of disability and qualification for the job, and then that an accommodation was requested. The burden then shifts to the employer to show that an accommodation was unavailable, or that providing the accommodation placed an unreasonable requirement upon the employer.

Interpretive guidance for the particular regulations that govern reasonable accommodation envision that ”it may be a reasonable accommodation to permit an individual with a disability the opportunity to provide and utilize equipment, aids or services that an employer is not required to provide as a reasonable accommodation.” It seems as if the fire department’s doctor and Ms. Rednour’s endocrinologist had been looking right at this text when they wrote about light duty time to adjust basal dosing and to suggest a CGM. The employer then botched things by firing her before these adjustments could prove its potential worth.

Rednour has since gone on to work as an emergency room paramedic. During the trial, evidence was presented from co-workers that she was a skilled and valuable member of the fire department. It will never be known if the CGM, which could have given advanced warning of the onset of a low, would have been a reasonable further accommodation allowing her to continue to work as a fire and rescue paramedic. This decision shows, however, the peril of an employer not waiting to find out.

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Bigger Capsules Keep Islet Cells Safe Mon, 31 Aug 2015 15:19:19 +0000 Finding may make islet cell transplantation a more viable therapy for Type 1 diabetes.

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shutterstock_155911565_bigger_capsules_300pxResearchers believe that increasing the size of capsules holding islet cells will help them survive in the human body during islet transplant therapy. This could provide a way to make islet transplantation a more viable therapy for Type 1, a FierceBiotech Research article reports.

Islet cells contain the beta cells responsible for producing insulin. For islet cell transplant therapy to work, the transplanted cells must be shielded from the body’s immune system, as the immune system attacks such cells in the body of someone with Type 1. Scientists have been trying to find ways to keep insulin-producing islets safe inside a gel-like transportation pod.

(Proposed islet cell capsules not pictured here.)

In previous studies involving mice models, scientists showed that containing islets inside of spheres with microscopic holes allows the insulin to seep out and nutrients to come in, keeping the islets alive without triggering the immune system to attack the cell. However, these islet-containing spheres developed scar tissue, cutting off the flow of nutrients through the holes in the spheres. Researchers believed at the time that if they increased the size of the capsules, the insulin wouldn’t be able to pass through the microscopic holes and be effective in the bloodstream.

Now, according to researchers at MIT, increasing the size of the islet-bearing spheres to 1.5 millimeters in diameter, 50% larger than the largest capsule used in previous studies, is a workable solution. They found that spheres that were 1.5 millimeters in diameter survived in the bodies of mice and primates and helped those animals maintain good blood glucose levels for 180 days, five times longer than capsules 0.5 millimeters wide.

The next step, according to researchers, is to begin clinical trials to test the safety and efficacy of these larger capsules. If all goes well, they are hopeful that this will help islet cell replacement therapy go mainstream.

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The Day I Wore My Son’s CGM Fri, 28 Aug 2015 23:41:39 +0000 A mother gets a glimpse into just how complicated diabetes must be for her son.

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A vector illustration of housewife handling multiple tasks, portrayed as half human half machineAt around 8:30pm one night I asked my son if he could put on his CGM—he was going to have an active week and I wanted more experience monitoring his blood sugar levels. He balked at the idea. To prove that it wasn’t a big deal to wear a CGM, I came up with the bright idea to wear it myself.

I should’ve known I was in trouble when I had to ask my husband for help just putting on the thing. Once we finally got the CGM in place, I started the sensor, but after the calibration period I was too tired to get up and take my blood sugar and enter it in the meter. It was easy to skip, so I did.

In the morning, I managed to calibrate the meter after a cup of coffee and two finger pricks. The pricks hurt and the CGM on my arm was annoying. Not painful, but an irritating sensation that I didn’t like.

Taking a shower and getting dressed were cumbersome tasks. I was in and out of range constantly and didn’t know where to keep the receiver amidst my work attire. I left the house without my meter and had to go back for it.

The constant feedback from the CGM was distracting. Obviously CGMs have an error margin, but it kept telling me my blood sugar was low. As the day progressed, everything reminded me of diabetes and it was kind of depressing.

A co-worker with Type 1 recently told me that he resisted using a pump for years because it’s harder to deny your diabetes with a pump attached to you. I now understood what he meant. My 10-year-old son was saddled with carrying more gear than I carry as a grown woman, and I wasn’t even burdened with the additional challenge of actually having diabetes.

When we sat down for dinner that night, my son had fun reminding me to check my sugars. I resisted the urge to whine.

I may have failed at having fake diabetes in the span of 24 hours, but I learned a lot about what my son goes through on a daily basis and I think I’m a better D-parent for it. I may have known the stress of caring for a child with Type 1, but until then I never realized the stress he must feel actually living with the condition. It was stressful for me managing blood sugars, and my life didn’t depend on it.

I learned from this experience that I needed to balance better my son’s desire to distance himself from his diabetes from my need as a parent to exert control over the condition.

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A DKA Death in Jail Fri, 28 Aug 2015 23:28:40 +0000 Social media erupts over the death of Michael Robinson while in custody. What do we know of what happened

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MichaelRobinson_Facebook_300pxSocial justice blogs have lit up since word broke of the death of Michael Robinson, who died from apparent severe hyperglycemia after slipping into a coma while in custody in a southeast Missouri county jail on August 23. It is believed that Robinson had diabetes. Robinson is said to have become combative and then incoherent and then unresponsive, symptoms that would have been easily recognizable by health care workers who know diabetes.

Robinson Family members have alleged publicly that despite urgings that the man be given his daily insulin intake while in jail, he was confined without access to his medication or to medical attention. There is not yet an official confirmation of death from diabetic ketoacidosis (DKA), but that is, from the circumstances, suspected. Contributors to posts on two family member’s social media pages and a newly-launched crowdfunding page allude to a blood glucose level exceeding 2,000 mg/dL at time of hospitalization. It’s not yet clear whether Mr. Robinson died while in the jail, or in transit to one of two hospitals, or after arrival.

There are conflicting accounts, one of the man’s refusal or inability to sign a consent form to receive treatment, and another of refusal by correctional personnel to see the man’s agitated state, and pleas from family members, as something other than a subterfuge to obtain his release. The postings have been going up at a remarkable pace reflecting grief and outrage – questioning how someone could be allowed to die from a treatable medical condition while being held on what amounted to a non-criminal warrant in a domestic relations matter. A newly created “Justice for Michael Robinson” Facebook page had collected more than 1,700 closed group members by August 26.

The municipal police department that arrested Robinson has its own social media presence, as has become a widespread practice among law enforcement agencies in support of their community policing efforts. The police department’s Facebook page has a brief two-item entry from its log for the days of August 13th and 14th, one identifying Michael Robinson and reporting his transport to a county facility to await bond. The log notes the arrest at 12:37 in the morning. The department’s Facebook post has drawn numerous replies, some evidencing anger and some sadness and some critical of the way Mr. Robinson’s condition was handled at the jail.

While there is no shortage of emotion surrounding this case, hard facts are scarce, but that may change in the near future. Pemiscot County Sheriff Thomas Greenwall said on his LinkedIn page that he has turned the matter over to the state police for investigation. Insulin Nation spoke with Highway Patrol Sergeant Clark Parrot, a Troop E informations officer for the Pemiscot County area; Sergeant Parrot was unable to offer an official comment due to the ongoing nature of the investigation. He was able to say, nevertheless, that he expected it would take three to five weeks to complete the investigation and issue a report to the county prosecutor.

This is not the only recent incident of a possible DKA death during incarceration in the news. As this article goes to press, the New York Daily News is reporting on an investigation into the death of a Rikers Island detainee in August 2013, whose DKA symptoms were mistaken by guards as heroin withdrawal.

Whatever the facts in Robinson’s case, such reports point to the need to better train law enforcement personnel about the symptoms of hyperglycemia and hypoglycemia. A pilot program in the U.K. that provided first responders rudimentary training on hypoglycemia showed real benefits to the health outcomes of people with diabetes.

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FDA Approves First Receiver-Less CGM Thu, 27 Aug 2015 14:19:21 +0000 The Dexcom G5 Mobile CGM gets the green light by the FDA to beam blood glucose readings directly to smartphones.

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G5-transmitter_300pxDexcom has announced FDA approval for their newest continuous glucose monitor (CGM), the G5 Mobile, which sends glucose readings directly to a mobile device. The device marks the first time CGM users can officially ditch a separate receiver. It is also the first on the market to be approved for users as young as two years of age, perhaps because it doesn’t require a separate receiver, which would take up a lot of real estate on a two-year-old body.

Using wireless Bluetooth technology, the device can send readings and alert notifications directly to an iOS-enabled device, and that information can then be shared with up to five other devices. The G5 mobile app, currently set to premiere first in the Apple App Store, is free to download and features a glucose graph and trend detection feature. An Android-friendly app is expected to become available at the beginning of next year, according to a Dexcom press release.

This is apparently one of the rare instances when the FDA moved quicker than expected to greenlight a new device, according to Dexcom President and CEO Kevin Sayer. The company was caught slightly off guard by the pace of approval and is now quickly trying to gear up to launch the product by the end of September. Dexcom is offering customers a no-cost upgrade if they purchased the previous generation product, the G4 Platinum, during the month of August, 2015.

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Low Points with My Health Insurance Tue, 25 Aug 2015 20:14:16 +0000 A recounting of a stingy and ignorant insurance company’s refusals to budge.

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shutterstock_109240199_health_forms_300pxWhen I was diagnosed with Type 1 at the age of five, I was blissfully unaware of the complicated relationship I would have with insurance providers for the rest of my life. It’s been 25 years now, and the experience has left me shell-shocked more than once.

The summer before college, my dad, who also has Type 1, started handing over the job of organizing medical responsibilities to me, including ordering prescriptions, asking my endo’s office to fax updated orders, and reordering supplies. I felt overwhelmed at first, but after successfully getting the supplies I needed when I needed them, I figured I was on top of things.

The first sign of trouble came when my insurance company denied me my Novolog insulin, saying they’d decided to only cover Humalog. Then I was denied coverage for my symlin and was forced to fork over $3,600 to a pharmacy clerk for my 3-month supply. I don’t remember what their excuse was, or why I hadn’t been notified that their formulary coverage policy had changed, but I remember crying in my car in the pharmacy parking lot for a very long time.

Things went downhill from there. My insurance company harassed me about why I need to test 10 to 12 times a day. They denied me pen caps for my symlin pen because they couldn’t grasp the difference between pen needles and syringe needles. They also blocked medical expenses for a car accident and for a hormone to treat cysts.

The most shocking moment came recently when I went to refill my basal insulin prescription. Did you know that a single bottle of Lantus could last for 90 days? Well, that’s what my insurance company thought anyways.

When I went to pick up my usual 90-day supply of Lantus, the pharmacy manager said my insurance company instructed her to only give me one bottle of the stuff. Their logic: the daily amount I took multiplied by 90 days totaled exactly how much was in one full bottle. I laughed and told the manager that was ridiculous; everybody knows that insulin has a 30-day shelf life, sometimes shorter if exposed to heat. But I soon realized I was wrong; my insurance company most certainly didn’t know that.

It was chilling to know that the people in charge of approving the medications that keep me alive don’t have even a basic understanding of my disease. It is up to those affected by Type 1 to push back to get such terrible policies changed. I encourage you to complain early and often when you confront such idiocy.

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7 Tips for Supporting an Anxious Person with Type 1 Tue, 25 Aug 2015 12:20:02 +0000 A guide for how best to support those with both diabetes and mental health issues, by someone who deals with both.

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shutterstock_134312588_melancholy_300pxA few months before I graduated college, I was diagnosed with ADHD, Generalized Anxiety, and OCD. Now that I’m taking medicine for ADHD, which also helps with my anxiety, I realize the impact my mental health has on my diabetes. When I notice triggers that affect both, I try to work on them.

Here are 7 things I’d love for other people to keep in mind regarding diabetes and mental health, based on my experience:

1. Please let me explain why I don’t love my CGM
It’s complicated. Being able to catch patterns and see my blood sugar during exercise is great, but seeing my number every five minutes increases my anxiety. I didn’t get a CGM for a long time because I knew it would stress me out. I’m also staying away from linking it to my phone; I don’t see that going well for me.

2. Please don’t tell me that repeatedly checking my blood sugar won’t help
Yes, I know that 20 minutes won’t make a difference, but I’m going to recheck it anyway. The moment I know my blood sugar is above target, I have to check. I also start to think about the money I’m wasting and then my mind fires off in a million different directions.

3. Please don’t tell me how to feel about a low or high
I start to freak out when I’m low. Lows scare me, especially middle-of-the-night lows. What if I’m alone or where people don’t know me? It’s stressful even without the anxiety. And when my blood sugar is above target, I think the worst: What will it do to my A1C? What if I go into DKA? How is it impacting my life? There are a lot of emotions at play, and it’s hard to bend them to the way you think I should feel.

4. Please don’t mention that commercial you saw about eyes and feet
My diagnosis was caught at an eye exam so I’m afraid enough, thanks. I don’t like thinking about complications because of the extra stress. I acknowledge them, but fear tactics do not help.

5. Please don’t say that diabetes and mental health have nothing to do with each other
Diabetes is a roller coaster. so is mental health. Here I am on both of these rides trying to stabilize them. I don’t know if becoming anxious is a symptom of an out-of-target blood sugar or that my my anxiety gets “worse” when I’m off target. Maybe both? How do I even separate them? Either way, I’m certain that my diabetes and mental health are in a very committed relationship together.

6. Please don’t…
Call me crazy, compulsive, an overachiever, obsessive, or Type A. Just no. One of my primary reasons for being so intensive with my care is because I don’t like my brain when my blood sugar is out of target. Also, I already know these things about myself, so reminding me of them isn’t helping.

7. Please do…
Sit next to me. Support me. Pass me the juice or water if you see the number on my screen, but don’t pass judgement. Know I might react more to things if my mental health and diabetes are in a fight, but I’ll apologize. Let me let my feelings out.

Please remember that I am a person first, but diabetes and mental health are very much a part of my life and always changing.

Thank you.

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The Lesser-Known Types of Diabetes Fri, 21 Aug 2015 17:11:14 +0000 MODY, monogenic diabetes, and diabetes insipidus, oh my!

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shutterstock_191371190_hidden_men_300pxIt’s not enough to be diagnosed with diabetes; it’s just as vital to be given the correct diagnosis of the type of diabetes. This isn’t as easy as it sounds. While Type 1 diabetes is rare, there are even rarer subsets of diabetes that can easily be confused for Type 1 or Type 2.

There is a difference between diabetes insipidus and diabetes mellitus. “Insipidus” relates to a disorder in urine production that is unrelated to excess blood glucose. It’s caused by the body not producing a key hormone, vasopressin. Connection to diabetes mellitus? None.

One of the better-known lesser-knowns is Mature Onset Diabetes in (or of) Youth, or MODY, for short. This comes about because of the mutation of a single gene, and it cannot be diagnosed without genetic testing early in life. As the name suggests, the biomarkers for the disorder resemble those of adult-onset, or Type 2, diabetes, but because the disorder manifests itself so early in life, it was routinely diagnosed as Type 1, and thousands of kids went straight to insulin therapy.

