Non-Diabetic’s Guide to Helping Loved Ones with Diabetes

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Whether you’re a brother, mother, aunt, boyfriend, wife or best friend, knowing how to support the people in your life who live with diabetes isn’t all that easy. In fact, it can be very tricky. Mostly, because:

  • Holding HandsWe all have different needs when it comes to the kind of support we want in diabetes.
  • You, as the person who loves us, really want to make sure we’re safe and healthy, and sometimes that might come off as overbearing or controlling or nosey…but really, you just really love us.
  • We don’t always behave the most wonderfully when we’re having a high blood sugar or a low blood sugar. And while we can’t always control that behavior, it does make communication a lot harder for you, the person who loves us.

Read more on Diabetes Daily

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Having problems in the bedroom? You are not alone

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Having problems in the bedroom? Too embarrassed to talk about it? You are definitely not the only one. Even without diabetes, it is normal to experience some issues in your sex life as you get older, busier and more stressed, but people with diabetes are more likely to experience them. Both type 1 and type 2 diabetes can lead to sexual complications, and approximately 50% of men and 25% of women experience some kind of sexual problems as a result of diabetes. In a study published in 2010 in the journal Diabetes Care they found that only half of the men and roughly a fifth of the women approach their doctor about the subject. And it seems that doctors are not too keen on prying their patients on the subject either. But it is very important to be open on any health concerns you may have, sexual dysfunction included, because it might be a red flag for other health issues.

Erectile dysfunction can be a sign of diabetes, for example. For people that already have diabetes, sexual dysfunction can be a clear sign of nerve damage, heart disease or hormonal problems. More is known about causes and treatment of men’s sexual problems in diabetes (for obvious external reasons), but a lot of research is being conducted on the causes for women’s sexual dysfunction in diabetes, which may shed light on better treatment. What researchers are absolutely sure of though is that controlling blood sugar is the first step in treatment.

How can diabetes affect my sex life?

  1. Lower libido- Men and women may experience lower libido as a result of poorly controlled sugar levels. So managing your diabetes and sugar levels may very well be the answer. If not- speak to your doctor as certain medications may affect sexual desire (such as anti-depressants). Low testosterone may also be the culprit. Studies show that men with diabetes have approximately twice the risk of low testosterone.

 

In women it is slightly more complicated as it is difficult to determine the reasons for low libido- whether diabetes is to blame, emotional issues, hormonal issues, or others.

 

  1. Arousal Issues- Both men and women with diabetes may experience no problem with their libido, but they do experience arousal issues. In men- that means erectile dysfunction. In women- vaginal dryness. Poorly controlled sugar levels are very likely the culprit here as well, because poor diabetes control for extended periods of time can lead to neuropathy (nerve damage) and damage to the vascular system (blood vessels) among other complications, inhibiting arousal both in men and in women. But medication may also play a part here as well, so consult your doctor.

As before, more is known about male arousal issues, but luckily there is treatment for both sexes, though there are fewer options for women.

  1. Ability to reach an orgasm- Again, both men and women can experience problems reaching an orgasm. Research published in the Journal of Obstetrics & Gynecology stated that insulin-dependent middle aged women are 80% more likely to experience these problems than women without diabetes. In Diabetes Care researchers found that 21% of men with diabetes have problems reaching an orgasm as well.

 

Neuropathy due to poorly controlled blood sugar is the culprit yet again. If the nerve endings are not functioning properly, you will experience problems with sensations, which can cause the inability to reach an orgasm. Hormonal instability may also be the one to blame in women. But research is only beginning in this field.

 

  1. Pain- pain is definitely not what you want to be feeling during sex, and it is a strong indication that something isn’t right. Men with diabetes are more likely to develop Peyronie’s disease, a condition in which scar tissue inside the penis causes a curved and painful erection. Women with diabetes can feel pain due to vaginal dryness. Discuss possible treatments with your doctor in both cases.

Having a healthy sexual relationship with your partner is important. Sexual dysfunction can cause great emotional tension in every aspect of a relationship, not only in the bedroom. And many times this can cause a downward spiral that only gets worse and worse. So it is very important to speak to your doctor about your problems, more often than not they can be treated with a few adjustments. You can seek out a specialist in sexual medicine as well, and a mental health professional, just in case stress, depression or self-esteem are the cause.

But even before speaking to a professional, the following tips are bound to help:

  • Balance your blood sugar (if you didn’t already guess). It is bound to help.
  • Be patient and speak to your partner regarding your problems. This is very important in a healthy relationship.
  • Stop smoking. Smoking makes controlling your sugar much harder (and read our blog post on the subject).
  • Try to be active and do exercise. It can help you lose weight, lower your blood pressure and control you blood sugar.
  • Check your cholesterol and triglycerides and make sure they are in range.
  • Review your medications and make a list for when you see your doctor.

 

Remember, sexual problems are very common in people with diabetes and those without as well. It is nothing to be ashamed of, but important to treat! There are many solutions out there; you just have to speak up to your health care team.

-Written by Liran Julia Grunhaus

 

Smoking and Diabetes- Not a Good Idea

 

 

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It is no secret that smoking is bad for you. Hundreds of studies have been published on the subject, and most people can tell you the hazards of smoking without even googling it. But if you have diabetes and smoke, that is a whole other ball game. Diabetes in itself can lead to severe complications that include heart disease, stroke, circulation problems, nerve damage (neuropathy), kidney disease and more; smoking adds to the risk of developing these complications. In some cases, smoking can even double the risk of developing these conditions, in addition to doubling the chances of suffering from erectile dysfunction. In addition, smoking makes diabetes-management much more difficult, as blood sugars are higher.

How does smoking raise the risk of diabetes-related complications?

Smoking and diabetes increase the risk of developing heart disease in a similar manner- both high sugar levels and smoking damage the arteries and facilitate accumulation of fatty deposits in “pockets” on artery walls. That, in turn, causes blood vessels to narrow and make blood circulation more difficult. Heart attacks occur when this happens in coronary arteries (arteries that bring oxygen to the heart), and strokes- when this happens in arteries in the brain.

Researchers have known for quite a while that people with diabetes who smoke have higher blood sugar levels, and their diabetes is much more difficult to control and manage. But what component or components of cigarettes cause blood sugar levels to rise?

Recently, a research group based in California found that nicotine is the main culprit in cigarettes when referring to raised blood sugar levels. Nicotine, when added to human blood samples, raised levels of hemoglobin A1c (HbA1c), and the more nicotine that was present, the higher the blood sugar levels were. The smallest dose increased HbA1C levels by 8.8 percent. The highest dose — after two days of nicotine treatment — increased blood sugar levels by 34.5 percent! The levels of nicotine used in the study were equivalent to those found in a smoker’s body- from light smokers to very heavy smokers.

HbA1C is a measure of the percentage of red blood cells that have glucose molecules attached to them. In diabetes management, the HbA1C — sometimes referred to just as A1C —gives doctors an idea of average blood sugar levels for the past three months or so. Most people with diabetes strive for a level of 7 percent or less, based on American Diabetes Association guidelines.

These preliminary results shed light on how smoking causes blood sugar levels to rise, but more studies are needed to confirm the data in humans. What is certain is that if you have diabetes and you smoke, your blood sugars will be higher and harder to control. Take this into account and test more often to see for yourself.

These results also suggest that nicotine replacement products aren’t a safe option for people with diabetes if used for long periods of time, because they might raise HbA1c levels just as cigarettes do. So if you have diabetes and are trying to quit- cold turkey is the best option for you.

Can smoking lead to developing diabetes?

Smoking is a proven risk factor for insulin resistance, which often leads to diabetes. According to a study published in the American Journal of Epidemiology, smoking around a pack of cigarettes a day increases your risk for type 2 diabetes three fold. So yes, smoking can lead to diabetes, among all of the other possible health risks smoking caries. So if you are a smoker, and have other risk factors for developing type 2 diabetes, you are going down a slippery slope.

-written by Liran Julia Grunhaus

 

 

Mouthwatering Holiday Recipes

The holiday season is a great time to just enjoy yourself and give yourself a dose of greatly needed R&R. Soak in the cheery atmosphere- the fabulous lights and decorations, the music and the excitement all around you. Seize the opportunity to meet old friends and distant relatives in addition to immediate family and friends. As a lot of these gatherings revolve around food, we collected a few mouthwatering recipes you can cook yourselves or send your host/hostess so that you can properly enjoy your holiday meals and keep your sugars in check as well. Warning- the following content will make you hungry!

Carrot and Ginger Soup (from taste.com.au)

Perfect for a cold December evening:

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Ingredients:

  • Olive oil spray
  • 1 large brown onion, coarsely chopped
  • 2 garlic cloves, crushed
  • 2 teaspoons finely grated fresh ginger
  • 2 teaspoons ground cumin
  • 500 gr sweet potato, peeled and coarsely chopped
  • 4 large carrots, peeled and coarsely chopped
  • 4 cups of water
  • 1 teaspoon chicken stock powder
  • 130g (0.5 cup) low fat natural yoghurt
  • Chopped fresh chives for decoration

Directions:

Heat a large saucepan over medium heat. Spray with olive oil spray. Add the onion and cook, stirring occasionally, for 5 minutes or until soft. Add the garlic, ginger and cumin. Cook, stirring, for 1-2 minutes or until aromatic. Add the sweet potato, carrot, water and stock powder. Increase heat to high. Bring to the boil. Cover and reduce heat to low. Cook for 15-20 minutes or until the vegetables are soft. Set aside to cool slightly. Place half the sweet potato mixture in the jug of a blender. Blend until smooth. Transfer the soup to a clean saucepan. Repeat with the remaining sweet potato mixture. Place the soup over low heat and stir until heated through. Season with pepper. Ladle the soup among serving bowls. Top with yogurt and chives to serve.

