Diabetes Archives - Active Healthcare

Added Sugar Amounts Now on Nutrition Facts Panel

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Nutrition News: Added Sugar Now on the Nutrition Facts Panel

FDA_Nutrition_Facts_Label

By U.S. Food and Drug Administration [Public domain], via Wikimedia Commons

You may have already seen an updated Nutrition Facts label on products you’ve recently bought. Effective July 2018 the FDA will require that the Nutrition Facts label include a new category – added sugar. This category will be shown in the Total Carbohydrates section – on a separate line.

The FDA says that added sugars, “include sugars that are either added during the processing of foods, or are packaged as such (e.g., a bag of table sugar), and also includes sugars from syrups, honey, and concentrated fruit or vegetable juices.”

This is another step in a series of efforts to help all of us make better food choices and minimize our risk of obesity and chronic conditions such as cardiovascular disease and diabetes. Many medical studies have shown that those chronic diseases of adulthood often begin in childhood. The American Heart Association (AHA) also believes there is strong evidence that atherosclerosis starts in childhood – and a poor diet, especially one with a high sugar intake may be the culprit.

How Much is Too Much?

American Heart Association Recommendations on Sugar Intake for Children

AHA guidelines suggest a limit of 25 grams or less of added sugars per day for children – only 6 teaspoons. These new recommendations also advise limiting the intake of sugar sweetened beverages to one or fewer 8 oz. servings per week.

Furthermore, for kids under age 2 the recommendations are even more stringent – the AHA recommends avoiding all added sugar. For perspective, one 12 ounce sweetened beverage could contain 40 grams of sugar (9 teaspoons.)

How does that compare with the typical intake of added sugar by children? Studies show that most kids are consuming an average of 80 grams of added sugar per day – more than 3 times the recommended amount.

Focus on Natural Sugars: Reducing Sugar Consumption for Children with Diabetes

fruitChildren with diabetes already need to monitor their food intake to manage their condition. By moving focus away from processed foods with lots of added sugar to whole foods like fruits, vegetables and dairy items, children will get better nutrition. Whole foods with naturally occurring sugars also provide vitamins, minerals, fiber and antioxidants instead of empty calories.

Remember to read nutrition labels as you shop and try out new fruits and vegetables. Watch portion sizes and limit sugar sweetened beverages. Why not get your entire family on the healthy eating bandwagon for a healthier future?

Additional Resources

The New and Improved Nutrition Facts Label – Key Changes

AHA Statement on Added Sugar Consumption by Children

Diabetes Rates Rise Among Children and Teens


Diabetes Rates Rise Among Children and Teens

Lisa Feierstein Children's Health, Diabetes Leave a comment   , ,

The New England Journal of Medicine recently reported that new cases of both type 1 and type 2 diabetes are on the rise in youth. Estimates indicate that in the United States, 29.1 million people live with diabetes. About 208,000 of those are younger than 20. While Type 2 diabetes has a strong correlation with excess weight, type 1 diabetes is an auto immune condition.

The study’s goal was to reveal trends in newly diagnosed cases of diabetes within various ethnic groups. Research revealed that from 2002 to 2012 the rate of new cases of type 1 diabetes in youth went up approximately 1.8 percent each year. During the same time period, the rate of new cases of type 2 diabetes went up quicker, at 4.8 percent.

Diabetes Rates Rise: Other Findings in the Report:

  • Higher Type 1 Rates in Male Participants. Across all groups, the rate of new cases of type 1 diabetes increased more annually from 2003-2012 in males (2.2 percent) than in females (1.4 percent) ages 0-19.
  • Hispanic Youth Showed Largest Increase of Type 1. Among ages 0-19, the rate of new cases of type 1 diabetes increased most in Hispanic youth, a 4.2 percent annual increase.
  • Type 2 Rates Highest Amongst Native Americans. Among ages 10-19, the rate of new cases of type 2 diabetes rose most sharply in Native Americans (8.9 percent), Asian Americans/Pacific Islanders (8.5 percent) and non-Hispanic blacks (6.3 percent).
  • White Youth Showed Smallest Type 2 Increase. The smallest upturn was seen in whites (0.6 percent).
  • Higher Type 2 Rates in Female Participants. The rate of new cases of type 2 diabetes rose more sharply in females (6.2 percent) than in males (3.7 percent) ages 10-19.

Increased Health Care Burdens and Reduced Quality of Life

Living with diabetes from a young age sets up a longer lifetime of increased health care costs. It also creates potential for diabetes related complications. Efforts are underway by organizations like the Centers for Disease Control (CDC) to find ways to prevent or delay youth from developing Type 2 diabetes, which has become more common in recent years.

Since the cause of Type 1 diabetes is still unknown, more work is needed to find out possible disease triggers that leave the body unable to produce adequate insulin. This study’s insights into the varying rates of diabetes by ethnic group may lead to new research directions.

Additional Resources:

New England Journal of Medicine Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002-2012

CDC National Diabetes Prevention Program

Exercise and Blood Sugar Control for Kids with Diabetes


Insulin Delivery Methods – New Technology

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Diabetes patients get their insulin in a variety of ways. Options include multiple daily injections and insulin pumps. Each of these methods involves a needle stick. New insulin delivery methods promise needle-free insulin delivery.

Insulin Patches

There’s an appealing new way of delivering insulin that’s in the stages of early research – insulin patches. The patch promises to deliver insulin through the skin similar to nicotine patches or patches for pain relief. The insulin would be delivered needle-free.

If successful, they would offer opportunities for people on insulin therapy to take it without needing to put needles or infusion sets into the body.

How Would The Insulin Patch Work?