Then there’s monogenic diabetes. In 1964, Dr. Stefan S. Fajans, a German-born endocrinologist, first described it as a subtype of Type 2 diabetes in a paper he co-published identifying a genetic marker for early-onset Type 2. (Along the way to this discovery, he’d landed with the 41st Evacuation Hospital at Omaha Beach on D-Day plus 3). In 1991, Dr. Fajans and colleagues mapped the gene responsible for this subset of diabetes at chromosome 20q. Treating physicians and researchers in the UK were also at work on the cause and began a collaboration with the Ann Arbor-Chicago group. Thanks to their hard work, we now know that some 1.2% of all diabetes cases are monogenic, with subtypes attributable to mutations in some twenty-five genes.

These differing definitions may seem academic, but they can sometimes make a huge difference. The documentary Journey to a Miracle – Freedom from Insulin features the story of Jack Matthews of Essex, England, who had diabetes and hard-to-explain developmental delays and cognitive difficulties that made it impossible for him to talk. His mom, Emma, tells of the day that monogenic diabetes researcher Dr. Andrew Hattersley said that Jack’s insulin could be stopped, and an oral medication was all that would be needed for glucose control. Within weeks, Jack started talking, and his learning disabilities began to steadily abate.

With so much variation about diabetes uncovered in such a relatively short span of time, it seems possible that more subsets of diabetes will be discovered. It also makes one wonder how many people who deal with “difficult to control” diabetes might be dealing with a yet-undiagnosed form of the condition.

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Why Pumps in the EU May be Less Safe Thu, 20 Aug 2015 17:16:16 +0000 In this final installment of our five-part series on pump safety, we examine the shortcomings of European medical device safety oversight.

The post Why Pumps in the EU May be Less Safe appeared first on Insulin Nation.


shutterstock_87087575_EU_flag_300pxIn previous stories in this series on insulin pump safety, we’ve been discussing the push to have U.S. and European pump standards more closely align, but such efforts might face an uphill battle.The 28 members of the European Union are, after all, sovereign nations, some having heritages defined by skirmishes with abutting neighbors, and they often don’t like being told what to do.

The EU was formed partly to adopt a common currency not subject to exchange discount or devaluation from member nation to member nation. Recent events in Greece have demonstrated the inability of the EU even to cajole a member nation to enforce tax collection and commit to timely public debt payments. An EU member nation could operate the shabbiest system of medical device safety and quality regulation on the continent, but as long as manufacturers distributing within its borders don’t aspire to carry the CE mark (for distribution and sale across the EU) on their products, no one else in the EU can complain. Those countries with laxer rules create a haven for manufacturers to quickly introduce new devices, or devices which have failed FDA clearance.

The EU directive on medical devices, last revised in 2007, is clearly intended for ensuring commerce, not safety. It recognizes in its preamble that “the content and scope of the laws, regulations and administrative provisions in force in the member states with regard to the safety, health protection and performance characteristics of medical devices are different … [and] certification and inspection procedures for such devices differ from one member state to another.” The directive approaches uniform regulation only in the context of harmonizing member state practices for ensuring safety and effectiveness of medical devices insofar as doing so will “guarantee the free movement of such devices within the internal market.”

For a dangerous or malfunctioning medical device to become subject to EU sanction, someone has to bring a failure to the attention of a nation’s regulators. Those regulators have to take action to ban or recall the product or order corrective action, and then that fact must be reported to a directorate within the EU Commission responsible for commerce in medical products among the member nations. The maker or distributor has to stop applying the CE mark, and there it pretty much ends.

Some nations apply rigorous requirements for pre-market clearance and post-market monitoring; others less so. Two or more EU countries wishing to adhere to highest standards of safety and effectiveness of devices could, in theory, enter into a treaty to adhere to a common quality standard, or grant reciprocity for devices meeting equivalently high standards, but the effect of that would be to contravene the EU’s purpose of removing commercial barriers. In practice, then, “harmonization” of safety and effectiveness requirements presents the risk that what will be achieved is a consensus moving toward a least common denominator of quality.

Diabetes patient safety advocates hope that any move to align EU and FDA standards on insulin pump safety will move closer to FDA regulations, and not the other way around. As we’ve seen in this series, the FDA standards may not be perfect in ensuring pump safety standards, but they are generally considered to be the gold standard for safety. So while people with diabetes in the EU may get newer medical devices sooner, people in the U.S. get medical devices safer, and that may be a good tradeoff.

To read other parts of this series, go to:

Part 1 – European Experts Call for Safer Insulin Pumps

Part 2 – Four Countries’ Different Standards On Pump Safety

Part 3 – The Pump Failure Reporting System is Flawed

Part 4 – Speaking Up to Make Pumps Safer

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Speaking Up to Make Pumps Safer Thu, 20 Aug 2015 14:22:50 +0000 Often, the only way the FDA can know there are insulin pump problems is if pump users accurately report when things go wrong.

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shutterstock_136595909_screaming_color_300pxWe previously discussed how flaws in the FDA medical device reporting system have made it impossible to know how many adverse medical events have been caused by malfunctioning insulin pumps. There are moves to fix the system, but change comes slowly.

In April 2013, the FDA published a report entitled “Strengthening Our National System for Medical Device Postmarket Surveillance.” The report announced goals of establishing a unique device identification system, incorporating collection and analysis of electronic health information, and developing national and international device registries for selected medical devices. Recently, the FDA has also launched an app to support its Medwatch reporting system; this will make it easier for patients and doctors to report device and drug problems.

There also are diabetes advocates working with the FDA to raise the standards of diabetes devices, and to push the FDA to do more to ensure quality control of diabetes devices and supplies. One of them is Bennet Dunlap, a diabetes care product safety advocate and founder of the Strip Safely campaign. He’s helped lead a lobbying effort to persuade Congress to require Medicare to pay for the services of certified diabetes educators and to cover the expense of continuous glucose monitors. While both efforts may be doomed to fail during this congressional session, according to bill watchers on Capitol Hill, the lobbying efforts of Dunlap and others have gotten more sophisticated and drawn more attention than such efforts have done in the past.

Dunlap knows how important it is to gather data from adverse events reports. Anything that can be done to make insulin dosing safer is vitally important, Dunlap says. He points out that the number of emergency room hypoglycemia cases relating to erroneous insulin dosing have now surpassed admissions for illegal drug overdoses in the U.S. He says some pump companies are working to get more customer feedback about when pumps go wrong. Medtronic, he says, has worked with the FDA “to develop a program that helps train users [in the reporting process] and helps maintain contact between users, the manufacturer, and the FDA.”

Dunlap strongly encourages people who manage diabetes with pumps and continuous glucose monitors to learn how to file medical device reports. Any educational effort about how to report adverse medical outcomes from pumps must help patients to clarify what is the pump’s fault and what is user error, he says. With the current system, there is little to prevent a user from submitting a report simply out of frustration over a new device or therapy change. On the flip side, many problems never get reported because the patient may mistakenly believe the pump is only tangentially related to the medical emergency, says Dunlap. However, he says, training insulin pump users to be smarter about reporting adverse outcomes can’t be the entire equation.

“While more data and more complete reporting can only help, I think it is also fair to point out that good diabetes care requires a fair amount of mental capacity from individuals. [Adding to it] the responsibility for device reporting to some extent seems unfair,” he says.

The FDA may some day succeed in optimizing its reporting protocols to reduce or eliminate accumulation of extraneous and erroneous data, and essentially turn these device issue reports into true quality assurance research resources. Until then, it’s best for users of diabetes care devices to stay vigilant, study the manufacturer’s manuals, and, when in doubt, report an issue.

To read other parts of this series, go to:

Part 1 – European Experts Call for Safer Insulin Pumps

Part 2 – Four Countries’ Different Standards On Pump Safety

Part 3 – The Pump Failure Reporting System is Flawed

Part 5 – Why Pumps in the EU May be Less Safe

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Adventures in Summertime Diabetes Management Thu, 20 Aug 2015 14:13:24 +0000 A mother tries to trace why her daughter’s blood glucose levels fluctuate when school lets out.

The post Adventures in Summertime Diabetes Management appeared first on Insulin Nation.


shutterstock_279560960_family_playing_300pxDear summer,

I cry uncle.

We thought managing our daughter’s Type 1 diabetes during summertime would be a breeze. School is finally out, fun summer activities are in, so increased physical activity and closer monitoring at home would result in a tighter blood sugar control, right? Not so fast. So far our summer has been full of highs and lows, just like uncontrolled diabetes personified.

We kicked off our summertime diabetes adventures with our daughter’s first ever bee sting. As her fingers took the shape of sausages, her blood glucose swelled proportionally. This was actually an insult to injury, as her levels had already been running inexplicably high for a few days prior to the sting. After consulting with Dr. Google and other Internet experts on all things bees and diabetes, we concluded that it was probable that her levels were rising in response to stress and pain, and not so much to the sting itself. Our daughter’s hand and fingers remained swollen for five days and her sugars remained elevated in sync with the swelling.

We consulted with her endocrinology team and were advised to not make any changes in insulin dosing, as she was heading to a sleep-away camp in a few days. Sure enough, her sugars started to stabilize just as the swelling subsided. However, we discovered one more confound: judging by how our daughter precipitously grew out of all of her shoes practically overnight, the bee sting may have coincided with a major growth spurt. It was entirely possible that her highs were a result of her growing and had nothing to do with the bee sting.

As our daughter left for a sleep-away diabetes camp, we hoped that a week there would bring more stability. Rookie mistake. We completely discounted the fact that camp was at a much higher elevation. And it was not after we read the paperwork upon our daughter’s return that it finally sank in: tight blood sugar control is not camp’s objective. Having an amazing and safe experience is. She did have a safe and amazing experience but her blood sugar fluctuated quite a bit. Upon return to a lower altitude and a big change in a daily schedule, we faced persistent highs again.

A stubborn blood sugar fluctuation pattern was emerging. Our daughter’s BG would skyrocket in response to an event or a change in routine and stay high for a number of days. Then it would stabilize for a few days, only to shoot up again in response to another event or change in routine. A summer cold that turned into a double ear infection had us running 200% basal rate and it was like water for insulin. A local diabetes day camp, on the other hand, produced such beautiful levels for four days straight that we could almost claim our daughter’s diabetes was cured. Not to be outdone, diabetes reminded us of its invincibility when it handed our daughter a record low of 38, apropos of nothing. And then there was one day at the pool that defied all logic. Normally, spending five hours in a pool would cause low blood sugars. However, spending five hours in the sun, in and out of a pool heated to 90 degrees, “cooked” insulin in the pump and sent our daughter’s levels up, up and away.

At our daughter’s appointment today, her endocrinologist pronounced her to be “a picture of heath”, despite her A1C inching up a little bit over the last three months. It is still in a good range, but so much for tighter control! That being said, with our endocrinologist’s support we are accepting the “gluco-coaster” reality of this summer. We’ve gotten a lot more proficient at manipulating temporary basal rates. We’ve gotten bolder and more precise with rage bolusing. We are developing a spidey-sense of when to intervene more quickly or more aggressively and when to wait things out. When we have questions or concerns, we have a great endocrinology team that helps us tweak insulin dosing.

Forget tighter control. We are going to manage diabetes the best we can while taking it one day at a time and focusing on having a safe and fun summer.

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The Pump Failure Reporting System is Flawed Wed, 19 Aug 2015 15:21:50 +0000 Why it’s pretty much impossible to know how many insulin pumps have malfunctioned in the last decade. Part 3 of our series

The post The Pump Failure Reporting System is Flawed appeared first on Insulin Nation.


shutterstock_65997214_STOP2_300pxIn the first two parts of this series on insulin pump safety, European and U.S. health officials called for better and more uniform insulin pump safety standards. In this third part of the series, we explore how the FDA tracks insulin pump problems.

It can be said that the FDA regulates every stage of the life cycle of an insulin pump. It’s in charge of the oversight of pre-market studies testing the safety and effectiveness of insulin pumps before they can be offered on the market. It also has a role in monitoring post-market performance of cleared pumps.

The FDA’s authority doesn’t go so far as to govern the minute details of each manufacturer’s product development and assembly operations, or their quality assurance or customer service policies. Regulators oversee pump safety using generalized electrical and manufacturing quality control standards, not specific standards for medical devices like pumps. And although the FDA has at its disposal experts in device therapies for diabetes, it doesn’t have a stable of software engineers, code writers and insulin pump assembly specialists to hover over the laboratories and factories where pumps are being developed and made.

That means manufacturers are ultimately the architects of what can and can’t be done in a commercially reasonable way to assure that their devices operate safely and effectively. Moreover, since neither the regulators in the United States or abroad maintain constantly updated logs of who has purchased what device and how well, or how poorly, it has performed, the ins and outs of tracking performance is pretty much left to manufacturers. Critics contend this method lacks consistency and can make for lax oversight. In recent years, the FDA regulators have begun to solicit feedback from the diabetes community about how to tighten up this reporting practice.

Here’s how the reporting process for insulin pump problems currently operates:

First, all medical device manufacturers are required to have product identification and traceability capabilities, so that users can be notified of product recalls. With a recall, defective or malfunctioning equipment can be remedied, discontinued, or pulled from market. When manufacturers become aware of any product failures that could lead to actual or potential injury, they must report that information to the FDA and then follow a schedule of supplemental reports that chronicle the steps to fix the problem. Manufacturers and distributors always have the option to remove a device from the market or recall it for replacement or repair. At any stage in the reporting process, the FDA may order a mandatory product recall, or suspension of the product’s sale or distribution within the United States.

Since 2002, according to the FDA’s reporting system, there have been 10 insulin pump-related U.S. recalls, the most recent in January of 2014. Of the 10 U.S. recalls between 2002 and 2014, five were related to infusion sets, two to power supplies, and two to the pumps themselves (one due to a malfunction in bolus dosing and the other due to false warning alarms). The final recall was for potentially leaking insulin cartridges for the Tandem t:slim pump.

That recall offers a good example of how the system is supposed to work. The lots of defective insulin cartridges were numbered and traceable to distributors and retailers. Tandem was able to quickly issue notices and offer replacements by overnight mail and couriers. Tandem’s internal manufacturing controls were sufficient to correct the problem. There have been no patient-reported or clinician-reported adverse effects related to the leaky cartridges, even after the recall was expanded to include more cartridges.

The problem is that this smooth recall may be the exception and not the rule, and much of that has to do with a lack of searchable information about potential pump problems. The FDA does maintain a registry of reported issues of concerns from pump users, but it may not be stringent enough to keep people safe. Also, the database of reported problems isn’t optimized for easy search, and it’s voluntary for doctors and patients to report pump problems. This reporting strategy could mean that many pump problems simply are never reported.

Here’s a case found in the database of pump issues that illustrates the shortcomings of the reporting system: In January 2015, a user of a sensor-augmented insulin pump was hospitalized for diabetic ketoacidosis (DKA). The pump manufacturer received a complaint call from the user, but the user’s blood glucose levels at time of hospitalization were not recorded in the report. The pump manufacturer promptly complied with its mandate to report the potential problem to the FDA, but the user did not return the pump to the manufacturer for examining or bench testing. Because of this, there is no information to deduce whether the problem was user error, a clog caused by outdated or incompatible insulin, an empty cartridge or reservoir, a burned-out motor, a dead battery, or a hose chewed through by a puppy. All that can be concluded from the report is that the patient owned a particular brand and model of pump and that he or she went to the hospital with a case of DKA and did not die.