 

Apple and Gorgonzola Cheese Salad (from diabetes.org): 

This crowd pleaser includes sweet fall apples which balance out the pungent flavor of the gorgonzola cheese. Pair it with roasted chicken, turkey, or pork chops.

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Salad:

  • 2 large Braeburn apples, thinly sliced
  • 2 tablespoons fresh lemon juice
  • 1 large carrot, peeled and thinly sliced
  • 8 cups mixed salad greens
  • 1 small red onion, thinly sliced

Vinaigrette:

  • 2 tablespoons fresh orange juice
  • 2 tablespoons fresh lemon juice
  • 1 tablespoon honey
  • 2 teaspoons Dijon mustard
  • ¼ cup walnut oil
  • sea salt, to taste
  • freshly ground black pepper, to taste

Garnish:

  • ¼ cup toasted walnut pieces
  • 3 tablespoons crumbled Gorgonzola cheese

Directions:

  1. Coat the apples with the lemon juice and set aside. Place the carrot slices and mixed greens on a platter. Top with the onion and set aside.
  2. Whisk together the orange and lemon juices, honey, and mustard. Slowly add the oil in a thin stream, whisking constantly.
  3. Add the apples to the salad. Top with walnuts and cheese. Drizzle on the vinaigrette.

 

Pork Tenderloin Medallions with Strawberry Sauce Recipe (from Taste of Home):

Pork tenderloin paired with strawberries is a heavenly match, made even more special with a tangy feta garnish. Serve with roasted spring vegetables.

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Ingredients:

  • 1-1/2 cups reduced-sodium beef broth
  • 2 cups chopped fresh strawberries,divided
  • 1/2 cup white wine vinegar
  • 1/4 cup packed brown sugar
  • 1/4 cup reduced-sodium soy sauce
  • 3 garlic cloves, minced
  • 2 pork tenderloins (1 poundeach), cut into 1/2-inch slices
  • 1 teaspoon garlic powder
  • 1/2 teaspoon salt
  • 1/2 teaspoon pepper
  • 2 tablespoons canola oil
  • 2 tablespoons cornstarch
  • 2 tablespoons cold water
  • 1/2 cup crumbled feta cheese

Directions:

  1. In a large saucepan, combine broth, 1 cup strawberries, vinegar, brown sugar, soy sauce and garlic; bring to a boil. Reduce heat; simmer, uncovered, 15 minutes or until slightly thickened. Strain mixture and set aside liquid, discarding solids.
  2. Sprinkle pork with garlic powder, salt and pepper. In a large skillet, heat oil over medium heat. Brown pork on both sides. Remove and keep warm.
  3. Add broth mixture to the same skillet; bring to a boil. Combine cornstarch and water until smooth and gradually stir into skillet.
  4. Return pork to skillet. Bring to a boil. Reduce heat; cook and stir 2 minutes or until sauce is thickened and pork is tender. Serve pork with sauce. Top with feta cheese, onions and remaining strawberries.Yield: 8 servings.

 

Spiral Stuffed Turkey Breast with Cider Gravy (from Eating Well):

When a whole bird is just too much- time and effort, as well as size- there is a quicker, simpler way: what’s known in French cuisine as a roulade. Using a boneless turkey breast, butterflied and flattened, you can serve a beautiful spiral of juicy meat.

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Stuffing:

  • 2 teaspoons extra-virgin olive oil
  • 1 cup finely chopped onion
  • 1/2 cup finely chopped celery
  • 2 cloves garlic, minced
  • 1/2 cup fresh whole-wheat breadcrumbs
  • 3 tablespoons chopped fresh parsley
  • 1 tablespoon chopped fresh thyme, or 1 teaspoon dried
  • 1 1/2 teaspoons chopped fresh sage, or 1/2 teaspoon crumbled dried (not ground)
  • 1/4 teaspoon salt, or to taste
  • Freshly ground pepper, to taste

 

Turkey and Gravy:

  • 1 2-pound boneless turkey breast half
  • 1/4 teaspoon salt, or to taste
  • Freshly ground pepper, to taste
  • 4 teaspoons extra-virgin olive oil, divided
  • 1 cup apple cider
  • 1/2 cup reduced-sodium chicken broth
  • 1 cup onion, coarsely chopped
  • 2 cloves garlic, crushed and peeled
  • 8 sprigs fresh thyme, or 1 teaspoon dried
  • 4 teaspoons cornstarch
  • 2 tablespoons water
  • 1/4 cup reduced-fat sour cream
  • 1 1/2 teaspoons Dijon mustard
  • 1 teaspoon lemon juice

 

Directions:

 

  1. Preheat oven to 300°F.
  2. To prepare stuffing: Heat oil in a medium nonstick skillet over medium heat. Add onion and celery; cook, stirring often, until softened, 2 to 4 minutes. Add garlic and cook, stirring, for 30 seconds. Remove from heat and stir in breadcrumbs, parsley, thyme, sage, 1/4 teaspoon salt and pepper.
  3. To prepare turkey: Remove skin from turkey breast and trim off fat. Butterfly the turkey breast. Flatten the turkey breast. Spread the stuffing over the breast and roll the breast up into a cylinder. Secure with kitchen string.
  4. Sprinkle the turkey roulade with 1/4 teaspoon salt and pepper. Heat 2 teaspoons oil in a large cast-iron or nonstick skillet over medium-high heat. Add the roulade and cook, turning from time to time, until browned all over, 5 to 7 minutes. Transfer to a plate. Add cider to the skillet and bring to a simmer, stirring to scrape up any browned bits. Add broth and bring to a simmer. Remove from heat.
  5. Heat the remaining 2 teaspoons oil in a Dutch oven over medium heat. Add onion and cook, stirring often, until softened, 2 to 3 minutes. Add garlic and cook, stirring, for 30 seconds. Add the browned turkey roulade. Pour in the cider mixture, then add thyme sprigs (or dried thyme). Cover the pan and transfer it to the oven.
  6. Bake the roulade until it is no longer pink inside and an instant-read thermometer inserted in the center registers 170°, 45 minutes to 1 hour. Transfer to a carving board, tent with foil and keep warm.
  7. To prepare gravy: Strain the liquid from the Dutch oven into a medium saucepan, pressing on the solids. Bring to a simmer over medium-high heat; cook for 2 to 3 minutes to intensify the flavor. Mix cornstarch and water in a small bowl; add to the simmering gravy, whisking until lightly thickened. Add sour cream, mustard and lemon juice, whisking until smooth. Season with pepper. Heat through.
  8. Remove the string from the roulade. Carve into 1/2-inch-thick slices and serve with gravy.

 

Roasted Green Beans in Champagne Vinaigrette (from diabetes.org):

Impress guests by whipping up this simple yet elegant side dish to go with any chicken, fish, or beef entree.

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Ingredients:

For Roasted Green Beans:

  • Cooking Spray
  • 1½ pounds fresh green beans, trimmed
  • 1 teaspoon olive oil
  • ½ teaspoon salt (optional)
  • ¼ teaspoon ground black pepper
  • 1 tablespoon minced garlic

For Champagne Vinaigrette: 

  • 1 tablespoon olive oil
  • 2 tablespoon champagne vinegar
  • 1 teaspoon Dijon mustard
  • 1 teaspoon Splenda
  • ¼ teaspoon crushed red pepper flakes

Directions:

  1. Preheat an oven to 230 degrees C. Coat a baking sheet with cooking spray. Set aside.
  2. In a large bowl, toss the green beans with 1 teaspoon olive oil, salt (optional), pepper and garlic. Pour onto prepared baking sheet and roast for 25 minutes or until cooked through and starting to brown.
  3. While green beans are cooking, whisk together 1 tablespoon olive oil, champagne vinegar, Dijon mustard, Splenda and crushed red pepper flakes. Set aside.
  4. When green beans are done roasting drizzle with champagne vinaigrette and toss to coat.

Chef Tip: If you can’t find champagne vinegar, use a good quality white wine vinegar instead.

 

Christmas pudding (from Delicious Magazine):

This no-sugar, diabetic-friendly Christmas pudding will be enjoyed by everyone; the carrots and apples keep it moist and the cinnamon and mixed spice warm it nicely.

