Have you had patients complain about calf cramps at night? They can be incredibly bothersome and painful. When I see a patient with diabetes and ask about pain, I am often told about annoying calf cramps. They can come without warning and wake a person up from a sound sleep. Most people will wriggle and stretch and get up from bed to try to walk them out.
What causes them? There are several possibilities. Here are a few common ones:
What to do? It is best if the cause of the cramps can be identified and managed. But, there are those situations when it isn’t determined. Sometimes, it is necessary to just treat the symptom.
In either case, I have found a substantial decrease in report of cramps if calf muscle stretches are done routinely before going to bed. Interestingly, when I did a search for the evidence, I didn’t find support. But, since this is a pretty low-risk intervention, it seems worth a try. This is the stretch I most often suggest to manage those annoying cramps:
• Stand facing the wall at arm’s length from the wall, feet shoulder-width apart.
I love the virtual meeting!! AADE did a great job providing access to the general and selected breakout sessions. This morning, I spent some time listening to Thursday’s sessions and catching up on the electronic newsletter. I have thoroughly enjoyed all the breakout sessions, but wanted to mention a few highlights from “Nutrition Adequacy of Various Popular Diets”. I listened to this presentation since I do not have a background in nutrition, but I am constantly reading articles or peer-reviewed publications on the topic. I think it is important to be able to teach and answer questions for patients about nutritional information.
Here are the selected highlights from this session:
• Diabetes has increased by 69% over the past 20 years.
It was interesting to learn about the various religious fasting days, which can be up to 180 days in a year. There was great information about potassium, calcium, vitamin K, zinc, and fiber intake.
Listening to the selected sessions reminded me about how exciting the AADE meeting can be and I hope to attend the meeting again in the future.
AADE14 has wrapped up. As I reflect on the meeting, I feel so good about the general session speakers, breakout sessions, the exhibit hall, the 5 K run/walk, and the social events. The Celebration of Giving was a great time! The dance floor was packed! If you didn’t go this year, definitely put it on the schedule for next year.
But, my main reflection for this blog is going to be about, I almost hate to put the words here for fear you will stop reading, the Business Meeting. There was a nice turnout. We didn’t have anything that had to be voted on. So, the meeting agenda focused on getting thoughts from the members about the future of diabetes education/educators and AADE. We have just started work on the 2016-2018 Strategic Plan. You will see more about the process and be able to provide input as the work progresses. The business meeting gave us a chance to hear what diabetes educators think are key trends for our future.
I jotted down notes as the attendees spoke. I am sure some of the trends/comments will resonate with you; others may be things you haven’t thought of. Here are some of the trends put forth:
What great ideas! Can you think of other trends that should be shaping our future as we move forward in the creation of AADE’s Strategic Plan for 2016-2018?
It’s a little difficult to give up hiking beside a mountain stream, fly-fishing and river rafting during the summer in Montana to head to the air-conditioned rooms and warm, moist outdoor air of the southeast, but off I go to attend AADE's Annual Meeting. Each year as I assess the greater financial contribution I need to make to attend the Annual Meeting, and time away from family, I realize that I make the choice to attend because I feel so good about being there. I love diabetes educators as a lot, and feel at home chatting with everyone from those who live in Florida to those who live in Alaska and Hawaii and all states in between. The bond in being a diabetes educator is strong, regardless of discipline. Our jobs are about helping people and each day I go home after a day at work, camp, or as a volunteer for Tour de Cure feeling a sense of contentment.
The Annual Meeting offers a wonderful place to learn more, relax with old acquaintances, meet new people and get re-energized and ready to return to work with new ideas and approaches. This year, for those of us that have been in diabetes education for eons, a new Masters level has been added. I look forward to an update on the most recently introduced medications, insulin pumps and other great technologies. I’ll network with other CDEs who volunteer at diabetes camps across the nation, and perhaps even find yet another one to attend! I will go to some committee meetings, judge research posters and moderate sessions. And when I return home I will hopefully be better informed, certainly recharged, and looking forward to incorporating both new and reaffirmed practices that will meet the needs of my patients.
Hope you are attending AADE's Annual Meeting either in Orlando or virtually and enjoying all that the Annual Meeting has to offer. And if you can’t make it this year, I encourage you to consider attending in 2015!
You can feel the energy in the air!! Diabetes educators from around the world are gathered for 4 full days of education and excitement. I love the tagline for AADE14 – REFRESH.RECHARGE.RENEW.
