Managing Diabetes in the Heat

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Summer is finally heating up! The CDC (Centers for Disease Control and Prevention) has some great guidance for understanding the effects of the heat and best practices for managing diabetes during the summer.

Feeling the Heat

People living with diabetes (type 1 and type 2) feel the heat more than others. Certain diabetes complications can affect sweat glands so that your body can't cool as effectively, and people with diabetes get dehydrated more quickly. Also, high temperatures can affect how your body uses insulin. The humidity also plays a part. It's harder to stay cool because sweat does not evaporate as well in high humidity. The CDC recommends checking the heat index and taking intentional steps to stay cool when it reaches 80°F in the shade with 40% humidity or above.

Summer Checklist

  • Drink plenty of water.

  • Test your blood sugar often.

  • Keep medicines, supplies, and equipment out of the heat.

  • Stay inside in air-conditioning when it’s hottest.

  • Wear loose, light clothing.

  • Get medical attention for heat-related illness.

  • Make a plan in case you lose power.

  • Have a go-bag ready for emergencies.

Read more details for managing summer heat here.

Summer at the Farm Market & Diabetes-Friendly Recipes

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Summertime is the best time for fresh food and enjoying the local harvest. Have you checked out your neighborhood farm market yet this year? A few favorites in the SE Michigan area are Eastern Market, the Oakland County Farmer's Market, and the Royal Oak Farmer's Market - but big or small, most communities have a local market. Last weekend, I happened upon strawberries, garlic scapes, cremini and shiitake mushrooms, lettuces, herbs and veggies ready to be planted, swiss chard, kale, early tomatoes, microgreens, rhubarb, sunflowers, and the list goes on! The market is full of colors and textures and hustle and bustle and the freshest food you can find (short of picking out of your own backyard).

Summer cooking is great on the grill, and simple creations let the flavors shine! When you're cooking at home this summer, get creative! You may find inspiration from these sources for diabetes-friendly recipes and new flavor ideas:

Some of these sites state that their recipes have been medically reviewed while a couple others don't. Be sure to use your best judgment for your own health needs when choosing recipes. Eat well and enjoy!!

Developing Best Care Practices for Patients with Diabetes Undergoing Surgery

Tamra Dukatz, Certified Registered Nurse Anesthetist

Tamra Dukatz, Certified Registered Nurse Anesthetist

People with diabetes need special care in the surgical setting to control blood sugar. Tammy Dukatz, a certified registered nurse anesthetist at Beaumont Health, has spent a lot of time, with exceptional success, doing research to develop best care practices for patients with diabetes who are undergoing surgery. Tammy has been a nurse anesthetist for more than 25 years and a nurse for 40 years. For the last 15 years, she has taken a great interest in diabetes since two of her three children developed type 1 diabetes. Her research has been aimed at strategies for the best possible glycemic control during surgery. She credits her colleagues and the anesthesia department leadership with phenomenal interest and support for these projects.

Conducting research with endocrinologist Dr. Solomon Rosenblatt and other Beaumont Health staff members, Tammy brought the Hospital guidelines up to date to provide the most appropriate strategies for blood sugar control for people with diabetes having surgery. This is important because high glucose levels during surgery may cause electrolyte imbalances and dehydration, and lows are especially dangerous under anesthesia because signs and symptoms largely can't be observed. The clinical research study on insulin glargine dosing took place from 2005-2008, was published in 2012, and was centered at Beaumont Hospital in Royal Oak, Michigan.

Now Tammy and her team keep up the guidelines up-to-date. It's a constant – reviewing the anesthesia and diabetes literature for current diabetes tech and best practices. Recent updates in diabetes technology have brought up new questions and decisions to be made. For example, a patient’s home continuous glucose monitoring (CGM) is based off interstitial glucose readings. CGM can be used in the hospital to follow the glucose trends, but patients are treated based on lab values using venous blood draws. Expert opinion is being sought to determine if hybrid closed loop insulin pumps should be kept in auto mode or put in manual mode during surgery.

