Diabetes Archives - Active Healthcare

Using a Low Carb Diet to Help Treat Type 1 Diabetes

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

For children with type 1 diabetes, snack time isn’t always simple. Diet is an important part of a diabetes management plan to help avoid blood sugar spikes. But new research by endocrinologists at Boston Children’s Hospital suggests that food can be used as a powerful tool to help keep blood sugar under control.

low carb veggies

About the Study

Endocrinologists Dr. David Ludwig and Dr. Belinda Lennerz from Boston Children’s Hospital conducted an observational study on diabetic children who follow a very low carb diet. The children’s very low carb diets included on average only 36 grams of carbs a day.

The parents of these children were members of a Facebook group for families with diabetic children. The observational data was confirmed by the child’s doctors and analyzed using the latest techniques.

Here are just 3 possible benefits of a very low carb diet for children with diabetes.

Greater Glycemic Control

Children in the study had what the researchers called “exceptional” glycemic control. The common target range for hemoglobin A1c values are below 7%. However, children in the study had average hemoglobin A1c values at 5.67%, within the normal range for children overall.

Researchers are very excited at the prospect of diabetic children achieving normal hemoglobin A1c values with the help of diet. More research is needed to confirm the connection, but the possibility is an amazing development in the treatment of type 1 diabetes.

Less Complications

The study found that children on the very low carb diet had lower hospitalization rates than usual. Only 1% of the children were hospitalized for hypoglycemia and only 2% were hospitalized for diabetic ketoacidosis.

Boost Mental Health

High or low blood sugar is known to negatively impact mood, mental resilience, and overall brain health. For children with diabetes prone to high or low blood sugar spikes, mental health is especially important. For more information and other ways to improve mental health in your diabetic child, see our blog on mental health for teens with type 1 diabetes.

Diet can be a powerful tool in the management of type 1 diabetes.

Ask your doctor about whether a low carb or other specialized diet could be a good addition to your child’s diabetes management plan.

Resources

Very Low Carb Diet can safely curb blood sugar in type 1 diabetes, study suggests – Boston Children’s Hospital
Management of Type 1 Diabetes With a Very Low–Carbohydrate Diet (Original Research) – Pediatrics
New Recommendations from the ADA: Management of Type 1 Diabetes In Children and Adolescents
Added Sugar Amounts Now On Nutrition Facts Panel


Tips For Managing Type 1 Diabetes at School

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Back to School 3

 

The first day of school will be here before you know it. If your child has type 1 diabetes, there should be a few extra items on your back to school checklist to make sure that your child and their school are ready for the year ahead.

Here are a few important tips for an easy adjustment back to school:

1. Make a Diabetes Management Plan

Your child’s Diabetes Management Plan is an essential tool. Work with your doctor to draft a plan containing all important information concerning your child’s diabetes care. Include all medication details, symptoms of low blood sugar, target blood sugar range, and other important details those caring for your child should know.

2. Connect with the school nurse and other staff

Provide a copy of your child’s Diabetes Management Plan to the school nurse, administration, and all of your child’s teachers, coaches, and other supervising adults. If your child’s school does not have a full time nurse, figure out which staff members are best equipped to help if the nurse is not present.

All your child’s teachers should be aware of symptoms of low blood sugar, what your child needs to do to manage their blood sugar, and what help your child will need with those steps, if any.

In addition, your child should wear a medical notification bracelet or necklace that indicates their diabetes diagnosis. This guarantees that even substitutes or other rotating staff will be aware of your child’s condition in case of an emergency.

If needed, consider creating a 504 plan. A 504 plan is an official document that details the exact responsibilities of the school and ensures that your child has the same opportunities as all other students.

3. Pack their backpack with the essentials

Make sure your child has the tools they need for diabetes management during the school day. Build a compact kit full of testing supplies, antiseptic wipes, and backup insulin, as well as glucose tablets or other fast-acting snacks for raising blood sugar.

4. Get your child involved (as age appropriate)

As your child gets older, they should take on more responsibility for their diabetes care. Depending on the age of your child, help them identify their symptoms of low blood sugar. When your child has a greater understanding and more responsibility in their own care, they will have more confidence in the face of adversity at school and beyond.

Give your child the foundation they need to succeed in the New Year

With careful preparation, you can ensure that your child gets the most out of their school days, minimizing the stress from managing their diabetes.

Additional Resources

Tips for Managing Diabetes at School from the CDC
Monitoring Diabetes at School
Diabetic Tips: Making Sure It’s in the Bag


New Type of Immune Cell Discovered in Connection to Type 1 Diabetes

Lisa Feierstein Diabetes Leave a comment   , , , , , ,

immune cellFor many years, researchers have theorized that type 1 diabetes is an autoimmune disorder, where the body attacks healthy insulin producing cells in the body instead of bacteria and viruses. However, the exact reason why the autoimmune response occurs had not been discovered.

