Insulin Nation http://insulinnation.com Technology. Science. Therapy. Tue, 09 Feb 2016 15:38:52 +0000 en-US hourly 1 http://wordpress.org/?v=4.2.7 Needle Phobia Leads to Pancreas Transplanthttp://insulinnation.com/treatment2/needle-phobia-leads-to-pancreas-transplant/ http://insulinnation.com/treatment2/needle-phobia-leads-to-pancreas-transplant/#comments Fri, 05 Feb 2016 19:20:04 +0000 http://insulinnation.com/?p=310258 A woman with Type 1 undergoes the procedure, setting off a debate about whether her case warranted a transplant.

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In the course of living with Type 1 diabetes for 38 years, Sue York of England developed a deep fear of needles. It was a phobia so severe that it caused her to shake and sometimes vomit when she injected insulin. Because of this, doctors eventually decided to undertake the world’s first-ever pancreas transplant in response to a phobia.

York, 55, explained in an interview with BBC’s Victoria Derbyshire Programme that she felt constantly afraid, even when she wasn’t directly using a needle. Because of this, she tried to find ways to avoid treating her diabetes more than absolutely necessary. When local rules were passed calling for people with diabetes to check their blood sugar levels before getting behind the wheel, for example, she simply stopped driving altogether.

A fear of needles, called trypanophobia, is said to affect approximately 10% of the population; the phobia can occur from birth or develop as a learned behavior after an unfavorable experience. Trypanophobia can be deadly for those living with Type 1 diabetes, as the anxiety associated with injections can cause people to forgo treatment.

York and her medical team exhausted other options before electing for the pancreas transplant, according to the report. She attempted cognitive behavioral therapy and hypnotherapy to ease her anxiety, but nothing worked.

Even once her team determined a transplant was the best option, it took over two years for her to be cleared for a transplant, a process that included three visits in front of a panel of doctors. Twenty-one days after being placed on the waiting list, she was matched with a donor. Now, after the success of the transplant, doctors say York’s life expectancy has doubled. She says her quality of life has dramatically improved.

There is fierce debate over whether York’s need was great enough to qualify for a transplant. Dr. Raman Dhanda of the Manchester Royal Infirmary defends the decision of the panel, explaining that there are strict guidelines both nationally and internationally to ensure that patients with the greatest need receive transplants first.

York’s story already has elicited strong opinions, both for and against the transplant, among the Type 1 community. Being a lightning rod of debate may be an unintended side effect of the transplant.

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Measuring Parental Distress of a Type 1 Diagnosishttp://insulinnation.com/living/measuring-parental-distress-of-a-type-1-diagnosis/ http://insulinnation.com/living/measuring-parental-distress-of-a-type-1-diagnosis/#comments Fri, 05 Feb 2016 18:58:35 +0000 http://insulinnation.com/?p=310253 A study finds parents of children with Type 1 need more mental health support as anxiety after a Type 1 diagnosis is widespread.

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shutterstock_313900673_measuring_parental_distress_300pxAccording to a Yale School of Nursing study, 33.5 percent of parents of children with Type 1 experience psychological distress upon the event of a child’s diagnosis, and 19 percent of parents report psychological stress one to four years after diagnosis. Researchers arrived at these figures by reviewing 34 peer-reviewed studies on parents of children with Type 1.

It’s not surprising that parents might experience profound psychological distress in the period after an initial Type 1 diagnosis; in fact, it’s a bit surprising those figures cited aren’t higher. Researchers warn, however, that there aren’t enough support mechanisms in place to ensure that such distress doesn’t evolve into depression, anxiety, and/or PTSD.

Children in the various studies ranged in age from about four years old to 14 years old, with parental distress being more prevalent the younger the child’s age of diagnosis. That distress is generated from the shock of diagnosis and the upheaval that blood sugar management brings. Meals were the most common part of daily life affected by a Type 1 diagnosis, parents reported. A child’s diagnosis also often required a mother to adjust her work schedule or leave her job altogether. Parents described their experience post-diagnosis as “life-altering” and “all-consuming.”

Previous research has revealed that children with Type 1 often have undiagnosed depression or exhibit depressive symptoms but do not receive treatment. The same appears to be true for parents of children with diabetes, and study authors suggest families of newly diagnosed children should seek professional mental health support. The researchers noted that when a parent’s distress level went up, a child’s blood sugar management suffered as a result. This points to the need for parents to care for themselves the best they can, if they want to care for their children the best they can.

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The Pain Of Saying No to Ice Creamhttp://insulinnation.com/living/the-pain-of-saying-no-to-ice-cream/ http://insulinnation.com/living/the-pain-of-saying-no-to-ice-cream/#comments Wed, 03 Feb 2016 23:07:35 +0000 http://insulinnation.com/?p=310235 in response to an Insulin Nation article, a parent of a child with Type 1 shares the emotional toll of following a diabetes-friendly diet.

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shutterstock_156172337_say_no_to_ice_cream_300pxOne warm Sunday afternoon in May 2013, I stood in the kitchen, hugging my sobbing 8-year-old daughter. The ice cream truck had just gone by and I had to say no.

Just a few days earlier our daughter had been diagnosed with Type 1 diabetes. She’d been put on a rigid insulin regimen and a meal plan that required her to eat a certain number of carbohydrates for each meal and snack, and we did not yet know how to dose insulin for “special occasions.” That day, as I held my daughter, stifling my own tears, I felt like her childhood innocence had been ripped away in an instant with her diagnosis. And to some extent that innocence had been ripped away from me, too.

The topic of healthful eating for children with Type 1 is a sensitive one. Feeding any child can be difficult; feeding a child with diabetes can be doubly so. Parents of kids with Type 1 do their best to encourage and model healthy eating while operating in a sleep-deprived and overwhelmed state, under the scrutiny of medical professionals who often provide conflicting information, and swimming upstream in a larger culture of unhealthy eating and judgment.

That’s why I cringed when I saw the title of Insulin Nation’s article, “Why Kids with Type 1 Are Fed an Unhealthy Diet.” Not another person telling us about the “diabetic diet” and how we are failing at properly feeding our children! On behalf of myself and all other parents with diabetes, I felt judged before I even read the article.

Interestingly, while I won’t claim we are the poster family for a healthy lifestyle, we are not half bad either. We rarely drink sweetened beverages, don’t keep junk food at home, encourage fruits and vegetables, minimize processed foods, and are physically active. We were relieved that we only needed to make fairly minor changes to our diet after our daughter’s diagnosis. The “diabetic diet,” it turns out, is not so different from regular healthy eating.

Yet we constantly question and judge ourselves and worry about not feeding our daughter an optimal diet. Are we kidding ourselves when we say that her diet is reasonably healthy? That ice cream, or pizza, or cookie – is it really only for special occasions or is it becoming more common? How bad is it that she eats cereal for breakfast almost every morning? How can we feed her more vegetables? How do we balance the need to restrict foods that wreak havoc with our daughter’s glucose control with her need to be a normal kid, unburdened by what her pancreas can no longer handle?

Eventually, curiosity won over my initial apprehension and I set out to read the full text of the study cited in the article. Not surprisingly, I first noticed what I consider to be the study’s flaws. The researchers defined healthy eating as meeting the USDA dietary guidelines. None of the children in the study met the “optimal score of 100,” mainly because of insufficient consumption of fruits and vegetables and higher than recommended consumption of empty calories. However, other studies demonstrated that children in the general population do not meet those same dietary guidelines, either.

The study does not differentiate between the ideal score of 100 and what can be considered “good enough.” Remember how I said earlier that we think our daughter’s diet is okay? So did most parents in the study. I would venture to guess that in our daily lives we do not define healthy eating as meeting the USDA ideal standards. Also, despite not meeting the dietary guidelines, the average A1C score for the study’s children was 7.8, only slightly above the recommended target of 7.5, indicating less than ideal but still decent glucose control. And, of course, let us not forget that diabetes management is so much more than a balance of carbs and insulin, especially with younger children.

All the shortcomings notwithstanding, the study won me over because its objective was not to shame and blame parents for feeding their kids with Type 1 a poor diet. On the contrary, at the heart of the study was a discovery of the disconnect between recommendations of medical professionals and the reality of feeding a young child with diabetes. The many barriers to healthy eating that the parents discussed – difficulty in getting the kids to eat new foods, time and financial constraints, insufficient nutritional education on meal planning as opposed to carb counting, and insulin regimens that lead to force-feeding the carbs to make up for insulin given – are all too familiar to all parents of kids with Type 1. Yet these issues are rarely addressed at doctors’ appointments. Parents are often told to make changes without any regard to how feasible they may be to implement in real life.

And then there is the big emotional factor about that “diabetic diet” – how do we protect our children from feeling different? All parents in the study voiced how difficult it is to keep their children eating healthfully when everyone else around them is eating and offering treats and junk food. It’s not the denial of diabetes diagnosis that makes parents give in to their children’s junk food requests; it’s the heartbreak of having to say no to a young child who does not understand why he or she can’t eat like everyone else. Healthcare providers need to understand and address this reality, and show genuine compassion for young children with Type 1 and their parents who are grieving the lost innocence of childhood.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Filming the ViaCyte Type 1 Stem Cell Experimenthttp://insulinnation.com/treatment2/cure-insight/filming-the-viacyte-type-1-stem-cell-experiment/ http://insulinnation.com/treatment2/cure-insight/filming-the-viacyte-type-1-stem-cell-experiment/#comments Mon, 01 Feb 2016 18:23:01 +0000 http://insulinnation.com/?p=310227 A pair of documentary filmmakers tracks the progress of the ViaCyte stem cell transplant project in “The Human Trial”.

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019_filming_the_type1_viacyte__stemcell_300pxResearch into possible functional cures for Type 1 diabetes is often open-ended, with no guarantee of success. The same can be said of documentary filmmaking, since the outcome of the story being told is often unknown when filming begins. A documentary in progress happens to combine the uncertainty of both endeavors in one project.

Lisa Hepner is a director of documentary films, and she has Type 1 diabetes. As she was recovering at the hospital in 2008 from a dangerous nighttime low, her business partner (and now husband) Guy Mossman said to her, “We should make a film about diabetes.”

By 2011, having moved from Brooklyn to Los Angeles, they began educating themselves about the medical research business, searching for a diabetes documentary project, and talking with medical researchers and people with diabetes who might be willing to come in front of their cameras. They found the opportunity in a stem cell implantation trial being organized in 2013 in San Diego.

“The public still knows very little about diabetes,” Hepner said in a telephone interview.

She and producer Angel Castillo believe that as treatment devices like pumps become smaller, and insulin pens make injections easier, it all makes daily maintenance more discrete, ultimately allowing a national public health problem such as diabetes to remain curtained in misunderstanding.

“That’s the great irony of it,” Castillo added.

Their non-profit company, Tenth Muse Films, hopes to raise the curtain in 2017 on The Human Trial, a film that will showcase the need for sustained philanthropic investment to bring about breakthrough technologies, in this case the implantation of self-regenerating pancreatic cells. Their first project is focused on ViaCyte, a San Diego biotech which is trying to use a novel approach to implant stem cells into people with diabetes that will mature into functional beta cells. (The filmmakers have no affiliation nor financial connection with any of the companies or entities appearing in the film.)

ViaCyte is testing a product identified as a VC-01 combination device. It’s a mesh pouch encapsulated in a pliable membrane which allows cellular material, metabolic fluids, and oxygen to migrate, but resists immune system T-cell invasion. T-cells in people with Type 1 often target implanted beta cells, making beta cell transplant a very frustrating treatment option.

The VC-01, dubbed the “teabag”, is designed to stop this destructive process. The pouch holds clusters of immature beta cells, glucagon, and nutrients for the cells. It’s about the length and thickness of a credit card, but half the width. Surgeons at UC San Diego and the University of Alberta have begun implanting it in live test subjects by making a small incision in the back. ViaCyte foresees six implantations of its VC-01 pouch in each patient to accomplish restoration of pancreatic function.

The beta cells ViaCyte uses originated with a single line of embryonic cell material harvested from an in vitro fertilization. Theoretically, this material, through laboratory regeneration, has the ability to supply hundreds of thousands of Type 1 patients with beta cells. If the cells prove able to self-regenerate once introduced to the body, there is the potential that this technology could benefit every person with Type 1 in the world. ViaCyte is careful to point out in its public communications and the film in progress that its cell material is not harvested from aborted fetal tissue.

019_filming_the_type1_viacyte_300pxViaCyte characterizes its trial as a test of safety, tolerability, and ability of the cells to withstand rejection, which is a risk associated with tissue transplantation. The FDA record of ViaCyte’s FDA submission also lists efficacy among its objectives.

The “teabag” approach taken by the ViaCyte addresses the thorny problem of educating stem cells. Stem cells generally need to be in an environment with mature cells to get the message as to how they are supposed to function. Eugene Brandon, project manager at ViaCyte, describes the VC-01’s mechanism of delivery this way: The pouch takes over the endocrine function of the diabetic’s non-functioning pancreas. In theory, the implanted cells do not need to migrate to the non-functioning pancreas to get the job done.

“The device delivers insulin and glucagon hormones into the circulatory system. The circulatory system will grow a dedicated blood supply for the product. The pancreatic progenitor cells that are delivered as the replacement islet cell therapy gradually differentiate into islet cell types, including beta cells, after being implanted. In animal models, glucose-responsive insulin secretion was observed two to three months after implant. The content of the pouch diffuses through the blood stream, just as do cells from a healthy pancreas, delivering insulin to tissue,” Dr. Brandon said.

ViaCyte’s FDA filing discloses a four-year time frame for implantation in a total of forty patients in the California and Alberta cohorts. In the U.S., it can take $5 billion to bankroll research and development of a drug or device, shepherd it through conventional, statistically measured, phased clinical trials, and only then take its chances at success on the U.S. market. When ViaCyte submitted its FDA filing in September 2014, only two other embryonic stem cell human trials had ever been given the green light in the U.S., and only five others in the world. FDA granted expedited review of the proposal, and cleared the human trial in 2014. Canada followed with its go-ahead in January of 2015. At the time we spoke with the filmmakers in late 2015, one American and two Canadian patients had undergone the implant surgery.

The film project, The Human Trial, doesn’t follow a screenplay with a happy ending. The filmmakers are working without any guarantee that their venture will break even. For Tenth Muse Films, it’s a pro bono mission, Castillo says, which is now entering its third year. Once the surgical trials commenced, the shooting schedule essentially went out the window.

“We‘re filming in real time, as progress is made. So we don’t know what the end point for filming is,” Lepner says. “There’s a tipping point out there, and we are someday going to have to decide that the film is ready for release.”

To see the trailer for the work in progress, go to The Human Trial.

Editor’s Note – This article has been edited to clarify that Tenth Muse Films is not financially or otherwise connected to the ViaCyte company. Also, an earlier version of this article incorrectly named Vox Pop Films as the non-profit funding the documentary; Vox Pop is actually one of several production companies working on this documentary.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Private School Expels Child With Type 1http://insulinnation.com/living/private-school-expels-child-with-type-1/ http://insulinnation.com/living/private-school-expels-child-with-type-1/#comments Fri, 29 Jan 2016 19:22:13 +0000 http://insulinnation.com/?p=310218 Parents file a lawsuit that may test the reach of disabilities law in the private school setting

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shutterstock_121588291_school_hall_300pxRecently, a parent revolt at a private church-affiliated school in Charlotte, North Carolina has morphed into a lawsuit under that state’s disability discrimination law. It’s alleged that two children, one diagnosed with a chronic abdominal migraine disorder and one with Type 1 diabetes, had been expelled from the Calvary Church private school in Charlotte because of their conditions.

Calvary Church officials have not commented on the lawsuit, but based on information provided by the parents it appears that the school’s position is that daily care for two students places an unreasonable burden on school resources. The school does not employ a full-time nurse, and it’s alleged that a teacher threatened to resign if the parent of the child with diabetes would come into the classroom to assist with care. The school’s parent handbook, obtainable online, stated that the school would administer all prescription medication, if under orders from physicians and with parental authorization.