Better reporting is the cornerstone of a proposal by the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) to improve international insulin pump safety standards. The EASD-ADA Technology Commission’s Statement on Insulin Pumps states that “in the US, relatively little useful clinical data on long-term pump use/safety is available.”

Luckily, there are signs that this ineffective reporting system might change. Diabetes advocates are partnering with the FDA to allow for more patient-centered input when it comes to insulin pump safety. We’ll be discussing that in the next part of our series.

To read other parts of this series, go to:

Part 1 – European Experts Call for Safer Insulin Pumps

Part 2 – Four Countries’ Different Standards On Pump Safety

Part 4 – Speaking Up to Make Pumps Safer

Part 5 – Why Pumps in the EU May be Less Safe

The post The Pump Failure Reporting System is Flawed appeared first on Insulin Nation.

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10 Comebacks to Dumb Diabetes Questions Tue, 18 Aug 2015 18:02:41 +0000 In this video, we compile some snappy comebacks for awkward conversations about Type 1.

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People affected by Type 1 diabetes often must politely answer some pretty silly questions about the condition. We all know it’s usually best to respond to such ignorance with polite, thoughtful responses. In this video, however, we indulge our inner jerk and respond to dumb questions with some snappy comebacks, because everyone needs to vent once in a while.

Enjoy our impoliteness, so you can continue to be a goodwill ambassador for the Type 1 community:

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Four Countries’ Different Standards on Pump Safety Mon, 17 Aug 2015 19:40:44 +0000 There’s a lot of difference between the rules in Canada, the UK, Germany, and Denmark. Part 2 of our series on pump safety.

The post Four Countries’ Different Standards on Pump Safety appeared first on Insulin Nation.


shutterstock_123177544_DrEarth_300pxAs discussed in the first part of this series on insulin pump safety, there is little international agreement on safety standards for pumps. Many people with diabetes in the U.S. have a rudimentary understanding of the FDA process for approving a medical device: the device will fall into one of three classes of regulation; manufacturers of some Class II and all Class III devices will need to provide scientific evidence proving the devices are safe and effective, as well as evidence that the devices are manufactured in a safe facility.

Some countries align closely to FDA standards, while others adhere closely to the standards set by the European Union; the EU standards are generally not considered as rigorous as FDA standards.

Here is how pumps are regulated in four other countries in North America and Europe:


Canada regulates medical devices in much the same way as does the U.S., through a combination of pre-market review, post-approval surveillance and the regulation of a manufacturer’s quality assurance program. Within the Health Canada agency, the Medical Devices Bureau of the Therapeutic Products Directorate (TPD) grants licenses for sale of different classes of medical devices, with classification based upon levels of risk to human health from misuse or failure. Devices are grouped into four classes, with Class I devices presenting the lowest potential risk (think a lancet), and Class IV devices presenting the greatest potential risk to human life (like a pacemaker). Prior to distributing a device in Canada, manufacturers of Class II, III and IV devices must obtain a Medical Device License from the TPD.

The regulations come from Canada’s Food and Drugs Act. Compared to the compendium of FDA regulations and guidance publications which pertain to medical devices, the Canadian statute and regulations are quite cleanly and economically written, which might reflect more on a better quality of lawyering than the quality of Canada’s medical device regulatory apparatus.

Canadian law is similar to U.S. law in that it requires devices to carry evidence of safety and effectiveness before they are allowed into the market. The time needed for pre-market clearance review varies depending on the class of the device, according to Health Canada. Class III & IV applications have a target review time of 75 days and 90 days respectively, and Class II applications have a 15 calendar-day target.

Canada allows non-reviewed and approved devices to be used by clinicians who request to do so through Canada’s Special Access Programme (SAP). A doctor may invoke SAP clearance in emergency situations, when conventional therapies have failed or are unavailable. This is equivalent to the way the FDA regulates Class III Humanitarian devices.

United Kingdom

The UK regulates medical devices through a registration process administered by its Medicines and Healthcare Products Regulatory Agency. For purposes of marketing a medicine or device, you can apply to distribute strictly within the UK or for distribution across EU member nations. The governing laws for this are Britain’s Finance Act of 1973 and Consumer Protection Act of 1987, the latter which calls on the UK government to adopt the EU regulatory scheme for such devices. Through this, the European Medicines Agency (EMA) sets standards for when and how devices must be submitted to pre-market trial, and it also prescribes the nature and scope of scientific information which must be submitted in support of the registration.

The principal difference from FDA regulation is that a device may achieve registration for sale in the UK without showing that it is an improvement over existing therapeutic products, or that it will meet an unmet medical need. The UK looks to EU directives to determine when a device should be removed from the market after a showing that it is unsafe, or has been misbranded or mislabeled, or that it bears the CE mark in violation of CE marking requirements.

The UK is home to Medtronic’s corporate headquarters.


Germany enacted a revised general law on medical devices in 2010. While it is generally quite similar in scope and content to its UK counterpart, German law includes a section prohibiting distribution of devices where “there are grounds to suspect that the safety and health of patients, users, or third persons could be compromised, directly or indirectly, to a degree which exceeds tolerable limits according to medical scientific knowledge.” By any standard of proof, “grounds to suspect” is a legal burden easily met, so the German standards are considered the toughest in the EU. Violation of that prohibition carries a minimum of three years of imprisonment, with enhanced penalty where death or irreversible medical injury is a possible outcome of device failure or poor design.


The Danish Health and Medicines Authority does not involve itself in the regulation of medical devices. Since 2014, the agency has maintained a registry of organizations headquartered in the country which are engaged in the business of manufacturing and distributing devices. With some exemptions for lowest-risk class products, any medical device offered on the market in Denmark must merely carry the CE mark, and can therefore be presumed safe. This means that Novo Nordisk’s home country has no regulatory role in the oversight of its products, other than registering it as a manufacturer.

To read other parts of this series, go to:

Part 1 – European Experts Call for Safer Insulin Pumps

Part 3 – The Pump Failure Reporting System is Flawed

Part 4 – Speaking Up to Make Pumps Safer

Part 5 – Why Pumps in the EU May be Less Safe

The post Four Countries’ Different Standards on Pump Safety appeared first on Insulin Nation.

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Pets Help Kids with Type 1 Control BG Fri, 14 Aug 2015 20:58:39 +0000 Younger kids who care for pets appear to manage their diabetes better.

The post Pets Help Kids with Type 1 Control BG appeared first on Insulin Nation.


shutterstock_18802462_girl_with_goldfish_300pxMany adults clean up their act when a baby is on the way. Now there’s evidence that children with Type 1 also act more responsibly when given the responsibility of another’s care.

A team of researchers at the University of Texas Southwestern Medical Center wanted to test whether glycemic control would improve in children with Type 1 if they were given the responsibility of caring for pets. According to a New York Times blog post, Dr. Olga Gupta and others gave 16 kids with Type 1 each a fishbowl, a $5 gift card to buy a betta fish, and instructions to test their blood glucose when they fed the fish—once in the morning and again at night. They were also asked to clean the fishbowl out every week and go over their blood glucose log books with parents. 13 other children with Type 1 were told to continue their normal testing routine with the promise of a gift card at the end of the study. All the children in the study were between 10 and 17 years of age, and they started with A1C scores greater than 8.5.

After three months, those who cared for fish showed an average 0.5 decrease in score while those promised a gift card saw their A1C climb by 0.8. Researchers also noticed that children aged 10-13 exhibited a greater response to the fish intervention than their older counterparts.

It can be hard for children to transition into being responsible and independent when it comes to their diabetes care, but it appears that giving them buddies to care for as they care for themselves might be helpful.

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Google+Dexcom=Smaller CGM Fri, 14 Aug 2015 18:06:50 +0000 If anyone can improve on Dexcom’s popular CGM design, it would be Google.

The post Google+Dexcom=Smaller CGM appeared first on Insulin Nation.


shutterstock_268187417_google_300pxIn the age of technology, it’s always about the next big product that has more features crammed into a slimmer device. Well, a small company that you might have heard of, Google, is partnering up with diabetes market juggernaut Dexcom, known for its CGM development, with the hopes of revolutionizing diabetes care, a Fierce Medical Devices article reports.

Their aim is to create a disposable, bandage-sized blood glucose sensor that combines Dexcom’s CGM knowledge and Google’s cloud storage technology. If successful, the partnership will not only expand Dexcom’s CGM capabilities, but also benefit Google’s life science division, a branch of the company’s Google X division that focuses on technological advancements in the medical field.

On the financial side, Dexcom is paying Google $100 million in installments during the product development process. And while Dexcom will have sales and distribution rights, they will pay Google royalties for products that surpass $750 million in sales.

Currently, Dexcom is working to get FDA approval for its newest CGM, the Gen 5 mobile system. The company is also experiencing a great deal of success from their recent Warrior campaign, featuring celebrity endorser and musician Nick Jonas. And with Google putting out more and more health-related products, thanks to their secretive Google X advancements, the two are hopeful that this partnership will expand their reach in the healthcare maintenance industry.

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European Experts Call for Safer Insulin Pumps Fri, 14 Aug 2015 14:42:17 +0000 European and American regulators call for uniformity in insulin pump regulation. Part 1 in a multi-part series focused on pump safety.

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shutterstock_221369425_flags_300pxIn recent years, newer models of insulin pumps have often been released in the European Union before they receive FDA approval in the U.S. For example, Medtronic released its MiniMed 640G insulin pump in the EU earlier this year, while the device hasn’t yet been approved for sale in the U.S. The device is considered cutting edge in “smart” pump technology; it can “anticipate” some blood sugar trends and suspend insulin delivery with that information.

There’s a trade-off for pump users in the EU. On the one hand, they can access new technology sooner than pump users in the U.S. However, they also might have to deal with possible technological snags. This past month, the FDA warned that the 640G could give an inaccurate bolus suggestion.

This year, diabetes care professionals with the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) published a paper calling for greater uniformity between European and United States standards on insulin pump safety and reliability. The paper, appearing in the April volume of Diabetes Care, presents 17 recommendations to address the lack of an international protocol for reporting insulin pump failures and adverse medical outcomes with pumps, and for determining what the root cause could be for these problems.

Several of the working group members and authors of the position paper currently consult or have consulted for makers of insulin pumps and continuous glucose monitors and related technologies; some are researchers; some are physicians; and one is a former FDA staff member with expertise in metabolic and endocrine disease drug therapy; all are experts of national or international stature.

The EASD also recently issued its own statement critical of the European Union’s lack of rigorous diabetes-specific device examination for “CE” mark approval in Europe (the CE mark is like FDA approval for countries in the EU). Citing “a continuous threat to the health of people with diabetes,” the authors of the EASD paper argue that “the CE marking claims to guarantee the safety of the device being sold. However, it does not, in any respect, represent an independent confirmation of its quality.”

There have been attempts to create uniform standards for medical devices in the past, but such efforts can be complicated and lead to weak agreements. Australia, Brazil, Canada, China, Europe, Japan, Russia, and the U.S. formed the International Medical Device Regulators’ Forum (IMDRF) in 2011. At the time, European regulators represented Europe in the group essentially as a single market, despite the fact that there are differing standards for regulating medical devices among EU member countries. Since 2011, however, the IMDRF has organized a working group to study software as a medical device, and Swedish and French regulatory officials have been seated as the members representing Europe. Bakul Patel, Associate Director for Digital Health at the FDA, is the chair. He has a background in engineering and quality assurance.

Dr. Anne Peters, an author of the ADA-EASD position paper, is the director of the Clinical Diabetes Program at the Keck School of Medicine at the University of Southern California. In email correspondence with Insulin Nation, Dr. Peters said the EASD was the driving force behind creating this joint position paper, and EU members invited her and other U.S. clinicians to join the working group. The FDA is recognized by governments abroad as a leader in requiring documented proof of safety and effectiveness of medical devices before introduction to the market, and then in monitoring clinician and patient experience afterwards. She says it’s right to question why devices often get released first in Europe.

“There are more devices than ever before on the [world] market, and all start in Europe,” Dr. Peters writes. “It seems reasonable for the Europeans to question the disparities – why is this device not yet considered safe enough for use in the U.S. when we are using it in Europe?”

She points out that there is not a single oversight agency empowered to regulate pump safety across sovereign European Union member nations, and so “each country makes its own rules, which makes it harder to regulate.” Nor is there a uniformly enforceable EU requirement for post-market safety and effectiveness monitoring of diabetes care devices. Nor is there a common definition of a “medically necessary” device.

“This lack of consensus as to whether something is medically useful or not leads to lack of reimbursement by the (medical care financing systems) in some countries,” she writes.

If any meaningful reform will come of this recent effort, it will require EU members to act as one when it comes insulin pumps. Many experts believe the path forward to greater pump safety requires adhering closer to FDA standards.

To read other parts of this series, go to:

Part 2 – Four Countries’ Different Standards On Pump Safety

Part 3 – The Pump Failure Reporting System is Flawed

Part 4 – Speaking Up to Make Pumps Safer

Part 5 – Why Pumps in the EU May be Less Safe

The post European Experts Call for Safer Insulin Pumps appeared first on Insulin Nation.

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The Logistics of Inspiration Thu, 13 Aug 2015 13:18:00 +0000 Go behind the scenes with Team Novo Nordisk.

The post The Logistics of Inspiration appeared first on Insulin Nation.


Adrenaline flows on race day for the cyclists of Team Novo Nordisk, and they inevitably must adjust their insulin regimen to compensate for both the excitement and the arduous race ahead. That excitement is shared by those spectators waiting to be inspired by this team of pro cyclists, all of whom have Type 1.

Yet for Vassili Davidenko, the team’s general manager, there is a certain, and rare, calmness to race day.

“What I like is to go to the races because everything is done then,” Davidenko says.

And so it goes for many within the organization of Team Novo Nordisk – the races represent a sliver of downtime to watch the fruits of the team’s labors. The logistics and coordination required to field an inspiring team can be a 24/7 job, with very few breaks in the year for those who work behind the scenes, like Davidenko or Phil Southerland, the team’s CEO.

“It’s a non-stop machine that’s always moving, and I’m very fortunate to have some people who have been with my organization for a long time and are drivers of that success,” Southerland says.

Southerland is well practiced at giving inspiring quotes about Team Novo Nordisk, as he is often called upon to speak about the team at events. If you ask him for details about how he fields a team, however, he reveals a mind that is constantly thinking of cycling logistics and benchmarks toward long-term goals. He ticks off the 20 or so support personnel needed at the races, from mechanics to a doctor to public relations staffers. He describes the sheer volume of vehicles, both two-wheel and four, that are required to field a team – including some 150 bikes per year and roughly two dozen cars, buses, and trucks. He creates a mental pie chart of the costs; about a quarter of the budget goes to travel alone, despite manager Sergey Davidenko’s (Vassili’s brother’s) best attempts at getting good travel deals.

“When I see that final number [for travel] at the end of the year, I cringe,” says Southerland. “We’ve got a big fleet of everything moving around so these guys can compete as athletes.”

(Team Novo Nordisk fields several different teams, including a women’s team and a Type 2 men’s cycling team. The men’s professional cycling team gets the most resources, and the most attention.)