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Ingredients:

  • 125g plain flour
  • 125g fresh white breadcrumbs
  • 125g shredded vegetable suet
  • 125g currants
  • 150g raisins
  • 1 tbsp low-calorie sweetener
  • 2 tsp each ground cinnamon and mixed spice
  • 1½ tsp baking powder
  • 4 large eggs, beaten
  • Finely grated zest of 1 large lemon
  • Finely grated zest of 1 large orange
  • 2 carrots, trimmed and finely grated
  • 2 dessert apples, peeled, cored and cut into small chunks
  • 150ml milk
  • Icing sugar, for dusting

Directions:

  1. Lightly butter a 1.4-litre pudding basin and line the base with a circle of baking paper.
  2. Mix together the dry ingredients, then stir in the other ingredients until well combined. Spoon the mixture into the basin and cover with a circle of buttered baking paper. Fold a pleat into a piece of foil and arrange over the pudding. Secure with string.
  3. Carefully place the pudding in a pan of boiling water, making sure the water comes a third of the way up the side of the basin. Cover, reduce the heat to a simmer and steam gently for 5 hours.
  4. Turn out the pudding and serve dusted with icing sugar.

 

Chocolate Crackles (from the Foodie Bride):

This recipe is surprisingly taken from The Big Book of Diabetic Desserts. It does contain sugar and butter though!

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Ingredients:

  • 1 1/4 cup all purpose flour
  • 1 tsp baking powder
  • 1/4 teaspoon salt
  • 2/3 cup unsweetened cocoa
  • 1/2 cup dark brown sugar
  • 1/2 cup Ideal (or Splenda, but I think Ideal is much better than Splenda for baking)
  • 1/2 cup butter, cubed and at room temperature
  • 2 eggs
  • 1 1/2 tsp vanilla
  • 1/4 cup powdered sugar

Directions:

  1. Preheat oven to 175 C. Whisk dry ingredients together in a bowl and set aside.
  2. Cream brown sugar and butter on med-high until light and fluffy. Add in Splenda, one egg at a time until well combined, and add the vanilla. Switch mixer to off, add dry ingredients, and turn to low until mixed, scraping down the sides of the bowl.
  3. Place powdered sugar in a bowl. Drop one tablespoon of dough into the bowl, turning to coat, and roll the ball around in your loosely cupped hand – this forms the dough into a ball without pressing the powdered sugar into the dough and allows the excess powdered sugar to fall back into the bowl.
  4. Place on a parchment-lined baking sheet 1-inch apart. Bake for 10 minutes. Cool completely and store in an air-tight container. Yields: 48 cookies

 

Enjoy your meal and happy holidays from the Dario Family!

 

-written by Liran Julia Grunhaus

‘Tis the season to be jolly- tips for surviving the holidays!

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‘Tis the season to be jolly- lights and decorations are popping up, stores are packed with cheery gift shoppers and most of you have already begun having dinners and parties with your friends, coworkers and relatives. The holiday season is fun, but as you know, it carries a lot of potential temptations for your Diabetes. Having Diabetes doesn’t mean you have to deprive yourself of all of the treats the holidays have to offer- you just have to prepare a bit so that you can enjoy the holiday season and keep your sugar levels under control.

During the holidays you may have less control over the food that is put in front of you, but you still have control over what you actually decide to eat. That is of course easier said than done, but one way to control it is not to let the usual party grub take you by surprise- If you are going to a holiday dinner or party, try to plan ahead and go as prepared as possible.

  • Know your trends- figure out the balance of carbs, fats and fiber that works for you. The Dario App can help you figure out how these affect your blood sugar.
  • Anticipate what kind of food you’ll encounter at the dinner/party- if you feel comfortable enough, ask. You have a good excuse! Once you know what’s in store for you, you can plan your meals and medication during the day so that you can have a slice of pie or bit of candy.
  • Offer to cook a dish that you know you can eat! It is a nice gesture and that way you can make sure you won’t go hungry. Cook a healthy version of your favorite dish.
  • If all fails and you are worried you won’t have anything to eat, snack on something beforehand. But don’t skip meals! It will make it much harder to control your blood sugar.

Once you are at the party, it is very easy to get carried away as everyone else will probably be overeating and overdrinking.

  • Concentrate on the great people around you instead of the food- indulge in conversations and small talk instead of heading to the snack table.
  • Try to be aware of “unconscious eating”- what we do when we pass a plate of snacks and just casually take one without even noticing.
  • Control what people put on your plate- don’t let peer pressure get to you! Just say no to seconds and be stingy on the gravy.
  • Stay away from alcohol- not only can it wreak havoc on your blood sugar; it can interfere with your medicine. If you do have a drink, make sure it is only one and that you eat with your drink.
  • If you already slipped, don’t take it as an excuse to go all out- it’s OK to slip once in a while, but pick yourself up and get back on the wagon.
  • Dance the night away! A great way to keep active and control your sugar. And you can be the star of the party while you are at it.
  • With all of the strange food and temptations around, be sure to check your blood sugar religiously.

In between the parties and dinners, try to stick to an exercise routine. It will help your body deal with all of the strange food intake and occasional slips.

It may be exhausting and difficult to stay in control on the holidays when everyone else is going over the top, but don’t let it get you down. Keeping your sugar on track will keep you feeling good and in the holiday spirit, so you can really have fun. You can enjoy the holidays and take care of your diabetes with the tips listed above- and think of it this way- it will be worth it when everyone else is crying about the pounds they gained!

By Liran Julia Grunhaus

Don’t let Diabetes burnout get to you!

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Living with Diabetes is hard. It’s a constant rollercoaster of monitoring your diet, exercise, blood sugar measurements and calculating your medication. And you never get a break- it is sort of like a job you hate but can’t quit, and the only reward you get for staying is that nothing bad happens. Even though you know what you have to do and have a treatment plan, all of it can feel overwhelming sometimes. It is very normal to feel overwhelmed and fed up once in a while, but you have to be careful not to go down the slippery slope of Diabetes burnout!

What is Diabetes burnout?

Diabetes burnout happens when people with Diabetes tire of managing their disease and just “ignore” it for a period of time (or in worse cases, forever). It is characterized by a person’s disregard for their blood sugar levels, missing doctor appointments, forgetting or avoiding insulin injections or other medications or switching back to unhealthy eating habits. Diabetes burnout is often accompanied by social withdrawal, emotional exhaustion, decline in activity, stress, anxiety, depression or emotional states such as anger, resentment, shame, guilt or helplessness. Diabetes burnout leads to self-destructive behavior that can cause serious medical complications- from fatigue and hypos to neurological damage and even comas and death. Needless to say it is very important to recognize the symptoms of Diabetes burnout in order to act to prevent it.

Avoiding Diabetes burnout

  1. Nobody is perfect– remember that as much as you would love to have your sugar measurements in range 100% of the time, nobody is perfect. Keep your expectations in perspective- good diabetes management does not mean being perfect, and the occasional slip is OK. Keeping that in mind will relieve your stress around your measurements.
  2. Accept your feelings– it’s OK to feel frustrated, angry or sad. Don’t hold back on those feelings, it is perfectly normal to feel them or to feel sorry for yourself once in a while. If you try to fight them, it will only make you feel worse. Don’t be afraid to vent to your loved ones or Diabetes educator. That will help you release all the bottled-up emotions.
  3. Remind yourself that monitoring your sugar lets you do the things you love keeping your sugar levels under control makes you feel good, so you can put more energy into doing the things you love- spending an afternoon with friends or family, taking the dog out for a walk, etc. Concentrate on the positive things monitoring your sugar levels lets you do and not the negative aspects.
  4. Ask your loved ones to help– explain how you manage your Diabetes, ask for their help in counting carbs, for example, or anything else that might help them be part of what you are going through. Let them know what doesn’t help as well, like buying a lot of junk food. Asking for help is a sign of strength, not weakness.
  5. Don’t miss out on your doctor’s appointments– your diabetes care team is there to help you stay motivated. If you are feeling sadness, insomnia, changes in appetite, loss of interest in usual activities, make sure to speak to them about it. People with Diabetes are much more likely to experience clinical depression. If they can’t help you they will point you in the right direction.
  6. Celebrate your wins– write down your triumphs over your blood sugar and food temptations; it will help you on your “down” days.
  7. Find a Diabetes buddy– Find support groups or connect to a friend that also has Diabetes. It is important to hear that you are doing a good job from someone else that understands what you are going through (try the Dario Lounge)
  8. Mix up your workouts– it is very important to vary the exercise you are doing so you don’t get bored. Try a new activity; it makes it feel like less of a chore. Even cleaning your house is a physical activity (even though definitely not new!). You can record and calculate your exercise (yes, even cleaning) on the Dario app.
  9. Attack barriers– Try to think of why you are not taking care of yourself. Don’t feel like going to the gym? Buy a treadmill or go walk in the park with your friend.
  10. Look for new recipes– nothing is more exasperating than boring food. Try to seek out new and interesting recipes to spice up your menu.

If you start feeling that you are having a bit more than just “a bad day”, try to keep these tips in mind. Diabetes is not just about your blood glucose- stress and other life problems will have an impact on your sugar levels and your health. So it is important to make sure you stay healthy in all areas of your life and keep away from burnout!

 

 

The Artificial Pancreas- science fiction or reality?