North Carolina statute law recognizes an obligation, at least on the part of public schools, to offer care for children with diabetes, providing that “[i]t is within the scope of duty of teachers, including substitute teachers, teacher assistants, student teachers, or any other public school employee when authorized by the board of education or its designee, (i) to administer any drugs or medication prescribed by a doctor upon written request of the parents …” The statute also provides a training requirement and a “Good Samaritan” shield from liability in administration of care. North Carolina is listed in the American Diabetes Association’s digest of state school diabetes care laws as one permitting unlicensed, but trained and authorized, personnel or volunteers to administer insulin and perform related care tasks, even though the statute does not specifically address diabetes care.

The lawsuit filed by the parents cites North Carolina’s Persons With Disabilities Act, which mirrors the Americans with Disabilities Act in providing protection to individuals with some medical conditions in employment, in access to public accommodations, and in access to government-sponsored services and benefits. The federal law does reach to schools, but includes certain exemptions for private and religious organizations. The North Carolina lawsuit highlights the part of the state law which outlaws discrimination by places of public accommodation, which is defined to include any facility or other establishment “which solicits or accepts the patronage or trade of any person.” So, one question to be decided in this complaint will be whether a private school for 800 toddlers and kindergartners is a business which offers its services and benefits to the public.

In a telephone interview, Josh Van Kampen, a lawyer who represents the parents of the two children who were expelled from school, said that the state law “fills a void left by the federal [Americans with Disabilities] law.”

The complaint alleges that the school, which claims immunity under the federal law, performs a service which “the overwhelming majority of comparable schools” in the city, and subject to the federal anti-discrimination requirements, perform. Further, the complaint states, the school “could voluntarily abide by these laws that protect disabled children … [i]t could add disability to its non-discrimination policy; it hasn’t. Accordingly, these families turn to North Carolina law and this Court for recourse.”

The attorney for the school has declined to comment to Insulin Nation and other news organizations on the lawsuit, citing his preference not to discuss a matter in litigation. At publication time, the deadline for the school to answer the complaint had not come.

The North Carolina suit will test the reach of that state’s education and anti-discrimination law into the private school setting. And, as we’ve mentioned in earlier installments of our series on diabetes care in schools, the reach of federal law into private schools will likely remain unsettled for some time to come.

UPDATE – 2/3/2016 – The two families have started a Change.org petition calling for the school to not discriminate. You can sign it here.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Type 1 Teddy Bear Wins IBM Awardhttp://insulinnation.com/treatment2/type-1-teddy-bear-wins-ibm-award/ http://insulinnation.com/treatment2/type-1-teddy-bear-wins-ibm-award/#comments Fri, 29 Jan 2016 19:03:21 +0000 http://insulinnation.com/?p=310213 Sproutel’s interactive creation now can help kids with allergies, too.

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jerry_bear_300pxThis past year, IBM hosted a webseries, New Way to Startup, a competition among startup companies to use new technology to help humanity. The 2015 winner of the competition may be familiar to the Type 1 community, as it was the creators of a teddy bear that teaches kids how to deal with Type 1 diabetes, among other conditions.

The show started out with ten up-and-coming millennial-run startups that were focused on solving health problems. After pitching ideas at SXSW, five teams were invited to Austin, Texas to participate in a series of accelerated challenges. Using IBM tools to increase outreach through social media platforms and getting advice from mentors, teams made a final presentation explaining what they learned and how they re-worked their business models. Sproutel, a company aiming to educate children about managing chronic illness and healthy living with a teddy bear, was named the winner, based on a combination of scores from mentors during challenges, judges’ scores from final presentations, and votes cast from social media.

Many in the diabetes community already know of this teddy bear, named Jerry. Jerry has been used over the past couple of years to help children newly diagnosed with Type 1 come to terms with the condition and practice diabetes self-care as reported in Insulin Nation’s 2014 profile story.

Sproutel co-founder and CEO Aaron Horowitz said the idea was spawned (or sprouted) when he and co-founder Hannah Chung observed kids dealing with their own chronic conditions by simultaneously treating themselves and their beloved stuffed animals. Thus was born Jerry the Bear, a plush teddy bear that holds a device between his paws to educate kids about health and wellness, Type 1 diabetes, or allergies. The diabetes version of the bear allows kids to monitor Jerry’s blood-glucose levels and administer insulin injections all while learning how to count carbs and recognize diabetic symptoms.

The item is available for preorder here and has a projected shipment date of June 2016. The Type 1 bear costs $199 and includes a backpack, an insulin pen, animated storybooks, and more. You can also check out Jerry the Bear on Facebook, and watch the entire web series that featured Sproutel from their first SXSW pitch to their eventual startup competition victory here.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Type One – the Web Comedyhttp://insulinnation.com/living/profilesinterviews/type-one-the-web-comedy/ http://insulinnation.com/living/profilesinterviews/type-one-the-web-comedy/#comments Thu, 28 Jan 2016 18:47:21 +0000 http://insulinnation.com/?p=310208 A pair of young comedians from Chicago set out to educate the mainstream on the misconceptions about Type 1 diabetes.

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ScreenShot_Type1_Comedy_300pxA pair of young comedians from Chicago have decided it’s time to educate people about the misconceptions surrounding Type 1 diabetes. Type One, an online web series produced by LVL Productions and created, written, and directed by Landis Wiedner and Mike Seskauskas, focuses on Matt, a young man in Chicago “looking for love…and a solid A1C.”

The web series uses comedy as a means to dismantle traditional bias and stereotypes around Type 1 diabetes by hyperbolizing the daily struggles of someone with the condition. From insulin injections to struggling with the young dating scene, Type One analyzes the common frustrations of a young person with Type 1 and educates with a laugh.

“[Type One is] first and foremost a comedy,” Wiedner said. “What it does is twofold; it uses humor to educate people about Type 1 diabetes and secondly, it helps to connect the community of people who have Type 1.”

The condition, Wiedner explained, is not commonly represented in mainstream media. This leads to stereotypes and common misconceptions around treatment and lifestyle. These are the stereotypes the show aims to eliminate.

“What struck me was the lack of knowledge people had about this disease,” Wiedner said. “We’re just showing some of the ins and outs of living with Type 1 with a heightened sense of reality. This is not a how-to program.”

Wiedner and Seskauskas originally had the idea to create Type One a little over a year ago, but didn’t begin buckling down on writing and filming until summer 2015. The pilot came together over three days of filming, and was the duo’s first foray into the film and production industry.

“It was a lot of fun,” Wiedner said. “We had a great time on the set.”

While neither Wiedner nor Seskauskas have diabetes, both have close connections to the condition. Wiedner’s sister was diagnosed with Type 1 at age 10, and Seskauskas has a close friend who was diagnosed at age 15. It was through seeing how misconceptions affected the lives of their friends and family that Wiedner and Seskauskas became passionate about eliminating Type 1 stigma.

The team is working with Beyond Type 1, an organization for Type 1 diabetes health. According to Wiedner, Type One was able to raise $4,000 for the organization with the show already, and they have plans to continue to give proceeds to the organization as the show begins to generate revenue.

A Kickstarter campaign has funded the show so far. The team reached their goal of $48,000 for production, which will go a long way in helping them reach their eight-episode goal. Each episode costs about $7,000 to shoot and edit. The team has seven more episodes written and plans to continue filming later this spring, releasing episodes in late summer/early fall of 2016. Interested viewers can watch the pilot episode of Type One here.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Glucagon Patch Performs Well in Phase II Trialhttp://insulinnation.com/treatment2/glucagon-patch-performs-well-in-phase-ii-trial/ http://insulinnation.com/treatment2/glucagon-patch-performs-well-in-phase-ii-trial/#comments Mon, 25 Jan 2016 20:04:58 +0000 http://insulinnation.com/?p=310204 A microneedle glucagon patch is competing with several other treatments to treat injectable glucagon.

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shutterstock_308293010_Glucagon_patch_300pxIn 2015, the pharmaceutical company Zosano Pharma conducted a Phase II trial on a glucagon patch to test the patch’s safety and efficiency. The small trial, which represented an important step forward towards getting FDA approval, yielded positive results. Researchers found that applying two glucagon patches was just as effective at combating hypoglycemia as two intramuscular injections of a glucagon solution.

Although the patch’s overall design has been kept under wraps, it can be conjectured that the microneedles on the patch are coated in glucagon, which is injected into the body when the patch is applied. There are several efforts to come up with more user-friendly approaches to reversing hypoglycemia. In 2015, there was a successful study that used formoterol, traditionally an oral asthma medication to treat hypoglycemia. Also, Lilly acquired the rights to a nasal glucagon spray that has proven very effective in human trials. For now, injectable glucagon, which can be challenging to administer in crisis situations, is the only option on the market.

Though Zosano Pharma declined to comment on the Phase II results, what we do know is that a Phase III clinical trial, while tentative, is expected to start at some point in 2016.

Patch not pictured here.

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Early, Underweight Babies May Face Greater T1D Riskhttp://insulinnation.com/treatment2/early-underweight-babies-may-face-greater-t1d-risk/ http://insulinnation.com/treatment2/early-underweight-babies-may-face-greater-t1d-risk/#comments Mon, 25 Jan 2016 14:54:23 +0000 http://insulinnation.com/?p=310195 A study examining 36 years of data finds a link between gestational age, birthweight and risk of Type 1 diabetes diagnosis.

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A statistical survey of live births in Sweden between 1973 and 2009 reveals that early gestational age and lower-than-average birth weight may be linked to the development of Type 1 diabetes. In other words, shutterstock_208386961_Early_Babies_greater_T1D_risk_300pxresearchers say they have established a strong link between premature births, lower-than-average birth weight, and elevated risk of developing Type 1.

The study recently published in Diabetes Care looked at 3.6 million single births recorded over 36 years. Lead author Dr. Ali Khashan of University College of Cork (Ireland) explained that earlier smaller population studies searching for a similar link yielded inconsistent or contradictory results. The broader census of essentially all live births in Sweden helped provide data to track patterns of the approximately 11,400 children who received a Type 1 diagnosis during the 36-year period. Researchers then matched the health records of those who developed Type 1 to those of their nearly 18,000 siblings to control for prevalence of diabetes in families. This helped researchers flag gestational age and weight as factors that could possibly indicate a risk of Type 1 development.

Some of the findings were surprising. For example, babies born early, but not too early, were shown to be at greater risk of developing Type 1 than those born very early and/or very light in birthweight. Dr. Khashan speculated in an interview with Medscape Medical News that the tendency toward diabetes risk in early-term babies may result from organ growth restriction while in the womb, or changes in the fetal gut microbiota, which may influence insulin resistance closer to the baby’s time to be born.

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Florida Triathlete Champions Type 1 Screening Billhttp://insulinnation.com/living/profilesinterviews/florida-triathlete-champions-type-1-screening-bill/ http://insulinnation.com/living/profilesinterviews/florida-triathlete-champions-type-1-screening-bill/#comments Mon, 25 Jan 2016 14:28:06 +0000 http://insulinnation.com/?p=310187 12-year-old Luke Rosser doesn’t want anyone else to go through DKA before being diagnosed.

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Luke Rosser at 2015 Championships.   Used by permission_300px

Triathlete Luke Rosser’s Type 1 diagnosis a year ago has motivated him, and his mom Meredith, to begin a lobbying effort in the Florida Legislature for a bill to encourage better Type 1 diabetes screening among medical professionals in the state. The proposed measure would be modeled after a similar bill in North Carolina, known as Reegan’s Rule.

Luke, age 12, has launched a Facebook page to tell the story of his brush with diabetic ketoacidosis from undiagnosed Type 1 and to urge lawmakers to strengthen early screening for Type 1 diabetes. The Rosser Family wants Florida to mandate blood glucose screening for newborns, with a requirement for further testing at wellness visits through age 17.

This is an ambitious cause. The North Carolina bill filed in January 2015 to mandate infant and toddler screenings yielded a compromise bill which encourages physicians to educate parents of children through age six about the symptoms and dangers of diabetes. Pennsylvania followed suit with a resolution similarly encouraging parent education and stopping short of enacting any mandate. Nevertheless, these measures are viewed by diabetes advocates as significant first steps to stop needless deaths from the unrecognized onset of Type 1.

Luke is a nationally ranked triathlete and a competitive swimmer. He began to feel what he thought was the flu gradually coming on in the week leading up to a swim meet. There were other changes in Luke’s physiology that no one caught.

“I was hungry all the time, but I didn’t want to eat,” Luke said. “I was weak and shaky.”

Luke’s parents and coaches, not thinking of the possibility of diabetes, wondered if Luke might just have been overtraining.

“No one in our family had diabetes,” Meredith says. “We had no idea what it looks like.”

Then, when the vomiting and the thirst set in, and Luke had trouble staying awake, a trip to the hospital yielded a blood sugar reading which maxed out the meter at 1400 mg/dL. An endocrinologist was brought in, who quickly recognized Luke’s symptoms and went to work to stabilize him.

Meredith and the doctor are convinced that they might have lost Luke if he hadn’t been an athlete on a training diet and following a rigorous training regimen. Meredith would know; she and her husband Steve are also triathletes, and she has been working for five years as a coach and trainer. A less durable kid, she believes, might not have bounced back, or could have slipped away undiagnosed.

Luke admits that he drifted into a “life’s over” frame of mind soon after he was diagnosed. Then he met Chris Clark, fellow Floridian and the first man with Type 1 to win the three-day Ultra Man competition. Clark invited Luke to lock arms for the final hundred yards of a running heat. Luke has formed friendships with Clark, and with Ironman Jarrod Shoemaker, who accompanied Luke on the ADA 2015 Step Out to Stop Diabetes.

“Chris Clark came into our lives and turned all this on its head,” Meredith says. “He’s our angel.”

Luke’s six-days-a-week training regimen has him swimming two miles, on his cycle for three to six miles a day, and running four miles daily. He returns to the Triathalon Nationals in Ohio come August. He also is in qualifying events for state swimming championships and will compete in the State Triathlon Championships in June. And, yes, the Olympics are his objective.

Luke is preparing to make his debut as a lobbyist. Meredith has begun cultivating relationships with the American Diabetes Association and JDRF, and networking online with other diabetes moms to learn the legislative ropes. Her husband Steven, a civil engineer and land developer, is working through his business contacts to become acclimated to statehouse politics. For the Rosser Family, this will be an all-hands-on-deck mission.

“I’m going to be loud, and I’m not going away,” Meredith said.

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Medtronic to Build Pump Factory for Chinese Markethttp://insulinnation.com/devices/pumps-cgm/medtronic-to-build-pump-factory-for-chinese-market/ http://insulinnation.com/devices/pumps-cgm/medtronic-to-build-pump-factory-for-chinese-market/#comments Thu, 21 Jan 2016 19:02:51 +0000 http://insulinnation.com/?p=310182 The move comes as health care companies rush to provide treatment options for the growing diabetes epidemic in China.

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shutterstock_251324323_medtronic_pumps_china_300pxPump-maker Medtronic recently announced it will be expanding its insulin pump operations in China. According to a Fierce Medical Devices report, Medtronic plans to build a manufacturing plant in Chengdu that will create next-generation versions of the insulin pumps and sensors the company currently offers in China. Alejandro Galindo, who heads Medtronic’s diabetes device division, said the new plant’s location is advantageous because Chengdu is a global medical technology hub.

The move reflects growing awareness among health care companies of the lucrative Chinese market for diabetes devices and supplies. Dr. Cesar Chelala, an international health consultant, writes in the political journal Counterpunch that market comes at the cost of a growing health epidemic in China.

“Twenty-five years ago, the number of people with diabetes in China was less than one percent. Today, China has more than 114 million people suffering from the disease, the highest number of any country in the world,” Dr. Chelala writes.

The Medtronic announcement indicated that the device will display information in the “Chinese language”, but it was not clear if this would include both Mandarin and Cantonese, the main dialects spoken in China.

The most recent announcement from Medtronic also didn’t specify the exact devices that will be manufactured in the new facility, but Medtronic officials said the devices will use the same SmartGuard technology used in the company’s MiniMed 640G glucose monitor and pump.