Fielding a pro cycling team is difficult, but starting one nearly from scratch creates new levels of complications. In 2012, Team Novo Nordisk was created out of Team Type 1, Southerland’s previous cycling team. That team featured riders with Type 1 and riders who didn’t have diabetes. Novo Nordisk executives agreed to sponsor a new team with Southerland, but only if it was an all-Type 1 team. Southerland agreed, and set off to try and find enough riders.

“We were calling guys out of retirement in 2012,” Southerland says. “We were scouring the planet.”

That’s no longer the case. Southerland and others on the team have created a feeder system, developing cyclists with Type 1 for the pro team by establishing development teams, as well as a camp for potential future riders. Sometimes, those in the system have a background in cycling; other times, they excel in other sports and convert to cycling. Each year, that system produces more riders for the pro team, but it can take 7 to 10 years for a young athlete to be ready to be a pro cyclist, says Vassili Davidenko.

“Our goal is to bring this team to top level, but we cannot rush, especially with young athletes.” Davidenko says.

Luckily, the team no longer has to scour the planet for good candidates. As Team Novo Nordisk’s visibility has grown, requests to join the team have come in from around the world. This year, for example, there will be some 28 riders competing for 15 to 18 slots on the development teams.

“We don’t have the depth just yet, that’s one of our limiting factors.” Southerland says. “The good news is we’re getting deeper.”

While Southerland speaks in specifics about percentages and human resources, he’s also practiced at demuring when asked about the actual budget for the team, as that is contractual information between his organization and Novo Nordisk. A Global Cycling Report on pro cycling team budgets suggests that the annual cost of fielding a cycling team for the International Cycling Union’s World Tour is about 20 million euros (roughly 22 million dollars). There’s no way to know if this figure corresponds with Team Novo Nordisk’s budget. Southerland does say that the team has to spend less than the average team on rider salaries, but more for medical bills and development. Those costs will only go up as the team comes closer to reaching its goal of competing in the Tour de France.

“Where we are now [budget-wise] won’t be enough if we’re in the Tour de France in ‘21,” Southerland says.

Luckily, it appears that the team will continue to get support from Novo Nordisk – the drug maker announced it has renewed its contract with the team until the end of 2017. Southerland says the company’s faith in the team has grown. As evidence, he offers how the word count has shrunk dramatically between the team’s initial contract and its current one. Southerland says Novo Nordisk is used to making financial investments that might only come to fruition a decade down the road.

“We’re kind of a different project,” he says. “We’re on the market right away.”

Southerland can’t help but sound inspiring, even when he’s discussing logistics. Perhaps that’s because it might be that the hardest part of creating Team Novo Nordisk is complete, and now comes the time to watch it all come together. Since re-upping with Novo Nordisk earlier this year, there is a sense of optimism that surrounds this team, and Southerland seems to share in it.

“We built the infrastructure,” he says. “And now we have a longer runway to look to.”

You can watch Team Novo Nordisk compete at the upcoming USA Pro Challenge in Colorado from August 17-23. The race will air on Universal Sports daily and on NBC on Sunday ( and will stream online (

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5 Lessons Learned from Year 1 with Type 1 Tue, 11 Aug 2015 20:04:44 +0000 A mother of a child with Type 1 shares what her family now knows about life with diabetes.

The post 5 Lessons Learned from Year 1 with Type 1 appeared first on Insulin Nation.


shutterstock_212933005_happy_family_300pxOur family recently passed the one-year mark since our son’s Type 1 diagnosis. I’ve heard that it can take up to a year to adjust, so this looks like as good a time as any to take stock.

Here are five things I’ve learned:

1. We’ve learned it’s best to over-prepare. Our son had been on insulin less than 12 hours when we first tried to leave the house…and we left without his kit. It hadn’t sunk in to us that the kit needed to go everywhere with him. Now, there are low boxes in all of our cars, low boxes in the kitchen, and a travel kit that has supplies packed and ready to go if we are going away for the night.

2. Parental diabetes stress evolves. When our son was first diagnosed, the stress was constant, and we flew into a panic with each low, each high, and each call to the doctor. Now we have a better understanding of what highs and lows mean and how to treat them. That leaves us the space to deal with new stress, like worrying about how to pay for his diabetes care and how to adjust as a family as he faces different stages in his life with diabetes. The stress never goes away, but how we react to it and what it’s about changes.

3. We’ve learned how to communicate with others about his Type 1. I now know what my son can successfully do on his own and what he needs help with when it comes to his diabetes. That means I don’t have to go through a full diabetes education session with every new adult in his life. This makes it much easier to let him go out with friends or spend the night away without me worrying myself to death. My son knows what I expect him to do and what he needs to communicate with me about while he’s away so that I am comfortable.

4. Type 1 bonds strangers together. I quickly learned that having a child with Type 1 creates an instant bond with other parents and families. One resource that has been invaluable is our local Parents of Diabetes group on Facebook. Here, parents who live in the same geographical area share tips on local resources, provide experience on working with our regional insurance carriers, and answer general care questions. There is something comforting knowing that there are people in your neighborhood living with Type 1 and who can be there for you if you need something.

5. It’s still really, really hard. Even though I rationally know that my son is ok, I still have moments where I flash back to life before diabetes, and there is a sense of loss. As a mom, I can’t help but still be a little mad and upset at times that he has to live with this and I can’t fix it or stop it. Something tells me that this feeling will never go away.

Making it through the first year had its challenges, but we did it. I know it sounds a bit silly, but I finally feel like we’ll be ok. There’s a feeling that if we were able to make it through this steep of a learning curve, we’ll be able to ride out anything.

And here comes Year 2….

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Revenge of the Diabetes Memes Fri, 07 Aug 2015 19:35:38 +0000 From Darth Vader with an insulin allergy to Oliver Twist at the pharmacy, see what strange imagery we’ve created.

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It’s time once again to share some diabetes memes. Here are five of our favorites to share with the special meme-lovers in your life.






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Selling a Lifetime of Insulin for $3 Fri, 07 Aug 2015 18:45:16 +0000 Read how Frederick Banting and his team essentially gave away the patent for insulin to help humanity.

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letter_514_selling_lifetime_insulin_300pxAs if balancing blood sugar levels was not hard enough, people affected by Type 1 also must balance their checkbooks as they try to afford life-sustaining insulin. That stress is aggravated when drug companies make it clear they view insulin as a cash cow, either by raising insulin prices much faster than the cost of production or by engaging in protracted legal battles to keep long-acting insulin formations from going generic.

US-1469994_300pxIt didn’t start that way. In fact, the first “sale” of insulin was for just $3 (Canadian), not for a vial, but the very intellectual property of the drug itself. Frederick Banting, Charles Best, and James Collip, the team that first discovered and refined insulin therapy, agreed to receive $1 each in exchange for giving their patent rights to the Board of Governors of the University of Toronto in 1923.

This was a bold move, and not without controversy at the time, according to an article posted by the University of Toronto Centre for Innovation Law and Policy. At the turn of the 20th century, it was considered beneath scientists and universities to patent medical innovation at all. However, Banting and company believed that they needed to patent their formulation of insulin to stop pharmaceutical companies from rushing to patent an inferior, less potent form of the drug. The university immediately gave pharmaceutical companies the right to manufacture insulin, royalty-free, and to improve upon the formulation and patent any subsequent improvements.

This may seem like a move that lets the genie out of the bottle, but it’s important to put it into historical context. Mass producing insulin was an incredibly difficult process at the time, and fraught with peril. The original team had trouble recreating the process to make uniformly potent insulin, and at one point it was even feared that they had lost the ability to do the process at all. Meanwhile, they knew this drug was a matter of life and death for thousands of children who were otherwise dying from Type 1. In such circumstances, it seems to make sense that the best action would be to get the drug in the hands of those who could best manufacture the drug on a large scale.

It worked, as within two years, Eli Lilly and Company was able to produce 60 million vials of insulin, according to Dr. Irl Hirsch, a professor of medicine at the University of Washington School of Medicine (as told to health blogger David Mendosa).

It wasn’t long before drug companies had figured out a way to turn a good profit on insulin, even by possibly illegal means. By 1941, Eli Lilly and Company and two other pharmaceutical companies were indicted for an alleged insulin price-fixing scheme at the time, according to a Chicago-Tribune article; it was a charge that Lilly would settle in a “no contest” agreement.

The price of insulin began to climb sharply once drug companies devised how to make synthetic insulin in the late seventies, and there has been little relief since that time. It is now a billion-dollar industry. Unfortunately, as the legal battles over long-acting insulin formulations demonstrate, it will be difficult in the free market to bring insulin prices back in line with the first altruistic principles that Banting and company demonstrated when they sold their idea of insulin for a dollar apiece. One can only hope that those behind future diabetes breakthroughs take a similar open-source attitude to their discoveries as the creators of insulin therapy did*.

*To read about a movement that seems to be following this open source ideology, go to or follow the CGM in the Cloud movement at

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Barred from Summer Fun Because of Type 1 Tue, 04 Aug 2015 18:48:54 +0000 A Minnesota school district denies a student’s enrollment in their summer program because of his diabetes.

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grant2_300pxWhen Katrina DeAntoni tried to enroll her son Grant, a 10-year-old who attends St. Michael Elementary in Minnesota, in a district summer program, the signup process went as smoothly as it had in previous years. Things changed when she informed the school that Grant had been diagnosed with Type 1 diabetes in 2014 and would need a bit of supervision throughout the day.

Katrina assumed this wouldn’t be a problem, considering Grant’s diabetes management was monitored by a school nurse throughout the school year. But on May 19th, Katrina was shocked to receive a rejection letter from the St. Michael-Albertville school district saying that her requests were “not a reasonable accommodation.”

grant and katrina_300px

grant and katrina

“[The letter] says, ‘The nature of the student’s diabetes and its management require more than what non-medical personnel can provide to ensure his safety,’” she read aloud during a phone interview.

Yet Katrina says her requests were purely observational in nature, and not for medical care. She asked that a designated supervisor simply watch Grant as he tested his blood glucose levels, ate food (that she would provide) if he needed to treat a low, and ensure he documented everything in his logbook. She even offered to provide a list of snacks and their corresponding insulin amounts so that the supervisor didn’t have to make any calculations.

The one request that might have raised a red flag was to inject glucagon in an emergency situation, but according to Minnesota law, administering glucagon is a task that can be delegated to a non-medical professional. Furthermore, Good Samaritan statutes state that any person providing care in a medical emergency will not be held liable for any negative outcomes as long as their intent was to help.

Katrina believes the school district is violating Section 504 of the Rehabilitation Act of 1973. This section “protects the rights of individuals with disabilities in programs and activities that receive federal financial assistance from the U.S. Department of Education,” including public school districts. Katrina says Grant would never call his diabetes a disability, but says that, as an umbrella term, her son’s condition falls within that category.

Still, the superintendent’s decision remained firm. In a 7-page letter from the school district’s attorney, the school district stated that they could not provide for Grant’s medical needs because they would cause a “fundamental alteration” in the program, which hosts about 500 children, according to Katrina. One of those kids has Type 1 as well; unlike Grant, who takes insulin shots, the other student uses an insulin pump.

It turns out that this isn’t the first time that the St. Michael-Albertville school district has denied enrollment to students for similar health reasons. Katrina says that after appearing in a short feature on Fox 9 News, at least 10 parents told her that the same thing happened to their children with diabetes or other conditions. Those parents tried to fight the district’s ruling, but eventually gave up, she said.

Unwilling to yield, Katrina decided to get in contact with the American Diabetes Association, which offers free legal advocates for situations like this. She also filed a complaint through the United States Department of Education Office for Civil Rights and the Minnesota Department of Human Rights, both of which have opened investigations on the matter. More recently, she spoke in front of the school board to formally voice a grievance. The board must respond with their decision by August 10, but Katrina’s lawyer is preparing for court because she says it’s rare for a superintendent’s decision to be overturned once it’s been made.

Multiple attempts to get in contact with Dr. James Behle, Superintendent of the St. Michael-Albertville school district, for comment were unsuccessful.

In the meantime, Katrina had to sign Grant up at a private daycare center. Even though they accepted her son immediately, she says the cost to send him there is a burden.

“It’s about four to five times more expensive,” she explains, adding up the costs of the daycare and additional childcare she must use to cover the time.

Overall, Katrina says that Grant has taken his diagnosis very well, and he’s cheering his mom on to win this battle.

“[Grant] has to know through my example that discrimination is not acceptable,” she says. “I don’t feel it’s appropriate to shield him from this. He knows he’s being discriminated against and he knows his mom is fighting for him.”


Update (8/5/2015 – 7:00 am) – The St. Michael-Albertville school district superintendent has contacted Insulin Nation and has promised to comment on this article within a week.


This story has been changed to correct the spelling of the superintendent’s name and with which offices Katrina has filed complaints, as well as to clarify a quote she offered on cost.

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Adventure As Type 1 Therapy Mon, 03 Aug 2015 17:43:32 +0000 Erin Spineto completes a 100-mile paddleboard journey, and preps an online guide to help others with Type 1 undertake similar ventures.

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P me_300pxErin Spineto found herself drawing up insulin on a paddleboard while being buffeted by four-foot swells. She finds this is a good way to stay healthy.

P last shot of four_300pxIn early July, Spineto, two other women with Type 1, and a diabetes researcher paddled 100 miles from Myrtle, South Carolina to Wilmington, North Carolina; the trip took four days. This was the third such Type 1-centered adventure Spineto has planned; she’s also gone on a sailing trip and undertaken a relay swim around Key West in Florida. A paddleboarding trip seemed like a logical next step.

P 3 paddle_300px“I spent the previous year staring at the bottom of the pool, and I knew I wanted to look up a bit,” Spineto says.

Even with such training, these trips always include elements of the unexpected. The four paddlers dodged thunderstorms, accidentally landed on a beach monitored by Homeland Security, and dropped various diabetes gear in the water. At one point, the crew had to hitch a lift on a party bus, and listen to 80’s frat music on the journey, to avoid inclement weather. The hiccups were worth it when they pulled up to their destination in Wilmington just as the sky darkened and fireworks went off.

”It was one of the best 4th of Julys I’ve had a while,” she says.

Spineto began planning such adventurous forays to keep herself motivated in her Type 1 diabetes self-care. About five years ago, she found herself slacking in her blood sugar control, as life crowded in and the possibility of diabetes complications got pushed mentally to the background. She realized she needed to plan for something positive to maintain her focus on her diabetes care.

P 3 in cape fear river_300px“If I know I have an adventure a year, I have to take care of myself for that adventure,” she says.

DCIM100GOPRONow Spineto is launching a digital service called Sea Peptide Adventure Academy to provide that same motivation to others with Type 1. This online curriculum will help inspire and guide would-be Type 1 adventurers to train for and undertake similar trips. The academy message is sent via 20 emails over a 60-day period. The academy, currently slated to cost $40, is scheduled to launch in mid-August.

P erin dig through bag_300pxIn the meantime, Spineto is already planning her next adventure. With this next trip, she hopes to include “Type 3s”, or spouses and parents who live with and help care for people with Type 1. It most likely will involve water once again, and it most likely will be at a locale that mimics Spineto’s sunny San Diego stomping grounds.

“I always like to go someplace where it’s warm,” she says.

To learn more about Sea Peptide Adventures, go to

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Why Does A1C Differ Among Races? Mon, 03 Aug 2015 14:45:10 +0000 Socioeconomics doesn’t explain it, researchers say.