Each patch would contain a set dose of insulin that is absorbed slowly through the skin. The insulin travels into the blood stream over a number of hours. Some of the insulin patches were developed to release insulin quickly. This feature addresses spikes in blood sugar following food intake (bolus insulin patches). Other patches have been developed to counterbalance the progressive release of glucose over the course of the day by the liver (basal insulin patches).

Diabetes New Insulin Delivery Methods

Technology Challenges in Insulin Patch Development

In order for insulin to pass through the skin in a controlled and consistent way, insulin patches require additional agents be added. These agents help prevent blood glucose levels from going too high or too low. A number of manufacturers are developing insulin patch options and conducting clinical trials. Early results are promising as being a feasible form of future treatment.

Inhaled Insulin – Another Delivery Method

Another another alternative insulin delivery method is inhaled insulin. The FDA approved inhaled insulin in 2014. Use by patients under the age of 18 is still not approved. Inhaled insulin can be used to manage both type 1 and type 2 diabetes. The insulin is in a powder format that is quickly absorbed after you inhale.

Some patients use inhaled insulin along with traditional injections. This regimen offers convenience and helps blood sugar management after eating and throughout their day. Additional versions of inhaled insulin are in development from a number of manufacturers.

Additional resources:

Smart Insulin Patch Development

Insulin basics from the American Diabetes Association

The 411 on CGM


Exercise and Blood Sugar Control for Kids with Diabetes

Lisa Feierstein Children's Health, Diabetes Leave a comment   , , , , , , , , , , , ,

There are many good reasons for anyone with diabetes to participate in a regular exercise program. But what are the important considerations about exercise and blood sugar control for kids with diabetes?

children-exercising-diabetes

Exercise can stabilize blood sugar levels and help maintain a healthy weight. Excess body fat prevents insulin from working to its full potential to control blood sugar. Another benefit of regular exercise is stress reduction and relaxation. Exercise is fun, especially when you are playing your favorite sport with your friends!

Preventing Low Blood Sugar – Hypoglycemia

Every diabetic knows the importance of planning in the successful management blood sugar. Regular blood sugar testing, or the use of a continuous glucose monitor, along with meal planning are all parts of comprehensive diabetes management plan. One consideration for active children, especially those participating in organized sports is the prevention of hypoglycemia.

Activities done for a long period of time, even at a moderate pace can cause the blood sugar levels to drop precipitously, even hours after the activity has ceased.

Keep coaches in the loop. They can assist with extra testing and have quick sugar snacks available, like fruit juices, hard candy, or honey. Coaches should know the signs of both low and high blood sugar, and keep handy instructions about what to do if either situation occurs.

Symptoms of Low Blood Sugar (hypoglycemia):Sweating, lightheadedness, shakiness, weakness, anxiety, hunger, headache, problems concentrating, and confusion

Symptoms of High Blood Sugar (hyperglycemia):Frequent urination, fatigue, increased thirst, blurred vision, and headache

Hyperglycemia and Dehydration

When your muscles work hard they signal for the body to release extra glycogen from storage in the liver. If this excess glucose is not needed, and the amount of insulin doesn’t match the blood glucose, hyperglycemia (too much blood sugar) can result.

Shorter intense activities – like sprinting or weight lifting may actually cause a rise in blood sugar. The body sees the energy expenditure uptick and releases stored glycogen from the liver. If the activity level is not maintained, the body can’t use the excess sugar and blood sugar levels go up.

Unfortunately the body tries to remove the excess glucose through increase urination – which can contribute to dehydration. As with all athletes, children with diabetes need to stay well hydrated during any physical activity. The excitement of competition can produce extra adrenaline, which can also raise blood sugar.

Planning is the Key

Your healthcare provider may recommend a change to insulin dosing on the days when your child has practice or a game where there will be a higher level of physical activity. Tracking blood sugar levels before, during and after activity can give valuable information to your child’s healthcare provider to adjust dosing schedules.

Get to know how your child’s body reacts to different kinds of activity. To prevent the worry of blood sugar swings consider adding a continuous glucose monitor (CGM) to your child’s diabetes management program. (link to 411 on CGM blog) A CGM will provide 24/7 updates on blood sugar levels and trending information.

A Lifetime of Fitness

Family Taking a WalkEveryone can appreciate the long-term benefits of fitness – improved functioning of your heart, lungs, and other vital body systems. Exercise enhances flexibility and increases muscle strength.

Even if your child does not play on a sports team you can still plan activities as a family to keep everyone moving. Ask your child to suggest activities for your family as they are much more likely to happily participate in activities that they already enjoy.

Additional Resources:

WebMD’s Safe Exercise Tip List for Children with Type 1 Diabetes

How to Exercise Safely with Type 1 Diabetes

The 411 on CGM


Summer Camp for Everyone: Even Kids with Diabetes!

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CampfireMany of us have fond memories of summer camp like singing around campfires, roasting marshmallows, creating arts and crafts treasures and swimming in cool refreshing lakes. Perhaps we’ll try to suppress the memories of itchy mosquito bites, rain soaked clothing, and ‘interesting’ food offerings. Good or bad, summer camp is definitely a rite of passage.

Even though the New Year has just begun summer will be here before you know it. It might be time to plan how your children will be spending their summer. If you are a parent of a child with diabetes, you have more to consider than the typical parent as you choose a summer camp program for your child.

Advance Preparation Will Reduce Anxiety and Worry

It is completely normal for parents to feel anxious about dropping their child off at an overnight summer camp. As we have discussed in other posts about diabetes , the key to managing diabetes centers on planning and preparation.