Tammy has been working on her newest project with a team including her daughter, Gwen, who is a student nurse anesthetist at Oakland University. To make it easier for nurses to ensure accuracy, Dr. Rosenblatt and Gwen created an algorithm to guide insulin use after heart surgery. The whole team worked with Beaumont’s IT department to place the algorithm into an electronic calculator. A pilot was performed in one Beaumont department in September of 2018. For further refinement of this algorithm and help with back-end programming, they are soon to be working with the Oakland University College of Computer Science and Engineering. Tammy's son, Carl, has also been involved in the tech end of this project.

If you have diabetes and you're going into a surgery soon, here are some tips to keep in mind:

  1. It does matter how well you are controlling your diabetes before surgery - it can lead to better outcomes.

  2. If you are scheduled for elective surgery and you are not meeting your blood sugar goals, check with your diabetes care physician. Your physician may recommend medication changes to help prepare for the surgery.

  3. Anesthesia prescreening nurses will give you individualized instructions for the day of surgery. These should include what medications to take and how to handle high and low blood sugars before hospital arrival.

  4. Communicate well with your anesthesia team. Your blood sugar will be checked frequently throughout your surgery and recovery time. Because of the stress of surgery, treatment with insulin is common - even if you do not usually take insulin. Be sure to speak up if you feel that your blood sugar may be low.

Lifting Up Healthy Living's Core Values

Healthy Living developed guiding Core Values a few years ago, and I thought today would be the perfect day to highlight them. These values affect our movements on a day-to-day basis, influencing our passion for customer care, our relationships with patients, providers, and manufacturers, and our positive internal culture.

Healthy Living's Core Values

  • Earn Trust: Delight customers, simplify their experience, and surprise them in unanticipated ways.

  • Get Better Every Day: Practice continuous improvement, determined to surpass yesterday over and over again.

  • Own and Learn from Mistakes: Seek to understand your mistakes, make things right, share what you learned, and move on.

  • Pursue Ongoing Learning: Strive for personal and professional growth through curiosity, exploration, and education.

  • Build a Positive Team: Work collaboratively to create a loyal customer following, and have fun along the way!

  • Embrace Change: Be agile and prepared to adjust to the quickly and inevitably changing healthcare environment.

  • Be Humble: Appreciate your teammates, be yourself, and focus on the goal instead of the spotlight.

As a growing company shaped by integrity and our purposeful commitment to customers and employees, we use these values to guide our way and focus our daily vision.

Dexcom Highlights Next-Gen G7 Updates

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This month has been full of diabetes tech news as many manufacturers revealed product updates and research at the ADA 2019 Conference in San Francisco. For a great summary article from Diabetes Mine, check this out.

At the conference, Dexcom highlighted their upcoming next-gen G7 updates. Being developed with Verily, the next-gen G7 product will:

  • Have a faster warm-up time than the current G6 startup window

  • Include extended wear time of 14-15 days

  • Offer a fully-disposable, all-in-one sensor-transmitter with a smaller on-body footprint

  • Provide a dramatic cost reduction and more accuracy and reliability

  • Allow direct Bluetooth-to-smartphone communication

Dexcom's slating this for later 2020 with a limited launch at first, and then rolling it out more broadly across the U.S. and internationally in 2021.

FreeStyle's LibreLink App Now Compatible with Android

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Starting last week, FreeStyle LibreLink is now available for Android phones, as well as compatible iPhones. FreeStyle LibreLink is a mobile app that enables compatible Android and Apple phones to scan a sensor and display glucose data and trends, including:

  • Current glucose reading

  • Trend arrow

  • Up to eight hours of glucose history

With a quick scan over the sensor, you will have glucose readings anytime and anywhere. You can download the new Android app here.

Learn more about the FreeStyle Libre continuous glucose monitoring (CGM) system by checking out these previous blogs:

Getting to Know Libre CGM

A Review of the FreeStyle Libre Sheds More Light on the New Technology

Healthy Living Now Providing the Abbott Freestyle Libre to Medicare Members

Real-World Data from Medtronic's Guardian Connect & Sugar.IQ Shows Improved Outcomes

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This week at the American Diabetes Association (ADA) Annual Meeting, Medtronic announced real-world data on its Guardian Connect continuous glucose monitoring (CGM) system and Sugar.IQ diabetes assistant app. The Guardian Connect system and Sugar.IQ app empower people using multiple daily injections (MDI) to more proactively manage their diabetes with meaningful, personalized insights. The real-world data was recorded by users of the Guardian Connect CGM paired with the Sugar.IQ.

