Last winter, I wrote an article on my blog (Where in the World is Katie Doyle?) about dropping my blood glucose meter off of a chairlift in the Alps and into the white oblivion below. Since then, I have been taking extra notice of the places I check my blood sugar--some of which strike observers as being remarkable. Here are a few places where pulling out my BG meter has had an impact on those around me (and on me, too!):
When I went heliskiing last March, the trip happened to fall on St. Patrick's Day. Although the Irish around the world, myself included, love to celebrate this "lucky" green holiday, it is significant to me for another reason: it's the day I was diagnosed with diabetes.
2. Mountain Climbing
I recently had a day off from my job in New Zealand, and the weather looked like it would cooperate. I convinced my roommate to climb up Mt. Fox, a long hike (almost 8km of a steep grade, round trip) with a sweeping, panoramic view as a reward. Being the kind of person I am, I would have done it by myself, had my roommate declined...however, I knew it would be smart and would make my parents and my diabetes team happy if I didn't attempt it alone.
3. Wilderness Living
AADE members: Are there any inspirational stories you like to share when counseling newly diagnosed patients or patients who are frustrated with their diabetes?
From the start of my blogging “career”, I have found it to be very motivational. I make it a point to set aside time to look through magazines, read other blogs and generally look for interesting items to share with you, my CDE colleagues. I realize that I am very fortunate to be able to focus on only diabetes and its related co-morbidities. I know many of you wear multiple hats at work. Here are a couple of items I found interesting. I think I will call this edition of my blog – In case you missed it.
Increased interest in the role of brown fat in diabetes.
I was intrigued by recent research I read about night shift workers having a higher risk for diabetes. The findings were posted January 11 in Diabetologia from a large ongoing study of African-American women, the Black Women’s Health Study (BWHS). They found that working night shift increased the risk of developing diabetes. The more years someone worked night shift, the higher their risk. Compared to women who had never worked night shift, the risk of developing diabetes was 17% for 1-2 years of night shift work, 23% for 3-9 years, and 42% for 10 or more years. They adjusted for BMI and lifestyle risk factors and still found a 23% increase in diabetes for those who had worked night shift for over 10 years compared to someone who had never worked night shift. They also found that the risk was even higher 39% for 10+ years of night shift for women under 50 compared to 17% higher for women over 50 years.
Welcome to 2015!
The start of the New Year often makes us think about possible activities, goals, and opportunities for personal growth. Have you thought about your possibilities for 2015? Getting involved in AADE can be a great way to increase your accomplishments and personal growth as you help other diabetes educators and people with diabetes.
As I write this blog, I am preparing to go to AADE’s 2015 Leadership Forum in Chicago. I will be joined by leaders of the State Coordinating Bodies and Communities of Interest, as well as others who are in various leadership roles within AADE. We will spend 1 ½ days in sessions where we will learn about the current diabetes landscape, advocacy, how to engage young professionals and future leaders, how to write a blog, reinventing professionally and as a volunteer leader, and mind and body balance in the work place. There are many positive things I have gained in the past from attending the forum including interaction with an amazing group of volunteer leaders and AADE staff, learning about how to be a better volunteer leader, and learning how to grow personally!
Bringing in the New Year and preparing to go to the meeting caused me to reflect on involvement in AADE. There are opportunities for all members of AADE to get involved. It doesn’t have to be at a national level, or involve travel or much time, or be a long-term commitment. There are so many ways to work with other diabetes educators in AADE, with a small time commitment, from the convenience of your own home/office.
Do you see yourself getting more involved in this great organization? You can go to the Get Involved page on the AADE website to explore some options. Once there, take a peek at some of the videos of some volunteer leaders and then go to the Get Involved checklist. You will see where you can choose your areas of interest, effort level and time interest, and if travel is required or not. Once you make your selections, some possible positions pop up. It is kind of fun to do! You can review the positions and choose “I’m interested!” where you are. This will put you in a pool of volunteers to be contacted when opportunities arise.