  • Research Options: Take time to investigate camp choices based on your child’s interests. Don’t focus solely on managing their disease.
  • Ask for help: Determine what services or accommodations your child may need during camp.
  • Document Needs: Gather documentation and create a written plan of care with your child’s healthcare provider.
  • Communicate: Connect with camp staff and open lines of communication as soon as possible.
  • Network: Check in with other parents that have sent children to programs in consideration. Ask your healthcare provider for additional ideas.

 

The American Diabetes Association notes that any camp should be prepared to make reasonable modifications so that any child with a chronic disease, like diabetes, can take full advantage of camp programs and activities like any other child.

Camp Victory Junction

Children with chronic medical conditions, such as diabetes, and others with serious illnesses that would preclude them from attending a traditional summer camp program should look into the options at Camp Victory Junction.

This summer, children ages 6 to 16, with diabetes can register for Camp Victory Junction in Randleman, NC. The week of June 17-12 is designated especially for kids with diabetes. Camp Victory Junction provides a typical camp experience within a medically-safe environment.

Additional Resources:

Traveling With Diabetes

Diabetes Tips: Making Sure Its In The Bag

American Diabetes Association: Rights of Children with Diabetes in Camp

Find a Camp – Nationwide Search

About Camp Victory Junction

Victory Junction enriches the lives of children with chronic medical conditions or serious illnesses by providing life-changing camp experiences that are exciting, fun and empowering; all in a medically-safe environment at no cost to the camper or their family.

Located in the hills of Randleman, North Carolina, Victory Junction is spread across 84 acres, allowing children to do what they do best— be kids, play, imagine, make friends and enjoy the adventures and experiences of camp life.


Diabetic Resolutions to Start 2018 off Right

Lisa Feierstein Children's Health, Diabetes, Men's Health, Women's Health Leave a comment   , , , ,

ShutterstockThe New Year is right around the corner. This is a time for reflection and planning. Have you thought about what you would like to change in the coming year? Many people resolve to get more exercise, eat healthy, lose weight, spend more time with family and friends, etc. at the beginning of a new year. Diabetics usually are a little more specific with their resolutions. Here are some ways to start the year in optimal health.

Check in With Your Doctor

  • If you aren’t already, make sure to see your doctor two to four times this year
  • Review and continue to follow your testing schedule, tweaking if necessary
  • Make note of your most recent A1C, blood pressure, and cholesterol numbers
  • Start or review your meal plan with your diabetes educator, tweaking if necessary
  • Don’t forget to get a renal function and microalbumin test

 

Get Moving!

  •  Ramp up physical activity.  Remember something is better than nothing at all.
  • Take your medications exactly as they are prescribed

 

Care for Your Whole Body

  • Get an annual eye exam
  • Go to the dentist twice per year
  • Examine your feet for cuts and/or sores daily
  • Brush and floss daily
  • Get your flu shot

 

Don’t Bottle Up Stress! Deal With It Right Away Using One of These Techniques

  • Deep breathing
  • Learning to say no
  • Asking for help when you need it
  • Making time for you
  • Getting enough sleep (7-8 hours is ideal)
  • Exercising (with other people if that motivates you)
  • Seeing a counselor or social worker if none of the above approaches are effective

 

Although this is a long and possibly daunting list, it is realistic and doable.  With the help of your doctor, you can get 2018 started off on the right foot.  Share your resolutions with someone to hold yourself accountable.


Budget Your Calories for a Bountiful Thanksgiving

Lisa Feierstein Children's Health, Diabetes, Men's Health, Women's Health Leave a comment   , , , ,

budget your caloriesThe year has flown by and Thanksgiving is only a few weeks away. For many, this holiday means overindulgence. For diabetics, it can be a very difficult time for many reasons. The hardest is resisting temptations. Who doesn’t love seconds or even thirds of their favorite dishes; i.e., mashed potatoes? An important thing to remember is “everything in moderation.” Here are a few tips to budget your calories and manage your blood sugar while still enjoying this wonderful time with family.

Stay on Schedule – Never Miss a Meal or Dose of Insulin

Set reminders on your smartphone for:

  • Meals and snacks to avoid a blood sugar dip
  • Blood sugar testing
  • Insulin doses

 

Budget Your Calories: Indulge in Sweets and Treats in Moderation

You can indulge in a few treats, but make sure to budget for those calories. Work treats into your existing carbohydrate budget instead of adding to it. Stick with proteins, vegetables and salad at dinner. Pick your favorite carb or treat and enjoy it with your calorie budget for the day.

Enjoy Alcohol in Moderation

Never drink on an empty stomach, as this lowers your blood sugar. Research nutrition information in advance for your favorite libations to make good choices. It is recommended that women with diabetes have no more than one drink per day and no more than two per day for men. The serving sizes vary depending on the type of drink.

One serving is:

  • 4 ounces of wine
  • 12 ounces of beer
  • 1 ounce of distilled spirits

 

Download Mobile Apps

Look for apps that help you count carbs for your favorite dishes, as well as how much insulin you need to take before meals.

Look for Lighter Menu Options When Eating Out

Choose dishes with less saturated fat, limit fried foods and sugars. Ask about substitutions. Most restaurants can accommodate your requests. Swap out butter with olive oil. Enjoy a baked or boiled potato in lieu of mashed potatoes or French fries.

If Asked to Bring a Dish, Cook a Light and Healthy One

This can put you at ease knowing that you can enjoy what you’ve prepared and takes out the guesswork of whether or not it is within your calorie budget.

Tips for Holiday Parties

Scan the table and look for vegetable-based options first, followed by meat or cheese. Use a napkin instead of a plate to keep your portions in check. Don’t socialize in front of the food table. Stay hydrated. Keeping water or a club soda in hand will also keep you and your hands full so you are less likely to overindulge.