The post Why Does A1C Differ Among Races? appeared first on Insulin Nation.


shutterstock_284519324_why_a1c_scores_differ_300pxIn various studies, researchers have found that A1C scores and treatment decisions differ significantly among different ethnic populations – the ratio of people on pump therapy across ethnic groups is extremely disproportionate and, as a U.K. audit report attested, white populations achieve lower average A1C scores. For a while, it was believed that differences in socioeconomic status was the reason behind this, but a recent study published in the journal Pediatrics found that this didn’t explain the disparities in diabetes care among children under 18 years old.

Using the T1D Exchange Clinic Registry, the research team collected a year’s worth of information from about 10,700 kids, 214 of which were Hispanic or black children from high-income backgrounds. Lead study author Dr. Steven Willi says that his team adjusted for modes of socioeconomic status like level of parental education, finances, and private versus public insurance plans and still didn’t have a definitive answer for the disparity.

“I was prepared to come to the conclusion that it would be socioeconomic status, so I was a bit surprised [by the results],” he says.

According to a Reuters article, black children, who comprised 7% of the total survey pool, had average A1c scores of 9.6%, significantly higher than the Hispanic (8.7%) and non-Hispanic white (8.4%) children that were also studied.

If social and economic status aren’t relevant, it would be fair to suggest that doctors simply need to get more children of color on CGM and pump therapy. It’s not that simple, says Dr. Elizabeth Littlejohn, an associate professor of pediatrics at the University of Chicago, who wasn’t involved in the study.

“Different ethnic groups have different ways they look at diabetes,” Dr. Littlejohn says. “I think it’s multifactorial, [including] cultural differences, family history with the disease…it’s a little bit of everything.”

Dr. Rochelle Naylor, who serves as assistant professor in adult and pediatric endocrinology, diabetes, and metabolism at the University of Chicago (and who also wasn’t involved with the study), agrees that there are a few factors at play.

“There are a number of healthcare and cultural factors that are working in unison to produce these results,” she says.

Dr. Naylor suspects that provider interactions may vary with minority populations. From her own experience, she has recognized differences in the treatment of pain among black sickle cell patients versus white patients with irritable bowel syndrome. Furthermore, she says pump therapy is not offered as often to minority populations. And while she and Dr. Littlejohn say they make sure all their patients are aware of continuous glucose monitors as a treatment option, it appears the medical community might have unknowingly crafted a concept of the “ideal” pump candidate.

“I have come from the bias that there is an ideal pump candidate,” Dr. Willi said. “If someone’s A1C was too high, then [I thought] they hadn’t ‘earned’ a pump. But this is no longer relevant—it needs to be about educating everyone.”

Dr. Littlejohn also believes there could be biological differences influencing the disparities, It’s been shown in previous research that glycated hemoglobin is higher in black individuals, Dr. Naylor points out. So the question then becomes, should black children even be striving for lower A1C scores, or do we need to say, at baseline, a non-diabetic African-American will run a higher A1C than a non-diabetic Caucasian? To answer this, there needs to be more research that examines genetic differences in minority populations.

The Diabetes Center for Children in Philadelphia is a contributing center for a new study that is seeking to address this issue. While Dr. Willi can’t give details on the research gathered so far, he projects the findings will be published in the next six months and likely presented at the American Diabetes Association meetings next year.

It appears that there are various components that need to be taken into account when addressing this disparity. If there is subliminal bias within the medical community, Dr. Naylor says it’s important to become aware of these biases and correct them. And if biology is a factor, expected A1C scores need to be redefined to something more universal rather than just being suitable for a majority population. After all, diabetes is a vastly complicated disease, so maybe the way we define it shouldn’t be so straightforward either. For any of this to happen, however, it’s important to advance the conversation on this issue.

“This issue gets less attention because it’s affecting a population that doesn’t influence policy,” Dr. Naylor states. “But if we don’t capture a diverse population from the outset, then we’re going to have difficulties when we try to apply our knowledge.”

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DKA – What You Need to Know Mon, 03 Aug 2015 13:46:25 +0000 A certified diabetes educator discusses what the condition is, how it can threaten your health, and how to protect yourself.

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shutterstock_269493536_dka_300pxIntegrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community.

Q – My doctor told me I needed to do ketone testing. What is it, how is it done and why is it important?

A – When you live with diabetes, there’s a lot to juggle. It can be understandable if your eyes glaze over when your physician or diabetes educator mentions ketone testing (another test!), but here’s why you should take this part of your treatment plan seriously:

Ketones are acid molecules generated when we burn fat for energy. This isn’t a problem as long as it doesn’t happen in excess. When you flood your body with too many acids, it starts to become toxic. Combined with dehydration and high blood glucose levels, it can lead to a life-threatening condition called diabetic ketoacidosis (DKA).

Often, DKA can occur when you’re not able to get enough glucose into your cells to burn as energy, and the body relies almost exclusively on fat for fuel. This can occur for a number of reasons:

Illness and infection (which can cause intense insulin resistance and elevated blood sugar)
A lack of insulin in the body (due to missed injections, spoiled insulin, or poor absorption)
Insulin pump malfunctions (clogs, leaks, air pockets, cannula displacement, prolonged
disconnection, failure to prime the tubing, or accidentally erasing the basal settings)

This is very different than nutritional ketosis, which is caused by starvation, prolonged fasting, or a severe lack of carbohydrates in one’s diet.

Like most health problems, ketones develop in stages:

Stage 1Rising blood sugar (due to one of the reasons listed above)Thirst, urination, low energy
Stage 2Ketones in the blood stream (ketosis)Thirst, urination, fatigue and Charaachiness
Stage 3Ketones in the Urine (ketonuria)Thirst, urination, plus more significant fatigue, headache/body aches, and possible nausea
Stage 4Diabetic Ketoacidosis (DKA)Same as above, plus vomiting, discomfort, confusion, dizziness, deep/labored breathing and a “fruity” smell to the breath
Stage 5ComaUnconsciousness
Stage 6Death

Ketones should be checked any time you experience an unexplained high blood sugar or feel ill. In many instances, you will not be ketotic when you test, but sometimes you might. Just remember that detecting ketones at the earliest possible stage allows you to fix the problem and avoid prolonged periods of high blood sugar, extreme discomfort, and possible progression to the more dangerous stages.

In most cases, ketones can be eliminated by taking extra insulin (via pen or syringe) and taking in plenty of fluids. You should notify your doctor when ketones are present, and exercise should not be performed until the ketones clear up completely.

Ketone testing can be done by way of a urine dipstick or a fingerstick blood sample. The urine test involves peeing on a test strip (or dipping the strip in a cup of urine) and observing the color change. The blood test can be performed with special ketone test strips using the Precision Xtra meter from Abbott, or the NovaMax Plus meter from Nova Biomedical. It is much like performing a blood sugar test, except that a ketone measurement is given. The blood test is a better way to check for ketones, since it provides a specific numerical measurement and detects ketones hours before they appear in the urine.

No one likes to do even more testing, but everyone with diabetes who uses insulin should have a way to test for ketones. DKA can quickly become a downward spiral when untreated, so it’s vital that you catch it and treat it as early as possible.

Integrated Diabetes Services provides one-on-one education and glucose regulation for people who use insulin. Diabetes “coaching” services are available in-person and remotely via phone and online for children and adults. Integrated Diabetes Services offers specialized services for insulin pump and continuous glucose monitor users, athletes, pregnancy & Type 1 diabetes, and those with Type 2 diabetes who require insulin. For more information, call 1-610-642-6055, go to or write

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Flaw Detected in Medtronic MiniMed 640G Wed, 29 Jul 2015 13:55:22 +0000 Medtronic says it could give inaccurate bolus suggestions, and the FDA takes action on the device, which is only sold in Europe.

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Black_Front_CGM_mmol_300pxAfter Medtronic rolled out the MiniMed 640G overseas, their next target was the US market. That effort now has hit a speed bump, as the FDA has given public notice that Medtronic has issued a recall notice for almost 2,000 of the devices in Europe.

According to a Fierce Medical Devices article, Medtronic released a customer notification letter on June 19th informing device users that there were instances when the bolus screen wouldn’t refresh properly, so the device might continue to show a bolus amount that was no longer accurate or appropriate. The pump manufacturer hasn’t said that returning the device is necessary. Instead, they advised pump users to not base bolus deliveries on any blood glucose reading that is more than 12 minutes old.

But the FDA has put out notice saying that the timeout problem could cause user confusion. They issued a Class 2 recall notice, meaning there could be “reversible adverse health consequences,” according to the news article.

It is worth noting that Medtronic has only released the MiniMed 640G pump, which has the ability to start and stop insulin delivery based on blood glucose readings, in 9 European countries and Australia, and the company has yet to submit the pump for pre-market clearance in the US. It’s unusual for the FDA to issue official notices about medical device failings for devices sold only in other countries.

Medtronic most likely will need to create a permanent fix to the error if it wants to get the MiniMed 640G approved by FDA regulators. It’s not a great first step in the FDA approval process to have your device show problems elsewhere, but it does not represent an insurmountable challenge to FDA approval if the shortcoming is addressed.

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Feeling Guilty About My Test Strips Tue, 28 Jul 2015 14:25:13 +0000 A young man with Type 1 bumps up against a test strip limit in Australia.

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shutterstock_174612272_508_feeling_guilty_test_strips_300px“Why do you need that many boxes? Are you going away or something?”

My pharmacist grabbed a pen and paper and began writing down the number of test strip boxes that I had taken to the counter to purchase. She told me that she would have to go and check if it was okay for me to take that many.

I was at a loss for words. I felt so guilty and ashamed.

It was just days before I was due to fly across the country for a much needed holiday. I had made the mistake of letting my stash at home run down too low, and I had picked up a few extra boxes of blood glucose test strips than I normally would.

“I’m going over to Sydney for two weeks, but I can make do with a few less boxes if it’s a problem,” I replied, hearing the lack of confidence in the words that came out of my mouth as I waited.

I’ve never had any problem getting my diabetes supplies here in Australia. I’m so lucky that our government heavily subsidises the cost of diabetes consumables such as test strips and needles through our National Diabetes Services Scheme (NDSS). Because of this, I’ve never had to worry greatly about the financial burden of having diabetes. I’ve been able to use as little or as much as I felt I needed. And I’ve never had to worry about rationing or preserving my supplies.

My local chemist (pharmacy) is an NDSS outlet. They helped me to register with the NDSS on the day I was released from hospital after my diagnosis, and I’ve been able to get all my supplies through them. They’ve been extremely helpful over the years, answering my questions about flu tablets, broken meters, expired insulin prescriptions, meter software and travel-sized sharps containers.

So I failed to understand why I was being questioned this time around. It was still bugging me days after the encounter, so I decided to contact the NDSS hotline. I later learned that the most that I could order from the NDSS is 900 test strips and 1200 needles. And apparently, this is deemed a six-month “supply.”

I’ve done the math. That “supply” works out to just five blood glucose tests a day. It’s a supply that caters to someone with perfect control of their diabetes. I’ve developed a great interest in the diabetes online community since I started blogging this year. I’ve connected with a lot of other people who, like me, live with diabetes. And I have yet to hear of anyone who says they have perfect control over their blood sugar levels.

I test a lot more than five times a day. I test when I wake up. I test before and after every meal. Sometimes I test in the middle of the night. I test more if I’ve eaten at a restaurant or done exercise. And when I’m extremely high or extremely low, I’ll be powering through those test strips.

And I certainly don’t do it by choice. I do it because it helps me to better understand the foods that I eat and the activities that I do. It helps me to better understand the effect that almost every activity that I do will have on my blood sugar levels. And most importantly, it gives me peace of mind, and a sense of control over my diabetes. And when I’m dealing with a disease that operates 24/7, I need all the peace of mind I can get.

I know that if I were to contact the NDSS today, I would probably be told that I’m not managing my diabetes properly. That I need to get help. And judging by this quote on the NDSS website, it seems that I am right. The website says:

“There are limits to the number of products you can purchase on the NDSS. If you reach the limit, we will contact you to give you information to help you manage your diabetes.”

Thankfully, my pharmacist knew me well enough to know I was being honest. They insisted I take all of the supplies without having to wait for them to check. I’m forever grateful to have such a supportive team to rely on for my diabetes needs and general wellbeing.

However, I long for the day when diabetes supplies won’t be so expensive, and that I could afford them on my own. I long for the day when I will be able to walk into a pharmacy, enthusiastically fill up a whole basket of supplies and proudly take it to the counter. And I long for the day where I won’t feel guilty for taking the very supplies that keep me alive and healthy.

Until that day comes, good relationships with my healthcare professionals are my best asset.

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10 Tips to Stay Healthy with Type 1 Tue, 28 Jul 2015 13:01:45 +0000 A Type 1 psychologist shares 7 guidelines from certified diabetes educators, as well as 3 mental tips of her own.

The post 10 Tips to Stay Healthy with Type 1 appeared first on Insulin Nation.


shutterstock_96871129_507_10_tips_to_stay_healthy_T1_300pxMichael J. Fox once said this about living with Parkinson’s disease: “I often say now I don’t have any choice whether or not I have Parkinson’s, but surrounding that non-choice is a million other choices that I can make.”

As someone who lives with Type 1, I argue that you can say the same about living with Type 1. You don’t have a choice whether or not you have Type 1 diabetes, but you can make “a million other choices” of how you will live with it.

My job is to help others with diabetes make the best choices for themselves. As a cognitive behavior therapist and certified diabetes educator, I specialize in treating the emotional issues of coping with diabetes. I help my patients examine their thoughts and actions toward living with diabetes.

The American Association of Diabetes Educators have developed seven key guidelines to help manage diabetes. Called the AADE7 Self-Care Behaviors, they include:
-Healthy Eating – Having diabetes means learning how to count carbohydrates and how the foods you eat affect your blood sugar. A healthy meal plan also includes complex carbohydrates, protein, fiber (beans, whole grains, fruits and vegetables), lots of green, leafy vegetables, and limited amounts of heart-healthy fats.

-Being Active – Physical activity can help you keep blood sugar levels normal and manage your diabetes. Being active can also improve your mood and reduce your feelings of stress and anxiety.

-Monitoring – Checking your blood sugar levels regularly gives you information about your diabetes management. Monitoring helps you know when your blood sugar levels are within your target range and helps you to make choices in what you eat and what you do.

-Taking Medication – Obviously, it’s important that you take your insulin, but it’s vitally important that you understand how much to take in certain situations. This comes from careful monitoring of your blood sugar levels and getting to know the cause and effect between your insulin therapy and your blood sugar levels.

-Problem Solving – Everyone encounters problems with their diabetes control. If/When you have a problem, you need to know how to troubleshoot your self-care. This can include analyzing and evaluating your situation and thinking about what was different from usual that could have affected your blood sugar. It also means coming up with solutions to try, as well as looking at what worked and what didn’t. Don’t get bitter, get better.

-Reducing Risks – You can take steps now to lower your risks of developing health problems in the future. Recommendations to reduce your risks and avoid other health problems include: not smoking, seeing you doctor regularly (to check A1C), visiting your eye doctor at least once a year, brushing and flossing daily and seeing your dentist, taking care of your feet, and listening to your body.

-Healthy coping – Living with diabetes and its daily demands for self-care can be stressful and may negatively impact your self-management. Not only can stress increase your blood sugar levels, but it can contribute to you making poor choices. The good news is there are many healthy ways to cope with stress.