I have always found AADE to be a wonderful organization with an amazing staff. Each time I participated in an activity, I have gained in my personal and/or professional growth, and typically feel like I gained as much or more than I gave. Is it time for you to dip your toe in the water by getting involved? Remember, it doesn’t need to be a long term or time-consuming commitment. Think about taking the first step by visiting the Get Involved section of the AADE website and see where you can go with AADE in 2015.
I wish you a happy and healthy 2015!
Earlier this year, I wrote a blog about TANZEUM – or albiglutide – as another GLP-1 agonist available for the management of type 2 diabetes. Many practitioners seek medications that have minimal to no risk of hypoglycemia, weight neutral or loss, and an effective hemoglobin A1C reduction. Glucagon-like peptide-1 (GLP-1) agonists have been available since 2007 with twice-daily exenatide immediate-release (BYETTA) as the first medication in this class. A GLP-1 agonist has multiple mechanisms of action that can be benefit for a patient with type 2 diabetes. As a review, a GLP-1 agonist increases insulin secretion from beta-cells and suppresses glucagon secretion from alpha-cells. In addition, a GLP-1 agonist can slow gastric emptying and promote satiety. According to the American Diabetes Association and American Association of Clinical Endocrinologists, GLP-1 agonists are appropriate second-line options if glycemic goals are not achieved after 3 months of metformin therapy. Over the past 6 years, there have been other approved GLP-1 agonists, which include once-daily liraglutide (VICTOZA), once-weekly exenatide extended-release (BYDUREON), and once-weekly albiglutide (TANZEUM).
In September 2014, a new GLP-1 agonist was approved for the management of type 2 diabetes mellitus. Dulaglutide or TRULICITY is the third FDA-approved once-weekly agent in this particular class of medications. Here are the Albiglutide is similar to exenatide extended-release. While the full package insert is not available, here are the key points regarding albiglutide:
• Indicated as an adjunct to diet and exercise among adults with type 2 diabetes mellitus
To me, I am very interested in learning about the injector pen. I have not seen the pre-filled syringe, but have heard that patients will not be able to see the needle. Therefore, the device may have an edge over exenatide extended-release and albiglutide. In addition, I think dulaglutide is a good option as it has similar hemoglobin A1C reduction to liraglutide and exenatide extended-release with the potential of 6-lbs weight loss. However, cost will remain a big factor. With this new approved agent, I would reinforce that diabetes management is individualized considering efficacy, tolerability, patient preference and cost for our patients.
It’s too bad the holiday season and winter coincide. Just imagine holidays with feasting in July when swimming pools, walkways in the park, hiking and biking trails are easy to access. Overeating might not have such an impact on our weight, and subsequently, our health. Studies show that the average American gains 5-7 pounds over the winter. If that is not lost of over the remainder of the year, it can add up to too much weight gain – resulting in risks of type 2 diabetes, high blood pressure and a wide variety of chronic diseases. So how do we educate our patients to fight this seasonal phenomena?
The tricks for avoiding high calorie intake over the holidays are in almost every magazine on the rack, with more information highlighted on the internet: from great resources to bogus concoctions to help limit or eliminate weight gain over the holiday season. The healthy options include: eating a little something prior to heading to a party so that hunger will not drive overconsumption; taking a light calorie item for the potluck (vegetables, fruit slices, or a meringue filled with fresh berries); having a hot beverage or broth soup prior to diving into the entrée. To ask a patient to shun all desserts and breads is to ask for revolt – so enjoying every mouthful of the small and delicious treat may be a more realistic (and acceptable) option.
The other part of the equation, exercise, is probably as much if not more the winter weight gain culprit. In the north, where I reside, the temperature can fall way below the freezing mark, or hover around 32?F, creating slick roads, walkways and bike routes. So the easy option of putting on a pair of sneakers and heading out is less than ideal for many. As we problem solve with our patients, we can help them work around the elements of winter. What are the options? A walk in the mall; join a fitness center; purchase an exercise bike as a gift for the family; build a step that can be folded up and stored for much of the year; dance in place. Ice skating, snowshoeing, skiing and hockey are options for some of the more adventuresome souls. Not only will activity burn up some of those holiday calories, but may help decrease the winter blues some experience, and replace some time that is spent looking into the refrigerator to ward off the boredom of long, dark winter nights.