Stay Active

Make it a priority to stick with your regular fitness routine while you are away from home. The holidays are generally the busiest time of the year for many people. You can break up your activity into 10-15 minute segments if it is not possible to get 30 minutes all at once.

Remember that there is a lot more to Thanksgiving and the holiday season than food. Focus on spending quality time with family and friends. Enjoy what you do eat and relax.


Insulin Pump vs. Multiple Injection: The Choice is Yours

Lisa Feierstein Children's Health, Diabetes, Men's Health, Women's Health Leave a comment   , , ,

insulin pump versus multiple daily injectionsTreating diabetes can be a very time consuming, day-after-day process, but today’s diabetic has a plethora of different treatment options available — more than ever before.

Type 1 diabetics can choose between an insulin pump or administering multiple daily injections (MDI) for their insulin delivery. If you are not on a pump currently, you probably aren’t aware of just how helpful these devices can be.  Below are some advantages of both methods.

Advantages of an Insulin Pump

  • Insulin delivery is continuous, which helps prevent sudden highs and lows in blood sugar levels
  • Blood sugar control is more accurate
  • Patients need fewer needle sticks
  • Patients have more flexibility
  • Dosage can be adjusted easily according to the patient’s activity level: i.e. while exercising or sleeping

Advantages of Multiple Injections

  • Injections require less training and education
  • MDI is less expensive
  • Easier to use
  • Not always connected to the body

What Does Research Show? Insulin Pump Versus Multiple Daily Injections

Recent studies suggest that insulin pump therapy may be slightly more effective than MDI when the patients received similar, proper training.  However, both methods have been proven to reduce HbA1c levels.  An insulin pump can improve quality of life in diabetics and allow them to be a little more carefree than those that use the MDI method.  The bottom line is to find the method that fits best in your life while keeping your HbA1c levels in check.

Many of the patients of Active Healthcare are benefiting from pump therapy.  We work with manufacturers to get the right pump for our patients, as well as carry all of the necessary supplies.

Please visit our Diabetes Management page for more information on how we can help you, as well as talk to your doctor to see if they think a pump is the right method for you.


Can Diabetes Give You The Blues?

Lisa Feierstein Children's Health, Diabetes, Men's Health, Women's Health Leave a comment   , , , , ,

diabetes depressionThe number of Americans that suffer from depression, also known as Major Depressive Disorder is increasing all the time. Depression is more than being sad or in a bad mood. This condition is a chemical imbalance in the brain.

Unfortunately, depression often goes undiagnosed and, therefore, untreated. As it turns out, diabetics are especially vulnerable to this condition.

Diabetics At Double the Risk of Depression

Several studies have found that diabetics are at double the risk of suffering from depression due to the physical and emotional stress of their chronic disease. A depressed diabetic is more likely to neglect his/her diet or medication plan, which is critical to their well-being. The cause is unclear, however if a patient’s depression is stress induced, a diabetic may be a greater risk because of a metabolic imbalance that already exists.

Managing a chronic condition like diabetes can be overwhelming, leaving less time and energy for dealing with life’s other challenges. The financial burden of treating diabetes may also be a contributing factor to higher rates of depression. The rising medical costs of their life sustaining treatment adds another burden.

Studies also suggest that diabetics who have a history of depression are at a higher risk of developing diabetic complications than those without. This is because depressed individuals have elevated levels of stress hormones such as cortisol, which can affect blood sugar metabolism and increase insulin resistance.

What to Watch for: Symptoms of Depression

People suffering from depression may not want to get out of bed in the morning. They neglect their diet and don’t exercise. Depressed people shun social gatherings and have trouble staying motivated at work or school.

Seek help if you are experiencing any of the following symptoms:

• Difficulty concentrating, forgetfulness and poor decision making
• Feelings of guilt, worthlessness and/or helplessness
• Insomnia or excessive sleep
• Irritability or restlessness
• Loss of interest in activities once enjoyed
• Overeating or not eating enough (dangerous for diabetics)
• Aches and pains including headaches, cramps, and digestive problems
• Persistent sadness, anxiety, and feelings of emptiness
• Thoughts of suicide or attempting suicide

Depression can be brought on by a number of factors including genetics, life circumstances, trauma, side effects of medication, stress, or other environmental factors. It is treatable with psychotherapy, as well as medication. As with most medications, anti-depressants (often called SSRIs, which stands for Selective Serotonin Reuptake Inhibitor) come with side effects including nausea, weight gain, fatigue, insomnia, dry mouth, dizziness, irritability, and anxiety.

You may have chalked your feelings of sadness up to the fact that you’re diabetic when you may also be depressed. Depression should be treated as a separate condition. Getting treatment for it can help you take better care of your diabetes, putting you in optimal health.

Additional Resources:

http://www.diabetes.org/living-with-diabetes/complications/mental-health/depression.html

https://www.childrensdiabetesfoundation.org/diabetes-and-depression/


Monitoring Your Diabetes at School

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Type 1 Diabetes requires continuous monitoring, regardless of the patient’s environment. In previous blogs, we’ve discussed carrying an emergency bag and other methods for managing your diabetes when away from home. However, one area we did not discuss is what to do at school.

Monitoring Diabetes at School - Communication is Key

Monitoring Diabetes at SchoolFirst and foremost, you cannot communicate enough with school staff including teachers, bus drivers, and health personnel about your child’s condition. Provide as much information as possible so they will know how to assist your child when the need arises.

A Diabetes Medical Management Plan (DMMP) should be completed and gone over with school administrators so everyone is on the same page. An example of this can be downloaded here.