I think this last point is vitally important, and I want to share three options for managing the stress of living with diabetes:

-Be kind to yourself. Do the best that you can do. It’s important to feel good about your successes. Give yourself credit when you are successful at managing your blood sugar and don’t be overly critical of yourself if you fall short of a goal.

-Seek support from a network of family and friends who you can talk to when you are upset. Seek opportunities to meet other people with diabetes, such as attending support groups or participating in online forums (such as podcasts or tweet chats), so that you won’t feel isolated and alone. Talk to a psychologist or other mental health provider who provides diabetes-focused therapy if you feel depressed or overwhelmed.

-Choose to have a positive attitude, and cultivate it every day, but also accept when you feel down about diabetes. To have occasional negative thoughts is normal; research has shown that acknowledging those thoughts may help people with diabetes keep their blood sugar levels stable. Acknowledge, but don’t dwell; living with a negative mindset will limit your ability to cope. The way you think about events can influence your mood, thoughts and actions.

Type 1 diabetes is a health challenge that you didn’t choose, but doing what you can to stay healthy is a choice you make each day. It’s a lifetime practice to embrace the best you can.

This text has been edited for length.

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How Pumpers Can Prep for Hospital Stays Mon, 27 Jul 2015 14:45:32 +0000 Because a hospital shouldn’t be a dangerous place when you have diabetes.

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shutterstock_171765992_pumpers_prep_300pxIntegrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community.

Q – I have diabetes and use an insulin pump. Although I’m healthy, I worry about the care I might receive if I have to stay in a hospital. What can I do to be prepared should a hospital stay occur?

A – Hospitals are supposed to be places to heal and recover, but unfortunately a trip to the hospital can be a major disruption in your diabetes self-care routine. You can minimize the hiccups if you do some prepping for every eventuality.

One of the first hurdles to your self-care can be diagnostic tests. It’s a good idea to talk to your diabetes care team about how to prepare. For some tests, such as x-rays, computed tomography (CT scans), or magnetic resonance imaging (MRI), you’ll need to disconnect from your pump. Most infusion sets have a disconnect feature that allows you to temporarily unhook the pump and tubing for these situations. For an MRI, both the infusion sets and the pump have to be removed, as they do contain small metallic parts. You should always check your blood sugar levels before, during, and after disconnection to ensure your blood sugar stays in your target range.

If you are hospitalized, you may be able to continue with your insulin pump, but this depends on the hospital policies and the seriousness of your condition at the time of the hospitalization. With a planned hospitalization, discuss a plan of action with your endocrinologist or diabetes educator. Also, most hospitals have a physician who acts as a point person on cases involving patients with diabetes, so work with him or her to create a plan for either independent care or care to be provided by the hospital.

If you need surgery, your pump may need to be disconnected and you may need to receive insulin by injection or through an intravenous line. Many surgeries can be done with the pump in place, but this should be discussed beforehand with your endocrinologist, the surgeon, and the anesthesiologist to ensure they are on the same page as you on how to manage blood sugar levels and keep your pump infusion site secure.

It also can help to have a friend or family member who knows how to check your blood sugar and use your pump waiting to join you in recovery after surgery. If you write him or her into the plan of care, they can assist with doing the checks and managing your pump until you are stable, awake, and once again ready to take control.

For surgeries that don’t allow continued use of the insulin pump, know that you will be started on an insulin drip as well as an IV of glucose. Blood sugar checks will be done through surgery. If necessary insulin will be given to address higher blood sugar, and glucose will be given to address lower blood sugar. Depending on how well you are doing after surgery, you can likely reconnect to your insulin pump as soon as you are back in your room or in recovery, and when your blood sugar levels are deemed stable. It’s important to keep your infusion site attached, even if you have to disconnect for a procedure, as you can reconnect rather than having to put in a new site to restart the pump. It is also imperative that all medical caregivers on your team understand you have “insulin-dependent diabetes” and CANNOT be disconnected from any insulin source for any amount of time. Be prepared to advocate for yourself, and try to have a friend or family member available to advocate for you, as well.

Not all hospitalizations are planned, unfortunately. Make sure to wear a medical ID bracelet or necklace which can alert EMT and emergency department staff that you have diabetes (wallet cards may not be noticed on a timely basis). Many credible medical ID bracelet providers also allow the option of having an ID placed on the bracelet/necklace. This additional ID can be enabled with an interactive health record; it then can connect with an online database that holds all your medical information – such as your insulin doses, the fact that you use an insulin pump (and possibly a CGM), the type of insulin you use, and any other medications. It can also contain emergency contact info, as well as a note about the do’s and dont’s of your insulin pump.

It’s also important for people with diabetes to prepare for the possibility of an unexpected hospital visit. If you use a pump, plan ahead by having extra supplies on hand, including extra reservoir cartridges, infusion sets, batteries, tapes and adhesives, emergency glucagon, food and/or glucose tabs/gel, and insulin vials/pens and syringes (in case your pump is not working properly). Make sure to have a printed prescription for each of these items in the bag for a backup. Create a note with all your pump settings, including basal rates, ratios, targets and active insulin time, in case your pump settings get changed or deleted.

A little “diabetes emergency bag” could be packed to carry in your purse, briefcase, or gym bag, or stashed at work or at the gym. With this, you’ll at least have a few days supplies, as well as information to help the medical caregivers understand your plan of care. Also consider carrying a pump emergency card (given by most pump manufacturers), which gives treatment recommendations if something should happen to you.

Having a safe and successful hospital stay is just like every other aspect of life with diabetes – the more you prepare beforehand, the more you minimize the risks.

Integrated Diabetes Services provides one-on-one education and glucose regulation for people who use insulin. Diabetes “coaching” services are available in-person and remotely via phone and online for children and adults. Integrated Diabetes Services offers specialized services for insulin pump and continuous glucose monitor users, athletes, pregnancy & Type 1 diabetes, and those with Type 2 diabetes who require insulin. For more information, call 1-610-642-6055, go to or write

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5 Diabetes Memes We Like Thu, 23 Jul 2015 12:42:38 +0000 Do you have a Type 1 meme theme to share?

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This summer, we’ve been having some fun making Type 1 diabetes memes. Feel free to share with anyone who you think might need a laugh:






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Mom’s BG Control May Affect Child’s Grades Fri, 17 Jul 2015 19:44:50 +0000 Researchers find a preliminary connection between a mother’s blood sugar levels and a child’s academic success.

The post Mom’s BG Control May Affect Child’s Grades appeared first on Insulin Nation.


shutterstock_103336655_moms_bg_control_300pxIf you’re an expectant mother with Type 1, your overall blood sugar control might determine your child’s success in school, a new study suggests.

The Danish study reviewed the school records of about 700 elementary kids who had mothers with Type 1, as well as the records of over 60,000 students of mothers with functioning pancreases, according to a Reuters article. Researchers at Aarhus University Hospital looked at the medical records of the mothers with diabetes and noticed a connection between blood sugar control and academic achievement. The mothers who maintained good glycemic control before and during pregnancy had children who achieved above average grades, while those who maintained poor blood glucose control before and during pregnancy had children who scored lower than average grades.

Socioeconomic factors may have been at least partly in play with these results. However, when researchers adjusted for the usual connection found between a mother’s educational level and a student’s good grades, the differences in academic achievement persisted among the children of mothers with Type 1.

While it’s far too early to conclude that glycemic control is directly influencing a child’s developing brain in the womb, researchers think the notion should be explored in future research. Still, such results should provide expectant mothers with Type 1 extra incentive to maintain good blood sugar control.

Of course, on the flip side, no one is suggesting that one bad day of blood glucose control will doom your future child’s chances of getting into Harvard. Blood glucose control during pregnancy is a process that no one has perfected, and that’s okay. To read more about the experiences of expectant moms with Type 1, go to and

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Beta Cell Study Searches for More Volunteers Fri, 17 Jul 2015 19:17:12 +0000 The study will test whether a common blood pressure medication can stop Type 1 shortly after diagnosis.

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shutterstock_238823719_betal_cell_study_300pxA study from the University of Alabama at Birmingham (UAB) is testing a drug to stop the body from destroying beta cells at the onset of Type 1 diabetes, and they are casting a wide net to find volunteers, according to a article.

After discovering that Verapamil, a blood pressure medication, could stop the destruction of beta cells in mice, researchers have been testing whether if it will do the same in humans. The study has caught the attention of JDRF, which provided a $2.1 million grant. However, if the study can’t find 40 more people, the results will be inconclusive, according to Co-Principal Investigator Dr. Fernando Ovalle.

The problem is one of timing. Researchers are looking for candidates who are 19-45 years old with Type 1 diabetes. However, the diagnosis must have been made within the past three months of applying to participate; the three-month period is a critical time to reach beta cells before they die off. It’s hard to find participants who meet that criteria, as a new Type 1 diagnosis in adults is fairly uncommon. Also, it’s difficult to find people who have been so recently diagnosed, as might be too busy mastering diabetes self-care to think about participating in studies.

Ovalle says that the potential of this study is significant, and he is confident they have a high chance of stopping the destruction of these beta cells with Verapamil. Only time will tell if the treatment results in mice is translatable to humans.

Study volunteers will be given either Verapamil or a placebo drug for a period of one year, and will need to have their blood drawn on a regular basis. They will also be asked to wear a continuous glucose monitor to record blood-glucose levels on a 24/7 basis. Anybody who is interested in learning more about this study or enrolling can either call at (205) 934-4112, or send an email to

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Senate Hears Testimony for Medicare CGM Coverage Fri, 17 Jul 2015 18:48:19 +0000 A trio of young athletes and a distinguished coach make the case that CGMs are indispensable for many with Type

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JDRF Delegates_300pxThe U.S. Senate Committee on Aging convened a special session July 15th to welcome delegates to the 2015 JDRF Children’s Congress and to take testimony in support of a variety of diabetes-related legislation. Despite the committee’s title, much of the testimony came from young people affected by Type 1 diabetes as part of a lobbying effort to get Medicare to cover continuous glucose monitors (CGMs).

The senators heard from a panel of experts including 10-year-old Isabelle Levesque of Arundel, Maine, who urged Congress to continue its support of diabetes research and to extend Medicare coverage to continuous glucose monitors. Diagnosed with Type 1 at age two, she estimated that she had pricked her fingers 28,000 times until she was able to switch to continuous glucose monitoring.

“I’m a happy child, but I have to think about it all the time,” she said. “I’ve had to think about it when I had to leave soccer and softball games to wait out low sugar when my teammates needed me.”

Isabelle Levesque_300pxLevesque had the support of Senator Susan Collins of Maine.

“I was surprised and troubled to learn that CGMs have been denied coverage under the Medicare program,” Senator Collins said at the hearing. After mentioning successes in technology and research achieved over the past decade, she added, “This is no time to take our foot off the accelerator.”

Levesque was joined by fellow athletes Amelia Cooper, a 15-year-old Nordic skier and marathon runner from Kansas City, MO, and Kate Hall of Casco, Maine, current national high school record holder in the long jump. Hall has pre-qualified for the 2016 U.S. Olympic trials.

Cooper and Hall both talked of their refusal to be deterred by diabetes in their athletic careers, and described how CGM use has been crucial to maintaining their training regimes and competitive performance. Cooper used her CGM last winter to perform a self-study to quantify how glucose levels dip during exertion in cold weather, and she presented her results at the ADA Scientific Conference in June. Hall described how when her parents switched health insurance carriers, she lost CGM coverage. Sen. Jeanne Shaheen of New Hampshire said this was unacceptable.

“Ninety per cent of private health insurance carriers cover CGM’s,” said Sen. Shaheen, a Diabetes Caucus founder and grandmother of a young child with Type 1. “They understand that it’s a matter of economics,” she remarked, referring to the costly diabetes complications and comorbidities which could be avoided with conscientious glucose control.

Also among the athletes offering testimony was Bob Amato, retired track and field coach at Providence College. Amato, who was diagnosed with Type 1 at age 7, is a 10-time New England Coach of the Year and a 2009 inductee into the college’s Hall of Fame.

When Medicare declined to cover his CGM, Amato filed an appeal and pursued it for four years until an administrative law judge at the third appeal level ordered the agency to cover the cost.
Two months later, a Medicare appeals council reversed the judge.

“For me a CGM is a matter of life and death. Literally,” said Amato, who is 81. “When you’re young, you learn to know the warning signs of low sugar. When you get to this age, the signs are gone.”

Amato closed his testimony by relating a recent hypoglycemic episode he suffered while driving alone on the Interstate between Boston and Providence. He was unaware of his condition or that he was weaving and dropping speed, but a tractor-trailer driver sensed what was happening and “gently nudged” Amato’s car onto the grass median.

“The driver of that eighteen-wheeler saved my life,” he said.

Senators Shaheen and Collins have been leading the congressional charge for Medicare coverage of CGMs. Unfortunately, bills in the House and the Senate for coverage have languished in Congress since March 2015. JDRF is urging people affected by Type 1 diabetes to contact their senators and representatives to try and move such legislation forward.

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BBC Drama Treats a Low with Insulin Thu, 16 Jul 2015 13:23:45 +0000 The Type 1 community in the UK cries foul with the season finale of The Syndicate.

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Programme Name: The Syndicate S3 - TX: n/a - Episode: n/a (No. 1) - Picture Shows: (L-R) Spencer Cavendish (SAM PHILIPS), Amy Stevenson (DAISY HEAD) - (C) Rollem Productions - Photographer: Matt SquireA BBC drama has drawn the ire of the diabetes community in the United Kingdom for its portrayal of how to treat hypoglycemia, and the show’s author hasn’t helped with her defense of the scene.

According to a report in the Mirror (U.K.), the season finale of The Syndicate featured a character with Type 1, Amy, who declared she was suffering from low blood sugar. A pharmacist goes to get an insulin pen. Amy’s low is apparently treated with insulin, which, as many people with diabetes pointed out, would probably have killed her.

As soon as the credits rolled, the tweets came in fast and furious about the error. The UK branch of JDRF also issued a statement in which they helpfully offered fact-checking for any shows that involve characters with diabetes. Karen Addington of JDRF said Type 1 diabetes is difficult enough and “only gets more difficult when the condition is misunderstood by other people and by the media.”

Show writer Kay Mellor has, perhaps unwisely, defended the show’s portrayal of Type 1 diabetes. In a statement, she said:

Thank you for your concern about the character of Amy and her diabetes. First of all can I just say, although I researched and spoke to people who were diabetic, the drama is purely fictional. And like any dramatist I have to take dramatic license sometimes to make the story work.

In this story Amy is a young woman who is diabetic but also quite manipulative and uses various ways to gain what she wants out of life. We have no idea if she is lying or telling the truth at any given time.

In this last episode we see that Amy had been through a traumatic time with her boyfriend and clearly feels unwell and confused, she could well have made an error saying her blood sugar was low.

I based the story of Amy around a young woman I spoke to who said when she’s been eating or drinking something sugary her blood level spikes [high] but then after a time her level drops dramatically. She told me she needed the insulin to stabilise her levels. Maybe it’s a case of no two people being exactly the same.

Also we have no idea what the chemist said to Spencer or what he did as a consequence. We come up on him untying the yacht and sailing out to sea then administering the insulin, but we have no idea how much time has passed.

I acknowledge that type 1 Diabetes is a very serious illness and appreciate your concern. The Syndicate is in no way a medical drama or a serious documentary about how to treat diabetes.