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The artificial pancreas might sound like something taken out a futuristic science fiction film, but it is a very realistic scientific approach aimed at helping people with diabetes automatically control their blood glucose level by providing a substitute for the function of a healthy human pancreas. The artificial pancreas is actually a name for all of the various different technologies in development that can possibly substitute the endocrinal function of the pancreas. Artificial pancreas technologies could truly transform the lives of those living with Type 1 Diabetes, allowing them to live longer and healthier lives and preventing at least part of the personal and financial toll diabetes takes.

The different technologies in development include:

  1. The bioengineering approach: the development of an artificial pancreas consisting of a “sheet” of encapsulated beta cells (those that produce insulin in the pancreas). When this sheet is implanted, it should substitute the function of healthy pancreatic beta cells and last for years at a time.
  2. The gene therapy approach- using genetically engineered viruses that can cause intestinal or other glucose-sensitive cells to become insulin-producing cells. There are also efforts going into trying to reverse beta-cell destruction by curing the cause.
  3. The medical device approach: a continuous blood glucose sensor connected to an insulin pump under automated closed loop control. The continuous blood glucose sensor feeds the insulin pump with real time data (using novel software), allowing it to adjust insulin doses.

The bioengineering approach is now in animal testing stages, with hopes for human clinical trials in the next few years. The gene therapy approach is advancing quickly but has many hurdles to overcome before it can be used as a proper therapeutic tool.

The medical device approach, on the other hand, is already being tested in short term clinical trials for type 1 diabetes, and may very much be a reality in the relatively near future. While not a biological cure for diabetes, scientists are trying to mimic the healthy human pancreas as closely as possible. This type of artificial pancreas will be especially useful overnight when the vast majority of hypo emergencies occur.  The main goal is to increase “time in range” as much as possible.

There is no doubt that these technologies have the potential to transform lives of millions of people around the globe, especially those who find it difficult to maintain good blood glucose control; both on a physical level and on an emotional level. But don’t hurry to throw away your home glucose meter– even though the artificial pancreas will definitely improve quality of life drastically for people with diabetes, users will still need to monitor it closely by checking blood sugar levels to make sure that everything is functioning smoothly.

 

 

Tired today? Or grumpy ? Can be due to your sleep habits

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Everyone knows how important it is to get a good night’s sleep. When we sleep well and enough we are more concentrated, more efficient and much happier. Sleeping well is also important for our hormones to regulate our appetite, weight control and the immune system. Unfortunately, Diabetes and sleep problems often go hand in hand, as many of you might already know, and research has shown that sleep deprivation and insulin resistance may be linked.

Statistically, sleep difficulties are more common in people who have Diabetes than in people who don’t. There are multiple reasons for that- first and foremost, because you get up to go to the bathroom at night. Any time your blood sugar is high, your kidneys will try to get rid of it by urinating. Logically it is hard to sleep if you get up to go to the loo a few times a night. Also, high blood sugar may make you feel too warm or irritable.

And the vicious cycle doesn’t end there- people who are tired tend to eat more because they want to get energy from somewhere. That can mean consuming foods that can raise blood sugar levels. Make sure to record what you eat on your Dario application so that you can track it.

Sleep apnea (or obstructive sleep apnea) may also be the culprit. It affects people’s ability to breathe while sleeping. It is most common in people between ages 35-55 with excess weight. Excess weight can cause fat deposits around the upper airway that obstruct breathing. Sleep apnea can prevent a person from getting a good night’s sleep, which can worsen Diabetes or increase the risk of developing Diabetes. So Diabetes, being overweight and sleep apnea are connected.

Having Diabetes also raises the risk for getting restless legs syndrome which also disturbs sleep, especially in the presence of diabetes-related complications such as neuropathy and kidney disease. People with restless legs syndrome have uncomfortable sensations in their legs (and sometimes arms or other parts of the body) and an irresistible urge to move their legs to relieve the sensations. The condition causes an uncomfortable, “itchy,” “pins and needles,” or “creepy crawly” feeling in the legs. The sensations are usually worse at rest, especially when lying or sitting.

Neuropathy can also bother sleep patterns. The most common type- peripheral neuropathy causes numbness, tingling and pain from things that do not normally give you that sensation.

Other reasons that can prevent people with Diabetes from having a good night’s sleep include hypos at night, anxiety and stress or diabetes-related complications such as heartburn or heart disease. Record your mood on the Dario app so you can see if there is a connection.

Some tips that can help you get a good night’s sleep despite all of the hurdles:

  1. If you are having trouble falling asleep or staying asleep, talk to your health care provider. He may suggest a sleep study to diagnose and treat sleep conditions such as sleep apnea.
  2. Keep your blood glucose under control. Make sure to check before you go to sleep.
  3. Ensure that you have a comfortable sleep environment- bed and pillows that are large and comfortable enough, that your room is cool and ventilated but dark and free of noise (use a sleeping blindfold or ear plugs if necessary).
  4. Stick to regular bed and wake times.
  5. Reserve your bed for sleep and other bedroom activities only. Don’t stay in bed too long if you can’t fall asleep!
  6. Exercise during the day, but at least a few hours before you go to sleep.
  7. Don’t drink caffeine after noon.
  8. Stay off your gadgets such as smartphone or tablet for at least two hours before you go to sleep.
  9. Don’t let your pets sleep in the bed with you.
  10. Avoid alcohol late at night.

In general, people with Diabetes have to be very careful about sleep because anything that throws off your routine can make you feel a lack of energy and fatigue, which just promotes insulin deficiencies. Proper sleep is as important as your diet! So follow the tips above and have a good night!

 

Winter is coming

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As much as we would all love to go back to the sunny weather and beautiful beaches of August, now that the cold is seeping back in and most of you have already seen a snow flake or two, it is important to learn how to protect your blood sugar levels from the effects of the chill.

During winter months, people with diabetes of all types tend to have higher A1C levels. Blood sugar levels creep up while the temperatures plunge. One of the reasons for this is that cold is a stressor on the body, and a reaction to stress is raised blood sugar levels. But the cold weather itself is not the only culprit- the colder months present everyone with big hurdles and potential pitfalls for diabetes management. The holiday season is one big temptation after another. And if you live in the northern climates with long winters, going out into the cold to exercise doesn’t sound so appealing.

So we’ve put together a few tips to help you deal with the cold and keep your blood sugar levels at bay:

  1. Keep your hands warm so you can keep testing: The cold weather can leave you with cold hands which make blood testing more difficult. So put on those mittens and keep testing your blood sugar regularly! Regular testing will help you catch any potential highs or lows and keep your sugar under control. Your Dario smart meter can help you with that!
  2. Don’t miss your workouts: You don’t even need to leave your home to work out- put on an aerobics video, play a game on Wii, do some yoga or just dance to your favorite tunes. Exercise increases insulin sensitivity, keeps you warm and is good for your psyche!
  3. Stay away from the comfort and holiday foods! Cold weather usually makes people eat more- which is a natural response as your body needs more calories to heat itself. But make sure not to over eat, and don’t be tempted by ‘comfort foods’ like ready meals, takeaways and snacks. The holiday season is also just around the corner- with all of its culinary temptations and big family meals. Make sure to eat and drink with moderation!
  4. Try not to get sick: Controlling your blood sugar while sick is hard. It usually rises in response to viruses. So try to stay healthy by keeping yourself warm, eat healthy, don’t leave the house if you are not feeling 100%, wash your hands regularly or use hand sanitizer, and go get your flu shot (check out our blog post about flu shots here).
  5. Don’t let the blues win! Wintertime gets many people down. The cold and unpleasant weather, the lack of sunlight and the stress of the holidays (and post holidays) all leave their mark. But don’t let depression win! Talk to a professional, a friend or other people with Diabetes (like on the Dario lounge).
  6. Keep your supplies out of the cold: Just like extreme heat, extreme cold can also affect your insulin and glucose monitor. So don’t leave your supplies in your car!
  7. Keep an eye on your feet: Diabetes can cause a loss of feeling in your toes and feet. Protect them with the right winter footwear, make sure the skin is moisturized and inspect them regularly for any injury that doesn’t heal.

Having said all that, the winter season is not so bad! Waking up to fresh snow all around, the holidays with all of the lights, meeting family and friends and getting gifts is fun and has no comparison in the summertime. So keep up your mood and follow these simple tips to ensure a safe and enjoyable winter season!

Can dogs smell your sugar levels?

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Any pet owner will tell you how amazing pets can be- and not only because of the warm greeting you get when you come home, the unconditional love and affection they give you or the never-ending entertainment they provide.  Your average domestic pet, such as a dog, cat or even a lizard can also benefit your general health by reducing stress levels and anxiety, increasing physical activity, easing loneliness and more.  Furthermore, experts are beginning to see more and more evidence suggesting that pets can positively benefit specific medical conditions. The greatest effect is seen in dog owners, but the effect is not exclusive to pooches.

Having a pet has been linked to lower risks for developing heart disease and longer life expectancy- due to lower triglyceride and cholesterol levels and higher survival rates after a heart attack when comparing to people who do not own pets; Pet owners are less likely to suffer from depression than those without pets. Playing with your pet can elevate levels of serotonin and dopamine, which calm and relax. In addition, pet owners over the age of 65 make 30% fewer visits to their doctors. In multiple studies dogs have been able to detect certain kinds of cancer by smelling breath, stool or urine samples.