This comprehensive and critical document should contain the following information:

  • Blood sugar target and testing times
  • Insulin schedule
  • List of supplies
  • Meal and snack plan
  • What aspects your child can handle on their own vs. what they might need help with
  • How to handle a low blood sugar or high blood sugar episode

ADA and IDEA

There are many laws that protect your diabetic child including the Americans with Disabilities Act (ADA) and the Individuals with Disabilities Education Act (IDEA). IDEA is a law that provides services to diabetic students. For more information about IDEA, click here. In addition, in a public school setting (or a private one that receives funding from the federal government), you are entitled to set up a Section 504 plan for your child.

This would require that the school make special accommodations for him or her including the following:

  • Allowing him or her to use the restroom and use the water fountain when they need to
  • Eating wherever and whenever necessary
  • Allowing extra absences
  • Scheduling exams at a time that will not cause your child to suffer from the hypo or hyperglycemia
  • Ensuring that a trained diabetes care personnel member be present during sports, extracurricular activities, and field trips

If your child is not currently using a Continuous Glucose Monitor (CGM) (more on this in our previous blog “The 411 on CGM”) or an insulin pump, the beginning of school is a great time to look into these options, as these devices provide peace of mind for the parent, school staff member, and child alike.


Diabetic Tips: Making Sure It’s “In the Bag”

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Emergency Diabetes BagAs a diabetic patient or parent, you are well aware that you need an emergency diabetes bag. This is one project that can’t be put off.

Advance planning is key to successful management of your diabetes. Don’t “live and learn,” coming up with a Plan B on the fly.

Here are some ideas for filling your emergency diabetes bag

Your Medical History and Contacts List

Take the necessary time to gather this information, which should include your health conditions, allergies, medications and dosages. Also, include contact information for your doctor, pharmacy, and emergency contact. Carry one in your wallet and smartphone.  Don’t forget to store a copy in an easy-to-locate area of your home, such as attached to the fridge.

Glucose tablets or gels are great to have in your bag in the event of a blood sugar nosedive.

But don’t forget a glucagon injection kit, you may need this depending on the severity of your episode. On that note, it would also be a good idea to keep a list of signs and symptoms at work and home so others can identify these and know how to assist.

Extra Medications – Include three days’ worth of your medications.

When you are ready to head out, keep your insulin cold with reusable frozen gel packs.

Snacks to keep blood sugar stable.

Always have some non-perishable snacks such as nuts, seeds, dried fruit, whole-grain crackers, trail mix, or dry cereal on hand.

Testing Supplies – so you can test as many times as you need to.

Being out and about can raise your stress level, causing your blood sugar to fluctuate more than usual. Therefore, it may be necessary to test a little more frequently.

Include the following:

  • Meter
  • Test Strips
  • Batteries
  • Lancing Device
  • Lancets
  • Needles
  • Alcohol Swabs
  • Hand Sanitizer

Let a Medical Alert Bracelet Speak For You When You Can’t

Always remember to wear a Diabetes ID bracelet. In the event you lose consciousness or cannot speak, bystanders and first responders will know that you are diabetic and can help accordingly. This bracelet should clearly state your diagnosis and any other key health information. You can find these at the American Diabetes Association’s (ADA) website at www.shopdiabetes.org.

Advanced Planning is the Key to Peace of Mind

Once you have your emergency bag packed, you can relax while on-the-go. For additional peace of mind, consider using a Continuous Glucose Monitoring (CGM) system or an insulin pump if you are not already benefiting from one of these devices.

More information about how CGM works can be found in our previous blog The 411 on CGM.


Pump, Don’t Fail Me Now!

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Diabetes Blood Glucose TestingHave you thought about what you would do if your insulin pump were to fail? It is important to have a plan in place for when and if this occurs. You can create a fail-safe plan for the rare event of a pump failure by following these four steps.

Pump Failure Action Plan

Step 1

First and foremost, call your pump manufacturer. Your pump’s warranty will cover repairs. The manufacturer may be able to troubleshoot the pump, arrange for repairs, or even a replacement.

Step 2

Next, call your endocrinologist. He/she can help you create a plan to manage your blood sugars in the interim and what warning signs to watch for.

Step 3

Keep the following items with you at all times, making sure all are within the prescription limits and not expired:

  • long-acting insulin (in case you will be without a pump overnight)
  • short-acting insulin (to inject and repeat for bolus and/or correction)
  • ketone strips
  • a list of 24-hour pharmacies

Step 4

Also, keep a record of your pump’s settings, as you may need to program a replacement or loaner pump. On this record, include the following:

  • Total basal
  • Your basal setting, which determines how much insulin you receive each hour
  • Insulin to Carbohydrates (I:C) ratio to help with adjusting pre-meal bolus insulin doses
  • Insulin Sensitivity Factor (ISF) — the number of points one unit of rapid acting insulin lowers your blood glucose
  • Insulin On Board (IOB) – the calculation telling you how much insulin is still in your body from previous bolus doses

The possibility of a pump failure may give you chills, but remember not to panic. With the help of your manufacturer and endocrinologist, you can be well equipped to deal with this unlikely event. Before you know it, you’ll be pumping again.


The Lowdown on Stress and Diabetes

Lisa Feierstein Children's Health, Diabetes, Men's Health, Women's Health Leave a comment   , , , ,

sleep deprived manIf you have diabetes, stress can take a larger toll on your body.  When the body is under stress, it acts as if it is under attack.  Cortisol (the stress hormone) levels rise, causing your body to store energy in the form of glucose and fat.  In diabetics, this process can be disrupted.  The glucose is released, and if it can’t be stored, it builds up in your bloodstream.