The 640G is not available in the U.S. market, and it does not appear that Medtronic has filed for approval for the device system with the FDA. In 2015, the FDA warned that there was a flaw detected in the 640G system that caused the device to not refresh bolus readings properly.

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Does Bribing Teens With Type 1 Work?http://insulinnation.com/treatment2/does-bribing-teens-with-type-1-work/ http://insulinnation.com/treatment2/does-bribing-teens-with-type-1-work/#comments Wed, 20 Jan 2016 16:18:25 +0000 http://insulinnation.com/?p=310121 A study seems to suggest teens who have trouble with diabetes self-care will shed their blood for pay.

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shutterstock_339464531_teen_money_bank_300pxThe teenage years can be a tough time for blood sugar control, as parents must slowly cede control of blood sugar testing to teens, who may or may not want the responsibility. This, plus raging hormones, can lead to some soaring A1C scores. Many parents are looking for ways to get teen offspring to take diabetes self-care seriously.

A small study suggests bribing might work. The study, led by Dr. Nancy M. Petry of the University of Connecticut School of Medicine and colleagues from the Yale University School of Medicine Pediatric Endocrinology, focused on using monetary rewards to motivate 10 young people with a history of poor blood sugar control to test more often. The test offered $.10 per test for the youths, with bonuses for conducting more than four tests per day.

On average, daily testing went up from 1.8 tests per day to 4.9 tests per day, and 90 percent of participants regularly did four or more tests per day. The findings suggest that monetary motivation is an effective method to inspire some young people to improve their diabetes self-care. For just $10 a week, parents can entice their children to test more often; that $10 is a much lower price-tag than the costs of hospital stays and long-term complications. Of course, the hope is that more testing will lead to better overall choices in diabetes self-care among teens.

The study was tiny, involving just 10 participants, so the findings of such a study can only be categorized as preliminary. A good next step might be for researchers to expand this study to include more participants to see if the results are the same.

While some parents may understandably balk at bribing teens to take care of themselves, others might find $10 a week a good price for reinforcing a vital habit in diabetes self-care.

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Infusion Set Rotation is a Really Good Ideahttp://insulinnation.com/devices/pumps-cgm/infusion-set-rotation-is-a-really-good-idea/ http://insulinnation.com/devices/pumps-cgm/infusion-set-rotation-is-a-really-good-idea/#comments Tue, 19 Jan 2016 16:37:13 +0000 http://insulinnation.com/?p=310110 A certified diabetes educator shares a system to help pump users avoid a lot of scar tissue.

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shutterstock_211893655_infusion_set_rotation_300pxIntegrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dietitians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community.

Q – I’m a relatively new pump user, and I’m starting to have trouble finding good sites for my infusion sets. Can I just go back to my favorite ones?

Overuse of infusion sites can cause scar tissue to develop if the areas are not rotated well. Over the years, having only a few sites in use will cause damage to the tissue under the skin and the area will become hard, decreasing insulin absorption.

Rotation of sites is very important – there are many places on the body to insert an infusion set – all of them have to be rotated regularly to maintain the integrity of the skin. To prevent the development of skin problems that could impair insulin absorption, rotate infusion sites in an organized fashion.

Try this system – identify nine possible sites on the left side of the abdomen and number them 1-9 in a chart. Do the same on the right side and label them 10 – 18, with numbers increasing as you move from the outer to the inner part of your abdomen, like this:

(left side of abdomen)

1  2  3
4  5  6
7  8  9  

(right side of abdomen)

12 11 10
15 14 13
18 17 16

Use each numbered site for 3 days before moving over 2 inches to the new site. It is also important on the abdomen to stay at least 3 inches away from the belly button on all sides. This area may not allow consistent absorption of insulin.

You don’t need to stay on the abdomen, of course. Rotate also between different areas of the body. The thighs are a good area – again, ensure proper site rotation (every three days) and allow ample time before returning to the same site. Try to use the lower back above the beltline (the love handle area) or even the upper butt. For those using tubeless pumps, the back of the arms is another alternative. When alternating, aim to use all sites on that part of the body before moving onto a new body part. This will ensure sites don’t get overused.

Keep the area that you last used clean after a site change. Apply an over-the-counter Polysporin or Neosporin type of antibiotic ointment and then cover the site with an adhesive bandage for 24 hours to speed the healing process and decrease the chance of scar tissue.

For the sites that do have scar tissue, avoid use of these areas for quite a while. The scar tissue still may never go away. Regularly massaging the hardened areas can help break up the scar tissue, much like massaging a stiff muscle. The massage would need to be done daily for awhile in order to notice a difference.

While scars may last forever, the more you can set up a system for rotation, the less likely it is that you will develop lasting scar tissue.

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 integrateddiabetes.com or write info@integrateddiabetes.com.

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U.S. Investigator with Type 1 Still Missinghttp://insulinnation.com/living/u-s-investigator-with-type-1-still-missing/ http://insulinnation.com/living/u-s-investigator-with-type-1-still-missing/#comments Mon, 18 Jan 2016 20:09:14 +0000 http://insulinnation.com/?p=310101 Robert Levinson, who unofficially was working for the CIA when he went missing, was not part of a recent prisoner swap between Iran and the U.S.

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008_US_investigator_withtype1_still_missing_300pxOn Saturday, January 16, Iran released four United States’ citizens formerly held in detention in a prisoner swap held after a deal was struck to halt Iran’s nuclear weapons program. However, the whereabouts of U.S. citizen Robert Levinson, who has Type 1 diabetes and has been imprisoned in Iran since March 2007, remain unknown; Levinson also suffers from hypertension and gout. Levinson, if alive, would currently be 67.

A retired FBI agent, Levinson has worked with the DEA primarily on thwarting Russian organized crime in New York and Florida. A report from The Guardian reveals that the first government report, after his incarceration explained that Levinson was in Iran as a private investigator investigating cigarette smuggling, and garnering intelligence for the book he was supposedly writing on Russian organized crime. In a later investigation, it was revealed that Levinson was in fact working as an unofficial consultant with the CIA under a government contract. On assignment, he uncovered sensitive information concerning Iran’s future nuclear program. Uncovered in email correspondence, Levinson explained his plan to meet a potential informant, Dawud Salahuddin, to discuss Iranian corruption and terrorism. Levinson met his contact, officially checked out of his hotel on March 8th, and is believed to have been apprehended by Iranian authorities.

In the years since his detention, Levinson’s family has received a single, 54-second video and a short series of photographs. The proof-of-life video, received in November 2011, shows Levinson had lost weight. In the video, he pleads, “I have been held here for three and a half years. I am not in very good health. I am running very quickly out of diabetes medicine… Please help me get home.”

The photographs released five months later show Levinson with a full beard wearing an orange jumpsuit and chains around his neck, and holding a series of crudely made signs. Since the photographs, his family has received no official word on Levinson, his health, or any treatment.

The video and photographs were traced and examined for potential leads by American authorities; when no clues were found it was concluded that whoever sent the video had to be professional. This led to the belief by many that he was imprisoned by a professional intelligence agency in Iran. The Iranian government adamantly expresses that they do not know the location of Levinson, but they are willing to work with U.S. authorities in the search.

The video and photographs show that at one time Levinson was receiving at least minimum medication to survive, which must have included the insulin. As anyone with Type 1 can attest, there is a lot more needed for proper treatment than just insulin, however. The video shows he is thinner, which could be attributed to lack of adequate insulin treatment, but could also be the result of many other physical stressors of being held in captivity. If Levinson is receiving adequate treatment to stay alive, but not to stay well, he could be enduring significant complications and physical discomfort because of his Type 1 diabetes.

It has been four years since any word has been heard from Levinson or his captors. One can only hope that this new period of openness between Iran and the U.S. will lead to his release, or at least a final determination of his fate.

In March 2015, the FBI raised its reward for information leading to Levinson’s return home; tipsters can now receive up to $5 million for useful information that leads to his safe return. Levinson’s family also maintains a website asking for information on his whereabouts. You can go to https://www.fbi.gov/news/news_blog/reward-increased-to-5-million-in-robert-levinson-case or http://www.helpboblevinson.com/ for more information.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Try Type 2 Nation – Our Sister Publicationhttp://insulinnation.com/treatment2/try-type-2-nation-our-sister-publication/ http://insulinnation.com/treatment2/try-type-2-nation-our-sister-publication/#comments Mon, 18 Jan 2016 08:53:44 +0000 http://insulinnation.com/?p=309957 Want to learn more about news and views on Type 2 diabetes? Go to www.type2nation.com.

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Did you know that Insulin Nation has a sister publication in Type 2 Nation? At type2nation.com, you can get the same depth of diabetes coverage you can find on Insulin Nation, but with a Type 2 focus.

Why are we telling you about this here? It’s because we know that some people with Type 2 diabetes are on insulin therapy, and some people with Type 1 have family members with Type 2. The diabetes community is a big tent, so that’s why we want to spread the word, and hope you will, too.

Click below to get a look at what Type 2 Nation has to offer:

Try_sister_site_type2nation_300px

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Family Therapy Helps Depressed Teens with Type 1http://insulinnation.com/treatment2/family-therapy-helps-depressed-teens-with-type-1/ http://insulinnation.com/treatment2/family-therapy-helps-depressed-teens-with-type-1/#comments Fri, 15 Jan 2016 14:12:19 +0000 http://insulinnation.com/?p=310008 Researchers find such therapy improves blood sugar control, lessens depression for teens struggling with diabetes management.

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shutterstock_267505091_family_therapy_for_teens_300pxManaging Type 1 diabetes is tough: add in depression and teenagehood, and blood sugar management becomes extremely difficult. Researchers are beginning to uncover ways to support teens with Type 1 who may be suffering from depression, and this support can lead to better blood sugar control over time.

A recent study published in Diabetes Care shows promising results. The study, led by pediatric psychologist Dr. Andrew R. Riley of the Oregon Health & Science University showcases the benefits of Behavioral Family Systems Therapy for Diabetes (BFST-D). This therapy treats the individual in the context of his or her family; therapists work to strengthen relationships and communication between family members to help an individual choose healthier behaviors and deal with challenges of depression.

For this study, therapy was delivered through videoconferencing or in-person meetings. Researchers found that helping to strengthen the support system of a teen with Type 1 led to better blood sugar control. It was equally successful in both videoconferencing and in-person meetings.

“In addition to improving treatment adherence and glycemic control, BFST-D has collateral benefits on depressive symptoms,” writes Dr. Riley.

Depression is an issue for many people with diabetes. According to a 2011 study published in Psychosomatics, depression affects approximately 17% of the general population, a number that can double for those with diabetes. Add in the complications of the teenage years, and it’s easy to see how teens can be overwhelmed by mounting pressures surrounding their diagnosis.

“Depression in patients with diabetes is associated with poorer adherence and worse health outcomes,” writes lead researcher Sarah Markowitz, a psychologist with ties to Harvard Medical School. “However treating depression may help improve these outcomes.”

The results of Markowitz’s study show how good mental health and a positive outlook can make a significant difference in dealing with a chronic condition like diabetes.

“If… a patient can learn to reframe his or her thoughts to see diabetes self-care as a positive step toward taking care of his or her health, he or she may experience a sense of mastery, and thus mood improvement, from engaging in diabetes self-care activities,” Markowitz writes.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Why Kids with Type 1 Are Fed an Unhealthy Diethttp://insulinnation.com/living/why-kids-with-type-1-get-fed-unhealthy-food/ http://insulinnation.com/living/why-kids-with-type-1-get-fed-unhealthy-food/#comments Wed, 13 Jan 2016 20:14:21 +0000 http://insulinnation.com/?p=309997 A new study finds a deep-rooted reason why some parents can’t fully embrace a diabetes-friendly diet for their children.

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shutterstock_149608760_girl_eating_pizza_300pxA child’s Type 1 diagnosis is a life-altering experience for a family, one which requires a fundamental rethinking of the familial diet. Unfortunately, many parents have trouble providing a healthy meal plan for children with Type 1, even with appropriate nutritional training.

That was the key finding of a recent study published in the Journal of the Academy of Nutrition and Dietetics. The small study focused on 23 families from the midwestern U.S. with young children (ages 1-6) who had been diagnosed with Type 1 within the past six months. Parents filled out a questionnaire, kept a three-day diet journal, and were asked how they defined healthy eating.

In an interview with Insulin Nation, lead researcher Susana Patton, an Associate Professor at the University of Kansas Medical Center, says the goal of the study was to more clearly define why parents were unable to keep children on an appropriate diet for diabetes management.

“We wanted to quantify what parents were perceiving and telling us so we could see how [buying diabetes-healthy foods] was a barrier for them,” says Patton.

Participants responded with some more obvious reasons for not being able to provide a diabetes-healthy diet, including the distraction of adjusting to diabetes care, the financial burden of buying healthy food, and a lack of time to cook healthy meals. Another problem that emerged, however, was a psychological block parents felt toward accepting their children had Type 1; parents reported that they didn’t want their kids to “feel different” from other kids, so they often gave in to demands for unhealthy foods.

The study results point to the need for incorporating psychological and behavioral strategies in diabetes nutritional education courses, says Patton. It’s important to get a complete picture of what families of newly diagnosed children are going through and design nutrition programs that fully meet their needs, she says.

“This study validates the concerns that families have and gives us an appreciation for what kind of impact families might experience when we ask them to make changes in diet,” Patton concludes.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Stuff a Hipster with Type 1 Might Sayhttp://insulinnation.com/living/stuff-a-hipster-with-type-1-might-say/ http://insulinnation.com/living/stuff-a-hipster-with-type-1-might-say/#comments Mon, 11 Jan 2016 18:40:17 +0000 http://insulinnation.com/?p=309990 We came up with 5 quotes. Can you add to our list?

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005_diabetes doge memeFrom composting to toast, the ubiquitous hipster is always trying to jazz up aspects of daily life, discover what’s cool before it becomes cool, and look nonchalant while doing it. That got us thinking of what a hipster with Type 1 might sound like.

Here are 5 things we think a hipster with Type 1 might say about his or her condition:

1. “I prick my finger like 1,000 times a day.”

2. “I wore a CGM before it was FDA approved.”

3. “Do you want to see a diabetes meme I made?”

4. “I keep a small supply of insulin in the fridge of a Starbucks I frequent so I can take a shot of it to bolus for my PSL. Oh, that’s short for Pumpkin Spice Latte.”

5. “I literally can’t with my endo sometimes.”

Now it’s your turn. Submit your best hipster diabetes quote to our editor, Craig Idlebrook (cidlebrook@epscomm.com) and we’ll add it to this article. Do it before this article gets discovered and literally everybody wants to do it.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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The Three Glendale Police Officers with Type 1http://insulinnation.com/living/profilesinterviews/the-three-glendale-police-officers-with-type-1/ http://insulinnation.com/living/profilesinterviews/the-three-glendale-police-officers-with-type-1/#comments Mon, 11 Jan 2016 18:14:37 +0000 http://insulinnation.com/?p=309985 James Calderon, Taylor Carr, and Derek Johnston have become a prime example of the ability of people with Type 1 to protect and serve.

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004_three_glendale_police_300pxRecently, an Arizona police department launched a campaign during Diabetes Awareness Month to let people know it’s hiring twenty officers, and that people with diabetes are welcome to apply.

The Glendale, Arizona police department has been using its Twitter account to initiate a community outreach effort featuring three accomplished officers with Type 1 from the force. In telephone interviews in December and January, we spoke with two uniformed officers, James Calderon and Taylor Carr, and Derek Johnston, a family services detective. Combined, the trio has been serving Glendale for more than 20 years, without any hiccup in their service or their health.

Calderon, a native of suburban New York City, aspired to be a pilot in the Armed Forces, but was turned away after his medical review.

“It was ‘You can’t do this. You’re a Type 1 diabetic,’” he says.

The New York Police Department also declined to consider him for a post. Then a friend who had become a police officer in Virginia encouraged him to apply for a position in Roanoke. After graduating from a regional Virginia police academy and beginning his law enforcement career in that state, he learned of openings in Phoenix and Glendale. Glendale responded first to his applications, and he made the move. He has been a patrol officer for a dozen years, and now serves as an in-service training officer.