I always look forward to AADE Annual Meetings and I’m bummed when I can’t attend! I have really loved the option of the Virtual Meeting since I am a mom of two little ones. Traveling several days with a baby at home can be a challenging childcare puzzle. I’m sure many of you can relate! I have done the Virtual Meeting since it has been offered and every year the user interface continues to improve and it is really quite simple to navigate. I love being able to fit it in to my schedule or watch a session after my kids have gone to bed.
“Nutrition Adequacy of Various Popular Diets” is one of the sessions offered and I’m really looking forward to that one. Fad and trendy diets have always intrigued me and I love staying up to date on the latest ones so I can educate my patient on the pros and cons as well as dangers. I want to know about the trends before my patients ask my opinion.
I’m also looking forward to learning about “Musculoskeletal Complications of Diabetes”. We don’t hear enough about the musculoskeletal complications. There have been many times when a patient with diabetes is sharing with me a list of ailments that they have and asking if it is related to diabetes. Of course, I refer them to their physician- but I would love to learn more about the connection between joints and muscles and blood glucose control since there is not much information about this type of complication.
It’s not too late to register for the Virtual Meeting! I would highly recommend it if you cannot attend the annual meeting this year.
When I think about what I am most looking forward to at the Annual Meeting, my first thought is what I can learn at the educational sessions and in the exhibit hall. But, I have to be honest; I am most looking forward to refreshing, recharging and renewing with other diabetes educators.
As I reflect on the past annual meetings I have attended, I can think of meeting people in a variety of situations; at the airport, waiting for a session to start, at a reception or social event, and even in line in the ladies’ room! It is amazing how a chance encounter can forge a long-term relationship.
This week, I look forward to seeing friends and colleagues I have met in the past and to starting new relationships. If you can come to AADE14, I hope you learn much in the sessions and exhibit hall. And, I hope you meet and start relationships with other diabetes educators who can become a major part of your professional and personal future.
Where can you find a meeting that brings together physicians, registered nurses, nurse practitioners, pharmacists, registered dietitians, physician assistants, physiologists, optometrists, physical therapists, and podiatrists for four days of diabetes education? Of course, the AADE14 meeting in Orlando, Florida! I am not able to attend the AADE14 meeting, but I am excited to listen to the great presentations through the Virtual Meeting.
I have patients that consider their CGM the best addition to diabetes management since the discovery of insulin. I also have patients who have been disappointed, and one who even needed to see a psychologist after following every trend and pattern and literally ending up in tears.
Many studies support the effectiveness of CGM, particularly when used consistently. Trends and patterns can be spotted, acute hypoglycemia averted. The newest system (Enlite-Medtronic) will respond to a low BG value when communicating with their insulin pump utilizing an automatic suspend. What a blessing to parents and caregivers!
Given the upside of CGM, why doesn’t everyone want one?
As we all know, type 1 diabetes is a chronic disease requiring due diligence to achieve the strict guidelines that are set for preventing long term complications. We ask patients to check BG a minimum of 4-5 times per day, to wear a device that resembles a cell phone but that can never be removed for more than an hour at a time. We ask them to count carbohydrates and when ill and hyperglycemia results, to pee on a strip and check ketones. We coach them on adjustments for exercise, realizing that the adjustments do not always work from one exercise session to the next. We ask them to refrain from carbohydrates for meals to determine accurate basal rates, realizing that it is a helpful tool, but not always providing a consistent answer. For 24 hours a day, 7 days per week, type 1 diabetes can never really be set aside for a break.
Now enters CGM. A movie picture so to speak. It generally follows BG trending, and can provide a great retrospective look to determine what could have been managed in a different and perhaps better way. It can be set to predict a low or high BG as it follows glucose trending. However, it is not always accurate and can provide false alarms and false readings adding to frustration in an already unpredictable disease. It is also another piece of equipment that must be worn consistently and it is financially an added cost – and for some – a huge cost due to lack of insurance coverage.
So how do we help our patients decide if it is the step they want to take?
I believe almost every patient on multiple daily injections or insulin pumps should be educated on the option to choose a sensor; to understand both the benefits and the drawbacks and to realize it will take time to learn the ins and outs of utilizing a CGM. Using a professional CGM first, and reviewing the data with a patient, may help them see how they could use the information to promote better management of their diabetes. Freedom to choose, assessing the benefits, drawbacks and costs, and allowing the patient to decide if it is something they want to pursue is part of our job as educators.
How successful have you been at embracing this great optional technology with your patients? And if they choose to use it, what educational steps do you use to make the experience a positive one?
“All my bags are packed, I’m ready to go…” This John Denver song reminds me that AADE14 in sunny Orlando, Florida is less than 30 days away!