Stress hormones are scientifically proven to affect blood glucose levels.  Scientists who have been studying the effects of stress on these levels have found that when diabetic mice were under stress they had elevated glucose levels.  In Type 1 diabetics, studies produced mixed results with some patients experiencing a rise in blood glucose while others noticed a decline.  Type 2 diabetics more consistently experienced a rise than a decline.  This research confirms the importance of stress reduction.

Not All Coping Mechanisms Are Good

Everyone has different ways of coping with stress on the outside.  Some negative examples are below:

  • Drinking more alcohol
  • Not getting enough exercise
  • Neglecting nutrition (very important NOT to do if you’re diabetic)
  • Not getting adequate sleep

 

Diabetics have even more to think about during stressful times and stress may cause them to forget important tasks such as checking their blood glucose levels on a regular basis or planning their meals ahead of time.

Positive Coping Mechanisms

On the other hand, there are many positive ways to deal with stress.  Below are some methods anyone can implement to reduce stress:

  • Get regular exercise
  • Spend more time on your hobbies or learn a new one
  • Perform volunteer work in your community
  • When commuting, take the less stressful route to work if your drive is long
  • Patch up conflicts with your friends or family

 

Relaxation Therapy Techniques for Stress Reduction

  • Breathing exercises
  • Replace negative thoughts with positive ones
  • Progressive muscle relaxation therapy — an example of this is shown in the video below

 


Leaving on a Jet Plane: Traveling with Diabetes

Lisa Feierstein Diabetes Leave a comment  

travel by airBelieve it or not, the upcoming travel season is upon us. If you’re diabetic and planning a trip, you may be a bit anxious about how best to manage your condition while away from home. You’re not alone.

Taking a trip will require more preparation, but can still be an enjoyable experience. Below are a few tips to help you with your trip planning:

Before You Travel: Get your documents together

  • Prescriptions from your doctor for any medications, as well as for your medical devices (CGM, insulin pump, etc.)
  • Documentation that specifies that you are a diabetic.
  • If traveling to a foreign country, make sure this document is translated to the language spoken in any of the countries on your itinerary.
  • Make a few copies of this document and distribute them to anyone traveling with you.

Packing Tips

Put medications in your carry-on bag

  1. Store medication in a quart-size plastic container or bag so that airport security can easily identify them at the checkpoint.
  2. Separate them from other liquids in your carry-on luggage.
  3. If possible, keep your insulin bottles or pens in their original packaging, as this will provide airport security staff with the prescriptions they will be asking for.
Packing Suitcase for Travel

Over pack your supplies

When packing your supplies, take twice as much as you think you will need.

Pack non-perishable snacks

Keep a few ready-to-eat snacks in your carry-on luggage for those blood sugar dips.


Additional Travel Resources

  • Visit the Transportation Safety Administration’s (TSA) website – Be sure to check out the requirements of the TSA ahead of time so you will know what to expect at the security checkpoint.
  • Look into loaner pumps – Many pump manufacturers offer loaner programs. Check with your specific pump manufacturer for details.


The 411 on CGM

Lisa Feierstein Diabetes Leave a comment   ,

The medical device market is always advancing technologically, as with most other industries. One new technological development, the Continuous Glucose Monitor (CGM), provides added peace of mind to diabetics by providing 24-7 information about blood sugar levels. This constant feedback provided by the device allows for better short and long term control of your diabetes, which will also improve your A1C levels.

The device is comfortable to wear and decreases the number of finger pricks you need to perform daily to check blood sugar. Patients who use a CGM often only need to test their blood sugar twice per day. Two finger pricks per day is much better than the typical number of ten times! This is a huge step forward in diabetes management.

CGM Components

A CGM system includes three components:  a sensor, transmitter, and receiver. The sensor inserts into your skin and uses the same enzyme as a test strip (glucose oxidase) to measure blood glucose. The glucose oxidase in the sensor converts the glucose in your blood to hydrogen peroxide, which reacts with the platinum in the sensor. This reaction sends a signal to the transmitter, which inserts into the sensor. The transmitter then communicates with the receiver (or other connected device), notifying you via alerts if your blood sugar is trending high or low. Sensors need to be replaced every seven days.

Here at Active Healthcare, we have a number of patients benefiting from CGM. Our patients appreciate the ability to analyze their blood glucose results and adjust their basal levels accordingly instead of guesstimating from multiple manual tests. We offer two Dexcom systems, the G4 Share and the G5.  The G5 is Dexcom’s newest model and pairs with a smartphone or any Apple device, eliminating the need to carry your receiver around. This is especially good for patients who already carry a lot of supplies and devices around to manage their diabetes, such as students. Both systems enable the patient to share device information with up to five other people.  We also provide the ongoing supplies for our CGM patients and can send these in the same shipment as your regular diabetic supplies.

Integration with Insulin Pumps

Many insulin pumps are now integrated with CGM including the Animas Vibe and Tandem G4.  The newest Tandem pump, the t-slim X2, will have compatibility with this feature later this year.  Because the CGM is a complex device, it is recommended that patients get as much information and training as possible both from their physician, diabetic educator, and the various manufacturers before beginning its use.


Keeping You in the Loop About the Artificial Pancreas

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If you have Type 1 diabetes, your entire day can be spent treating your condition. Over the past few decades, technology has advanced significantly, making life as a Type 1 diabetic easier than ever before. The FDA approval of a new medical device called the artificial pancreas in September 2016 will continue this trend. Derek Rapp, President and CEO for the Juvenile Diabetes Research Foundation (JDRF) says that the artificial pancreas “is a historical achievement for JDRF and the entire T1D community. After years of laying the ground work, this life-changing breakthrough is a true testament to the reason JDRF exists, which is to accelerate ways to cure, prevent, and treat this disease.”