Carr, an Arizona native, was given a Type 1 diagnosis at the age of 11. It was quite an adjustment for him and his family.

“I wound up in the hospital for two or three days,” Carr says. “No one in my family had ever had Type 1 or Type 2.”

Carr had dreamed of military service as a child, but found the possibility of entering the armed forces increasingly unlikely. Instead, he entered Northern Arizona University to study psychology. It was there that he was prodded to pursue a career in law enforcement.

“It was an after-class meeting with a professor, who’d been an officer and with the FBI. I’d given up being a police officer, too, because of my diabetes,” Carr says. “Then he said, ‘No, what are you talking about?’ He knew officers and agents with diabetes.”

Carr changed his major to criminal justice, applied to the Yuma Police Department, and went to the Police Academy for recruit training. He started work with another force in the state before joining up with the Glendale force two and a half years ago. The move meant he worked near where he grew up. He’s an alumnus of Camp AZDA, a diabetes camp where he also served as a counselor for five years; he also has been a fundraiser for annual diabetes walks.

“Camp changed my life, so I need to give back,” he says.

Johnston is a Phoenix-area native who was diagnosed with Type 1 at age 14. He studied criminal justice at Glendale Community College and Arizona State University before entering the Arizona Law Enforcement Academy. He has been an officer since 2005, and now works in the Department’s Family Violence Unit. Johnston says his fellow officers have been very supportive as he manages his diabetes and the demands of the job.

“Every supervisor has always said, ‘Do whatever you’ve got to do to keep yourself healthy and safe,’” Johnston says.

Carr echoed Johnston’s observations about the Department’s collegial atmosphere and support.

“Both of my sergeants have always said, ‘Don’t worry about taking a break when you need to,’ even if I’m responding to a call.”

Carr says he has felt lows coming on while on duty, but he’s always kept things in control.

“I have a little bottle of maple syrup from the Cracker Barrel on the seat in case I need it.”

The three report that their personal experience with Type 1 has helped them better navigate diabetes-related issues in their police work. Calderon said he teaches recruits and other offices how to recognize signs of diabetic distress at traffic stops and during emergency calls. He’s also used it to bust an impaired driver who offered a phony diabetes ploy to try to avoid a DUI arrest.

“I asked him what kind of insulin he used,” Calderon says.

The police department’s decision to hire people with diabetes, and to talk up that hiring policy, is a refreshing change. Hopefully, it will nudge other less-inclusive law enforcement department units to follow suit.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Readers Suggest a Diabetes Naughty-or-Nice Listhttp://insulinnation.com/living/readers-suggest-a-diabetes-naughty-or-nice-list/ http://insulinnation.com/living/readers-suggest-a-diabetes-naughty-or-nice-list/#comments Wed, 06 Jan 2016 16:45:37 +0000 http://insulinnation.com/?p=309977 A post-Christmas look at who deserves coal in their stockings next holiday season.

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shutterstock_1643969_hand_in_fridge_300pxThe holiday season may be over, but readers have been responding to our 2015 Naughty or Nice list with their own takes on who deserves what in Christmas stockings. See if you agree with their naughty-or-nice list:

“The creator of Downton Abbey had a character name auctioned off to benefit JDRF. Although it happened in 2014, the episodes featuring Atticus Aldridge weren’t seen in the U.S. until 2016.”
-Christine G.

“Healthfirst Medicaid HMO is naughty. The continuous glucose monitor system is no longer a covered benefit. Other Medicaid HMOs are bound to deny this benefit in 2016.”
-Shifra G.

“I think Dr. Denise Faustman might be on your nice list. Her lab is a ray of hope.”
-Brian S.

“Medicare and the U.S. Congress need to be added to the naughty list. No Medicare policy of any type will cover the cost of continuous glucose monitors or the sensors needed for CGMs in 2016.”
-Becky H.

“Al Mann should be on the nice list. His tenacity and persistence…has helped the launch of Afrezza (an inhalable insulin system).”
-Hillard S.

 

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Sanofi Walks Away From Afrezzahttp://insulinnation.com/treatment2/medicine-drugs/sanofi-walks-away-from-afrezza/ http://insulinnation.com/treatment2/medicine-drugs/sanofi-walks-away-from-afrezza/#comments Wed, 06 Jan 2016 13:59:44 +0000 http://insulinnation.com/?p=309973 The move casts major doubt on the economic viability of the inhaled insulin system.

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AFREZZA3_BW_200pxOn January 5, news came that Sanofi and MannKind were severing ties on a licensing and marketing agreement the two companies reached for Afrezza in mid-2014, meaning that one of the biggest diabetes companies in the world was walking away from inhalable insulin. It was the biggest news of the day, but not unexpected; Afrezza sales had been very slow. The move could mean that Afrezza will be the second inhalable insulin system to fail in the 21st century, joining Exubera, which Pfizer pulled the plug on within a year of its launch in 2006.

Even though major investment analysts like Goldman Sachs had downgraded Afrezza sales forecast as far back as March 2015, Sanofi officials had remained outwardly optimistic until the end. The hope was that boots-on-the-ground education about Afrezza by Sanofi sales representatives would pull up sluggish sales. Those hopes were echoed by a passionate Twitter base of users and Mannkind investors, who talked up Afrezza’s possibilities online and fiercely defended the product.

MannKind’s CFO Matthew Pfeffer repeated that same kind of optimism on the January 5 conference call, pointing out that Sanofi’s move on January 4 to terminate the agreement frees MannKind from a non-compete obligation. Pfeffer noted that MannKind was now free to pursue worldwide licensing of its product.

“This is not what we anticipated, but we knew that change would have to come,” Mr. Pfeffer reported. “But what doesn’t have to change is the experience of users. With resolve, I can say that this is not the end of the line for MannKind or Afrezza.”

With the news, the price for Mannkind stock plummeted, losing nearly 50% of its value on January 5th alone. Pfeffer closed the fourteen minute call by assuring Afrezza users of a continuing joint commitment with Sanofi to deliver inventories, and assuring investors that the company has adequate cash and borrowing availability to fund production and distribution operations at least through the first half of the year. Moreover, he pointed out that contrary to what has been reported in the financial press, Mannkind is under no obligation to return Sanofi’s initial $150 million up-front licensing fee payment.

Despite his optimism, it appears unclear at the moment how the company can move forward with the product if a deep pockets pharmaceutical company was unable to make inhalable insulin work economically.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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How to Get Approved for Pump Therapyhttp://insulinnation.com/devices/pumps-cgm/how-to-get-approved-for-pump-therapy/ http://insulinnation.com/devices/pumps-cgm/how-to-get-approved-for-pump-therapy/#comments Tue, 05 Jan 2016 19:55:31 +0000 http://insulinnation.com/?p=309969 A certified diabetes educator provides a step-by-step process for getting fitted with an insulin pump.

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001_get_approved_pump_therapy_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 want to use an insulin pump, but I hear insurance might be a problem. Can you tell me how one gets approved for a pump by a doctor and insurance?

A – It’s smart to at least consider an insulin pump as a treatment option. The precision in how insulin is delivered with a pump can make a notable difference in blood sugar control.

Your first step in procuring an insulin pump is to talk with the doctor who helps you manage your diabetes. Many endocrinologists and certified diabetes educators have demo insulin pumps in their offices or information from different pump companies that they can give you. It’s important to discuss with your doctor what you hope the pump will do for you and the reasons you feel it will be an asset to your blood sugar management.

For many people, pump therapy may be easier than multiple daily injections, but it is only effective if the person using it understands the pump and is proactive about blood sugar control. Doctors don’t automatically approve pumps for all their patients with diabetes, and some will refuse to prescribe pump therapy until blood sugar levels are improved to a certain level with traditional insulin therapy. It’s important to advocate for why you believe a pump could help improve your blood sugar management. Bring blood sugar logs and records to your visits, and give concrete reasons why multiple daily injections alone isn’t cutting it.

When considering insulin pump therapy, most people who have insurance coverage should look at their DME (Durable Medical Equipment) coverage; it’s the section of your insurance that covers insulin pumps and continuous glucose monitors. The good news is that almost all insurance companies today cover some portion of the cost of insulin pumps for qualifying patients. Now whether the insurance company thinks you qualify is another matter altogether.

To assess eligibility for a pump, insurance will require a Statement of Medical Necessity from your prescribing or treating physician. This is where it is very helpful to have a good endocrinologist or a good certified diabetes educator in your corner. These providers can work with you to ensure you have the proper paperwork filled in to submit to the pump company of your choice.

Once the paperwork is filled out from you and your doctor, the pump company will contact your insurance carrier and find out what is covered and how much to expect for out-of-pocket expenses; all insurance plans are different in this regard.

Once the approval is confirmed, the pump company will send you the device and set you up with initial training. It will be important to follow up closely with your endocrinologist or CDE to finetune your pump settings and to learn about all of the pump’s features. The rest will be up to you. Pump therapy isn’t for everyone, but those who are proactive in learning about their pumps more often succeed and enjoy better controlled blood sugar levels than those who don’t dive in and learn all there is to know about their pumps.

If you want to learn more about the different types of insulin pumps available, Integrated Diabetes Services has created a guide that you can read here: http://integrateddiabetes.com/insulin-pump-comparisons/

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 integrateddiabetes.com or write info@integrateddiabetes.com.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Can I Use the Back-of-the-Fridge Insulin?http://insulinnation.com/treatment2/medicine-drugs/can-i-use-the-back-of-the-fridge-insulin/ http://insulinnation.com/treatment2/medicine-drugs/can-i-use-the-back-of-the-fridge-insulin/#comments Tue, 29 Dec 2015 18:06:45 +0000 http://insulinnation.com/?p=309962 A certified diabetes educator weighs in on the wisdom of using a forgotten vial of insulin.

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shutterstock_1643969_hand_in_fridge_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 just found insulin that’s been in the refrigerator (unopened, unused), for two years. Is it dangerous for me to use it?

A – I wish I could say it’s fine to use it, but the problem is you’ll never know what you’re getting out of expired insulin, and that can make it more trouble than it’s worth.

Using insulin past the expiration date on the bottle is not clinically recommended, and there’s a reason for that: although it has been refrigerated and unopened, it will not be as potent as it was meant to be. Insulin is not a stable medication, thus the reason it’s only “good” for 28 days after you open a bottle/vial/pen and keep it at room temperature out of the refrigerator. Although insulin’s shelf life is a bit more stable unopened, it’s never recommended to use it past the date on the box. You could be playing potency roulette with a drug therapy that already involves a lot of guesswork.

Contact your prescribing physician and obtain a new prescription. Fill this prescription about a week before your current bottle/vial or pen of insulin is used up or expires so that you can keep up with use without having so large a back-stock. Set a reminder on your calendar on your phone or wall calendar to help you remember when to fill the next prescription. It also can be a good plan to date the bottle/vial/pen of insulin when you initially open it; that way, you won’t have to worry if the insulin has lost its potency for being past its prime.

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 integrateddiabetes.com or write info@integrateddiabetes.com.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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10 Big Deals in Type 1 Treatment in 2015http://insulinnation.com/treatment2/cure-insight/10-big-deals-in-type-1-treatment-in-2015/ http://insulinnation.com/treatment2/cure-insight/10-big-deals-in-type-1-treatment-in-2015/#comments Tue, 29 Dec 2015 15:06:12 +0000 http://insulinnation.com/?p=309948 We run down our picks for the biggest news stories in diabetes research and treatment.

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shutterstock_275300672_exciting_discovery_300pxIf a good time existed to have Type 1 diabetes, this would be it.

In 2015, Type 1 treatments that once seemed far-fetched have taken major steps forward. We’ve seen continued commercialization of pump technology based on artificial pancreas algorithms, good news on the future of stem cell treatments and beta cell transplants, expansion in treatment options, and real competition among insulin manufacturers.

Here, in no particular order, are our picks for the 10 biggest events of Type 1 diabetes treatment in 2015:

Medtronic releases the MiniMed 640G pump internationally, the first commercially available pump that uses predictive algorithms to anticipate lows and stop insulin delivery to ward those lows off. The pump’s release was exciting enough for the non-diabetes press to breathlessly declare the 640G an artificial pancreas. Not quite, but thanks for playing.

Of course, the 640G isn’t available yet in the U.S (Thanks, FDA). Of course, there already was a software glitch that caused inaccurate readings for some international pump users (Flipside – Thanks, FDA).

Medtronic executives seem to be eager to quicken their artificial pump research and development. That may be because….

shutterstock_158418200_Closed-sign_300pxBigfoot Biomedical became the first company created from the #WeAreNotWaiting movement. Last year, Bryan Mazlish came out as the mythical Bigfoot, a dad who hacked together a non-closed-loop artificial pancreas system at home. This year, he, former JDRF CEO Jeffrey Brewer and others created Bigfoot Biomedical to commercialize that system. Then they went one step further and bought out the physical remnants of the defunct Asante company (RIP – Snap pump), showing they meant business.

Of course, the development of an artificial pancreas means being attached to equipment. However, another promising functional cure involves restoring the cells that produce insulin. And that’s why it’s awesome that…

Beta cell therapy showed in 2016 that it was for real. Researchers at the Diabetes Research Institute and at the University of Alberta are zeroing in on ways to protect implanted beta cells, which produce insulin, from the inevitable attack from hyperactive immune systems. They are doing this by implanting the beta cells in little safehouses that keep overeager killer T-cells out.

The Diabetes Research Institute reported that their safehouse, dubbed the BioHub, helped protect beta cells enough to keep its first human trial patient with Type 1 free of the need for insulin. The trials, funded by JDRF and the Diabetes Research Institute Foundation, are just in the beginning stages, and the University of Alberta effort to create safehouse devices called ViaCytes is behind that, but we’re hoping.

That being said – what’s with the double capitalization fad, researchers? Just asking.

Until replacement beta cells becomes something you can get at any doctor visit, it’ll be necessary to stick to insulin therapy. Luckily, pharmaceutical companies are finally teaching that old dog of a therapy some new tricks. One example is that…

Afrezza has finally gotten its day in the marketplace. The inhaled insulin product, developed by Mannkind and marketed by Sanofi, is now readily available. Of course, sales have been sluggish…just like they were with the last inhaled insulin product (RIP-Dreamboat). However, even if Afrezza only becomes a niche product, it’s still good to have it as a treatment option for those times when many injections simply aren’t an option.

The muted response to Afrezza hasn’t helped Sanofi’s bottom line. In fact, the company had a 2015 it might want to forget, partly because…

tresiba_mesa_300pxSanofi finally loosened its grip on the basal insulin marketplace. Sanofi lawyers have been busy in recent years trying to hold onto the patent rights for its blockbuster Lantus insulin. They seem to have softened their stance now that they have a new basal insulin on the marketplace, Toujeo (Coincidence? I think not).

In this kinder gentler atmosphere, Sanofi came to an agreement with Lilly for the latter company to come out with a biosimilar (generic) form of Lantus in late 2016. Also, Novo Nordisk was able to get its new basal insulin, Tresiba, approved by the FDA this year. One hopes for a price war.

New insulin formulations don’t eliminate the risk of hypoglycemia, sadly, so that’s why it’s big news that…

Nasal glucagon proved safe for kids. The human trials conducted by Locemia Solutions provided hard evidence that the days of injectable glucagon might be numbered. Making glucagon treatment more user-friendly could make the difference between riding out a bad low at home and taking a trip to the hospital. Lilly, the company which has the lock on the injectable glucagon market, was so impressed of nasal glucagon’s chances for FDA approval that it bought up the rights to market the treatment. Let’s hope they come to praise nasal glucagon, not to bury it.

Trying non-injectable diabetes treatments seemed to be a trend in 2015 as…

Researchers used oral insulin in an attempt to ward off Type 1. A small German study, funded by JDRF, gave high doses of oral insulin to children genetically susceptible to developing Type 1. The dosing created an immune response in 5 of 6 children, one that the researchers take to mean that the body will start recognizing beta cells again, instead of just killing them. Time will tell.