In the last few years there have also been a few reports of dogs detecting hypoglycemia in their diabetic owners. A research study conducted in Queen’s University Belfast in Northern Ireland suggested that over a third of dogs living with people with diabetes would show behavioral changes when their owner’s blood sugar level had dropped to hypoglycemic levels. Most animals tried to attract their owner’s attention by barking, licking, nuzzling, jumping or staring. One explanation was that dogs can smell the different composition of our sweat or breath.

A recent observational study carried out by researchers from the University of Bristol examined whether dogs could reliably be used as an early-warning system for hypos. Specially trained dogs (“glycaemia alert dogs”) were found to accurately and consistently detect the signs of low or high blood sugar in their owners. Some dogs even brought the measuring kit to their owner when sensing low blood sugar. The glycaemia alert dogs placed with people with diabetes significantly improved the owner’s control over sugar, independence and quality of life.

The enormous potential of these trained dogs is clear- on the lives of people with diabetes and the general costs of long-term health care. But the results of this study have to be taken with a grain of salt- they were based on a very small sample of people, so the results should be interpreted with caution. Also, it was less clear how beneficial the dogs were to longer term diabetes control and disease complications. Another downside – “diabetes-sniffing” dogs have a waiting list of three years, so clearly the demand is much higher than the offer.

Until the benefit of “diabetes-sniffing” dogs is clear and the offer rises, if you are living with diabetes and are concerned that your symptoms are poorly controlled, there are many options which can help you better understand and manage your condition. Using your Dario can give valuable insight on the trends and patterns of your condition so you can be more in control. In addition, we encourage our users to join the Dario Lounge to talk to people that are sharing similar experiences.

Cannabis and Diabetes

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Cannabis, otherwise known as marijuana, and its potential use in the treatment of various diseases and symptoms (“medical marijuana”), has been all over the news in the last few years, getting a recent boost from media craze surrounding the total legalization of marijuana in two US states earlier this year. Many countries have already approved the use of medical marijuana, mostly for the treatment of pain, from headaches to long-term conditions like glaucoma or nerve pain. It is also used to treat muscle spasms caused by multiple sclerosis, nausea from chemotherapy, Crohn’s disease, and more. Recently, the potential use of cannabis in the treatment and management of Diabetes has been researched.

Until recently, the common notion was that cannabis decreases energy expenditure and increases food intake and fat storage due to raised appetites (what is known as “munchies”), in addition to impaired glucose tolerance. However, a growing body of evidence is pointing to medical marijuana as useful for managing Diabetes symptoms such as pain and cardiovascular disease as well and combating the disease itself. There are a number of ways that marijuana may one day come part of diabetes treatments, though the current data is only preliminary and primarily based on surveys and must be validated by clinical trials.

Cannabis and Obesity

It is commonly known that obesity and Type 2 Diabetes go hand in hand. Large scale surveys have shown lower rates of obesity, BMI and diabetes among marijuana users compared to non-users. Furthermore, an observational study published in 2013 by Harvard University researchers (published in The American Journal of Medicine) found that marijuana users had lower waist circumferences despite consuming more calories. The study collected data from over 4,500 adults during a 5 year period. So it seems that marijuana plays a role in regulating energy balance. Associate professor Dr. Murray Mittleman from Harvard Medical School told Time magazine that “current users of marijuana appeared to have a better carbohydrate metabolism than non-users”.

Cannabis and Insulin

The increased carbohydrate metabolism probably has to do with the effect of marijuana on Insulin. In the Harvard study they found that adults who used marijuana had lower fasting insulin levels and a lower probability of being insulin resistant. Beta cells that produce insulin in the pancreas have receptors for the active compounds in marijuana, further supporting that there is a connection there. Clinical trials performed in the UK have showed promise in preserving those Beta cells. Many studies are being performed on mice to further research that connection.

Cannabis and Cardiovascular Disease

Recent studies also suggest a role of marijuana in cardiovascular complications related to diabetes. It turns out that there are also receptors for the active compounds in marijuana in the cardiovascular system and immune cells that affect the system. Marijuana users also had higher levels of HDL (“the good cholesterol”) which can protect against heart disease.

Cannabis and Neuropathic Pain

Approximately 60-70% of people with Diabetes suffer from nerve damage which can lead to neuropathic pain. Neuropathic pain is one of the few applications of medical marijuana to be studied in clinical studies. Sativex- a cannabis-derived oral spray- has been approved in various countries for the treatment of cancer and multiple sclerosis-derived pain.

Before anyone gets too excited, researchers don’t yet know how to explain these possible effects on Diabetes, and since some of the evidence comes from survey-based studies and not controlled trials, it’s not clear whether marijuana or some other factor actually accounted for the results. Researchers can’t be sure that marijuana will shed light on understanding how to best control glucose and insulin to prevent or treat diabetes. But what is clear is that marijuana’s connection to Diabetes will be in the spotlight of research in the fu

Why get the flu shot?

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You may be busy picking pumpkins, raking leaves and searching for carb-friendly pumpkin pie recipes that won’t wreak havoc with your blood sugar levels, but October could also be the time of year you schedule your flu shot. The flu shot is an important vaccine for everyone, and especially for those who have Diabetes.

There are several reasons why people with Diabetes might want to go get their flu shot:

  • In general, illnesses can make it harder to control your blood sugars. They might raise your sugar; but people that are sick with the flu don’t feel like eating and this can cause blood sugar levels to fall. It becomes increasingly important to monitor blood glucose levels closely when you are sick. The Dario smart meter can help you with that (Learn more on our website).
  • People with Diabetes tend to have a more difficult recovery from the flu; according to the U.S. Center for Disease Control (CDC), 10,000-30,000 people with Diabetes die from the flu and pneumonia each year (a rate three times higher than the non-diabetic population).
  • People with Diabetes who get the flu also have a higher incident of secondary complications as well as hospitalizations. This is because diabetes can make the immune system less able to fight infections.

October is the best month to get the flu vaccine. The flu season can start as early as October, but will peak December through February, so by getting your vaccine now, you can be as protected as possible from the impact on blood sugar levels. Because of the added risk people with Diabetes face and the challenges they have in controlling their blood sugar levels with the flu, early birds will help their bodies deal with the virus.

The annual flu vaccine will not protect you from every strain of the flu, but it is designed to protect you against the most likely flu viruses of the season. Getting a flu shot is relatively easy. Even if you need to contact your health provider to arrange for a flu shot, it is worth the time and effort. In the case that you do get sick, your flu vaccine can help minimize the symptoms and prevent you from having complications.

In addition to getting the flu vaccine, you can also take other preventative steps to protect yourself from the flu:

  • Use warm water and soap to thoroughly wash your hands, especially if you have coughed or sneezed or been around someone who has.
  • Keep your hands away from your face.
  • Use a tissue or the corner of your arm at the elbow to cover your mouth when you sneeze or cough.
  • Stay home when you’re not well to limit contact with others.

For more information about why the flu shot is important if you have Diabetes, download this brochure from the CDC:

http://www.cdc.gov/diabetes/projects/pdfs/eng_brochure.pdf.

Let us know if you have received your flu shot this year. Stop by The Dario Lounge on Facebook and encourage others to get a flu shot this month so we can all have a cozy and healthy winter!

Keep Calm and Don’t Stress

We live in a high-paced society constantly putting us under pressure. All of us feel the impacts of this pressure- and feel “stressed out” from time to time. This feeling can be caused by many things- trouble at work or a high work load, marriage and relationship issues, parenting or taking care of an elderly parent, financial insecurity and even “trivial” issues like traffic. Health problems also have a strong influence on our stress levels. Being told you have Diabetes or any other chronic condition can cause immense emotional turmoil- being diagnosed, adjusting to the treatment or dealing with the psychological effects of the disease. Stress can also cause chronic conditions like Diabetes- recent studies show that stress at work raises the risk for Diabetes by 45%.

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In a nutshell- Stress happens when our body feels emotional or physical “danger”, whether it is life-threatening or not. As a response to this “danger” our body goes into “fight or flight” mode. That is basically preparation for dealing with this situation of danger. “Fight or flight” mode puts a lot of stress and strain on the body, causing the release of stress hormones such as cortisol and epinephrine. This in turn raises our blood glucose levels which give the body access to immediate energy, increases our blood pressure to stream more fresh oxygen to muscles and provokes adrenaline secretion to heighten our alertness.

In Diabetes the “fight or flight” response doesn’t work very well. Insulin is needed to transport elevated blood sugar into our cells for use. But as you know, in Diabetes, insulin is either not produced (Type 1 Diabetes) or not used effectively (Type 2 Diabetes). As a result, blood sugar levels stay high as a result of stress. The extent of the impact of stress on blood sugar levels naturally varies from person to person.

Constant stress is a downward cycle for people with Diabetes- difficulties in controlling blood sugar levels can simply exhaust people and cause them to neglect their Diabetes care- by ignoring their sugar levels or forgetting to check them, exercising less, eating unhealthy foods, drinking alcohol and smoking- what is known as “Diabetes burnout.”

How do you know if stress is affecting your Diabetes management?