The holidays and winter can be a wonderful time of the year; snowflakes falling, music playing, family surrounding the table laden with every favorite dish, a fire in the fireplace. By helping our patients plan for the health challenges winter can throw at them, they can continue to make good choices that will enhance their health all year! Happy holidays to all of you – and have an enjoyable winter!
There’s a new movement gaining substantial momentum in the diabetes world. Maybe your patients have shared their firsthand stories of how it’s impacted them. Maybe you’ve read an article about it or have seen a presentation. Maybe you’ve heard the social media cry: We Are Not Waiting.
Here’s what it takes: the DexCom G4 Platinum CGM system, a smart phone[i] (see footnote), OTG technology (on the go technology – think usb connector), and wireless access. There is even an option to program a smart watch to display CGM data for maximum “glanceability”. While it may sound complicated, many people find it is easy to follow the instructions. Those who are interested but struggle with the setup can easily access the network of nearly ten thousand other NightScouters for troubleshooting tips.
The NightScout website is another reminder of the project’s roots in the patient community as opposed to device makers. According to www.nightscout.info:
“There is no support or any warranty of any kind….This is a project that was created and is supported completely by volunteers. Data may go missing without warning, data may be absent, data may be wrong, data may be delayed, you may void your warranty, [and/or] you may break something.”
That said, the number of patients using NightScout to supplement self-management continues to grow exponentially. NightScout boasts some very enthusiastic users, and here are what a few of them had to say to a recent poll on Facebook:
• “Prior to set-up (four months ago), little guy's A1c was stuck in 9’s & high 8’s. This visit, 7! More importantly, we had highest percentage in range ever and lowest percentage of lows!”
With such anecdotal evidence in mind, researchers are beginning to look into the “glanceability effect” on clinical and quality of life outcomes.
NightScout has drawn some comparisons with the newly FDA approved DexCom SHARE; however, there are key differences in set up, cost, mobility, device compatibility, and access to glucose data. While the makers of NightScout are in talks with the FDA, it remains an unapproved, yet extremely popular tool for people living with diabetes.
What is your take on the patient community’s attempt to tackle data accessibility? How can educators navigate this uncharted tech terrain?
This has been a joint guest blog by Rachel Head, RD, CDE, and Molly McElwee-Malloy, RN, CDE, CPT.
At the end of November, the FDA finally announced its long-delayed calorie labeling rules. This new rule requires facilities that sell prepared foods and have 20 or more locations to post the calorie content of their products ‘‘clearly and conspicuously’’ on their menus, menu boards, and displays. Companies will have one year or ‘til November 2015 to comply. The regulations will also apply to convenience stores, bakeries, coffee shops, pizza delivery, amusement parks, and vending machines.
I recently went to a continuing education program presented by Pam Baird, BBS, BBA and Candy Hart RN, BS at the Kentucky Statewide Diabetes Symposium titled “Diabetes and Brain Health.” How diabetes affects the brain is a topic that we are hearing more about. Since diabetes is high blood sugar and obviously there is blood in our brain, it makes sense that diabetes affects the brain. They discussed how blood vessel damage occurs from hypertension, cholesterol, and diabetes. This vessel damage is the biggest risk factor for Alzheimer's.
Insulin also plays a key role in brain function. From the HBO special, “The Alzheimer's Project,” there is an article explaining the research from Dr. Suzanne Craft, professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. She is studying how insulin resistance causes lower insulin levels in the brain resulting in memory problems. They are working on how to restore insulin levels to the brain but not cause higher insulin levels in the rest of the body. Since higher insulin levels in the body would increase insulin resistance and beta-amyloid levels (a protein that contributes to Alzheimer’s).
Besides keeping blood sugars levels in check, they outlined other lifestyle things everyone can do aid in brain health:
Have you discussed the relationship between cognitive decline and Alzheimer’s risk with your diabetes patients? Have you seen firsthand how uncontrolled diabetes increases the risk of Alzheimer's with your patients? Comment below on creative ways to teach the connection between diabetes and brain function.