Recently, researchers at John Hopkins have discovered a new type of immune cell that may be the source of the autoimmune reaction that causes type 1 diabetes.

How the immune system works

The immune system consists of T cells and B cells, known as lymphocytes. These cells seek out, identify, and destroy antigens that are harmful for the body, including bacteria and viruses.

When an immune cell identifies an antigen, it alerts other cells to create antibodies and eliminate the threat. However, when immune cells wrongly identify a healthy cell in the body as a antigen, it triggers an autoimmune response, causing disorders including arthritis, multiple sclerosis, and type 1 diabetes.

What is the hybrid X cell?

However, groundbreaking new research has identified a different sort of hybrid immune cell with properties of both T cells and B cells. Researchers call these X cells. The dual structure of the X cells means the cells can activate both T and B cells, making them uniquely powerful actors in the immune system.

What is the connection between X cells and Type 1 Diabetes?

X cells are able to create a special protein called x-Id peptide. Scientists believe this protein mimics the signature for insulin, which wrongly identifies insulin as a dangerous antigen. Since X cells have a  hybrid structure, both T and B cells are alerted to attack insulin-producing beta cells in the pancreas.

Researchers compared the immune cells of both patients with and without type 1 diabetes. While both diabetic and non-diabetic patients had X cells, diabetic patients had substantially more X cells present.

In addition, only diabetic patients had X cells with the genetic code for producing the x-Id peptide. This leads scientists to believe that the production of this protein could be connected to the diabetic autoimmune response .

What are the next steps for diabetes research?

With the discovery of X-cells and the x-Id peptide, it is possible that a early detection procedure for type 1 diabetes could be developed. The genetic code for the production of the x-Id peptide in X cells could serve as a bio-marker, indicating a higher chance of developing the condition. Early detection can lead to better treatments and healthier lives for children with type 1 diabetes.

Researchers also explained that these discoveries about the possible mechanics of type 1 diabetes has pushed science closer to an eventual cure. Immunotherapy could be the new frontier of diabetes treatment.

Scientific discoveries lead to better diabetes treatment

With the effort of countless researchers, we have gained a deeper understanding of how diabetes works in the body. This greater understanding helps patients with type 1 diabetes get better care and pushes the medical field closer to a cure.

Additional Resources

Medical News Today – Could this unusual immune cell be the cause of type 1 Diabetes
The Scientist – Novel Type of Immune Cell Discovered in Type 1 Diabetes Patients
Five Misconceptions About Diabetes
5 Natural Remedies to Aide Diabetes


Mental Health for Teens with Type 1 Diabetes

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

Research shows that diabetics are at higher risk for mood disorders and other mental illness. During the often tumultuous teenage years, it’s important for parents and caregivers of teens with diabetes to understand how diabetes and mental health interact.

Why mental health is crucial for teens with diabetes

teen mental healthAccording to the American Diabetes Association, diabetic teens tend to show 2-3 times the rate of psychological distress than their peers without diabetes.

Living with diabetes is not easy and can add to the other stress that teens experience. Stress has a negative effect on diabetes, leading to a feedback loop if both a teen’s stress and diabetes are not managed correctly.

Here are some tips for supporting the mental health of teens with diabetes.

Encourage independence

Every teenager wants to be more independent, including those with diabetes. New technology can make it easier than ever for teens to take on a larger role in their diabetes care. Cell phone apps can sync to continuous glucose monitors (see our previous blog “The 411 on CGM” for more information), allowing teens to take initiative while their parents are kept in the loop with automatic updates.

Prioritize self-care

The busy lives of teens can leave no room for personal time to recharge. Especially during stressful times like finals, encourage your teen to take short breaks. Spending a few minutes to take a walk, listen to music, or do something else enjoyable can do wonders to lower stress.

Build a foundation of self-esteem and acceptance

Insecurity can cause teens with diabetes to try and hide their condition from peers. From a young age, educate your child about diabetes and how each part of their diabetes management plan is important. This will instill self-confidence and a greater sense of self-understanding in your child.

Be aware of warning signs

Early detection of psychological distress is important, especially for teens with diabetes. If you notice your teen has lost interest in their favorite activities or has unexpectedly lost or gained weight, check in with your teen and consider getting the help of a professional if needed.

Take care of your own mental health as a caregiver

Several studies have shown that caregivers of children with diabetes have a higher likelihood of depression. While caring for your child, don’t neglect your own mental health. Try joining a local support group for parents of children with type 1 diabetes. Talking with other parents in the same situation can do wonders to boost your outlook.