The statement has more than a few problems. First, when she said she spoke to people with diabetes, it sounds too close to the “Some of my best friends are x” defense that people use to justify insensitive comments. Secondly, it’s best not to use “could” when describing your character’s controversial actions; you’re the character’s creator, so you should know. Third, even if a show is not a medical drama or documentary, it can still cause damage when it is factually inaccurate about a medical condition.

Of course, The Syndicate isn’t the first show or movie to draw the ire of the diabetes community. A central plot point of Con Air is that Nicholas Cage must stay with a band of plane hijackers to rescue his friend with diabetes, who quickly seems to go into acute stages of diabetic ketoacidosis in a matter of hours without his insulin, despite having no food on the flight. (One wonders if the same would have happened in Con Air’s world had there been a delay on the tarmac.) In the Panic Room, a young Kristen Stewart (pre-Twilight fame) is a teenager with Type 1 who has the misfortune of having pizza and (non-diet) soda before her home is invaded; we are left to guess she might have bolused too much because her mother, Jodie Foster, must go on a desperate hunt for glucagon before she goes too low.

Both scenarios could be justified, but the justifications strain credulity. However, this is the first show in recent memory that seems to have made the fatal flaw of confusing insulin for glucagon. Hopefully, after the social media blowback, it will be the last show that does so, at least for a while.

You can see some other examples of Hollywood’s portrayal of Type 1 diabetes here:

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A Prefilled Syringe That Contained No Insulin Tue, 14 Jul 2015 20:03:17 +0000 A British pharmaceutical firm is fined for its role in the 2010 death of a man on insulin therapy.

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shutterstock_12552319_syringe_300pxA British court has found a pharmaceutical firm to be at fault for a man’s death from diabetic ketoacidosis (DKA) after a prefilled insulin syringe made by the firm failed to contain any insulin.

Neil Judge, 58, died of DKA at the Northern General Hospital in Sheffield in November 22nd, 2010. According to a Mirror (UK) report, Judge required insulin while being hospitalized for an amputation; he had pancreatic disease, not Type 1. Two days after the injection, he died of multiple organ failure. It was later determined that the pre-filled syringe contained only saline, not saline and insulin, and the coroner’s report ruled lack of insulin was a “major contributing factor” in his death.

According to a recent BBC report, a British court has fined the company, Fresenius Kabi, 500,000 pounds (a little more than $750,000) for its role in Judge’s death. A Fresenius company executive admitted that some 160 pre-filled insulin syringes were found to be faulty, but only 30 were recovered for testing. That could mean that the remaining syringes were either thrown away or used. The company ceased making prefilled insulin syringes after Mr. Judge’s death.

The published report of the court’s findings fails to answer one critical question: why wasn’t it noticed by medical staff at the hospital that the insulin injection failed to bring down Judge’s blood sugar levels? According to the Mirror article, doctors only realized their error 14 hours after the injection, at which point it was too late to save his life.

This kind of tragedy reinforces the idea that it’s best for people on insulin therapy to have a support team in place that can advocate for their needs in a hospital setting. Advocates, be they friends or family, should know a patient’s normal insulin regimen, blood sugar range, and symptoms when blood sugar levels go out of bounds, and contact information for the patient’s primary care physician. Such an advocate should be brought up to speed on a patient’s* diabetes well before a hospitalization might occur.

*Insulin Nation writers normally don’t refer to people with diabetes as “patients”, but we felt it made sense when discussing hospitalization.

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FDA Gives Diabetes Treatments Low Priority Tue, 14 Jul 2015 19:47:51 +0000 An explanation of how the agency allocates its resources, and why diabetes drugs and devices aren’t first in line.

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shutterstock_214235758_fda_300pxEven though health officials readily admit that diabetes is an urgent public health problem, a new diabetes medicine or device usually finds itself in ninth position on the FDA docket for a pre-market clearance. To understand why requires an understanding of the history of the FDA, and its limitations.

I first became interested in this question after the ADA Scientific Sessions in Boston. There I listened to a presentation of Joseph A. DiMasi, PhD, who analyzes the economics of health care at the Tufts University Center for the Study of Drug Development. Although not an expert in diabetes care himself, he was able to find in his research that the approval pipeline for diabetes treatment is indeed slow.

“We’ve seen very large trials and lengthening clinical development times, which would suggest larger than average development costs,” DiMasi said.

The FDA is a jack-of-all-trades regulatory agency. It receives requests for regulatory approval in areas way beyond food, drugs and equipment. In recent years, marketing and formulation of tobacco products and additives and smokeless products have fallen within its reach. Veterinary practices and medications have a bearing upon medical research, and so are subject to FDA regulation, as are prosthetics, motorized wheelchairs, and surgical and radiological devices. The agency even regulates components of materials used to package food, personal care products, pet food, and surgical instruments.

The agency started out in the Theodore Roosevelt Administration, when slaughterhouses and packing plants were as dangerous to human health as modern Superfund sites, and snake oil salesmen roamed the western frontier with cures for vapors, rheumatism, and “female hysteria.” The federal Pure Food and Drug Act of 1906 incorporated safeguards previously handled, evidently not very well, by the Agriculture Department.

In years following, the act was amended to broaden the agency’s regulatory scope to include the regulation of food, drug, and cosmetic manufacturing practices. By 1984, drug price competition and restoration of patent protections had come within the FDA’s purview. The law underwent significant and substantial changes again in 1992, with amendments requiring that any proposed therapeutic innovation show it works and improves on existing therapies.

Here’s the FDA’s modern medical workload: 20 to 30 new drugs a year (new molecular formulations — this does not include the thousands of changes to existing cleared drugs it must review) and 50 to 70 new devices — not counting about 4,000 improvements to devices and submissions of post-market quality assurance reports. To meet this demand, priorities have to be set, so the FDA follows a four-tier system of assigning its resources and putting applications on expedited timetables, based upon the needs of the country’s health care delivery system.

The highest priority (fast-track) cases are proposals that can lead to improvements in diagnosis, overcome dangerous side effects of existing therapies, or meet an emerging public health crisis. A 60-day deadline is imposed upon the agency to determine whether the application stays on the fast track to approval or is assigned a different priority. The FDA assigns senior staff to these projects, and its staff and manufacturers’ representatives work collaboratively.

Next in the hierarchy are breakthrough therapies, which indicate therapies that possibly provide a clear advantage over available therapies. Again, the agency is obliged to take action also within 60 days of initial filing to determine whether to continue pursuit of breakthrough status or reassign to a different level of priority. Progress reports are submitted by the applicant on a more frequent schedule than for other review categories, and the FDA and applicants staff hold regular meetings to confer on trial data.

Accelerated status is granted primarily to laboratory devices or measurement equipment where it appears evident that reliability can be established over a relatively short period of time versus a year or more of experimental use. In the case of a drug application, accelerated status is granted to drugs that can extend the survival time of patients and/or shows improved short-term success in attacking a disease.

In considering which of the three categories above is most appropriate for the handling of a pre-market investigation, the agency takes into account evidence of past failures of similar drugs or devices, and the number of patients who potentially could benefit. It’s important to remember that it’s not the agency’s job to secure new competitive opportunities for pharmaceutical companies. The agency is charged with making sure that therapies are first safe, and then effective. A tweaking of a component of a biosimilar insulin which might benefit a small cross-section of patients only from the standpoint of convenience will not climb to the top of the inbox.

The fourth expedited review category is called priority review. Here, a drug or device is very often an alteration to that which has already received final clearance or is making its way along successfully in another expedited review category. An example would be the approval that (the now closed pump maker) Asante received last year to make modest mechanical changes in its disposable Pearl pump assembly, which would have no adverse effect upon durability or service life of the Pearl, or of the Snap version of the pump, which was proceeding to market.

A survey of pre-market approval filings over the past half dozen years reveals that the vast majority of diabetes drug and device applicants are granted priority handling, and proceed from pre-market notification to clearance in a year or less.

It’s possible that diabetes treatment is a victim of its own success. Because people with diabetes can have long lifespans and existing treatments can, in theory, control blood sugar levels relatively well, the FDA doesn’t give new treatments or improvements higher priority. Likewise, established drug companies may have less financial incentive to risk financial resources for true breakthroughs in diabetes treatments. If this is ever to change, it might require political pressure, either to prod legislators to change FDA criteria or to educate regulators about the limitations of current treatment options.

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How to Detect Type 1 as Early as Possible Thu, 09 Jul 2015 18:10:54 +0000 A Swedish study finds biologic markers in young children that predicts a future Type 1 diagnosis.

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shutterstock_6929149498_how_to_detect_diabetes_300pxA Swedish-based study is attempting to determine precursors to diabetes development in young children before symptoms appear, according to a Reuters article. The team of researchers is focusing on genetics, protein chemistry, and metabolism as biologic markers that Type 1 diabetes might develop in children.

The researchers have taken blood, stool, and nail samples from 8,600 Swedish, American, German, and Finnish children who have an increased hereditary risk of diabetes. The kids are also asked questions about their diet, and have their weight and height measured during clinic visits.The study, named The Environmental Determinants of Diabetes in the Young (TEDDY) project and led by Lund University researcher Ake Lernmark, has found signs of future diabetes at an earlier stage than previously thought possible. The team has found four common antibodies in blood samples that make it easier to detect eventual diabetes diagnosis.

Earlier detection could mean earlier treatment, which could head off diabetic ketoacidosis and provide the possibility of extending the so-called honeymoon period, when the pancreas can still produce some insulin. In an unrelated German study, researchers are trying to determine if early insulin dosing can immunize children against Type 1, and the Swedish researchers are hoping their work can lead to the development of a Type 1 vaccine.

The study’s researchers are hoping next to test all four-year-old children in Sweden for these biologic markers.

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Nasal Glucagon Proves Safe for Kids Thu, 09 Jul 2015 13:32:42 +0000 New trial data shows it performs just as well as injectable glucagon, and even cuts the risk of nausea.

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Locemia Solutions ULC glucagon nasal powder device. June 2, 2015 Locemia Solutions 8505 Chemin Dalton Montreal, QC  H4T 1V5 http://www.locemia.comGlucagon can make the difference between life and death during a severe bout of hypoglycemia, but using it requires someone to mix up and inject the right dosage during a crisis situation. That’s asking a lot, especially of strangers who might not have any medical training or diabetes knowledge. Too often, glucagon isn’t administered until the emergency room, and that can be too late to prevent hospitalization or death.

Locemia Solutions is developing a nasal glucagon delivery system that doesn’t require any mixing or needle jabs. The goal is to expand the field of people who might be able to help in a crisis, says Locemia CEO Claude Piché.

“We’re hoping to make hypoglycemia rescue something that everyone is comfortable doing,” Piche says. “We’re talking about teachers, bus drivers, coaches.”

Locemia Solutions ULC glucagon nasal powder device. June 2, 2015 Locemia Solutions 8505 Chemin Dalton Montreal, QC  H4T 1V5 http://www.locemia.comThere is growing clinical evidence that nasal glucagon is safe and effective to use on people with diabetes. Most recently, a T1D Exchange-led study has found nasal glucagon performed just as well as injectable glucagon in correcting low blood sugar levels in children, and actually was less likely than injectable glucagon to cause nausea.

The seven-site study recruited 48 children, ages 4 to 17. Volunteer recruitment was easy, even though the study involved dropping children’s blood sugar levels to 80 mg/dL. That’s because parents understand the importance of creating a better glucagon treatment option, says lead researcher Dr. Jennifer Sherr, a Yale pediatric endocrinologist.

“When you described the study to them, they were so eager to participate,” Dr. Sherr says.

Once children’s rates were dropped to 80 mg/dL, they were given either an injection of traditional glucagon or a puff of nasal glucagon. The study has not yet been published, but the preliminary data suggests that injectable and nasal glucagon performed equally well at bringing blood sugar levels up. However, only about 40% of children experienced nausea after getting a dose of nasal glucagon, in comparison to roughly 60% of children who received injectable glucagon. That’s important because nausea can further disrupt blood sugar levels after a low, creating the possibility of a vicious cycle of blood sugar swings.

Another plus with the nasal glucagon was that it didn’t seem to matter if two or three milligrams of glucagon were administered. Injectable glucagon dosage is typically dependent on the weight of the person with diabetes. Removing the need to determine dosage size removes variables for parents in a panic situation, says Dr. Sherr.

“Parents in times of stress might overdose….or remember (the lower dose) they were first trained on” when their children were younger, she says.

This study builds on earlier trial data that found the nasal glucagon is safe for adults. For adults, the nasal glucagon performed just as well in raising blood sugar levels and caused the same rate of nausea as injectable glucagon. Piché hopes to announce the results of other nasal glucagon trials in September 2015.

Even if trial data shows that nasal glucagon performs just as well as injectable glucagon, it will still be a win for Locemia, and likely for people with diabetes. The more people who can easily administer glucagon, the better, says Piché.

“It’s about trying to make the network (of rescuers) much larger so (a low) is not the big, scary horrible experience that it is today,” Piche says.

In a recent newsletter, Locemia’s product was incorrectly referred to as “inhalable.” We apologize for the error.

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How to Manage a Young Athlete’s Blood Sugars Thu, 09 Jul 2015 13:01:55 +0000 A mother shares 7 tips she learned from trial and error with her daughter.

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shutterstock_221276785_how_to_manage_young_athletes_300pxPop Quiz: You’re about to go on a 3-mile jog with your 10-year-old child, who has Type 1 diabetes. Her blood sugar is 140 mg/dL.

Do you:
A) Reduce her pump’s temp basal rate before you start running to keep her blood sugar stable and prevent a low.

B) When, according to her continuous glucose monitor (CGM), she starts dropping below 110 mg/dL, start giving her fast-acting sugars, hoping to stop her from dropping even further.

C) Panic a little at 1.5 miles because the CGM says 85 mg/dL and still dropping, and keep feeding her fast-acting sugars.

D) Smack yourself on the head for completely forgetting to reduce temp basal rate AND for deciding not to bring the Omnipod PDM with you on the run.

The correct answer is, of course, A. Unfortunately, I learned this the hard way (after doing B, C and D).

Since her diagnosis in 2013, my daughter has continued to participate in multiple sports: gymnastics, Bike Moto Cross (BMX), running, and swimming. Through lots of trial and error, my husband and I developed several strategies to better manage her blood sugar during physical activity.

No Two Activities Are Created Equal
While different activities may last about the same time and be fairly similar in intensity, they can have different effects on blood glucose levels. For example, I’ve learned that during gymnastics, if my daughter’s level nears 200 mg/dL and she’s had little to no insulin, I don’t have to make changes to her basal rates and can let her “burn off” some of the high. However, BMX and running require a reduction in the temp basal rate. And nothing sends her levels plummeting faster than an intense swim practice, which means a complete suspension of basal insulin in addition to a pre-practice carb snack.

Variety Is the Spice of Sports
It’s helpful to experiment with a variety of snacks and fast-acting sugars. My daughter finds that sipping Gatorade throughout BMX and running is very effective. A quick carb snack or energy gel works well for gymnastics. And at swim practice, glucose tabs are the most practical because it’s easy to keep them in a container at the edge of the pool and they only take a few seconds to eat.