As a recent college graduate, I can appreciate the beginning of the end of that first semester--no matter what year you're in. The light at the end of the tunnel can manifest itself in a first-year student's sigh of relief for having hit the halfway mark, or a senior's spidey senses picking up on the freedom brought by the holidays.
Winter breaks signify something else for students with type 1 diabetes: the mid-term checkup. I can still feel the sharp pangs of anxiety that haunted me when my thoughts turned to my A1C after that first semester in college. I dreaded my appointment with my diabetes team because I already felt like I had "failed" that test. Moving away for college is an adjustment for any student, but negotiating dining hall carb counting and coming down with the inevitable dorm-living illnesses made it much more challenging for me to take care of my diabetes.
Looking back, I wish I had asked for and received some different advice from my diabetes support team. Here are some tips for AADE members on counseling college freshmen during that winter break checkup:
1. Be sympathetic and understanding.
2. Shift the emphasis away from numbers.
How is the rest of your college life going?
Are you wearing a CGM? Introducing another helpful device may be a way to put the patient in more control of his or her diabetes.
Is (fun) exercise part of your routine?
3. Offer support.
AADE members: What has been your experience working with college students over the holidays? Share your comments or suggestions!
My last two blogs reviewed the specifics of intensity and type of exercise recommended for a person with diabetes (PWD), and for most adults for that matter. This is the final blog in the series about the prescribing exercise using the FITT Principle (F=frequency, I=intensity, T=type and T=time).
When prescribing exercise, frequency and time go together; the more time spent exercising in one bout, the less frequently exercise would be done. In general, the goal for aerobic/cardiovascular endurance exercise for most people is 150 mins./wk. This can be split up in a variety of ways: 30 mins. on 5 days/wk., 50 mins. on 3 days/wk., or even several times per day such as 10 mins. done 3 times/day or 15 mins. done 2 times/day. As diabetes educators (DEs), we should work with an individual to determine what is most reasonable and achievable.
If a person has limited time, limited motivation, gets bored quickly, or lacks the ability to perform a longer bout of exercise (30 or more mins.), we might suggest starting with 5, 10 or 15 mins. at a time. Other people do well with one bout of 30 mins. or more, certainly if going someplace to exercise (a park, mall or gym). As DEs, we would ask the PWD about reasonable options based on their ability, interests, time, etc. and individualize the general exercise prescription, providing knowledge about how to be flexible day to day with regard to time and frequency.
What about the person who isn’t up to doing a regular bout of exercise? Some people do well with an increase in activity throughout the day. One problem with this is tracking what was actually done. A pedometer can be useful to track steps. It can be a surprise to see the final daily total; some walk more and others are shocked at how few steps are taken.
Is 150 minutes/wk. enough for everyone? The answer is probably “no.” This is the initial goal for general health, blood glucose (BG) control, and for cardiovascular endurance. But, for a person who wants to lose weight, more exercise is needed, with most people who are successful with weight loss/maintenance of weight loss doing 200-250 mins./wk. If this sounds like too much for an individual, encourage him or her to start slowly and try to increase as exercise becomes a part of the routine; better to do some than none. Once a person is able to do 30-40 mins./day, he or she may be able to increase to 50-60 mins./day to meet all of their goals.
It may be helpful for the person to track exercise as a motivational tool and to know how much has been done over time. This can be done by noting the time of exercise or total daily steps on a calendar, a BG log sheet, a separate exercise log, or by using one of the many apps that will help log exercise (and food intake). A couple of possibilities are “Lose It!” and “MyFitnessPal.”
Finally, follow up with the individual to see how it is going. I encourage this and specifically say to please check in whether things are going as planned or if they aren’t. We work as a team, DE and PWD, to adjust the plan as we move toward a successful exercise program.
To summarize, a person will tend to follow an exercise program if it is specifically prescribed; using the FITT principle, you as a DE can work with an individual to create a successful, specific plan and adjust as needed to help promote lifelong exercise and better health.