Sugar.IQ diabetes assistant is a separate app that continually analyzes how an individual's glucose levels respond to food intake, insulin dosages, daily routines, and other factors. The Sugar.IQ app combines data from the Guardian Connect CGM system with artificial intelligence technology from IBM Watson Health to detect important patterns and trends for people with diabetes and help them make more informed decisions on how to better manage glucose levels and stay within target range.

The data showed that people using the Guardian Connect system with the Sugar.IQ app experienced 4.1% more Time in Range (63.4%) compared to Guardian Connect alone (59.3%), which represents about one extra hour per day. And those who also used the optional Glycemic Assist feature to review their response to specific foods increased Time in Range by an additional 4% compared to those not using that feature.

Learn more from the official Medtronic press release.

Noteworthy Positive Trial Results for Tandem's Closed Loop System

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The diabetes community is excited about positive results from two Tandem studies that were announced earlier this week. Data from the studies has demonstrated that Tandem's advanced hybrid closed-loop system has achieved the primary outcome of increasing time in range (70-180 mg/dL) without any severe hypoglycemic events for both adult and pediatric age groups.

Tandem's t:slim X2 insulin pump with Control-IQ technology utilizes Dexcom G6 continuous glucose monitoring (CGM) sensor values to predict glucose levels and adjust insulin delivery to prevent highs and lows, while still allowing the user to manually bolus for meals. The system also automates correction boluses, a feature not commercially available today on automated insulin delivery devices.

Read the entire press release for many more details on the studies and outcomes. This news supports Tandem as the company moves toward a future FDA approval on their closed loop system, expected later this year.

In the News: Newly Discovered Hybrid Immune Cell Could Finally Explain The Cause of Type 1 Diabetes

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We have learned that type 1 diabetes is caused by the body's immune system turning against insulin-producing cells. New research has found a 'hybrid' white blood cell that displays features of two of our immune's system most important cells (T and B cells). Further research will work to confirm the white blood cell's actions and possibly provide insight into treatments for diabetes and other immune conditions.

Read the whole article for a lot more details at Science Alert.

Diabetes Myths Debunked from Beyond Type 2

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Have you heard about Beyond Type 2? We are big fans. This site is chock full of resources and guides for living with and understanding Type 2 diabetes. I want to point out the Diabetes Myths Debunked article. It covers a lot of territory and is definitely worth a read.

From Beyond Type 2... 11 Myths About Diabetes

Check out the entire article to find out the truth about these topics.

  1. Diabetes isn't that serious.

  2. You get Type 2 diabetes after you have been scared.

  3. Being overweight causes diabetes; thin people don't have diabetes.

  4. I can never eat sweets or my favorite foods again and have to follow a strict, bland diet.

  5. Diabetes doesn't run in my family, so I'm good to go.

  6. It's okay to stop taking my medication once my blood sugar is under control.

  7. Type 2 diabetes is a death sentence.

  8. Going on insulin means you "failed" at diabetes management.

  9. Type 2 diabetes can be cured.

  10. Insulin causes blindness.

  11. Eating too much sugar causes Type 2 diabetes.

Don't forget to check out the Beyond Type 2 website!

Encouraging Resources for May - Diabetes & Mental Health

We are nearing the end of Mental Health Awareness Month, but we couldn't have missed this important topic! From small, day-to-day stressors and burdens to larger scale, chronic mental health issues, everyone needs to create their own path to balance and stability. Type 1 and type 2 diabetes bring additional challenges to already complicated lives, but in the midst of this we can strive to find moments of peace, glimmers of light, and hope through connection.

At some point, you may find some encouragement in these resources:

ADA's Mental Health Provider Directory
(Mental health professionals who specialize in diabetes)

Beyond Type 1 Mental Health Resources Page
(Articles on Stress, Diabetes & Type 1, Diabetes Burnout, Diabulimia, Caregiver Burnout, Eating Disorders, Anxiety & Diabetes, Self-Care, and more)

NAMI: National Alliance on Mental Illness
(For a deeper dive on mental health issues and concerns)

In the News: The Omnipod DASH Now Available in the U.S.