Speaking of time…

shutterstock_111168947_baby_grip_300pxResearchers have found symptoms of Type 1 years in advance of the condition’s traditional onset. Another JDRF study, this one involving like a zillion people (okay – roughly 400,000) effectively screened for early biological indicators in children who developed Type 1. Is this just an effort to deliver bad news early? Nope. The thinking is that if we’re going to stop Type 1 diabetes in its tracks, we have to get in on the opening bell. It’s sort of a “If it bleeds, we can kill it” moment in Type 1 diabetes research.

These researchers weren’t the only ones to think outside the traditional care models, because…

Some researchers think that an old tuberculosis vaccine might really slow down the development of Type 1. Faustman Labs is conducting Phase II human trials to see if a weakened bacteria strain (hereafter known as the “Notorious BCG”) can convince the body to forget to have Type 1 diabetes…at least somewhat. Phase I trial results showed that the treatment confuses the autoimmune response that usually kills off insulin-producing beta cells. That’s a good thing.

Researchers are great, but the real first responders to Type 1 diabetes care are usually parents of children with Type 1. That’s why it is great news that…

Parents of children with Type 1 are changing laws to make those with Type 1 safer than before. A grieving family in Ohio pushed for a new law to make sure people with diabetes in that state can get insulin even if their prescription is expired. D-families in North Carolina and Pennsylvania also pushed legislative action through that encouraged better doctor screening for Type 1 diabetes. Meanwhile, countless others are lobbying for bills that may bear fruit in 2016.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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6 New Year Diabetes Memes 2016http://insulinnation.com/living/6-new-year-diabetes-memes-2016/ http://insulinnation.com/living/6-new-year-diabetes-memes-2016/#comments Tue, 22 Dec 2015 17:17:25 +0000 http://insulinnation.com/?p=309924 Viewing these memes is like going to a New Year’s party...except without food, a crowd, or a kiss. Okay, it’s nothing like a New Year’s party.

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A New Year brings a fresh wave of optimism…and a fresh wave of memes about life with Type 1 diabetes. Here are six New Year-inspired memes to enjoy as we turn the page on 2015.

Disgust party

luke no

party resolution

vader choke

picard celebrate

New Year Resolution

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Rapping About Type 1http://insulinnation.com/living/profilesinterviews/a-new-song-takes-us-into-the-daily-grind-of-life-with-diabetes/ http://insulinnation.com/living/profilesinterviews/a-new-song-takes-us-into-the-daily-grind-of-life-with-diabetes/#comments Mon, 21 Dec 2015 21:33:49 +0000 http://insulinnation.com/?p=309908 A new song takes us into the daily grind of life with diabetes

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Gambo_T1-Rap_300px2015 appears to be the year that life with Type 1 diabetes got put to music. A research group, Perle Bioscience, commissioned a song by American Idol contestant Adam Lasher and country singer Amanda Jo called “Needle Free” to rally the troops for Perle’s work to find a two-pronged functional cure for Type 1 diabetes. A Teen Mom, Mackenzie McKee, also…ahem….tried to rap about how to be healthy with diabetes, but she sadly ends up muddling things with her lyrics. YouTube also had many homemade entries of songs on life with Type 1 diabetes in 2015.

One track that might have flown under the radar for some is a spoken-word R&B tune called “TYPE-1” by Gambo, an Indiana-based musician. He describes the daily grind of diabetes care that his nephew, Rajan, must undergo, and praises the nephew’s mom for her perseverance.

“He’s also autistic, non-verbal…..he can’t speak, so it makes it so much more intense,” Gambo said in an interview with Insulin Nation.

Gambo said he was inspired to write about Type 1 after watching his nephew have to deal with a bout of hypoglycemia. He went home from that visit and began brainstorming lyrics.

“In my music, I try and portray real-life things,” he said. “I try and write about [others’] situations. Very seldom do I write about me.”

The song provides a snapshot of the daily schedule in the life of a child with diabetes, including blood sugar testing, insulin injections, and the need to sit out of activities at times because of blood sugar fluctuations. Gambo also uses the lyrics to dispel myths about diabetes. Gambo says that his goal isn’t strictly to educate people, but to bring people together to think about the condition.

“I try to use the music as common ground,” he said. “If I can do that and make it musical and sound good…..people have no choice but to learn.”

Gambo has been active in Type 1 diabetes fundraising in Indiana, and has created a non-profit, We Want Victory, to fundraise for JDRF. To learn more, you can go to http://wewantvictory.com/new-home/.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Another Diabetes Crossword Puzzlehttp://insulinnation.com/living/another-diabetes-crossword-puzzle/ http://insulinnation.com/living/another-diabetes-crossword-puzzle/#comments Thu, 17 Dec 2015 21:14:29 +0000 http://insulinnation.com/?p=309886 All the clues are based on Type 1 terminology and diabetes news.

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crossword_again_300pxWe had fun creating the last crossword puzzle, but we might have been taking it too easy on you. Round Two of the Diabetes Crossword Puzzle is here. Are you up for the challenge?

Click here for a PDF of the crossword: Another Diabetes Crossword Puzzle

Another Diabetes Crossword Puzzle UPDATED

Tweet us a photo of you with your completed puzzle at https://twitter.com/InsulinNation.

For answers click here: Answers

Editor’s Note – A previous version of this crossword had a typo mixing up “hypoglycemia” and “hyperglycemia”. Thanks to reader @chloeirena for catching it.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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The 2015 Type 1 Naughty and Nice Listhttp://insulinnation.com/treatment2/the-2015-type-1-naughty-and-nice-list/ http://insulinnation.com/treatment2/the-2015-type-1-naughty-and-nice-list/#comments Tue, 15 Dec 2015 16:30:07 +0000 http://insulinnation.com/?p=309875 Stuffing the stockings for 10 positive and negative diabetes events that happened in the past year.

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shutterstock_38005519_Santa_naughty_list_300pxSanta Claus and the NSA aren’t the only ones making lists and checking them twice. Here at Insulin Nation, we’ve compiled a list of who has made a positive impact for the diabetes community and who deserves a lump of coal.

See if you agree:

Naughty
CrossFit CEO Glenn Glassman – Mr. Glassman decided to equate diabetes with death in a tweet connecting Coca-Cola to diabetes. On June 29, he (or someone connected to him) tweeted a picture of a fake Coke ad saying “Open Diabetes” and a cheerful message to make sure you “pour some out for your dead homies.” Aside from the many disrespectful and hurtful thoughts he packed into one tweet, we can’t overlook his use of the word “homies”. 1993 is calling, Glenn, and they want their word back.

Nice
Sean Parker – The founder of Napster and former president of Facebook chipped in a cool $10 million to the University of California at San Francisco to seek a cure for Type 1 diabetes in the next five years. A nice gesture, even if we won’t hold our breath. Now, if others connected with Facebook take the hint….I mean, surely Mark Zuckerberg has $10 million between the couch cushions, right?

Naughty
The Script-Writers of The Walking Dead – They waited until Season 6 to introduce a character with apparent Type 1 diabetes….long after the insulin would lose its chill. Better late than never, right? Oops….never use the word “late” on that set….the poor hapless girl with Type 1 lasted just about ¾ of an episode as a plot device before being eaten by zombies encased in melted greenhouse glass. Because that’s what happens.

Nice
The We Aren’t Waiting Community – They’re like Anonymous, except they aren’t really anonymous and never hack into anything bad. Instead, these home programmers are trying to create artificial pancreases (pancreai?) through crowdsourced code. This year, one from their ranks has helped create a legit insulin pump business, Bigfoot Biomedical. We hope more entrepreneurs come out of this underground pipeline.

Naughty
Trolls Among the Type 1 Community – While not naming names, we know of several online Type 1 support groups which have been decimated by infighting and gossip. Please re-read the “support” part of “Type 1 support groups”, and remember that everyone is in the same boat on an unsteady sea of insulin.

Nice
Locemia Solutions – Businesses are created to make money, but it’s important to note that they can create life-changing improvements to health care, as well. Locemia invested a lot of time and money into creating a nasal glucagon formula that has done really well in human trials. It was enough for Eli Lilly and Co., the leader in injectable glucagon, to come in and buy them up. Dear Lilly, please don’t pull a “Who Killed the Electric Car” fast one with this easy-to-use glucagon, or you will end up on the naughty side of the ledger in 2016.

Naughty
Insulet – The makers of the OmniPod wearable pump had a tough year in quality control. They got warned by the FDA for pump manufacturing practices not meeting regulatory standards in periods of 2013 and 2014, and had two voluntary recalls of its products. This is not how one keeps up with Medtronic.

Nice
Dr. Douglas Melton – The Harvard researcher announced this year that his team has developed a way to grow functional beta cells from stem cells in just 40 days. This could really advance beta cell replacement therapy. Mind you, it took more than a decade to develop, so good job on keeping up with the long slog, Dr. Melton.

Naughty
Celebrities Who Are Connected to Questionable Diabetes Supplements – Sadly, this list is way too crowded. Elite quarterback Tom Brady has aligned himself with a trainer who once was a big player in a company whose salesforce pushed a cure-all supplement that was anything but. Meanwhile two politicians – former Governor Mike Huckabee and Dr. Ben Carson – have had their judgement questioned for lending their voices and names to some shady supplements that have been marketed to combat or cure diabetes. Might not win many Type 1 votes that way, guys.

Nice
Diabetes Parent AdvocatesDee Oxendine and Dan Houdeshell both channeled their grief at the loss of their children with diabetes to successfully advocate for legislation that has passed in their states. Debbie Haley and others helped lead the charge for a resolution calling for better Type 1 screening in Pennsylvania. And let us not forget every single parent who fought to get their child with Type 1 the care needed at school. If there was a designation beyond Nice on this list, you’ve earned it!

Do you have ideas of who should be added to this list, either naughty or nice? Send me an email at cidlebrook@epscomm.com.

Happy holidays!

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Another Type 1 Holiday Tunehttp://insulinnation.com/living/another-type-1-holiday-tune/ http://insulinnation.com/living/another-type-1-holiday-tune/#comments Tue, 15 Dec 2015 15:26:45 +0000 http://insulinnation.com/?p=309871 A reader gives a high-carb spin in his parody to the tune “Here Comes Santa Claus”.

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vichyssoise santa claus_300pxEarlier this month, we gave the song “White Christmas” a Type 1 diabetes makeover, with new lyrics dreaming of a new endocrinologist. When we posted that bit of holiday fluff, we challenged the Type 1 community to come up with their own diabetes-themed holiday songs.

One brave soul heeded our call, and found a way to substitute “Santa Claus” with a high-carb holiday favorite. Here’s how he did it:

“Here Comes Vichyssoise” (sung to the tune of “Here Comes Santa Claus”)

Here comes vichyssoise*
Here comes vichyssoise
Cream and taters again
Should I bolus so I can eat it
Or instead abstain?

Carbs are slinging,
Glucose swinging,
Can’t get my insulin right!
Hence my balking
At Christmas meals
For my fasting overnight.

Best,
John Dillon

*Vichyssoise is pronounced vee-shee-swahz.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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A Type 1 Family Gets a Diabetes Alert Doghttp://insulinnation.com/treatment2/a-type-1-family-gets-a-diabetes-alert-dog/ http://insulinnation.com/treatment2/a-type-1-family-gets-a-diabetes-alert-dog/#comments Mon, 14 Dec 2015 20:51:32 +0000 http://insulinnation.com/?p=309864 Read about one family’s journey for a canine CGM in the new memoir - “Elle & Coach”.

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Elle&Coach_BookCover_300pxA new memoir focuses on how a diabetes alert dog can help a family struggling with a Type 1 diabetes diagnosis. Elle & Coach: Diabetes, the Fight for My Daughter’s Life, and the Dog Who Changed Everything is authored by Stefany Shaheen, mother of four and daughter of U.S. Senator Jeanne Shaheen of New Hampshire.

The book begins with the surprise Type 1 diagnosis of Stefany’s daughter, Elle. For three years after the initial diagnosis, Elle suffers through blood sugar swings of severe lows and near-DKA highs and can’t get her A1C down below 9. The family feels at a loss for what to do when they witness a girl helped by a diabetes alert dog at the 2011 JDRF Congress.

Here’s an excerpt from the book about that incident:

At the closing event, Craig and I took notice of that little girl with her sweet dog, sitting in the well of the U.S. Senate committee hearing room. The children were gathered front and center, seated on the floor, while parents took a back seat in the galleries along the perimeter. That dog sat ever so patiently at the girl’s feet, even in the middle of a large crowd, surrounded by dozens of cameras while a series of JDRF representatives, including some of the kids, shared testimony with members of the Senate…I never knew a dog that could walk into a room full of people without running around and sniffing everyone or barking at something for seemingly no reason or jumping up to say hi. Not this dog.

Elle was sitting close to the girl and her dog, and I saw her look over when suddenly the dog sat straight up. He scanned the crowded room looking for the girl’s mother. When he couldn’t find her, he started circling around the child to get the mother’s attention. Soon the mother was at the daughter’s side. She whispered something to her. The girl pulled out her lancet and test kit and checked right there in the middle of the hearing room. Her dog kept pacing…I wasn’t there to discern if she was high or low, but they made their adjustments, rewarded the dog, and he lay right back down. The incident was over in a matter of seconds. They didn’t even disturb the hearing. It was stunning.*

Dogs are hunters, cognizant of a “pack” hierarchy. They are capable of distinguishing their owners and owners’ family members as members of their pack. They also can be trained to react consistently to prompts and commands. That is why some breeds are exceptional as protectors of children, as gatherers, and watch dogs.

A body of research has shown a dog’s sense of smell to be in orders of thousands more sensitive than a human’s. A dog may have more than 200 million scent receptors in its nose, compared to a human’s approximately 5 million. About an eighth of its brain is made up of a nerve bundle called the olfactory bulb, about 40 times the size and signal-transmitting capacity of a human’s olfactory bulb. This gives the dog not only greater than human capacity to detect odors, but to “factor out” masking and ambient odors. Combining this highly refined smelling ability with a dog’s instinctual drive to hunt prey for reward underpins the training process.

A hyperglycemic event causes the body to expire ketones, and the exhaust from the process can be sensed in the breath. A hypoglycemic event, on the other hand, is characterized by production of urea from metabolism of nitrogen, which the body disposes of through perspiration that carries an ammonia scent which the dog can sense. Diabetes assist dogs learn that an “alerting” behavior, such as nudging, barking, circling, or even fetching a test kit in response to a low or a high scent results in praise, a treat, or both.

There are a number of agencies offering selection and training services for diabetes service dogs, and their humans. It’s important to investigate whether the agency carries the credentials necessary to document the dog as a trained service animal, qualifying it under the “public accommodations” title of the Americans With Disabilities Act and under your state’s corresponding public health and disabilities rights laws.

The dog at the center of this story, Coach, came from the CARES non-profit foundation of Kansas. With Coach by her side, Elle continues to grow as an athlete, budding thespian, and formidable diabetes advocate.

To read more about the family’s journey with a diabetes alert dog, you can order Elle & Coach: Diabetes, the Fight for My Daughter’s Life, and the Dog Who Changed Everything at Amazon and Barnes & Noble.

*Excerpt © Stefany Shaheen. Used by permission of Hachette Book Group.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Ohio Bill to Safeguard Insulin Access Passeshttp://insulinnation.com/treatment2/medicine-drugs/ohio-bill-to-safeguard-insulin-access-passes/ http://insulinnation.com/treatment2/medicine-drugs/ohio-bill-to-safeguard-insulin-access-passes/#comments Fri, 11 Dec 2015 16:39:57 +0000 http://insulinnation.com/?p=309857 Ohio pharmacists will be allowed to fill expired insulin prescriptions in certain circumstances.

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Update – 12/28/2015 – The legislation has been signed by the governor, and will become Ohio law early in 2016.

shutterstock_316917155_ohio_healthcare_300pxThis past week, Ohio legislators passed a bill authorizing pharmacists to fill expired prescriptions for some lifesaving medications, including insulin. The bill was partly in response to the 2014 death of an Ohio man with diabetes, Kevin Houdeshell, and was championed by his family.