Wellness of body and mind for diabetic teens is possible

The teenage years are the best time to develop good habits for both physical and mental health. For teens with diabetes, these good habits allow a smooth transition into self-sufficient diabetes management in adulthood.

Additional Resources

ADA Position Statement

JDRF (Triangle/Eastern NC ) – Support Resources for Parents of Children with Type 1 Diabetes

CDC: Diabetes & Mental Health

Teen Focus: Dangerous Duo Type 1 Diabetes and Drinking

Can Diabetes Give You The Blues?

The Lowdown on Stress and Diabetes


The Dangers of Hypoglycemia – New Educational Resources

Lisa Feierstein Diabetes Leave a comment   , , ,

One of the biggest fears of people living with Type 1 Diabetes (T1D) and their caregivers is a low blood sugar event, also known as hypoglycemia. While people with T1D may not recognize the signs of dropping blood sugar, most know how dangerous it can be if left unnoticed or untreated.

What is Hypoglycemia?

  • Low blood glucose levels – outside of your target range
  • Typically less than 70 mg/DL
  • Triggers your fight/flight response due to a release of adrenaline
  • If left untreated, may lead to seizure or coma.

What is Hypoglycemia Unawareness?

Diabetes Blood Glucose TestingHypoglycemia unawareness is a complication of T1D where the patient misses the typical symptoms of a blood sugar drop (palpitations, sweating, anxiety, etc.). When their body does not release adrenaline there are no warning symptoms and then they are at risk for life threatening complications.

Online Interactive Resource – Hypoglycemia Education

We recently came across a new educational resource about hypoglycemia from the ‘Diabetes Sisters.’ This online resource includes basic information about hypoglycemia as well as video-based and interactive learning, infographics and more. Topics include “What Does Hypoglycemia Feel Like?” and “How to Talk to Your Doctor About Hypoglycemia.”

Each topic includes videos, quick tips and a quiz to test what you’ve learned. Visit the website to test your knowledge and share with family and friends so that they can be familiar with the signs of low blood sugar and help you if needed. It is important that people with diabetes know the risks of hypoglycemia as part of your diabetes management plan.

Additional Resources

Diabetes Sisters – visit this online community to read stories of how others deal with the real life challenges of diabetes.

411 on the CGM

American Diabetes Association – Hypoglycemia (Low Blood Glucose)


Upcoming Diabetes Educational Event – Taking Control of Your Diabetes

Lisa Feierstein Diabetes Leave a comment   , , , , ,

Patient Education is one of our favorite topics here at Active Healthcare. We wanted to share the exciting news about an upcoming diabetes educational event coming to the Triangle area of North Carolina in a few months.

Taking Control of Your Diabetes (TCOYD) is a non-profit charitable educational organization that sponsors educational events in cities across the United States for people with diabetes, their families, and caregivers.

Taking Control of Your Diabetes“TCOYD educates, motivates, empowers and inspires people with diabetes — and family and friends who care about them — to take a more active role managing their diabetes, and being self-advocates. We do this by providing the best diabetes conferences & educational programs!”

Save the Date: TCOYD in Raleigh on Saturday May 11

This educational conference is for patients with both Type 1 and Type 2 diabetes. The conference has sessions specifically designed for each group. Attendees can get the latest info on their disease and treatment options via keynote speakers and breakout sessions. Lunch is included in the $25 registration fee. Conference goers will also have the opportunity to ‘Ask a Specialist’ (Endocrinologists, Diabetes Educators, Dietitians, Nurses, and Pharmacists), visit the event’s health fair, meet with equipment vendors and also participate in a number of free health screenings.

The Triangle event will be held at the Raleigh Convention Center on Saturday, May 11th.

Full Raleigh Conference Schedule

For those of you outside of the Triangle Area, check out the TCOYD website for their full schedule of 2019 events. The conference will be in Charlotte NC area this fall on Saturday, November 2nd.

Additional Resources

Check out the TCOYD website for additional educational resources including videos and blog posts.

New Recommendations for Treatment of Type 1 Diabetes in Children and Adolescents

Diabetes Rates Among Children and Teens


New Recommendations from the ADA: Management of Type 1 Diabetes in Children and Adolescents

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

The American Diabetes Association recently shared an updated position statement on the management of type 1 diabetes in children and Adolescents. This statement is an update to their previous position statement issued in 2005. Their statement highlights the common sense idea that children are not just mini-adults. Treatment plans for children with Type 1 diabetes need to be tailored to both their current situation and their future growth and development.