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Insulet's Omnipod DASH is now officially available in the United States. The Omnipod DASH™ System combines a tubeless, waterproof, wearable Pod that provides up to 72 hours of non-stop insulin with an easy-to-use, touch-screen, Bluetooth®-enabled Personal Diabetes Manager (PDM) that looks like a normal smartphone. The Pod can be worn anywhere you would administer an injection. Placement is easy, completed with the touch of a button and without even seeing a needle. The DASH system is available with limited release right now, and Healthy Living anticipates providing the system at the end of this year or early in 2020.

There are two components to the DASH system.

The Pod:

  • The Pod is a small, waterproof device that you fill with insulin and wear directly on your body.

  • The Pod includes a small, flexible cannula that inserts automatically with the push of a button.

  • The Pod communicates wirelessly with the Personal Diabetes Manager (PDM) to program insulin delivery.

The Personal Diabetes Manager (PDM):

  • Multiple PDM features support how you control your insulin.

  • The system includes two mobile apps and accompanying widgets.

  • Compatibility with other systems simplifies the tracking and recording of data.


Beyond Type 1 addresses the updates in the Omnipod DASH system:

What’s New in the DASH™ System?

  • Updated PDM (Personal Diabetes Manager) – The handheld portion of the Omnipod Insulin Management System got an update and will feature a color touchscreen display.

  • Bluetooth wireless technology – DASH™ PDM and Pod will communicate via Bluetooth, laying the groundwork for current and future integrations with compatible technology – like meters, CGM, and management apps.

  • Meter integration – DASH™ will be optimized for use with CONTOUR® NEXT ONE Blood Glucose Meter for the transfer of blood glucose readings to the PDM’s bolus calculator via Bluetooth – The PDM will no longer have a built-in BGM.

  • Diabetes management app integrations – The Omnipod Display and Omnipod View apps will provide users and their caregivers easy access to their insulin therapy information on their smartphones.

    • Omnipod DISPLAY allows users to discreetly monitor their PDM data on their smartphones.

    • Omnipod DISPLAY on a smartphone will include a “Find My PDM” feature.

    • Omnipod VIEW allows parents and caregivers to monitor their loved ones’ diabetes more easily.

    • The iOS Today View widget allows users and their care teams to see their or their loved ones’ PDM and continuous glucose monitor (CGM) data on one smartphone screen with one swipe.

  • New Pods – The DASH™ pods will look and work the same, but have been updated for Bluetooth compatibility with the DASH™ PDM. Old pods will not work with the new PDM.

  • Rechargeable Battery – The DASH™ PDM will require recharging of its lithium ion battery, replacing the AAA batteries used in current Omnipod PDMs.

  • Payment Structure – The DASH™ PDM will be offered at no cost with the purchase of Pods.

Dexcom Apps Make Your Smart Devices Smarter

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With the Dexcom G6 and G5 mobile apps, you can know your number with a quick glance at your smart device (no need to carry an extra receiver!). Trend lines show where your glucose levels are heading and how fast they're getting there, so you can take action when needed for better diabetes management. You also have the ability to share your glucose readings with loved ones and caregivers.

If you have a new device or are just getting started with a Dexcom CGM, you may wonder what devices and software are compatible with Dexcom apps. Find out here.

Learn more about the features and benefits of Dexcom CGM!

Medtronic Moves Beyond A1C with CGM

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In early April, Medtronic entered into a "value-based outcomes agreement" with Blue Cross Blue Shield of Minnesota, and the two organizations have agreed to use a metric other than the gold standard A1C test to measure members' success using the device. A Medtronic spokeswoman recently told Diabetes Mine that Guardian Connect has become the first-ever stand-alone CGM using "Time in Range" as the key metric. Many advocates and innovators in the diabetes community have been pushing to move "beyond A1C.”

Medtronic's press release about their "Time in Range" metric explains:

"Time in Range (TIR) is a standard measurement in diabetes management that tracks the amount of time a person’s glucose is in their target range with 70-180 mg/dL being the standard range. Spending more Time in Range helps minimize both short- and long-term health complications from going too high or low. Results from an analysis of people who used the predictive alerts feature on the Guardian Connect system showed that they experienced fewer high events 39 percent of the time (vs. 10% without alerts) and fewer low events 60% of the time (vs. 33% without alerts)."