Smart Phones and Diabetes Control: Mimicking the Pancreas

Researchers at the University of Virginia are developing and testing these devices. This device has two components: a smartphone and an implanted insulin pump. You may be asking yourself, but how does it work? The smartphone component uses an algorithm to deliver just the right amount of insulin into the body, as well as control blood levels. The insulin pump receives the patient’s blood sugar levels from the smartphone every five minutes in a process called “looping.” The device performs the same functions as a healthy pancreas.

Clinical Trials for Closed Loop Systems

Trials are being conducted all over the United States and Europe, the first of which is the International Diabetes Closed-Loop trial. This trial will be performed using the device developed by UVA and will be led by Boris Kovatchev, director of the UVA Center of Diabetes Technology. According to Kovatchev, the artificial pancreas is “not a single-function device; it is an adaptable, wearable network surrounding the patient in a digital treatment ecosystem.”

Les Hazelton, a 59 year old type 1 diabetic from Minnetonka, Minnesota, says that until he enrolled in a trial at Park Nicollet’s International Diabetes Center in Minneapolis, he was always chasing his blood sugar. “It was totally mind-blowing. I like being in better control of my body and my disease. The more I know about what’s happening right now, the better I can manage it,” he said.

You are likely wondering when such a device will be available on the market. Diabetes In Control www.diabetesincontrol.com says that with several trials having been conducted in 2016, we could see the first artificial pancreas available sometime this year.


Five Misconceptions About Diabetes

Lisa Feierstein Children's Health, Diabetes, Men's Health, Women's Health Leave a comment   , ,

There are many misconceptions about diabetes. Below are a few of them followed by the truth.

Myth: People get Type 1 diabetes from eating too much sugar

Reality: No one really knows how someone gets the disease.

It does not mean that the patient eats too much sugar. “Type 1 is like being hit by lightning, and it’s not anybody’s fault,” says Steven Griffen, MD who is a vice president for the Juvenile Diabetes Research Foundation (JDRF). Researchers still can’t pin down the real cause of this disease, but it means that the patient’s pancreas is not processing insulin the way that it should.

Myth: It is dangerous for people with diabetes to exercise or participate in sports

Girls Walking for Exercise

Photo from Shutterstock.

participate in sports and even thrive as an athlete. Professional athletes such as tennis star Bill Talbert, boxer Jersey Joe Walcott, and golfer Sherri Turner are all Type 1 patients.

Myth: Diabetics should avoid all sugar and carbohydrates

Reality: Diabetics can and should have some sugar and carbohydrates. 

Did you know that diabetics also experience extreme lows in their blood sugar?  Yes, it’s true.  When a diabetic has a blood sugar nosedive, this is called hypoglycemia.  The highs are referred to as hyperglycemia.  Hypoglycemia can make the patient feel just as bad as if their sugar is too high. Hypoglycemia can be avoided by a regular intake of natural sugars. Diabetics can try eating fruit and complex carbohydrates like whole grain bread and pasta to prevent hypoglycemia.

Myth: Diabetes is caused by being overweight

Reality: There are two very different types of diabetes.

Type 1 is an autoimmune disease that never goes away. Type 2 symptoms can diminish with weight management and dietary changes.  Being overweight puts you at risk for Type 2 diabetes, but Type 1 patients often find it difficult to gain weight.

Myth: Diabetes is easy to control.

Diabetes Blood Glucose TestingReality: Diabetes is hard to control, no matter how diligent one is with sticking to his/her meal plan and treatment schedule.

Treatment is ongoing. People often assume that the patient “has it all figured out.”  Stress, hormone changes, growth spurts, and illnesses can all cause a diabetic’s blood sugar to swing.

On the upside, there are so many more ways to combat Type 1 diabetes now than ever before. Patients now have many options available to them to make life with Type 1 diabetes more manageable including insulin pumps, continuous glucose monitors, and even an artificial pancreas.


The Sunshine Vitamin: Diabetes Edition!

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The Sunshine Vitamin
The sunshine vitamin strikes again! Last month, we discussed how important vitamin D can be to reducing children’s risks for asthma. Now we will also look into how the “sunshine vitamin” could be affecting risks for diabetes. First, what exactly is vitamin D?

Not a Vitamin, but a Hormone

Vitamin D is a unique steroid hormone that influences nearly all the cells in your body. It is the only vitamin your body can create – when sunlight is absorbed in your skin. Your body creates this vitamin and turns it into a hormone. Vitamin D is important to your overall health – and low levels have been linked with many chronic diseases. Most recently, diabetes and pre-diabetes have been linked with low levels of vitamin D.

There is a distinct connection between insufficient vitamin D and insulin resistance and diabetes, both type 1 and 2. Findings in recent research indicate that a vitamin D deficiency affects your glucose metabolism. Low vitamin D may actually be more closely linked to diabetes than obesity. In one study of 118 people, it was determined that a vitamin D deficiency and obesity interact synergistically to raise the risk of diabetes and other metabolic disorders.

How Much is Enough?

Researchers also discerned that for every unit increase in vitamin D levels, the probability of progression towards diabetes in people with pre-diabetes went down by eight percent.

In another study in 2013, researchers gave type 2 diabetics 50,000 IUs of oral vitamin D3 per week for eight weeks. Study participants experienced a meaningful reduction in fasting plasma glucose and insulin. A different study with over 5,000 individuals with impaired glucose intolerance discovered vitamin D supplementation increased insulin sensitivity by 54 percent.