The best way to see if stress is affecting your Diabetes is by looking for a pattern. Rate you stress level on a scale of 1 to 10 every time you test your blood sugar levels and record the results. Add a few notes on what you are feeling. Your Dario™ smart meter can help you do this. After a few weeks you should see whether your sugar levels correspond to your stress levels and what causes the fluctuation. It’s a good idea to check blood sugar levels more frequently when you feel you are under stress. You might need to change your insulin doses during stressful periods.

How do you reduce your stress levels?

Learning how to cope with stress is very important. Some people try to change the situation that causes them stress (such as avoiding traffic areas, changing jobs, etc.). Others try to accept stressful situations as a part of life, convincing themselves that “it is not so bad.” Both of these coping methods work well.

Learning to relax is also very important. Breathing exercises, progressive relaxation therapy, yoga and meditation, psychotherapy and cognitive behavioral therapy can help. Exercise and sports are great stress modulators. Sign up for the gym or start your own exercise program. Starting a new relaxing hobby can also help get your mind off things and blow off steam. Try to avoid caffeine and drink a lot of water.

No matter what you do, some sources of stress are here to stay, such as having Diabetes. But reducing the stress that comes from living with Diabetes is still possible. If the tips above haven’t reduced stress levels enough, try joining a support group, such as the online Dario Lounge on Facebook and meeting people that are in the same boat. Talking to your care team is also important; they can help you deal directly with the aspects of the condition which are most difficult.

 

Carbs or No Carbs? That is the Question

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You have all heard it before- should you stay away from carbohydrates or eat them in moderation? People with Diabetes must closely control their blood sugar levels, and eating carbohydrates can directly affect those levels (carbohydrates are used in the body for energy in the form of blood glucose- AKA blood sugar). Many people with Diabetes, in particular those who are insulin dependent, find that their blood sugar is much easier to control if they limit the carbohydrates in their diet. Others claim that as long as you eat a balanced diet, you are more likely to stick to that diet and keep your blood sugar levels in check through medication and exercise.

The source of the heated debate lies in the fact that scientific research hasn’t given conclusive answers. There is research that shows that low-carbohydrate diets are very successful in improving A1C levels, as well as lowering triglyceride levels and raising HDL levels (“good” cholesterol). These go along with weight loss in many cases. Low-carbohydrate dieters have been shown to have less risk for hypoglycemia, or low blood sugar, because they need less insulin to manage their blood sugar. Low carb enthusiasts emphasize that as carbohydrates are our body’s main source of glucose- they are logically the first target.

On the other hand, low-carb diet critics say that that type of diet is very hard to stick to. They say that the improvement in A1C levels is a direct result of weight loss. Research supporting this approach has demonstrated that eating a moderate-carb, high-fiber diet may improve post meal sugar levels and lower the risk for cardiovascular disease. In addition, many foods that contain carbohydrates contain many other important nutritious elements. Vegetables and fruits contain carbs, but are a very important source for vitamins and minerals; dairy products contain calcium and grains such as lentils have high levels of fiber, which helps lower cholesterol. Lastly, a low-carb diet is usually high in fat, and eating higher quantities of saturated fat can increase insulin resistance.

So, who is right? There is no right answer, and different research groups have found evidence to support both theories. Currently, most people with Diabetes are encouraged to eat a healthy and balanced diet of lean meats and dairy, whole grains, healthy fat, fruits and vegetables. The American Diabetes Association, the American Heart Association and the American Dietetic Association all recommend a more moderate carbohydrate approach of approximately 40-45% of the daily calorie intake.

But these associations also stress that there is no one “right” diet. Every person is different- and what manages to control one person’s blood glucose levels won’t necessarily do the same for someone else. Professionals recommend speaking to a dietician or nutritionist to help construct a nutrition plan that is tailored to one’s needs and lifestyle. Sometimes a bit of trial and error is needed to learn how your body reacts to different foods. Make sure to check your levels with your blood glucose monitor often when you make changes in your diet. It is very important to have your own personalized diabetes management tool, like Dario, to give you an indication of what works for you and gives actionable insights and reports.

What is clear is that healthy foods, portion control and scheduling are necessary to manage you blood glucose levels. If you stray from your prescribed diet, you run the risk of fluctuating blood sugar levels and more serious complications.

Dr. Paul Rosman, DO FACP FACE FACOI, on Dario’s Scientific Advisory Board, commented: “I believe that people with diabetes must start with their basic food choices and modify them to meet the needs both in serving their likes and recognizing their dislikes, as well as serving the needs of their diabetes. This balance makes the percentage of carbohydrates negotiable. The real issue is paying attention and being self-aware of what you put in your mouth. Yes, counting and limiting carbohydrates is important, but sustaining how you do it is what counts in the end.”

Dr. Paul Rosman has served roles in industry, academia and non-profit leadership. He was Former Senior Medical Advisor at Eli Lilly & Company, has held teaching positions at Ohio University and Northeastern Ohio Universities College of Medicine, as well as served as President or Chair of American Diabetes Association, Ohio Chapter, American Association of Clinical Endocrinologists, Ohio River Chapter, and the Ohio Diabetes Prevention and Control Program at Ohio Department of Health.

Your Dario Smart Meter helps you manage your carbs easily and efficiently.

 

5 Ways Smartphones Can Improve Clinical Trials

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Erez Raphael is the CEO and President of LabStyle Innovations, creator of Dario diabetes management solution. Dario is an all-in-one smart meter and app that provides people with diabetes instant glucose level readings, management of fitness activities and a database of sugar levels in foods.

When it comes to bringing better drugs to market, clinical research is a critical step. Enormous time is spent proving that a product is safe and effective. Yet several common inefficiencies tend to slow down the process often preventing these drugs and devices from helping those who could benefit from them most.

Smartphones offer us incredible new opportunities for implementing efficient clinical research trials. They allow researchers to simplify complexities that have traditionally surrounded clinical research with tools that are now easily accessible to both practitioners and patients. Smartphones can be used to gather critical information from an enrolled patient including factors such as weight, blood pressure, glucose levels, and more. Not only can smartphones be used to automate and speed up information entry, they offer ways to improve the methodology and accuracy of research.

Erez Raphael 5 Ways Smartphones Can Improve Clinical TrialsHere are 5 issues making clinical research less efficient as well as costly, and how smartphones can help significantly improve the process.

  • Recruitment – Recruitment for clinical research can be a major challenge – the process of finding exactly the right types of patients can be taxing. For example, how do recruiters go about finding someone who is newly diagnosed with diabetes with a specific family history? If the trial needs someone who was diagnosed in the last six months, time can slip away at an alarming rate. Smartphones make it easier to reach large masses of potential trial participants instantly. Their medical history can be verified quickly and accurately without having to wait long periods of time to check if they could be a good candidate and delaying start dates. Participants can register for trials easily, and submit their information with minimal hassle.
  • Maintaining Participation – Maintaining study participation for trials that can last years is an obstacle that almost all clinical trials face, as participants are reluctant to commit to long-term trials that often disrupt daily life. Smartphones lessen the number of face-to-face meetings required during the process and makes communication easier between researchers and participants. Smartphones can also lower the disruptiveness that a study takes on the day-to-day life of a participant. For example, some apps like Dario, allow real-time sharing of blood glucose and medication compliance without interrupting daily routines.
  • Data Integrity – Research data can often be inaccurate. What is a study administrator supposed to do when someone stops logging important information? If the right data isn’t collected, they may not be able to use any of that person’s data in the trial. Participants already carry their smartphones, making it easier to track things like symptoms, and the study administrators can monitor in real-time whether it’s being tracked correctly. This saves a tremendous amount of time for both the patient and the trial administrator.
  • Safety – By embracing secure mobile technology, clinical researchers can monitor studies in real-time for safety issues. Is a new diabetes medication causing severe low blood sugars? With smartphones, worrying trends can be spotted proactively, enabling the study administrator to intervene and protect patients.
  • Cost – Perhaps the greatest issue preventing successful trials and medical devices from coming to market is the cost involved in exhibiting successful tests. Staff, supplies, facilities, and paying participants all come at a high price. Smartphones can cut the cost of every facet of clinical trials. Since a smaller commitment is needed on behalf of the participants when smartphones are used in collecting data, researchers can hire the participants at a lower cost. The price of overhead goes down significantly as well when smartphones are used to enter data automatically and less patient visits are required.

Smartphones are the ultimate cost-effective way to make clinical research more efficient. They are a non-intrusive tool for monitoring patients, and can be used to survey patients anywhere and at any time. While we aren’t there yet, smartphones really do provide a very reasonable alternative to today’s system of conducting clinical trials. Clinical researchers need to embrace the mobile revolution so that essential drugs and medical devices can get through the clinical process quicker and more efficiently and fulfill their intended purpose, saving lives.

Click here for the full article

 

Making Better Use of Today’s Diabetes Technology

DavidWinmill

David Winmill may not live with diabetes himself, but he certainly understands real-life with this disease as well as any non-diabetic ever could. With 20 years under his belt so far as a Certified Diabetes Educator and Nurse Practitioner, David entered the field of diabetes care right from the start after becoming a Nurse Practitioner. He’s known well for his ability to naturally blend education with compassion while caring for his patients, and has also taken many budding CDEs under his wing as well. 