The legislation would authorize an Ohio pharmacist to provide a refill of certain medications, even if a prescription has expired, if it is determined by the pharmacist that failure to fill the prescription would significantly impact the health of a patient. There are several caveats that were inserted into the bill:

  • A pharmacist must attempt to contact the medical provider who wrote the prescription.
  • He or she also must have the prescription previously on record.
  • The amount of drugs dispensed generally shouldn’t be more than what is needed to get someone through 72 hours, although it can be filled for up to 30 days.
  • The emergency refill can only be done once in a 12-month period.
  • Pharmacists will be barred from using this new power to refill expired prescriptions for some controlled substances.

The bill was championed by the Ohio Pharmacists Association. Its spokesman, Antonio Ciaccia, says the measure will help pharmacists ensure the health of patients when physicians and other medical providers are out of contact.

“This provision will reduce some of the hassle of pharmacists having to move heaven and earth to reach the doctor in the event the patient needs the meds. As long as the pharmacist makes a good attempt to reach out, if there is no response, the pharmacist can dispense without issue,” Ciaccia said in an email interview with Insulin Nation.

Ohio Governor John Kasich has 10 days from when the bill is delivered to him to either sign the law or veto it; if he takes no action, the bill will pass into law. The law will take effect in 90 days from the governor’s signature or 90 days past the 10-day gubernatorial waiting period. It passed both chambers of the Ohio legislature with very strong bipartisan support.

This bill will help people with diabetes and other medical conditions deal with the dreaded situation of running out of needed prescription medication over a weekend or during holidays. It is believed that Kevin Houdeshell tried to refill his insulin prescription on December 31st, 2013, but the prescription had expired. He was unable to contact his doctor because of the holiday, despite attempts on January 1st and January 2nd. It is not known why he didn’t attempt to use non-prescribed insulin, which is often available at Wal-Mart, or go to the emergency room. His family says he was still trying to come to terms with his recent diagnosis of insulin-dependent diabetes. Kevin was found dead in his home on January 8th, 2014.

His father, Dan Houdeshell, and the rest of his family have been advocating for this bill since his death. They garnered support from several influential legislators, and the bill passed within 14 months – which is considered a very quick turnaround in the legislative process. Dan Houdeshell was weary, but grateful, the day after the bill passed. Although this bill was very much a personal mission for Dan Houdeshell, it seems unlikely that his days as a patient advocate are over.

“We can’t thank the Ohio legislators enough,” he said in an email interview. “I am getting lots of requests now from so many states and lots of discussion going on across the country,” he said.

Although the bill gives more prescribing authority to pharmacists, Ciaccia does not believe there will be a legal challenge to the new provisions from other state medical organizations.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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What if the School Nurse is Busy?http://insulinnation.com/treatment2/what-if-the-school-nurse-is-busy/ http://insulinnation.com/treatment2/what-if-the-school-nurse-is-busy/#comments Thu, 10 Dec 2015 14:53:29 +0000 http://insulinnation.com/?p=309844 The family of a 10-year-old with Type 1 wants his sister to help with his diabetes care in school, but the school district says no.

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shutterstock_137437088_sad_boy_behind_fence_300pxIn the previous story in our four-part series on in-school diabetes care, we discussed how one family found a welcoming school environment in Portland, Maine for their son with Type 1. Unfortunately, access to diabetes care during the school day varies wildly from school district to school district, and from state to state. Less than two hours west of Portland, and across state lines, another child with Type 1 is struggling to find enough help during school hours.

Ray Duckler, a columnist at the Concord Monitor in New Hampshire, wrote a piece on November 29 about Luc Gautreaux, a seven-year-old who can’t get anyone at his school in the Winnipesaukee region to help him with his diabetes self-care – excepting the school nurse, whom Luc has to go in to see several times a day. Luc’s 10-year-old sister Mellie, who told Ray that she can “do [his diabetes care] in her sleep,” isn’t allowed to help Luc while they’re in school together.

When Duckler tried to contact officials in the school district about Luc, he learned that they not only preferred not to talk to him, but that they also believed that the school nurse or a nursing assistant with the required professional credentials should be the only individuals authorized to care for kids with diabetes.

New Hampshire is one of the states that has some grey in its black letter law on care of children with diabetes while they’re at school. By state statute, school children are permitted to possess and use epipens and asthma inhalers. Also, by a 2015 amendment to state law, a parent or guardian may authorize a school employee without a nursing license to administer glucagon injections if a school nurse is unavailable to do so. The rationale here is that allergic reactions, asthma attacks, and hypoglycemia are medical emergencies requiring rescue medication, and persons suffering such emergencies are often disabled by such attacks and therefore not able to self-administer. Insulin injections are, on the other hand, seen as maintenance, as is glucose testing.

New Hampshire’s Nursing Practices Act recognizes four tiers of professional licensure. State rules allow for the licensing of another kind of medical helper – a Medication Nursing Assistants (MNA’s), to whom nurses may delegate tasks associated with medication.

As is true in nearly every state, New Hampshire requires a written medical treatment plan, submitted by the parent or guardian in consultation with a physician, for a child who may require treatment for diabetes, or any other condition requiring daily attention, at school or at school-sponsored outside activities. Yet there is no rule that requires a private or public school to provide for insulin injections, or for administration of oral anti-diabetic medications. If the nurse isn’t available and a child can’t give the injection himself or herself, that child is out of luck.

The law, as it currently stands, gives the school nurse no authority to delegate tasks to Luc’s sister Mellie, even though Mellie is quite possibly just as knowledgeable of Luc’s needs and competent to handle them, as a licensed nursing assistant. In fact, any responsible adult employee at Luc’s school who wanted to take the initiative to take a diabetes education course couldn’t care for Luc either without a license permitting them to do so. This has been the state of things, except for the glucagon provision adopted by the New Hampshire Legislature in July of this year, since the most recent technical advisory issued by the Department of Education on the subject in February 2009.

Across the country, diabetes advocates are asking state legislatures to relax in-school testing and insulin-administering restrictions – restrictions which school nurses and administrators believe in good faith they have no choice but to abide by lest they break the law and face professional disciplinary sanctions. As mentioned earlier in this series, the American Diabetes Association submitted testimony of an endocrinologist and a certified diabetes educator to this effect in Nurses’ Association v. Administrator, and succeeded in persuading the California Supreme Court to craft an accommodation in 2013 that overrode a stringent scope of practice rule under the state’s nursing practices code. The ADA, a co-plaintiff in that case, has been at work with state legislatures through its “Safe In Schools Project” to make daily diabetes care accessible to children in schools which do not offer the full range of professional staffing. The ADA is doing this by mobilizing volunteers – physicians, students with diabetes and their parents, diabetes educators, and elected and appointed officials – to advocate for legislation to bring school diabetes care into modern practice.

There have been efforts in seven states to adopt all or variations of a model reform act, which has come to be known as the Diabetes Safe in School Law. This legislation removes barriers to self-testing and self-administration of anti-diabetic medications, and secures training in diabetes care for school employees who do not hold medical licenses, so that they may administer glucagon and insulin and assist children with testing if a school nurse isn’t available.

To learn how you can get involved, check out American Diabetes Association’s Safe at School Victories.

Read the series:
Part 1 – “How to Make Canadian Schools Diabetes-Safe”
Part 2 – “Are Schools Required to Provide Diabetes Care?”
Part 3 – “The Patchwork Problem of School Diabetes Care”

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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The Patchwork Problem of School Diabetes Carehttp://insulinnation.com/treatment2/patchwork-problem-school-diabetes-care/ http://insulinnation.com/treatment2/patchwork-problem-school-diabetes-care/#comments Wed, 09 Dec 2015 20:24:16 +0000 http://insulinnation.com/?p=309835 Whereas in Washington, a child with Type 1 is barred from school, in Maine he is embraced by a school community.

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shutterstock_309237824_kids_at_school_300pxAs we discussed in the previous article about the laws surrounding in-school diabetes care, what level of care a child with Type 1 receives during the school day varies wildly by state and district. This was the case for Owen Pollard, a child with Type 1 who was refused diabetes care during the school day in two schools in the Seattle area.

In theory, the Americans With Disabilities Act and other federal civil rights laws focused on providing equal educational opportunity are supposed to protect children with diabetes by barring discrimination based on a medical condition. In practice, it’s a bit more complicated than that.

According to the American Diabetes Association, 29 states and the District of Columbia permit teachers, administrative personnel, and coaches to administer insulin injections and emergency glucagon, if staff are given proper training. However, there is no uniform model law for state legislatures to adopt, as existing laws vary significantly from state to state.

In Maine, where the Pollard family relocated, all public and private schools come under the authority of the state’s education commissioner insofar as administration of medications in a school setting is concerned. Every school board or district is required to appoint a registered professional nurse (RN) who also holds the credentials of a public health nurse, and who by law has the buck-stops-here authority over administration of medication. The nurse has the authority to delegate that job to a licensed practical nurse (LPN) holding equivalent credentials.

Glucagon is considered an emergency life-saving medication, which under Maine law can be administered by a lay person. Glucagon is covered under the same set of state education department rules which address Epipens and asthma inhalers. Maine follows a “Good Samaritan” doctrine, which shields anyone who offers emergency assistance against civil liability.

Insulin administration in school is a little less clear. There is no prohibition against its administration by personnel not holding medical licenses, but neither is it specifically allowed. In practice, for children who cannot test themselves or self-administer insulin, state education department guidelines require that an RN or LPN perform that task, and also administer other injectables, unless an emergency calls for it. There’s a presumption that children develop testing and insulin-taking skills as they grow, and there are tiered expectations laid out for diabetes self-care as children change schools from elementary to middle school to high school.

An accompanying Department of Education rule sets out a training requirement for non-licensed school personnel involved in administering medications. It is rigorous, and includes annual refresher education. The state sets minimum training requirements, provides a model training program to be followed, and the local school board or district is permitted, within the parameters set by state law and regulation, to author its own policy.

The state’s education department has published a comprehensive booklet for schools entitled Maine Guideline for Schools: Tools for Schools Who Have Students with Diabetes (2004). Among its contents is the age-tiered outline of tasks that students are expected to carry out on their own, including glucose self-testing and self-administration of insulin. Parents are expected to submit detailed daily care plans, including testing times, snack times, dosage information, and the like, accompanied by doctor orders, and to supply and resupply prescriptions and materials for diabetes self-care.

There is no provision in the handbook stating that the school will always be responsible for administering insulin, or that it will make a staff member available for that task. What the school will do is make available a person who has undergone the required training to supervise self-testing for blood glucose and urine ketones, and self-administration of insulin. A school is required to set aside an area in which these tasks can be done in private.

The Pollards’ son, Owen, goes to school in one of the most affluent school districts in Maine – Portland. The Portland school he attends has two nurses, and so the biggest daily difficulty he and his parents ran up against back in Washington State, that of not having a nurse available for testing and insulin injections, has been swept away. But as his mom told Insulin Nation in a telephone interview, a diabetes-friendly school is about more than just having the right amount of medical personnel on hand.

“The school community here has been incredibly receptive [with teachers and staff showing] willingness to learn about diabetes and the daily struggles kids like Owen have,” says Dr. Jessica Pollard, a pediatric oncology specialist with the Maine Children’s Cancer Program.

Not every local school board or district in Maine has resources at its disposal to employ nurses or LPNs at the same level as Portland area schools. Not every Maine kid has two practicing physicians as parents, either. Diabetes advocates in several states are working hard to ensure that every child with diabetes can be as lucky as Owen when it comes to in-school diabetes care.

The American Diabetes Association’s “Safe At School” program maintains a multi-jurisdiction digest of laws governing administration of diabetes medication in school. The list is subject to periodic updating and one should confer with a lawyer when considering a challenge to school diabetes care policy.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Are Schools Required to Provide Diabetes Care?http://insulinnation.com/treatment2/are-schools-required-to-provide-diabetes-care/ http://insulinnation.com/treatment2/are-schools-required-to-provide-diabetes-care/#comments Tue, 08 Dec 2015 19:01:31 +0000 http://insulinnation.com/?p=309828 A look at the unsettled law surrounding children with Type 1 diabetes and school diabetes care.

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Diabetes_Christmas_Dream_455pxOn October 26, the New York Times wrote about the Pollard family of Seattle. Their ordeal began when Owen Pollard was denied admission to a neighborhood kindergarten and a private school on the basis that he had Type 1 diabetes. A third school, which did not employ a staff nurse, admitted the child and his twin brother, but then did an about-face, saying that the safety of all students in the school dictated that it decline to offer in-school diabetes care. Unconvinced, the Pollards filed grievances with the State of Washington and in court under the federal Americans With Disabilities Act. The complaints eventually were settled, and the Pollards moved to Maine.

There was once a time when school nurses were not in so short a supply as today. It was a given that a young child in a public school could routinely have his or her diabetes self-care needs filled; it was also a given that a school nurse would be available to check on kids during the day. Then a nationwide nursing shortage developed, and tight school budgets led to vacancies in school nurse positions.

According to the The Times story, the American Nurses Association argued in a 2013 California appellate case that allowing unlicensed non-nursing personnel to give insulin injections would put children at risk. Many diabetes parents may balk at the idea, but there can sometimes be cause for concern. For example, the Dallas-Fort Worth Fox News affiliate KDFW recently aired a story about an elementary school child who normally received her insulin injections at home receiving an additional injection from another child’s insulin pen at school. The little girl thought it was the nurse giving her the injection; the TV reporter said it was a teacher. The teacher had the presence of mind to quickly get candy, juice, and crackers into her. The school said it was human error, and that its protocols would be reviewed.

The Times story infers that schools that do not offer daily care for students with diabetes clearly are in the legal wrong, citing a time when the U.S. government warned some Alabama public school districts for not allowing children with diabetes to attend school field trips or sports practices under provisions of the Americans with Disability Act. In reality, the legal landscape is still unsettled about what diabetes care school districts may provide, depending on where one lives, and the courts and state legislatures are still wrestling with this issue.

Let’s examine how the issue is being decided in several states, starting with a landmark case in California:

In American Nurses’ Association v. Administrator, 57 Cal. 4th 570 (2013), a group of parents of four children initiated a class action complaint, in which the American Diabetes Association joined as a complainant. They alleged, among other things, that schools in a consolidated public school district had:

-failed to adequately prepare a plan mandated by federal law, called a 504 Plan, to ensure that students’ medical needs would be properly met
-failed under the Disabilities in Education Act to provide for diabetes treatment under the children’s Individual Educational Plans (called IEP’s)
-refused or failed to allow unlicensed school personnel to administer medications when no nurse was available

The complaint was settled by a consent agreement that acknowledged that people who did not hold medical licenses, if adequately trained and experienced, could be fully competent to care for school children with diabetes. (Makes sense since most parents who administer insulin at home lack medical licenses.) One of the settlement stipulations called for a revision of a 2007 legal and medical practices advisory to school personnel by adding a new category of individual authorized to act in place of a school nurse. In adopting the revision, the school district attempted to reconcile the state’s Nursing Practice Act with federal law requiring accommodation for children with chronic care needs, which it saw as preempting state law. The new guidelines recognized a “voluntary school employee who is unlicensed but who has been adequately trained to administer insulin.”

Afterwards, the American Nurses Association and many state nurses’ groups went to court to invalidate the new regulation, saying that it violated state medical licensing law, which appeared to authorize only licensed medical personnel to administer injections. This argument was advanced despite the fact that there was a provision under the California education code that specifically provided that a student may be assisted by a non-nurse or non-doctor, under physician orders and with parental authorization, when a nurse is unavailable.

The argument boiled down to how to reasonably fill a need which long-settled disabilities rights law required the school to meet. In supporting its assertion that those trying to invalidate the new public school advisory were off base – overstating the idea that insulin was a “dangerous” and complicated to administer drug – the American Diabetes Association and the parent group entered declarations in court demonstrating that non-licensed persons were indisputably capable of rendering diabetes care to school children. The California Supreme Court sided with diabetes advocates, and the regulation is still considered in good standing today.