Pre-exercise Nutrition Matters a Great Deal
Whether it’s a sit-down meal or a quick snack on the go, I try to make sure my daughter has a good mix of protein and carbs available before she exercises. We always keep a small arsenal of granola and protein bars at home and in her diabetes kit, and you’ll usually find a metric ton of string cheese and yogurt in our refrigerator.

Practice and Competition Are Very Different Animals
We are learning how to manage diabetes differently for practice and competitions. Practice typically brings more strenuous and longer-lasting activity, while competition is a lot of hurry up and wait. Add an adrenaline rush to the mix, and we’ve got blood sugar spikes. We have to adjust both insulin delivery and snacks to prevent a high during races.

Timing Is Everything
Exercise’s effects on blood glucose levels can often last hours, sometimes well into the next day. These effects can be difficult to predict, so we have to be particularly mindful of bedtime and nighttime readings. It’s often a fine art of manipulating bolus and basal rates based on prior experience, gut feeling, and crystal ball predictions.

Sometimes Daughter Knows Best
I’m constantly working to find a balance between monitoring my daughter’s levels and letting her listen to her body. During some activities, I’m more comfortable letting her do it “by feel.” For example, during BMX and gymnastics, “feeling low” might indicate a rapid drop, even if it’s within an acceptable range. Running is trickier because it’s hard for her to tell a difference between being tired and being low. We may not stop to test frequently, but we find CGM data invaluable in helping to monitor her numbers on the go.

Kids Are Resilient
When it comes to managing lows during physical activity, I’ve learned to trust my daughter’s amazing resilience. She once raced BMX with a blood sugar level in the 60s when we all missed that she was dropping and didn’t intervene fast enough. And one time she came out of the pool to treat a low of 39 mg/dL and got back in the water 10–15 minutes later.

Remember the opening story about that time we went for a run and did everything wrong? We managed to avoid a low but ultimately over-treated with sugars, which resulted in a nasty post-run spike. But we finished the run strong, had fun, and learned valuable lessons. Diabetes may slow my daughter down, but it will not stop her from doing what she loves.

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Facebook + Skype Doc Visits Improve A1C Wed, 08 Jul 2015 13:38:04 +0000 A study found that online interactions with doctors were as effective as office visits in kids with diabetes on pump therapy.

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shutterstock_155858564_facebook_skype_doctors_visits_300pxWho needs to go to the endocrinologist’s office when there’s high-speed internet available?

A new study from the University Clinic of Endocrinology, Diabetes and Metabolic Disorders in Macedonia has found that conducting doctor visits via Facebook chats and Skype is as good as regular clinic visits at improving A1C scores for kids with Type 1.

Researchers split 56 children and adolescents who were using insulin pumps into two groups, according to a Diabetes in Control article. The first received standard in-office visits while the second conducted similar visits over social media.

After 6 months, both groups showed equal improvement in A1C scores after consultations with a doctor about pump settings, basal bolus insulin, and other diabetes education. After an entire year, improvement continued to remain steady in both groups, so researchers concluded that both methods of healthcare were equally effective. Also, there were no evident complications with hypoglycemia, weight, or insulin dosage among study participants in either category after the 12-month mark.

54% of the social media users in the group used Facebook chats exclusively, 12% used Skype, and the remaining 34% used both. All consultations were tailored to each individual patient so that they could get the appropriate level of support from their healthcare provider.

If such study results are replicated in the future, the findings could be great news for many families who live in rural areas and have to roadtrip to the nearest endocrinologist.

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Fatal Police Interaction Leads to Diabetes Safety Law Tue, 07 Jul 2015 14:10:22 +0000 A Florida man’s death prompts state legislators to mandate diabetes education for police.

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shutterstock_33349258_traffic_stop_death_300pxNot long ago, a North Carolina couple mourning their child’s death from undiagnosed diabetes pressed their state legislators to pass legislation promoting diabetes awareness education for parents of infants and toddlers. Now, a Florida man’s death following a traffic stop has prompted his family to successfully lobby Florida lawmakers to mandate diabetes emergency response training for police.

In April 2014, Arthur Green Jr. was stopped by a Tampa police officer responding to a call of a pickup truck slowly swerving between sidewalks and oncoming traffic, and colliding with other vehicles. The Tampa Bay Times reported that the first officer on scene suspected a medical emergency and attempted to take Green’s keys and help him out of his truck. Green resisted, appeared confused, and then became combative. The officer pulled Mr. Green from the vehicle, sent an “officer in distress” call (a step up in urgency from a call for backup), and handcuffed him.

The second responding officer, who had a family member with diabetes, recognized that Green was in severe distress from low blood sugar and summoned EMTs. Mr. Green stopped breathing and was resuscitated with a weak pulse, but he was later pronounced dead at the hospital. His blood glucose levels had dropped to 29 mg/dL.

Officials later learned that Green had suffered two diabetic emergencies in the weeks leading to his death. It seems likely, in hindsight, that he should never have been behind the wheel, but the regulations surrounding diabetes and driver licenses are confusing in the Sunshine State.

In the past few decades, Florida regulations have gone back and forth when it comes to diabetes and driver licenses. At one point, it was required that people with diabetes on insulin therapy have special licenses indicating such; at another, the only regulation was voluntary reporting of medical conditions that could impair driving ability.

Currently, according to an American Diabetes Association’s digest of state driving laws, the only Florida provisions addressing non-commercial drivers with diabetes is voluntary and allows for a medical alert to be marked on driver licenses.

The Tampa Bay Tribune account noted that Green wasn’t wearing a medic alert bracelet and had not told the police officers that he had diabetes. He was 63 and a good driver, with only one ticket in the past ten years. There would have been no record of a medical condition potentially affecting his ability to drive.

Following her husband’s death, Lena Young Green, a community activist, put her family and her political skills to work. Within three months, the Arthur Green Jr. Memorial Foundation and a social media campaign were created to lobby legislators and the governor to take action. The foundation has enlisted the support of the ADA to advance diabetes awareness and treatment as a public safety concern.

In response, state legislators passed the Arthur Green Jr. Act (2015 Fla. Laws Ch. 168), which requires the Florida Department of Law Enforcement to create online diabetes training courses for officers. In the same session, the legislature also created a Diabetes Advisory Council to guide the legislative and executive branches in “a statewide comprehensive approach to diabetes prevention, diagnosis, education, care, treatment, impact, and costs.”

As of publication time, the Florida Department of Law Enforcement had not yet issued administrative rules addressing the training requirement.

Katherine Gordon, a lawyer with the ADA, told the Tampa Bay Tribune that training requirements for state and municipal police officers are not uniform throughout the country:

Some departments are very good about (diabetes emergency response) training, but many have no knowledge of what diabetes is, what an emergency looks like and how police officers can correctly determine if there is a medical emergency and what can be done.

This is a shame because there is evidence that training EMTs about diabetes can lead to better medical outcomes for people with diabetes in crisis. Recently, a UK project to educate ambulance corps on emergency diabetic treatment reduced rates of diabetes-related emergency hospitalizations in one county.

It appears that an increasing number of state legislators are getting the message that it’s important to pass regulations to ensure people with diabetes get the medical care they need in crisis situations. Though these regulations are patchwork in nature, they represent incremental progress. Still, it’s sad that it takes a tragedy to hold that momentum.

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5 Times I Felt Guilty Writing About Diabetes Mon, 06 Jul 2015 12:49:21 +0000 An Insulin Nation reporter who does not have diabetes learns to appreciate his pancreas, and the everyday bravery of those with diabetes.

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shutterstock_84146302_5_ways_gulty_300pxI started writing for Insulin Nation first as an intern, then as a staff writer. As someone without diabetes, I’ve had several moments when I’ve grown concerned that I was in over my head. Diabetes is amazingly complicated.

Here are 5 moments when I’ve felt guilty about writing about diabetes:

A Short List
Back in January, I walked into the office of my new internship with my book bag, first-day jitters, and almost zero knowledge of diabetes. “Insulin” was a word that sounded vaguely familiar, but I decided to read through Insulin Nation a bit more thoroughly before plunging into the job.

I pulled out my notebook and wrote words I didn’t know, like “CGM”, “T1D” and “HbA1c”, along with their definitions. It was a sad list of the most basic diabetes phrases and I stopped after the fifth word. It felt like I would never figure it all out. While I’ve certainly expanded my medical vocabulary since then, I can’t deny my guilt when I have to Google something.

Piece of Cake
I went out to get pizza for my lunch break a couple days ago. On top of that, I got a piece of chocolate mudslide cake which, yes, is as ridiculous as it sounds.

I brought the food stuffs back to my cubicle space and demolished that pizza. I looked down at the brown square of cellophane-wrapped cake. Then up at my screen. Back at the cake.

What a luxury, I thought, being able to enjoy pizza and cake whenever I want to.

A Different Kind of Low
Generally, a lot would have to go wrong for me to have hypoglycemia, but that doesn’t mean I can’t experience a different kind of low.

One morning, I walked into the office after getting a donut, and discovered that whoever had served me decided to place the donut frosting-side down into the bag, so all I got was a naked circle of cooked dough. I was not happy and I wanted that frosting.

So I ripped the bag straight down to the bottom and tried to reapply the pool of chocolate spread, but with no success. Clearly, my only option was to lick it right off the bag…so that’s exactly what I did. As the sugary substance hit my tongue, I floated outside my body and looked at myself licking chocolate frosting from the bottom of a Dunkin’ Donuts bag. It wasn’t pretty. This was a new low in my life, and eating sugary foods was the problem, not the solution.

Nana Mame
One night when I was a kid, my grandmother, now 79 years old, was babysitting my siblings and me. Before we had dinner, she pricked her finger and told us she had to do it because she had diabetes.

Until I began writing about it on a daily basis, I, like many who are uneducated about the condition, didn’t realize there were two different types of diabetes. After writing about both for a bit now, I like to think I’m pretty good with the distinctions between the two. Still, I don’t know for certain if my grandma has Type 1 or Type 2. I’m a bit timid about asking, because it’s not something she seems to like to discuss, but I wonder if that is more my concern than hers.

A Customer’s Low
One night as I was working my other job as the manager of a movie theatre, a gentleman came over to the concession stand after it had closed and asked to buy a small soda. I apologized and said I couldn’t sell him anything. He said he had diabetes and needed to treat a low, so I immediately grabbed a cup and filled it up. He was very grateful and hurried off to his movie.

I was afraid of how differently I might have reacted if I had never taken on a job writing about diabetes. Obviously, I would’ve given him the drink because it was a medical issue, but I feel like I would’ve thought he was overreacting and being too demanding. I’m glad I’ve been educated about a very serious disease, and I’m glad I’ve had the opportunity to help others learn about it, too.

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Searching for Blame in a Boy’s DKA Death Tue, 30 Jun 2015 15:37:52 +0000 A 13-year-old dies at basketball summer camp, and his parents and the camp accuse each other of wrongdoing.

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shutterstock_205194643_basketball_death_300pxFrom Utah comes a tragic story of Kaden Jones, a 13-year-old who died unexpectedly from diabetic complications the morning after his first day at basketball camp in July 2014. The story has received brief coverage in the Salt Lake Tribune, regional television news, and the local paper in the young man’s hometown of St. George.

There has been a wrongful death suit filed by the young man’s parents alleging negligence on the part of the basketball camp. Lawyers for the camp have countered that the young man and his parents bear responsibility for his death. Meanwhile, many readers of these news stories have decided to weigh in with their judgement despite not knowing what actually happened; some of the online comments have been brutal, especially towards a family that, for whatever reason, lost a child just a year ago.

In Utah, death certificates are protected against public disclosure for fifty years. Pleadings in civil cases carry something of a presumption of veracity, and in some jurisdictions, have to be supported by affidavit under oath. Even then, complaints are nothing more than allegations of fact, and answers come in the straightforward form of admissions or denials of facts. There really is no way to know who, if anyone, is ultimately to blame for this loss.

All we really know, or can surmise from the initial filings is this:

The young man had Type 1 diabetes and was under proper professional care. He had parents who understood his daily needs and submitted a medical release, general liability release, and medical history forms, as well as additional information on his medical condition to camp officials.

He and a buddy arrived at summer basketball camp at Westminster College, a private college in Utah, where he’d wanted to go for some time. The college fields varsity teams in basketball and seven other sports. It operates summer day and overnight youth camps at various ability levels in basketball and three other sports.

The young man began feeling nauseous shortly after getting to camp, sat out much of the day, skipped meals, may have skipped his insulin, and died the next morning of diabetic ketoacidosis (DKA).

What we know about DKA is that as it worsens, it does so rapidly, and the sufferer loses cognitive function –- the ability to understand what is happening. Often emergency hospital care with an insulin IV and electrolytes is needed to stabilize the system. What we do know about adolescents with diabetes is that “the competing distractions of young adult life often interfere with the requirements of successful diabetes management, including the need to maintain consistent medical care”, according to a 2011 ADA position paper on diabetes and teens. We also know that outside the circle of people with diabetes and their caregivers, Type 1 is a misunderstood illness, and there can be a lot of wrong decisions made by those not in the know when confronted by an episode of glycemic imbalance.

That’s it; that’s what we know. It will be up to the parties involved in the case or a jury to sort out the causes of this boy’s death and attribute fault. The only lesson we can take away right now is that there will always be the need for constant vigilance for the most vulnerable who are afflicted by Type 1. That, and that no parent should feel guilty for wanting to follow up “one more time” on their child’s well being at summer camp.

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New Group Seeks to Jumpstart Diabetes Research Tue, 30 Jun 2015 13:49:00 +0000 The Diabetes Research Connection steers crowdfunding to younger scientists with innovative ideas.

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shutterstock_287773643_new_groups_300pxThe Diabetes Research Connection (DRC) is a new organization that helps fresh-on-the-scene scientists conduct Type 1 research. The group believes that innovative research is often done by early-career scientists, and that good ideas shouldn’t languish until researchers get tenure. They point to the success of young scientists who have done groundbreaking work, including Albert Einstein, who developed the theory of relativity in his twenties, and Frederick Banting and Charles Best, who created insulin therapy in their thirties.

The DRC process begins when researchers submit their proposals to be evaluated by a team of more than 80 established diabetes researchers. The best proposals are then selected and given to the group’s Layperson Committee, who then translate the science of each study into something the general public will understand. The selected (and demystified) proposals are submitted to the public for crowdsource fundraising.

Not only does this process get proposals from drawing room to lab work quicker than with traditional fundraising, but it also gets the public involved in the research, says Christina Kalberg, DRC’s executive director. That public involvement means some proposals can be crowdfunded quickly, sometimes even in just one day.

“[It] allows everyday people to choose what they want to support and how much they want to support it,” says Kalberg.

If a project meets its fundraising goal in three months, the researcher(s) set to work. They are paired with more established diabetes researchers, who act as mentors throughout the project. Each project’s progress is documented on the DRC website, as transparency is key to the organization, says Charles King, a DRC board member and a research scientist at the University of California, San Diego.

“Donors are kept in the loop from beginning to project conclusion,” King says. “We want people to continually follow the research.”

DRC currently has four projects on its website. They include:

  • A University of Vanderbilt project to reverse Type 1 without insulin
  • A UCLA School of Medicine proposal to make “more and better” beta cells
  • A University of Washington project to make cells to repair the pancreas
  • A University of Michigan project to find a way to reinvigorate stressed beta cells

By 2016, the group hopes to have up to 10 active projects available for donors. You can click here to donate.

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