The following areas were highlighted in the updated statement of recommendations for children and adolescents with Type 1 Diabetes (T1D):

  • Diagnosis of Diabetes
  • Blood Glucose Level Management
  • Lifestyle Considerations
  • Self-Management of Diabetes
  • Complications and Comorbidities
  • The Transition from Childhood to Adolescence and Adulthood

Diabetes Blood Glucose Testing

New Recommendations for Blood Glucose (BG) Management in Children and Adolescents

Most children’s T1D should be treated with insulin regimens with either multiple daily injections or via insulin pump therapy. Healthcare professionals should measure A1C levels of their non-adult patients at 3 month intervals. The target level of A1C should be 7.5 %. Patients or their caregivers should monitor BG levels multiple times a day, typically 6 to 10 times.

Medical devices such as insulin pumps and continuous glucose monitors (CGM) can be very helpful in the management of T1D. The ADA recommends that the CGM be considered in all children and adolescents, even though not using insulin pump therapy. Studies have found that compliant use such devices correlates with better BG control, lower A1C levels and reduction in hypoglycemic events.

Adjunctive Therapies for Children with T1D

One highlight in their recommendations between the management of type 1 diabetes in children versus adults is in regard to adjunctive therapies. They do not recommend the use of adjunctive therapies, such as the medication metformin in children. Clinical trials showed that despite the advantages of such therapies to help with weight loss or other diabetes comorbidities, there are more risks than benefits for children.

Check back next month for our follow-up blog talking about the unique behavioral aspects of managing diabetes in children and adolescents. We’ll focus on the challenges of self-management of their disease and other related health and wellness concerns.

Additional Resources

411 on CGM
Exercise for Children with Diabetes
ADA Position Statement


Teen Focus: Dangerous Duo – Type 1 Diabetes and Drinking

Lisa Feierstein Children's Health, Diabetes 3 Comments , , ,

Drinks in GlassesYou might suspect that drinking alcohol would cause your body to react similarly to consuming other carbohydrates. Alcohol is filled with calories. The surprising difference is that alcohol needs to be processed by the liver. Teen type 1 diabetics who drink can actually experience a drop in their blood glucose (BG) levels as their liver focuses on processing the alcohol and doesn’t work on its other function – releasing glycogen into the blood stream.

Another worry is the length of time it takes the liver to process alcohol. Did you know that your liver can be busy for one to one and a half hours handling just one alcoholic drink? Teens who drink multiple alcoholic beverages risk a low blood sugar event.

The symptoms of inebriation are similar to those of low blood sugar – sweating, lightheadedness, shakiness, weakness, anxiety, hunger, headache, problems concentrating, and confusion – which can make it more difficult for teens to sense that their blood sugar is trending too low. The best answer is to test BG levels.

Top Tips for Teens

If your teen decides to attend a party or share a drink with friends, they can minimize the negative impacts by heeding these ideas:

  • Make Moderation your Mantra – alternate alcoholic drinks with water or other non-sugary beverages to prevent dehydration. Wait between drinks to allow your body to catch up.
  • Food is Your Friend – Eat healthy snacks including fats and protein before, during and after drinking. Consider enjoying a drink along with a meal instead. Eating prior to bedtime will also help prevent hypoglycemic events during sleep.
  • Don’t Guess -Test – Bring along testing supplies – don’t rely on how you feel as an accurate gauge of your BG level, test to confirm. A Continuous Glucose Monitor can be a great tool to monitor BG levels.
  • Alert your Friends – Educate your friends on the symptoms of low and high BG level events. Have a buddy that can help just like a designated driver to watch for worrisome symptoms. They can remind you to test and eat snacks. Consider wearing a diabetic alert bracelet or necklace.

If you vomit it is even more important to test BG levels and consume non-alcoholic drinks to rehydrate.

Tips for Parents

Communicating with teens about drinking is a challenge for all parents. As with most difficult topics, open, and honest communication goes a long way. Talk about your concerns in advance – before any party invitations. Educate yourself and your teen about the effects of drinking in general and the special considerations for those with type 1 diabetes.

Even if there will be consequences if your underage teen drinks, consider creating an agreement so that they know they can contact you for help if they run into trouble. This will keep them safe and keep their diabetes in control. Seek support from your teen’s healthcare providers and/or diabetes educators if needed.

Once your son or daughter knows all the potential and possibly life-threatening side effects to their health from drinking, we can hope they will seek out other activities that aren’t focused solely on drinking.

Additional Resources

JDF – Teen Tool Kit
The 411 on CGM
American Diabetes Association – Teens & Parties


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

Lisa Feierstein Diabetes Leave a comment   , , , ,

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!

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

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

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

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”

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

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!

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

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.


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