In an article to follow, we’ll have a look at the Pollard Family’s new home state, Maine, as an illustration of how a school navigates unsettled law to approach the needs of an insulin-dependent school child, and at Pennsylvania, where the legislature is moving toward the California approach.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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How to Make Canadian Schools Diabetes-Safehttp://insulinnation.com/living/make-canadian-schools-diabetes-safe/ http://insulinnation.com/living/make-canadian-schools-diabetes-safe/#comments Fri, 04 Dec 2015 21:42:47 +0000 http://insulinnation.com/?p=309823 An Ontario diabetes advocate suggests seven changes based on her family’s experience navigating the public school system.

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Diabetes_Christmas_Dream_455pxWhen my daughter was diagnosed with Type 1 diabetes, she was five months away from starting kindergarten. Like all parents faced with Type 1, we were in a state of shock. At the time, I was scared to leave her with another adult, let alone send her to school by herself.

A month after the diagnosis, I went to see the school principal. I figured she’d need time to arrange for additional staff to help manage my daughter’s diabetes during the school day. Instead, she told me there was no support available. She would ask her staff for a volunteer to check blood sugar, but she made it clear that no one could be mandated to help. There would be no one assigned to ensure my daughter ate her meals and snacks, to watch for low blood sugars, or to keep an eye on her during special activities.

Our school is not required to provide any support because our school board has no policy for students with diabetes. The province of Ontario, despite being the first jurisdiction in the world to enact legislation aimed at preventing anaphylaxis in school, does not require schools to support children with other serious and life-threatening conditions like Type 1 diabetes.

The Canadian Diabetes Association estimates there are 30,000 schoolchildren with diabetes across Canada, yet only five provinces have specific policies or guidelines on diabetes in schools. Even some of those policies fall short. For example, not all make it clear who will administer insulin during the school day. Also, many Canadian schools only employ part-time public health nurses who come in for services like immunizations, meaning they aren’t nearby for daily testing or in case of emergencies.

Too many parents are on their own when it comes to securing day-to-day help for their children, whether that involves giving insulin, checking blood sugar, supervising meals and snacks, or preventing hypoglycemia. Instead, we patch together solutions that are often less than ideal. We rely on a mix of persistence, advocacy, and goodwill to ensure that our kids get what they need to keep them safe at school.

Each child, each family, each school is different, but as parents of kids with a disease that requires constant vigilance, what connects us is fear – fear that someone is not watching our child as closely as we do; fear that someone will forget our instructions or a special request; fear that our child may not be safe at school.

Many of our kids are the only ones in their schools with Type 1 diabetes. Many teachers have never had a student with Type 1, and simply don’t realize the seriousness of the disease and how quickly things can change over the course of a day. Many parents are fighting alone, year after year.

In 2014, I joined with a few other parents to form Support Ontario Students with Type 1 Diabetes. Our goal is to see comprehensive policy introduced in Ontario, because every time we hear of a child being excluded, put at risk, or unfairly treated, it breaks our hearts.

So what changes do we need to feel safe in Canadian schools?

– First, we need an overarching and comprehensive policy at the provincial level, so that all jurisdictions are on the same playing field. Support shouldn’t depend on where you live, how hard you can advocate, what resources you have, or what your principal is prepared to do.

– We need better understanding and awareness of Type 1 diabetes in school, so that teachers and other staff know what the risks are, and what can be done to prevent problems.

– We need day-to-day support for all aspects of our children’s disease management. Parents should be free to make treatment decisions that are in the best interests of their children’s health, and not because a particular regimen is convenient to the school day.

-That support needs to ensure children’s full participation in school, so that no child has to sit on the sidelines during gym class or a field trip.

-We need trained staff to help provide that support, and resources for training.

-We also need emergency management protocols for when things do go wrong.

-And in all these approaches, we need to ensure that children are at the center. When I do diabetes education at the beginning of the year, I start by telling my daughter’s teachers that she is a kid first; she just happens to be a kid with diabetes.

The Ontario Ministry of Education says it is working on a policy for children with medical conditions in schools. Whether it meets the unique needs of children with Type 1 diabetes remains to be seen, but we are hopeful. Parents and children who are coping with what is likely the most difficult news of their lives should not have to wonder whether their kids will be safe at school.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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A Type 1 Christmas Songhttp://insulinnation.com/living/type1-christmas-song/ http://insulinnation.com/living/type1-christmas-song/#comments Thu, 03 Dec 2015 20:47:04 +0000 http://insulinnation.com/?p=309808 For the caroler whose pancreas has taken a permanent holiday.

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Since Type 1 diabetes worms its way into every aspect of life for those affected by it, this year we’ve decided to embrace the concept of Type 1-tinged holidays. Last week, we celebrated by making holiday diabetes memes. This week, we’ve taken Irving Berlin’s “White Christmas” and crafted our own diabetes-themed lyrics to go along with the melody.

It’s corny, but it’s short:

Diabetes_Christmas_Dream_800px

We’d like you to participate in this holiday goofiness. Can you take your favorite holiday tune and give it a Type 1 spin? If you get it to us by December 15th, 2015, we’ll publish it. Send it to our editor, Craig Idlebrook, at cidlebrook@epscomm.com.

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6 Diabetes Holiday Memeshttp://insulinnation.com/living/6-diabetes-holiday-memes/ http://insulinnation.com/living/6-diabetes-holiday-memes/#comments Tue, 01 Dec 2015 21:40:56 +0000 http://insulinnation.com/?p=309775 ...to get you through the next big family gathering this month.

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We’re knee-deep in the holiday season, which means a lot of carb-counting for special occasion meals and awkward conversations with relatives around the dinner table. Here are six diabetes-themed memes to help you enjoy the holidays!

When you test_455px

New Year Resolution_455px

Latke Grandma_455px

Everyone is like_455px

Break in case_455px

Brace Yourself_455px

Happy holidays from Insulin Nation!

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Watch Out for Lumpy Skin at Injection Siteshttp://insulinnation.com/living/watch-lumpy-skin-injection-sites/ http://insulinnation.com/living/watch-lumpy-skin-injection-sites/#comments Tue, 01 Dec 2015 14:29:26 +0000 http://insulinnation.com/?p=309771 It might be a sign of lipohypertrophy, a condition that affects insulin absorption.

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shutterstock_93529864_love_fingers_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 – Every time I think I know what I’m talking about when it comes to diabetes, I come across a new thing to worry about. I saw something about lipohypertrophy. What is it and should I worry about it?

A – Lipohypertrophy is when fatty lumps appear on the surface, or just under the surface, of the skin. This is a fairly common side effect from insulin injections or insulin pump sites. It is more likely to occur if injections are administered to roughly the same part of the skin over a period of time, or if the same patch of body real estate is used for pump infusion sets over and over again.

When the skin becomes lumpy, the insulin injected or pumped into this area won’t be absorbed as consistently as it once was, which can mean it will take longer to be absorbed or it will be inadequately absorbed. This can lead to higher than usual blood glucose levels.

The signs of lipohypertrophy are a raised area of the skin at the injection or infusion site. The raised area may cover a wide area – up to an inch in diameter. The skin affected will feel more firm than the skin elsewhere on your body.

The best treatment for lipohypertrophy is to avoid injecting or applying infusion sets in the affected area of skin until it has fully healed. Prevention is easier than dealing with lipohypertrophy after the fact. Make sure you pick a different area of skin for each injection and rotate your injection and infusion sites. Ideally, you should aim to keep each new injection spot at least an inch away from your previous injection sites and a new infusion site two inches from the old site.

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 integrateddiabetes.com or write info@integrateddiabetes.com.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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3 Diabetes Dating Sites – A Reviewhttp://insulinnation.com/living/3-diabetes-dating-sites-review/ http://insulinnation.com/living/3-diabetes-dating-sites-review/#comments Mon, 30 Nov 2015 15:23:43 +0000 http://insulinnation.com/?p=309765 An irreverent look at online dating for those who know their way around insulin.

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shutterstock_93529864_love_fingers_300pxIf you have diabetes and want to find someone else who knows a thing or two about insulin, you’ve probably found that apps like Tinder, okCupid, and Grindr just aren’t the best places to message a potential beau.

Here’s a list of some online dating sites for the Type 1 romantics:

Diabetic Date

Diabetic Date is the most traditional website for going out with someone with Type 1. Features of the site include how-to dating articles and an “advanced wink system” (similar to poking on Facebook).

When you initially sign up for the site, you can enroll in the free, basic membership. However, flirtations are limited to winking at other online singles, so no chat or messaging. If you decide to pay the $6.95 monthly fee for the premium account to message a pancreatically faulty person back, you should be warned that Diabetic Date does not offer refunds, so don’t expect to see your money again.

The homepage is adorned with a slideshow of corny date jokes and tips. I don’t know that I’d trust their suggestions though; apparently, a gentleman should arrive on time, not incessantly message after a date, and not discuss his favorite sex positions. Great to know, thanks.

There are quite a bit of spam warnings, and account verification simply means having a valid email, so security is questionable. And though I suggest the site designers invest in a resident proofer to correct the surplus of typographical errors, Diabetic Date ranks as the Match.com for people with diabetes.

Diabetes Dating Site

The services that Diabetes Dating Site offers are spelled out pretty perfectly in their title, so props for being straightforward, but my immediate concern with the website was the seemingly exclusive targeting of straight men. There is a slideshow layout on the homepage of female-exclusive profile pictures, and if you go to the Browse section you’ll be hard pressed to find even one male profile.

There are zero security checks conducted on new members, so safety features are minimal. But the site admins review profiles so that no personal contact information or lewd text appears.

Similar to Diabetic Date, initial registration includes a free account that doesn’t include messaging, only “flirts”. But the site offers several premium account packages of varying prices and a 60-day money back guarantee if you are unsatisfied for whatever reason.

The website allows couples to enroll under a single profile, in case you’re looking to chat, make friends, or go for something….complex in number, I guess. They also have a camming feature so you can live-chat with people in a group or one-on-one. Honestly, I was too afraid to adventure into one of the chatrooms because I was getting an uncomfortable Chatroulette vibe. Just cam with caution, people.

DiaSingles

For any Facebook addicts out there, you can try joining DiaSingles, a closed group of almost 700 singles with diabetes, aged 18+, who want to enjoy an entree of mingling and chatting with a side of potential easy-access Facebook stalking.

The security for DiaSingles is pretty lax. I was approved as a new member within an hour of requesting to join. I didn’t expect to get a blood test in the mail, but my healthy pancreas and I were able to infect this “private” group faster than sunlight rendering a vial of insulin defective on a hot summer day.

What I found while scrolling:
-Memes about being single
-People posting what state they live in
-Awkward, unsolicited flirting in the comments section

This page is clearly about creating community and doesn’t appear to make any strides towards establishing romantic foundations. However, a group member did post a link to receive 80% off my next pair of Ray-Ban sunglasses. So not a total loss.

Whether you have diabetes or no, the best advice I can give when online dating is to be safe and smart, and keep your expectations of finding true love low. If you find that things aren’t panning out, go offline and do what makes you happy first, and let the pieces fall where they may. That’s why I’ve stopped looking for my soulmate, Channing Tatum. He’s out there somewhere, he’ll find me.

The opinions discussed in this article are solely those of the writer and do not reflect the opinions of Insulin Nation, its staff, or other contributing writers. The author is also aware that Channing Tatum is married, but chooses to remain hopeful.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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The Nude Diabetes Calendar is Backhttp://insulinnation.com/devices/meters-and-cgms/nude-diabetes-calendar-back/ http://insulinnation.com/devices/meters-and-cgms/nude-diabetes-calendar-back/#comments Mon, 23 Nov 2015 19:31:57 +0000 http://insulinnation.com/?p=309754 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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A Love Letter During a Blood Sugar Swinghttp://insulinnation.com/living/love-letter-blood-sugar-swing/ http://insulinnation.com/living/love-letter-blood-sugar-swing/#comments Mon, 23 Nov 2015 14:50:55 +0000 http://insulinnation.com/?p=309747 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 www.pngwd.com/store.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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How to Get Fired with Diabeteshttp://insulinnation.com/living/get-fired-diabetes/ http://insulinnation.com/living/get-fired-diabetes/#comments Fri, 20 Nov 2015 14:46:55 +0000 http://insulinnation.com/?p=309724 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 www.pngwd.com/store.

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

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Diabetes Makes a Cameo in The Walking Deadhttp://insulinnation.com/living/diabetes-makes-cameo-walking-dead/ http://insulinnation.com/living/diabetes-makes-cameo-walking-dead/#comments Tue, 17 Nov 2015 16:27:19 +0000 http://insulinnation.com/?p=309713 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, Walkingdeadwikia.com, 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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The 7 Best Ways to Publicize Your Diabetes Eventhttp://insulinnation.com/living/7-best-ways-publicize-diabetes-event/ http://insulinnation.com/living/7-best-ways-publicize-diabetes-event/#comments Mon, 16 Nov 2015 18:05:40 +0000 http://insulinnation.com/?p=309707 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!

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Diabetes Drives MMA Athlete Dessi Zaharievahttp://insulinnation.com/living/profilesinterviews/diabetes-fuels-mma-athlete-dessi-zaharieva/ http://insulinnation.com/living/profilesinterviews/diabetes-fuels-mma-athlete-dessi-zaharieva/#comments Fri, 13 Nov 2015 20:52:58 +0000 http://insulinnation.com/?p=309693 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 Pumphttp://insulinnation.com/devices/pumps-cgm/5-reasons-people-ditch-pump/ http://insulinnation.com/devices/pumps-cgm/5-reasons-people-ditch-pump/#comments Fri, 13 Nov 2015 17:16:38 +0000 http://insulinnation.com/?p=309684 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 integrateddiabetes.com or write info@integrateddiabetes.com.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Diabetes Awareness Month – The Year of the Selfiehttp://insulinnation.com/living/diabetes-awareness-month-year-selfie/ http://insulinnation.com/living/diabetes-awareness-month-year-selfie/#comments Wed, 11 Nov 2015 18:47:01 +0000 http://insulinnation.com/?p=309675 Blue self-portraits and diabetes-related hashtags have taken over social media. Is it enough?

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Commentary

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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Pennsylvania Lawmakers Call for Type 1 Educationhttp://insulinnation.com/living/pennsylvania-lawmakers-call-type-1-education/ http://insulinnation.com/living/pennsylvania-lawmakers-call-type-1-education/#comments Tue, 10 Nov 2015 19:46:49 +0000 http://insulinnation.com/?p=309666 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. 

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Why Celebrities with Diabetes Matterhttp://insulinnation.com/living/celebrities-diabetes-matter/ http://insulinnation.com/living/celebrities-diabetes-matter/#comments Mon, 09 Nov 2015 17:18:58 +0000 http://insulinnation.com/?p=309650 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.

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

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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How to Detect Type 1 Years in Advancehttp://insulinnation.com/treatment2/cure-insight/detect-type-1-years-advance/ http://insulinnation.com/treatment2/cure-insight/detect-type-1-years-advance/#comments Thu, 05 Nov 2015 18:42:09 +0000 http://insulinnation.com/?p=309640 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Dr. Ben Carson’s Dietary Supplement Troubleshttp://insulinnation.com/treatment2/carsons-supplement-troubles/ http://insulinnation.com/treatment2/carsons-supplement-troubles/#comments Wed, 04 Nov 2015 15:24:28 +0000 http://insulinnation.com/?p=309628 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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My Lost Year with Diabetes Burnouthttp://insulinnation.com/living/year-with-diabetes-burnout/ http://insulinnation.com/living/year-with-diabetes-burnout/#comments Mon, 02 Nov 2015 20:27:54 +0000 http://insulinnation.com/?p=309622 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Yoga Allowed Me to Give Up on Diabetes Perfectionhttp://insulinnation.com/living/yoga-allowed-give-diabetes-perfection/ http://insulinnation.com/living/yoga-allowed-give-diabetes-perfection/#comments Fri, 30 Oct 2015 18:14:41 +0000 http://insulinnation.com/?p=309615 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 Articlehttp://insulinnation.com/living/not-nick-jonas-article/ http://insulinnation.com/living/not-nick-jonas-article/#comments Thu, 29 Oct 2015 14:02:51 +0000 http://insulinnation.com/?p=309599 An argument for not getting too attached to celebrities with diabetes.