Medtronic also has been promoting their Time in Range infographic:

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Diabetes Mine explained how Medtronic's reimbursements will work with Blue Cross Blue Shield:

"With Blue Cross Blue Shield, they are actually tying insurance payments to the amount of time users spend in this healthy glucose range -- an approach known as "value-based payments." So if a Medtronic CGM user does not manage to stay in that ideal 70-180 mg/dL range for a certain amount of time when using the device, then Medtronic will actually pay back the cost to the insurance company."

Learn more from Medtronic.

Hiring & Training to Improve the Customer Experience

At Healthy Living, we believe that we can always improve, and we are constantly trying to give our customers a better experience — from when they contact us to when they receive their supplies. To that end, we have been hiring and training qualified, competent, compassionate customer care agents to expand our team. We will have more availability when you contact us for assistance with your diabetes supplies and will continue to provide proactive follow-up to keep things simple for our customers.

Launching Now: The Eversense CGM System

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The Senseonics Eversense CGM recently received FDA approval and is in the process of launching in the United States (it's already up and running in Europe). It has been designed to be the first ever CGM with an implantable sensor that lasts up to 90 days. The Eversense System consists of a fluorescence-based sensor, a smart transmitter worn over the sensor to facilitate data communication, and a mobile app for displaying glucose values, trends and alerts. While being light, discreet, and comfortable to wear, the system’s smart transmitter interprets glucose data from the sensor and sends it to the system’s mobile application via Bluetooth, so patients can review their glucose data to help them make daily diabetes decisions.

The Eversense Long-Term Continuous Glucose Monitoring (CGM) System offers many new benefits:

  • No weekly sensor self-insertions: With Eversense, a trained health care provider numbs the area and places the sensor in the upper arm and you’re good to go for up to 3-months.

  • Quickly detects glucose highs and lows: In clinical studies, the Eversense system detected 95% of hypoglycemic episodes (70 mg/dL) and 99% of hyperglycemic episodes (180 mg/dL) within 15 minutes.

  • Alerts you can see, feel, and hear: The Eversense CGM System can be configured to provide three types of alerts - visual, auditory, and on-body vibe alerts, which can provide you with an additional safety advantage, even during sleep.

  • Discreet and flexible: The smart transmitter, with its low profile and flexibility to remove and reattach without wasting a sensor, enables a greater level of discretion.

Learn more here.

Eversense CGM Reviews

Check out this article from Beyond Type 1 with reviews from two people with T1D who have tried out the Eversense. They both have a lot of insight about the nuances of using the Eversense. For example, I learned about the advantages of the adhesive: "The adhesive is by far the main differentiator of the Eversense from their competition – this was easily the best thing for me. Because the sensor is fully below the skin, the transmitter adhesive can be changed as often as you like. Each adhesive patch lasts a day and can be peeled off and stuck right back on multiple times per day. Because the adhesive only has to last a day, it is completely hypoallergenic. Technically, you can stick the transmitter on however you like – while at work once, I ruined my Eversense patch and just stuck the transmitter back using materials from an office first aid kit!"

Definitely check out the article for more practical knowledge about using the Eversense.

Why Try CGM?

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Continuous glucose monitoring (CGM) brings many people with diabetes better insight into what is happening with their blood sugar levels in the present and over time, with a lot less hassle. A CGM is a small, wearable device system that tracks glucose throughout the day and night. Some systems notify users of highs and lows so they can take action when needed. All systems substantially minimize the need for fingerpricking.

The top CGM systems on the market right now are the Dexcom G6, the FreeStyle Libre 14-Day System, and the Medtronic Guardian Connect CGM. Each system offers a unique set of benefits, but here are some of the best benefits of CGM overall:

  • Better insight into blood glucose trends

  • Less fingerpricks

  • Small and discreet sensors

  • Smartphone apps to track blood glucose levels

  • Alarms and alerts, especially helpful when struggling with nighttime lows

  • Remote monitoring of CGM data from a smartphone, ideal for pediatrics

Get started with CGM by calling the Healthy Living CGM Therapy Team at 866.779.8512 (Option 2) or texting us at 248.577.9903. We will give you a free benefits check to help you understand your coverage and walk you through the next steps, even contacting your doctor's office for you. From start to finish, a CGM enrollment will take commercial and Medicare members roughly 1-14 days, depending on the turnaround on paperwork from the doctor's office.