Today, David works with patients at Intermountain Healthcare in Ogden, Utah. 

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You’ve been working in diabetes as a Nurse Practitioner for practically 20 years—most of your nursing career—so you’ve seen some incredible changes in the treatments, insulin, and technology available for patients over the years. Which technology development do you think has had the greatest impact on the daily lives of people with diabetes? 

David: Probably the technology that has had the greatest impact in the lives of patients with diabetes has been and continues to be the advances in insulin pump technology and its integration with continuous glucose monitoring.

What aspects of diabetes technology and treatment in general do you feel is still falling short? What do patients need the most next? 

David: While there has been a move to greater integration of the insulin pump and CGMS, I believe it is important for the technology to provide feedback to patients and provide tools for greater decision making on the part of the patient.  So much focus is made on the blood glucose monitoring and CGMS as a tool for the provider.  That paradigm needs to shift so the monitor/CGMS data is as much a tool for the patient, if not more so.

A great deal of this relates to patient education, and that involves teaching patients to engage with the information they get from their glucose meter/CGMS.  The meter should have prompts to assist the patient in identifying patterns and trends and perhaps suggestions for change. For instance, a notification that fasting blood sugars for the past week have tended to be a bit low could prompt a suggestion to reduce the morning basal rate or basal dose of insulin.  Most patients have the skills to make these kind of decisions and often do so anyway.

Ahh, yes! We definitely understand that need at Dario! The Dario app was designed not only to help patients analyze their own blood sugars more easily, but also to communicate with their healthcare team more often and easily as well!

In what ways do current technologies improve your ability to support your patients as their healthcare provider and what’s still missing?

David: The amount of information available to providers can be overwhelming. Our health care network is in the midst of launching a new electronic medical record system. One of the areas that I have encouraged focus is integrating blood sugar reports into the actual record.  It is so important to have the actual blood sugar reports and trends in the record and takes so much time to dictate into the record. The problem is that there are so many different glucose meters, each reporting the blood sugars in their own specific format.  It would be nice if the blood sugar data could be reported in the same format and once downloaded actually become part of the clinical notes.

Lastly, you work with a variety of patients, of course, but I would guess that you have one cluster you could categorize as people who actually “thrive” in their life with diabetes, what’s different about these patients that has helped them develop that positive perspective and approach towards this disease?

David: I have often thought about this. Two patients who come from similar backgrounds, similar degree of support from family and friends, diagnosed at similar ages, one flourishes and the other barely gets by if at all.  There are so many variables that play a factor in how patients deal with their diabetes. Much relates to the degree of motivation and ownership of the challenge that is diabetes. Cognitive ability in mastering the skills and judgment to manage diabetes can play a role. I don’t mean necessarily a matter of intelligence, just that we all have different aptitudes as relates to dealing with levels of information. This requires an ongoing assessment of the manner in which patients process and use information and adapting the diabetes care plan accordingly.

THANK YOU, DAVID!

 

Diabetes is the 300 lb. Gorilla on Your Shoulders

BillWoods

Bill Woods was originally known in the diabetes online community for his positivity through blog and videos at 1HappyDiabetic.com, but he has since become an integral part of the type 1 diabetes community, Glu, which is designed to “accelerate research and amplify the collective voice of those living with type 1 diabetes.”

Recently, Bill Woods was chosen to be part of the Bionic Pancreas patient trials. The Bionic Pancreas, created by diabetes research engineer and father of a son with diabetes, Ed Damiano, combines an insulin pump, a glucagon pump, and a continuous glucose monitor to take the thinking and the fluctuations out of daily diabetes management with non-diabetic blood sugars as a result.

Father of 2 young kids, Bill took a little time out of his busy schedule to chat with us about the Bionic Pancreas and life with diabetes.

You’ve been one of the select few type 1 diabetics in the country to have already experienced the Bionic Pancreas! Can you describe what a day-in-the-life of a Bionic Pancreas felt like?

I would love to say it was a diabetes-less bliss all the time but there was an around-the-clock nurse supervision and nighttime IVs that were involved in the study protocol. But enough with the downsides! Having a device make a majority of your diabetes decisions and waking up in range everyday…I’ll take one!  It’s hard to put into words the mental relief this device allowed me to have. I have been so calloused with my diabetes decisions over the year that to have it reduced so dramatically was beyond impactful.

With any technology, from smart-phones to awesome medical devices, there are flaws or aspects that need improvement and development — I think many are hesitant to consider something like the Bionic Pancreas merely because it requires the user to wear 3 different devices all at the same time…how stressful or challenging was that for you?

I get this question a lot. Let’s say that this isn’t the final version of the device. But with that said, I would wear double, even triple, the amount of infusion sets and sensors. It looks like a large amount to wear but really for me it was just one extra insulin pump.   What you don’t see is the overall feeling of being well with numbers in range and not having to guess at carbs or glucose corrections.  That is the 300 lb. gorilla…not the device attachments.

Aside from the Bionic Pancreas, what other piece of diabetes technology do you value most, and why?

Without a doubt it is a continuous glucose monitor.  The value of seeing trends to save a serious low is priceless. Add in the fact you are recording your numbers every 5 minutes at night. This all helps you get numbers in range for the morning…which is most important for me.

In your work at MyGlu.org, you hear from so many different people with type 1 diabetes across the globe through polls and research…what information or poll results around technology have been the most surprising?

We have done a number of interesting questions and surveys on Glu. One that surprised me the most was that based on respondents, over 40% did not have a glucagon kit. And one of the leading reasons why was because their doctor never mentioned it to them.

Wow – that is actually very worrisome. And that definitely sounds like a place where the Dario App would help instill better (and easier) communication between doctor and patient.

Thank you for sharing your insight, Bill!

Why There’s No Cookie-Cutter for Managing Diabetes

Ann-Bartlett

Ann Bartlett has lived with type 1 diabetes since she was 5 years old—over 35 years. As an expert in balancing traditional, non-traditional, and lifestyle health choices, she has been a practicing massage therapist for 24 years for clients ranging from terminally ill to professional and world-class athletes and is owner of the Body in Balance Center, an integrated wellness practice in Alexandria, VA. 

Ann’s father was a founding board member of JDRF. A pilot for TWA, he used his international travels to find Type 1 researchers from around the globe and engage them in collaborative sharing.  He successfully fostered relationships in London, Tel Aviv and Milan and helped create the first international Type 1 diabetes symposium in the mid 70s.

In addition to speaking at conferences as a patient advocate, Ann is an expert patient blogger at HealthCentral.com, and serves as a consultant for Sanofis US diabetes.

You’ve seen the evolution of diabetes technology from the 1970s to today, which developments in diabetes technology do you think have had the most significant impact on overall patient well-being? 

For me personally, the best development has been the CGM. In 1970, we had to use urine and test tape. It was never immediate information, so we had to really know “how we felt” in order to catch a low blood sugar.  I can remember a handful of times waking up to my mom holding my head trying to get orange juice down, also being partially paralyzed for an hour after and trying to work on getting my hands and feet on one side of my body back to functioning normally. Blood glucose meters helped to give immediate information, but it is the CGM that tells you trends and that’s been very helpful to cutting out a number of lows and highs. I have always said, it’s like having eyes to the inside of my body and being able to follow the trends within your body is one of the most successful tools we have.

What aspect(s) of patient care (and wellbeing) do you feel are still being under-addressed through technology, doctor’s appointments, and overall diabetes education?

Under addressed?! Where to begin….as someone who has had diabetes 45 years, the education process blows.  Because I had a solid below 7 A1c, the healthcare system assumed I was an educated patient. In fact, my education was from my years as a pediatric patient, but as an adult, the system assumes that patients will figure it out.  I was always offered nutrition, and only 10 years ago I had my first visit with a CDE, but there was an immediate jump to “you need to start on a pump for better control.” Two problems with this, 1) the RD root was not a fit for my needs and 2) jumping to a pump had explanation for why. The advice felt cookie cutter diabetes care. Where were the steps that needed to walk me to transitioning to a pump?

It wasn’t until I landed in Gary Scheiner’s office at IntegratedDiabetes that I had a full year of working with his team to I understood why I needed to consider a change in my system of care. In my first appointment with Gary, he went over all my diabetes management and said, “Your diabetes management is about 20 years old and it would be wise to upgrade your system of management.” From there I worked with his RD/CDE to update my nutrition education, and then we modified tactics for exercise, daily routine and refreshed things like sick day management. After we had a few months we looked at the blood glucose patterns to talk about where a pump may level out the inadequacies of my current system and we spent another couple of months talking about pumps. Also, Gary’s team was on board when after 4 years on a pump, I was struggling with a rising A1c and I wanted to change to injections. Again, they were on board with helping me make the right choices for me, and the next step was CGM.

I have had diabetes for 35 years and as an adult I had never had this kind of engagement from a doctor’s office. Adult education and refreshers are necessary education and without them we will inevitably fall into complacency in our management.

You have worked hard to stay on the forefront of diabetes research development, sharing that information with your blog readers — what current studies in cure research do you think are breaking the most ground and perhaps holding the most potential?