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Commentary

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 cidlebrook@epscomm.com.

 

Nick Jonas Image: Jaguar PS / Shutterstock.com
Halle Berry Image: DFree / Shutterstock.com

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Could Formoterol be the New Glucagon?http://insulinnation.com/treatment2/formoterol-the-new-glucagon/ http://insulinnation.com/treatment2/formoterol-the-new-glucagon/#comments Wed, 28 Oct 2015 13:22:53 +0000 http://insulinnation.com/?p=309591 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 Diabeteshttp://insulinnation.com/living/shameless-disappearing-diabetes/ http://insulinnation.com/living/shameless-disappearing-diabetes/#comments Tue, 27 Oct 2015 19:16:29 +0000 http://insulinnation.com/?p=309586 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.

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Shameless_300pxCommentary

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 Rulehttp://insulinnation.com/living/reegans-mom-reflects-reegans-rule/ http://insulinnation.com/living/reegans-mom-reflects-reegans-rule/#comments Mon, 26 Oct 2015 20:26:59 +0000 http://insulinnation.com/?p=309580 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 Candyhttp://insulinnation.com/living/heres-carb-count-top-halloween-candy/ http://insulinnation.com/living/heres-carb-count-top-halloween-candy/#comments Fri, 23 Oct 2015 17:40:25 +0000 http://insulinnation.com/?p=309556 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:

candy-carb-counts

(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 Claimshttp://insulinnation.com/living/tom-bradys-business-partners-false-diabetes-claims/ http://insulinnation.com/living/tom-bradys-business-partners-false-diabetes-claims/#comments Thu, 22 Oct 2015 12:38:27 +0000 http://insulinnation.com/?p=309543 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 Mail.com 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Diabetes Refugeeshttp://insulinnation.com/living/diabetes-refugees/ http://insulinnation.com/living/diabetes-refugees/#comments Wed, 21 Oct 2015 18:41:32 +0000 http://insulinnation.com/?p=309534 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:

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Hey McFly, Where’s My Type 1 Cure?!http://insulinnation.com/treatment2/cure-insight/hey-mcfly-wheres-type-1-cure/ http://insulinnation.com/treatment2/cure-insight/hey-mcfly-wheres-type-1-cure/#comments Tue, 20 Oct 2015 19:16:55 +0000 http://insulinnation.com/?p=309527 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Lilly Acquires Rights to Nasal Glucagonhttp://insulinnation.com/treatment2/lilly-acquires-rights-nasal-glucagon/ http://insulinnation.com/treatment2/lilly-acquires-rights-nasal-glucagon/#comments Fri, 16 Oct 2015 20:39:17 +0000 http://insulinnation.com/?p=309521 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Diabetes Takes Halloween Offhttp://insulinnation.com/living/profilesinterviews/diabetes-takes-halloween-off/ http://insulinnation.com/living/profilesinterviews/diabetes-takes-halloween-off/#comments Fri, 16 Oct 2015 19:38:39 +0000 http://insulinnation.com/?p=309514 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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U.S. Pays Much More Than UK for Insulinhttp://insulinnation.com/treatment2/medicine-drugs/u-s-pays-much-uk-insulin/ http://insulinnation.com/treatment2/medicine-drugs/u-s-pays-much-uk-insulin/#comments Wed, 14 Oct 2015 16:09:14 +0000 http://insulinnation.com/?p=309504 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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When the Diabetes Honeymoon Endshttp://insulinnation.com/living/diabetes-honeymoon-ends/ http://insulinnation.com/living/diabetes-honeymoon-ends/#comments Fri, 09 Oct 2015 16:51:53 +0000 http://insulinnation.com/?p=309496 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Is it Zombieism or a Blood Sugar Swing?http://insulinnation.com/treatment2/zombieism-blood-sugar-swing/ http://insulinnation.com/treatment2/zombieism-blood-sugar-swing/#comments Wed, 07 Oct 2015 19:25:10 +0000 http://insulinnation.com/?p=309482 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):

ZombieismORBloodSugar_Poster_72dpi

 

 

 

 

 

 

 

 

 

 

 

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Can an Old Drug Delay Type 1 Diabetes?http://insulinnation.com/treatment2/medicine-drugs/old-drug-new-tricks-type-1/ http://insulinnation.com/treatment2/medicine-drugs/old-drug-new-tricks-type-1/#comments Tue, 06 Oct 2015 19:20:26 +0000 http://insulinnation.com/?p=309476 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 https://www.crowdrise.com/firedup4cure.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Reegan’s Rule Passes in North Carolinahttp://insulinnation.com/living/reegans-rule-passes-north-carolina/ http://insulinnation.com/living/reegans-rule-passes-north-carolina/#comments Mon, 05 Oct 2015 18:33:09 +0000 http://insulinnation.com/?p=309470 Legislation is first to call for improved Type 1 diabetes screening efforts.

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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. TestOne.Drop.org 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Parent Refuses Insulin for Teen with Type 1http://insulinnation.com/living/parent-refuses-insulin-teen-type-1/ http://insulinnation.com/living/parent-refuses-insulin-teen-type-1/#comments Mon, 05 Oct 2015 12:27:15 +0000 http://insulinnation.com/?p=309461 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Artificial Pancreas Beats Humans in Type 1 Carehttp://insulinnation.com/treatment2/artificial-pancreas/artificial-pancreas-beats-humans-blood-sugar-management/ http://insulinnation.com/treatment2/artificial-pancreas/artificial-pancreas-beats-humans-blood-sugar-management/#comments Fri, 02 Oct 2015 21:40:55 +0000 http://insulinnation.com/?p=309449 Two European studies find tech did better than humans at blood sugar control, especially at night.

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welcome_robots_meme_300px
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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Readers Share Their Missed Type 1 Diagnoseshttp://insulinnation.com/living/readers-share-missed-type-1-diagnoses/ http://insulinnation.com/living/readers-share-missed-type-1-diagnoses/#comments Fri, 02 Oct 2015 20:56:09 +0000 http://insulinnation.com/?p=309437 Sadly, their stories are all too common. New diagnostic strategies are needed to prevent such misery.

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559_Readers_Share_Their_Missed_Type_1_Diagnoses_300px

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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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7 Consejos Para Combatir La Ansiedad del Tipo 1http://insulinnation.com/en-espanol/7-consejos-para-combatir-la-ansiedad-del-tipo-1/ http://insulinnation.com/en-espanol/7-consejos-para-combatir-la-ansiedad-del-tipo-1/#comments Thu, 01 Oct 2015 14:01:47 +0000 http://insulinnation.com/?p=309432 ...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.

Gracias

Traducido por Edel Mancina

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Mark Lowe – The Playoffs Pitcher with Type 1http://insulinnation.com/living/mark-lowe-playoffs-pitcher-type-1/ http://insulinnation.com/living/mark-lowe-playoffs-pitcher-type-1/#comments Thu, 01 Oct 2015 13:41:06 +0000 http://insulinnation.com/?p=309426 Lowe has bounced back from injuries to have a career year and become a valued member of the Toronto Blue Jays pitching staff.

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Lowe2_300px

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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Tresiba Gets FDA Approvalhttp://insulinnation.com/treatment2/medicine-drugs/tresiba-gets-fda-approval/ http://insulinnation.com/treatment2/medicine-drugs/tresiba-gets-fda-approval/#comments Tue, 29 Sep 2015 19:15:38 +0000 http://insulinnation.com/?p=309413 Will it offer enough of an improvement over other basal insulins to compete in the basal insulin marketplace?

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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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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I Had Type 1 Diabetes and Didn’t Know Ithttp://insulinnation.com/treatment2/type-1-diabetes-didnt-know/ http://insulinnation.com/treatment2/type-1-diabetes-didnt-know/#comments Tue, 29 Sep 2015 12:34:40 +0000 http://insulinnation.com/?p=309405 A young adult with diabetes describes how easy-to-recognize symptoms went unrecognized.

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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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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10 Consejos Para Mantenerse Saludable con Tipo 1http://insulinnation.com/en-espanol/10-consejos-para-mantenerse-saludable-con-tipo-1/ http://insulinnation.com/en-espanol/10-consejos-para-mantenerse-saludable-con-tipo-1/#comments Tue, 29 Sep 2015 12:20:09 +0000 http://insulinnation.com/?p=309399 Consejo de un educador de diabetes.

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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!http://insulinnation.com/devices/pumps-cgm/dress-pump-cgm-halloween/ http://insulinnation.com/devices/pumps-cgm/dress-pump-cgm-halloween/#comments Mon, 28 Sep 2015 19:50:02 +0000 http://insulinnation.com/?p=309393 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 cidlebrook@epscomm.com. Be safe, but have fun!

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Having T1D Doesn’t Give You a Monopoly on Sufferinghttp://insulinnation.com/living/t1d-doesnt-give-monopoly-suffering/ http://insulinnation.com/living/t1d-doesnt-give-monopoly-suffering/#comments Fri, 25 Sep 2015 18:30:22 +0000 http://insulinnation.com/?p=309385 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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8 Things I’d Tell My Teenage Self About Our Type 1http://insulinnation.com/living/8-things-tell-teenage-self-diabetes/ http://insulinnation.com/living/8-things-tell-teenage-self-diabetes/#comments Tue, 22 Sep 2015 16:00:35 +0000 http://insulinnation.com/?p=309376 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

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Acetaminophen Can Affect Meter and CGM Readingshttp://insulinnation.com/devices/meters-and-cgms/acetaminophen-can-affect-meter-cgm-readings/ http://insulinnation.com/devices/meters-and-cgms/acetaminophen-can-affect-meter-cgm-readings/#comments Tue, 22 Sep 2015 15:36:38 +0000 http://insulinnation.com/?p=309371 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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¿Puedo Obtener Insulina Sobre el Mostrador?http://insulinnation.com/en-espanol/puedo-obtener-insulina-sobre-el-mostrador/ http://insulinnation.com/en-espanol/puedo-obtener-insulina-sobre-el-mostrador/#comments Tue, 22 Sep 2015 13:35:48 +0000 http://insulinnation.com/?p=309365 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 integrateddiabetes.com o escriba writeinfo@integrateddiabetes.com

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 Depressionhttp://insulinnation.com/treatment2/grapple-hypoglycemia-induced-depression/ http://insulinnation.com/treatment2/grapple-hypoglycemia-induced-depression/#comments Tue, 22 Sep 2015 11:43:32 +0000 http://insulinnation.com/?p=309359 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?”

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Injecting Movies with Type 1 Diabeteshttp://insulinnation.com/living/injecting-movies-type-1-diabetes/ http://insulinnation.com/living/injecting-movies-type-1-diabetes/#comments Fri, 18 Sep 2015 17:47:55 +0000 http://insulinnation.com/?p=309345 What if Hollywood blockbusters included more characters with diabetes?

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Frozen…Insulin

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.
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E.T.T1

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?

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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.)

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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?

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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.)

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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The Supreme Court Justice with Type 1http://insulinnation.com/living/profilesinterviews/supreme-court-justice-type-1/ http://insulinnation.com/living/profilesinterviews/supreme-court-justice-type-1/#comments Fri, 18 Sep 2015 17:13:23 +0000 http://insulinnation.com/?p=309336 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Google and Sanofi Join Forceshttp://insulinnation.com/devices/products/google-sanofi-join-forces/ http://insulinnation.com/devices/products/google-sanofi-join-forces/#comments Fri, 18 Sep 2015 16:25:31 +0000 http://insulinnation.com/?p=309331 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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5 Diabetes Memes You Need to Seehttp://insulinnation.com/living/5-diabetes-memes-need-see/ http://insulinnation.com/living/5-diabetes-memes-need-see/#comments Thu, 17 Sep 2015 16:11:45 +0000 http://insulinnation.com/?p=309320 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 cidlebrook@epscomm.com.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Deal With Your Emotions to Improve Your A1Chttp://insulinnation.com/living/deal-emotions-improve-a1c/ http://insulinnation.com/living/deal-emotions-improve-a1c/#comments Tue, 15 Sep 2015 18:46:47 +0000 http://insulinnation.com/?p=309314 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Not One More Missed Type 1 Diagnosishttp://insulinnation.com/living/not-one-missed-type-1-diagnosis/ http://insulinnation.com/living/not-one-missed-type-1-diagnosis/#comments Tue, 15 Sep 2015 18:28:18 +0000 http://insulinnation.com/?p=309308 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 1http://insulinnation.com/living/odyssey-runaway-type-1/ http://insulinnation.com/living/odyssey-runaway-type-1/#comments Mon, 14 Sep 2015 12:52:47 +0000 http://insulinnation.com/?p=309288 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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How a School 504 Plan Helps a Child with Type 1http://insulinnation.com/living/school-504-plan-helps-child-type-1/ http://insulinnation.com/living/school-504-plan-helps-child-type-1/#comments Thu, 10 Sep 2015 16:57:38 +0000 http://insulinnation.com/?p=309282 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Pump Maker Deals with Quality Control Fallouthttp://insulinnation.com/devices/pumps-cgm/pump-maker-deals-quality-control-fallout/ http://insulinnation.com/devices/pumps-cgm/pump-maker-deals-quality-control-fallout/#comments Thu, 10 Sep 2015 16:44:10 +0000 http://insulinnation.com/?p=309277 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Donate Your Pancreas to Science…Laterhttp://insulinnation.com/treatment2/cure-insight/donate-pancreas-science-later/ http://insulinnation.com/treatment2/cure-insight/donate-pancreas-science-later/#comments Wed, 09 Sep 2015 15:35:04 +0000 http://insulinnation.com/?p=309271 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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NFL Player Misidentifies his Diabeteshttp://insulinnation.com/living/nfl-player-misidentifies-diabetes/ http://insulinnation.com/living/nfl-player-misidentifies-diabetes/#comments Wed, 09 Sep 2015 15:27:51 +0000 http://insulinnation.com/?p=309266 Patrick Peterson initially says he has reversible Type 1 diabetes, then reverses himself.

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Commentary

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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Dad with Type 1 Investigated by Child Serviceshttp://insulinnation.com/treatment2/dad-type-1-investigated-child-services/ http://insulinnation.com/treatment2/dad-type-1-investigated-child-services/#comments Tue, 08 Sep 2015 15:14:14 +0000 http://insulinnation.com/?p=309260 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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My Type 1 Outpatient Support Teamhttp://insulinnation.com/living/type-1-outpatient-support-team/ http://insulinnation.com/living/type-1-outpatient-support-team/#comments Tue, 08 Sep 2015 13:45:23 +0000 http://insulinnation.com/?p=309255 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.

Have Type 2 diabetes or know someone who does? Try Type2Nation, our sister publication.

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Illegally Fired for Hypoglycemiahttp://insulinnation.com/treatment2/wrongly-terminated-hypoglycemia/ http://insulinnation.com/treatment2/wrongly-terminated-hypoglycemia/#comments Wed, 02 Sep 2015 18:12:51 +0000 http://insulinnation.com/?p=309246 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 Safehttp://insulinnation.com/treatment2/medicine-drugs/bigger-capsules-keep-islet-cells-safe/ http://insulinnation.com/treatment2/medicine-drugs/bigger-capsules-keep-islet-cells-safe/#comments Mon, 31 Aug 2015 15:19:19 +0000 http://insulinnation.com/?p=309238 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 CGMhttp://insulinnation.com/devices/meters-and-cgms/day-wore-sons-cgm/ http://insulinnation.com/devices/meters-and-cgms/day-wore-sons-cgm/#comments Fri, 28 Aug 2015 23:41:39 +0000 http://insulinnation.com/?p=309229 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 Jailhttp://insulinnation.com/living/dka-death-jail/ http://insulinnation.com/living/dka-death-jail/#comments Fri, 28 Aug 2015 23:28:40 +0000 http://insulinnation.com/?p=309223 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 CGMhttp://insulinnation.com/devices/meters-and-cgms/receiver-less-cgm/ http://insulinnation.com/devices/meters-and-cgms/receiver-less-cgm/#comments Thu, 27 Aug 2015 14:19:21 +0000 http://insulinnation.com/?p=309212 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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