Last Friday the FDA (US Food and Drug Administration) approved the latest inhaled insulin, Afrezza. I can remember a few years back the inhaled insulin Exubera was approved and then later pulled from the market due to safety concerns regarding lung tissue. I can remember my patients being so excited and then bummed when it was discontinued.
Afrezza is an ultra-rapid acting mealtime insulin approved for adults with type 1 and type 2 diabetes. It comes with a cartridge of the inhalation powder and then a very tiny inhaler. I can remember the Exubera inhalers were large chambers that would draw some attention if pulled out in a restaurant. This little inhaler looks a little smaller than the size of an asthma inhaler. Afrezza dissolves immediately after inhaling and then peaks at 12-15 minutes after being absorbed into the bloodstream.
The MannKind Corporation page for Afrezza reports that there have been clinical trials with over 6,500 patients, and the results have found reductions in hemoglobin A1cs, hypoglycemia and weight gain in comparison to rapid-acting insulin. They found that there were some small changes in lung function and did not continue with Afrezza was stopped. The most common side effect was a cough.
According to the FDA, studies have been done to compare Afrezza to insulin aspart and found that the HbA1c reductions were lower in aspart than Afrezza. They also of course caution that Afrezza is not a substitute for long-acting insulin and is not recommended for the treatment of DKA or in patients who smoke, have chronic lung diseases like COPD or asthma. The FDA also notes other common side effects of hypoglycemia and throat irritation. Studies are being conducted now to evaluate Afrezza in children and to see if using Afrezza increases cardiovascular risks and lung cancer.
When new products come out like this, it’s great to be the first ones to tell our patients so we can educate them on the pros and cons and how to correctly use products. I’m sure we will be hearing a lot more about this soon!
We all know of the possible negative outcomes of high blood glucose (BG) including micro- and macrovascular complications. A large part of what we do as diabetes educators is to work with people to help manage BG, aiming for goal ranges. I now share a sad story about another negative outcome involving high BG that describes several missed opportunities with very bad consequences.
On May 20th, I received a call from my cousin. Her father, my uncle and godfather, had cancer. We knew this already. He had various treatments over the past couple of years. As part of his cancer treatment, he was on steroids and recently developed diabetes. His scans were now negative but blood work suggested there was still cancer somewhere. His current problem was pain and numbness in his lower extremities and incontinence. He had started using a cane. It was determined that he had degenerative changes in his spine and was going to undergo neck surgery the next day. Within a couple of hours, the surgery was cancelled. They found where the cancer was, in the covering of the spinal cord.
The plan was set: 13 radiation treatments and then start chemotherapy. He underwent a radiation treatment the next day and was discharged home to continue. He was on insulin in the hospital but placed on one dose of one oral medication for home; no insulin, no diabetes education. When he arrived home, he was weaker than when he left a few days earlier so he borrowed a rolling walker.
Within a day of getting home, his BG went up to 450. My cousin knew this was too high so tried to control it with very low carbohydrate meals until his next appointment with his PCP. Off to radiation each day, BG checks during the night, avoidance of carbs.
I stopped by on May 24th to help with strategies on how to get up from the chair and go to the bathroom due to rapidly increasing weakness. His BG that morning was in the 200s but had been in the 300s. I talked to my cousin about this and encouraged her to contact his PCP. Monday, May 26th, Memorial Day, our family had a get-together but I worked the holiday so didn’t see my uncle. My mom said he looked very weak. I checked with my cousin the next day to see how things were going. BG was still very high; they were doing the best they could with monitoring, watching carbs, taking the one oral medication and were going to the PCP soon.
Later that week, I called to check on how things were going. My cousin sounded so tired since she had been staying bedside to monitor BG during the night. They generally remained in the high 200s, an occasional spike to 350.
On June 2nd, BG was 450 again and my uncle reported a fruity taste in his mouth. It was determined at the PCP office that insulin should be started so they would get a call to be scheduled with the person who comes in to do insulin starts. Radiation continued daily, other physician’s appointment mixed in, my uncle kept getting weaker, so they got a wheelchair, BG still in the 200s to 300s.
Now, things start to change quickly.
My uncle had terminal cancer. We all knew he was going to die. But, did it have to happen this way? Could the UTI have been avoided? Could he have been started on insulin for home? Could he have received diabetes education? High BG can cause so many problems. There were many missed opportunities that might have changed this course. What can we do to help others appreciate the horrible consequences of hyperglycemia? Thank you for listening to my story. I hope we can increase our influence so others don’t have to go through something similar.