I love all research and, in particular, I love to understand research that did not meet its end point. Many people like to claim that the cure is out there, but I believe it’s so complicated and we still have holes in theories that looking for a cure is a bit like watching a horse race. I have found that looking at research that didn’t make it, tells us a story about diabetes we didn’t understand and creates new innovation. Let’s take antiCD3 trials, all three failed to meet their endpoint, which basically means that there is a missing factor in how diabetes develops and affects the body.  I often wonder if the same hole that affected the outcome of antiCD3 is what causes a couple of other current projects to have to continually increase the dosages to create a cure. I’m watching Faustman Labs and Insulin Independence to see if they run into the same problem.

I love reviewing all research for new iterations of technology and insulin.  For example, I’m eyeing the work being done by Merck on the polymer-based insulin known as smart insulin. I love the fact that the Artificial Pancreas will help to drive technology and insulin to new levels of efficiency. To breathe life, the AP will require an insulin to have faster uptake, like 5 minutes compared to the 20 minutes available now and redundant sensors for the CGM to keep the sensors from wondering. These advancements will prove invaluable to me, whether I choose to wear an AP or not.

People ask me if I am frustrated that we don’t we have cure, yet. In honesty, I never get tired of learning what research is revealing.  It keeps me motivated and teaches me things about my own body. It’s an endless cycle of learning.

If you could make any one aspect of daily diabetes care simpler (for you, for everyone) what aspect would you choose? 

In a word: data.  Diabetes is so driven by our data and we walk around with a ton of it hanging on our bodies, or in our purses, it’s ridiculous how much we are accumulating daily. I would like to see better integration of that data.  I know Medtronic is working to create a platform for pumpers to see data streams side-by-side, but I also think that data collection needs to vastly improve for all people with diabetes, so that includes type 2 population, who barely have basic access to tools and good education. So we need platforms that will give people who are on injections similar opportunities to look at data streams. That may involve combining something like a fitness wearable to help with data uploading. Technology is certainly going to move us in to new levels of self-management and better outcomes.

At Dario, we certainly understand the need for not only great data but the ability to analyze that data and share it with our healthcare team! The Dario app definitely strives to sync all of that data into one easy-to-use platform! (Read more here…)

Thank you, Ann!

 

Pediatric Endocrinologist Says, “First, We Listen”

DrJenDyer

Dr. Jennifer Shine Dyer is a pediatric endocrinologist, social media enthusiast (@EndoGoddess) researcher, blogger at EndoGoddess Musings, and mobile technology entrepreneur at Ohio startup Duet Health and creator of the app, “Endo Goal.” She is focused on implementing engagement platforms with compensated feedback loops for chronic diseases such as diabetes.

Dr. Dyer is a board-certified physician in both Pediatrics and Pediatric Endocrinology previously at Nationwide Children’s Hospital affiliated with The Ohio State University College of Medicine in Columbus, Ohio where she recently earned her MPH degree in health behavior studies.

What are a few aspects of the patient experience that you wish more endocrinologists could learn about?

I am really proud to be a part of the diabetes online community…one of the largest and most active of all online healthcare communities. I wish that endocrinologists would recommend the diabetes online community as an important resource for support and information to their patients. In general, endocrinologists are afraid that the online environment will provide misinformation to their patients. What they don’t understand is that the community itself, particularly when there are a lot of voices involved like the diabetes online community, polices itself with regards to misinformation and mischief by those without the best of intentions. In other words, the diabetes online community is a democracy where the intention is to provide accurate and helpful information to its participants. Thus, endocrinologists should not worry but rather embrace the diabetes online community.

Where are today’s diabetes technologies falling short?

Data management interoperability is a major flaw of all of our technologies currently: no universal cord or software program for each of the glucose meters and insulin delivery devices (pens, pumps) at one time. Furthermore, there are no glucose/insulin/carb data management solutions that allow wireless cloud-based data updates in real-time without manual entry or manual downloads to a central platform. In our clinic alone, we have a huge mess of cords that we must sort out to download data from devices at an appointment…a universal cord would be a start in the right direction so that valuable time at an appointment is not spent trying to locate the right cord.

DrJenDyer-CordsPhoto

When working with a patient who is struggling with the demands of diabetes management, how do you as a healthcare provider focus on their emotional state in their life with diabetes and the support that they may or may not be able to find from diabetes technology?

In our clinic, we are constantly trying to find the best ways to support our patients that are struggling. We are always learning and changing our approach as we learn more. However, currently, the first thing we do is listen. Listen to what the patient is saying…or not saying. In other words, what is the biggest problem that they are facing in their life unrelated to diabetes. The first priority is to have each patient create a diabetes goal and to help them to see how that that diabetes goal can help whatever problem that they are having in their life. The second step is to help formulate some easy answers specific to that problem for the next several days that the patient feels that they can be successful at. Finally, if the problem that they are having requires specific psychological support such as in a case of bullying or teasing at school about their diabetes, we have a wonderful psychologist in our office that can see them in conjunction with their diabetes appointment.

What can the diabetes online community do to help alleviate fears of misinformation that endocrinologists have?

Endocrinologists are always listening to the results of studies and improvements in outcomes so anytime the diabetes online community can be studied and improved outcomes published in medical journals, then endocrinologists will eventually lose their fears. In the meantime, all of us in the diabetes online community must continue to inform those who don’t understand about its power and natural policing of information. It’s up to us to keep up the effort until everyone understands.

 

Thank you, Dr. Dyer!

Actor Jim Turner On Getting to Diabetes Acceptance

Jim+Turner+Celebs+Screen+Actors+Guild+Golf+1gsd1pDa0Izl-150x150

Jim Turner was diagnosed with type 1 diabetes in 1970 as a teenager in high school. Glucometers didn’t exist. Pumps, CGMs, and even a steady long-acting insulin didn’t exist. But Jim is also a well-known actor whose starred in TV shows such as Arliss back in the late 80s, and more recently Granite Flats and Anger Management. He’s known in the diabetes community for his true-to-life videos at dLife that are always a charming mix of both humor and serious aspects of living with type 1 diabetes.

Can you imagine going back in time to the 1970s during your first few years of life with type 1 diabetes, and how different things would have been if you had had today’s technology like glucometers that give results in 5 seconds, insulin pumps, and continuous glucose monitors? Do you feel as though the technology would have impact far more than just your overall blood sugars, but any parts of your life or emotional wellbeing as well?

I think that, of course, my blood sugar management would have been better. But emotional well being; I’m not so sure. I think the initial diagnosis is such a shock that having more stuff to learn how to use doesn’t help things. I’m a fairly simple guy. I have many reasons for not going on the pump but a main one is that it seems like a giant mess of stuff to figure out and frankly, I don’t want to. I’ve seen perfectly intelligent people struggle with how to simply test their blood sugar. I think it would have slowed my acceptance of my diabetes initially.

Where do you feel, in your own personal experience living with diabetes, diabetes technology is still falling short?

Right about the time that I started testing my blood sugar in 1980 with the old Chem-Strips (no meter, just an eyeball guestimate based on the color the strip turned after being dipped in urine) I had this idea for a thing about the size of a dime that would be surgically inserted into your bloodstream and then somehow cordlessly forwarded to a device you carried around. This was during the heyday of the cordless phone. Wireless was not a thing yet. We now have the CGM that works the same way, but I still kind of like the thing inserted in your blood stream. As far as actual things, I’m not much of a visionary. I love my CGM. I don’t mind taking shots. I read about the artificial pancreas and it just makes me nervous — what if it reads your BG wrong and pumps you with insulin. I know this is silly but that’s where I am. If it was left up to me, diabetes technology would probably wither and die right where it is. I’m awful.

You’ve shared a great deal through dLife episodes and interviews about hypoglycemic episodes during work and home-life and how supportive your family and coworkers have been…do you have any tips or suggestions for helping people educate their friends and family about diabetes and get the support they need?

Oh jeez. I think just talk it up. Talk about it all the time. I think people are pretty bored with my diabetes stories by now. The main thing is not feeling any shame about it. Talk, talk, talk. I got really mad playing golf the other day. Really mad at myself. I threw a club. The first thing my friend asked was if I need something to eat. Like NOW. I said no, I’m just mad that I suck at golf. He said, are you sure, why don’t you test? I did. It was my golf. So… find a way to accept it (the diabetes) and yourself and let people know. If people want to get educated about it, there’s a lot of wonderful books — your book “Your Diabetes Science Experiment” is a great way to understand it. But the person has to make the commitment to read it. I don’t expect my friends or family to go reading about my diabetes. That’s why I continually talk about it.

You have a wonderful way of talking about diabetes with both a lightness and a serious respect for how overwhelming it can be…do you have any personal mantras or philosophies that help you face diabetes each day?

I used to meditate and I think even though I don’t anymore, I think that continues to help me deal with the moment I’m in. I try to stay in the moment instead of racing off into the future to deal with things that haven’t happened yet or running back into the past to fix things that can’t be fixed anymore. A character in the movie, The Adventures of Buckaroo Banzai, says something to the effect, “wherever you go, there you are.” Man, is that the perfect diabetes guideline, or what!

Thank you, Jim!