Animal studies have also supported that vitamin D is a foundational factor necessary for normal insulin secretion. They also found that vitamin D improves insulin sensitivity.

Optimizing levels of vitamin D among the general population could help protect against cardiovascular disease, autoimmune disease, and infertility. DNA repair and metabolic processes, migraines, mental disorders, and notably, both type 1 and 2 diabetes, could be improved as well.

As stated in our other Sunshine Vitamin post, all it takes is a few minutes in the sun to absorb some vitamin D. No need to sit in the sun for hours and raise risks for skin cancer! Additionally, supplements with vitamin D3 are also recommended – in particular if they contain vitamin K2, as it has been found to aide in the maximum absorption of vitamin D into your body.

The Sunshine Vitamin is truly invaluable support to your body’s overall health and disease prevention!


Diabetes and the Dopey Effects of Dopamine

Lisa Feierstein Diabetes Leave a comment   , ,

dopamine levels in your brain

Have you ever wondered if there was more as to why it can be so hard to eat well? Insulin has been linked to the pleasure centers of our brain! According to a recent study, insulin has been found to be strongly allied with dopamine, a neurotransmitter that controls pleasure. This can mean a myriad of things for people with diabetes, as well as those at risk.

What is Dopamine?

First, what exactly is dopamine? It is a neurotransmitter that acts as a chemical messenger in the brain. It has many vital roles in our brain and its functions include movement, memory, attention, and most commonly known pleasure and reward seeking behavior.

At New York University Langone, researchers determined that the more insulin in the in the brain, the higher the release of dopamine. Consequently, this creates the need for us to seek out high-carb or sugary foods in order to escalate insulin levels in the brain. That in turn triggers the release of dopamine. Thus, instilling a reward system in the brain.

“Our work establishes what we believe is a new role for insulin as part of the brain’s reward system and suggests that rodents, and presumably people, may choose to consume high-carb or low-fat meals that release more insulin – all to heighten dopamine release,” said Margaret Rice, senior study investigator and neuroscientists at New York University Langone.

Low Calorie Diets = Healthy Levels of Insulin in the Brain Too

Dopamine levels were found to rise between 20 and 55 percent as a group of mice and rats ate and increased their glucose quantities. Rats who were fed a low-calorie diet only needed 10 percent of the insulin needed by rats on a normal diet to elicit an elevated release of dopamine. Essentially, this means that lowering insulin intake lowers the baseline needed to stimulate a dopamine release.

The link between higher insulin levels and diabetes makes this a dangerous discovery for those with a type 2 diagnosis. Higher carb and sugary foods increase insulin levels in the brain. This may explain why many find it difficult or near impossible to follow a healthy diet. Likewise, following an unhealthy diet means that people need more insulin to trigger the dopamine response in the brain. And so, the cycle continues.

The good news is that if these findings continue to hold, diets can be adjusted in healthy ways to manage that dopamine-reward rush! I don’t know about you, but making smart food choices and conscious decisions are much easier for me when I understand the mechanisms working behind it.


5 Natural Remedies to Aide Diabetes

Lisa Feierstein Diabetes Leave a comment   ,

herbs smallI have often thought that there has to be ways to boost my body’s ability to care for itself without adding to my medicine cabinet. There has been a surge in patients seeking naturopathic doctors, as well as traditional medical doctors researching the benefits of naturopathic remedies alongside necessary prescriptions. Many clinical trials have shown that herbs can successfully assist in the treatment of various diseases such as diabetes. The traditional medical system of India, Ayurvedic medicine, finds the following herbs to help manage diabetes. It is still extremely important to maintain your relationship with your doctor and to check in before trying any herbal supplements. However, herbs can become a complimentary support to your regular treatment plan.

1. Gurmar – Translated from Hindi as the “sugar destroyer,” this is a tropical herb native to southern and central India and Sri Lanka. Its leaves have been known in India for centuries for its anti-diabetic and anti-inflammatory uses. Natural Medicines Comprehensive Database (NMCD) states there is developing research suggesting an extract, in combination with diabetic medications, can moderate blood sugar levels in people with type 1 or type 2 diabetes. It is also used to facilitate weight loss.

2. Cinnamon – A familiar spice to Americans, particularly in the fall, some evidence suggests that cinnamon might help people with Type 2 diabetes. In an early study, two daily doses of cinnamon showed that it lowered fasting glucose by 18 to 29 percent, triglycerides by 23 to 30 percent, LDL cholesterol by 7 to 27 percent, and total cholesterol by 12 to 26 percent. Despite this, a few studies still yield mixed results. As it is easy to incorporate into a diet, many doctors still recommend it.

3. Fenugreek – A common addition to Indian dishes, this plant’s seeds have been cited to have an affinity for regulating insulin. It contains an amino acid known to increase the body’s production of insulin when blood sugar levels are high. In some studies of animals and humans with both diabetes and high cholesterol levels, fenugreek lowered cholesterol levels as well as blood sugar levels.

4. Shilajit – Every summer as the Himalayan mountains warm, India’s most prized herbal remedy literally oozes from resins in the mountain crevasses in the form of Shilajit. This nutrient-rich biomass has been touted for millennia by Ayurveda’s Materia Medica as the best carrier of energy and nutrition into the human body. As an endocrine tonic, shilajit supports the pancreas in insulin secretion.

5. Artemisia – Also known as “wormwood,” for women with gestational diabetes, a daily extract is associated with improved insulin sensitivity, according to a study. The researchers observed significant reductions in fasting plasma glucose, serum insulin levels, insulin resistance, and beta-cell function in the Artemisia extract group compared with the placebo group.


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