Have every compared your finger stick glucose to your CGM glucose only to find s significant difference between the two values? So why? A physiologic time lag of glucose transport from the vascular to the interstitial space. Therefore, interstitial glucose readings (aka CGM readings) tend to lag finger stick glucose values by 5 – 10 minutes. It is even longer if glucose readings are changing rapidly. To learn more, click the link below to watch a short video.
As a diabetes educator, I have heard many people with diabetes say to me, “I did not want to come see you because I have bad control of my diabetes.” Some have even said, “I feel I have done everything that I can possibly do and I still have poorly controlled diabetes.” These statements reflect a sense of shame, blame, and frustration. My heart sinks every time I hear these statements. I want to yell it from the mountain tops a person with diabetes does not have to have it “all together” in order to see their diabetes educator or provider. Your diabetes educator and provider are here to support and empower you along this tough journey rather than place judgment on you. Yet, I also get that some diabetes educators and providers do judge people with diabetes based on what a person’s current A1C or blood values are.
So what are any alternatives to the term “control,” when used as a verb or adjective? “Manage” is an ideal alternative. So why? In reality, diabetes is a disease where the body no longer does what it is designed to do so “control” is really difficult to achieve in such a reality. By focusing on what the person is doing well, helps develop a structure to help the person build upon what that they are already doing well. It is not good or bad. Terminology that does not induce blame, shame or judgment is important. Have any of us ever benefited from being kicked when we were down or struggling? I certainly have not!
Control when used as a noun is often stated as good control,
bad control, or poor control. It takes
only a moment to realize that it creates a swinging pendulum where one feels
temporarily uplifted when they have “good control” and defeated when they are pronounced
to have “bad or poor control.” The reality of diabetes, like any other chronic
disease, is there are days where all is going as one would hope and then we
have those days where the feeling of what else could go wrong emerges. Alternatives for control should be based on
neutral words and on physiology. Terms
such as glycemic variability/stability/target/goal, blood glucose
levels/targets or A1C are more objective and based on biology.
In closing, a short story about Betty. I have been seeing Betty as her diabetes educator for a year. When I began seeing Betty, she would refer to herself as a “bad diabetic?” She would list off all of the self-management behaviors that she considered herself “failing” at. Betty really struggled to identify those behaviors that she had consistently performed. Finally, after about six months, Betty began to start off the conversation with behaviors that she consistently performed such as taking her insulin injections, following her eating plan and utilizing Freestyle Libre system for tracking glucose. Interestingly, Betty found herself building more positive behaviors upon other positive behaviors by shifting her focus from good or bad control.
Special thanks to
Jane Dickinson, Susan Guzman, Melinda Marynik, Catherine O’Brian, Jane
Kadohiro, Richard Jackson, Nancy D’Hondt, Brenda Montgomery, Kelly Close and
Martha Funnell who wrote Use of Language in Diabetes Care and Education
FDA gave a great Valentines gift for those living with diabetes on insulin pump therapy…the green light on Tandem Diabetes Care t:Slim X2 insulin pump with interoperable technology (interoperable t:Slim X2). It is also referred to as an alternate controller enabled (ACE) infusion pump, or ACE insulin pump. It can be used with different components that make up diabetes therapy systems, allowing patients to tailor their diabetes management to their individual device preferences. To learn more click below.
I have recently written a manuscript on a quality improvement project focused on increasing frequency of documented diabetes eye exam in EMR system for an internal and family medicine practice. So naturally, the article, “Diabetes Eye Exam Frequency in US is ‘Alarmingly Low,'” on Medscape Medical News caught my eye. Dr. Benoit with Centers for Diabetes Control completed an analysis of claims data for insured persons with type 2 diabetes (300,000) with no retinopathy at baseline, and type 1 diabetes (3000). For those with type 2 diabetes in this analysis, only about one in seven met the American Diabetes Association (ADA)’s recommendation for annual or biennial exam. For those with type 1 diabetes, only a quarter met the ADA recommendation. Remember this analysis reflects insured not uninsured persons. To learn more, please click below.
As I was reading my Pharmacy Today from American Pharmacists Association this morning, the headlines of “CDC: influenza activity has highest level this season,” and “In measles outbreak, demand for vaccine spikes” caught my attention. Later in day, a question arose about catch up immunization schedule for polio vaccine in a young adult. To have creditability, I can confidently say that I am up to date with all of my vaccines. Vaccines truly matter as evidenced by the recent measles outbreak. Are you uncertain as to whether you or kids are up to date on your immunizations? If not, click below on link to CDC for vaccination details.
Innovation is vital in transforming all aspects of our life. For those with living with diabetes, the recent innovation of delivering insulin via a specialized pill injection from a MIT research is of great interest. It utilizes self-orienting millimeter scale application (SOMA). The capsule contains a small needle that is made up of solid, compressed insulin. The ingested insulin is injected into the stomach wall which is pain less. To learn more please click below.
Prior to reading an article by Renza and Chris (they live with diabetes so they have full creditability) in BMJ, I thought that I was doing great when I shared “you do not have to have complications from diabetes, they are preventable” to a person with newly diagnosed diabetes. I assumed that this statement would empower the person with diabetes. Well, as it turns out this language is not so helpful. Implying that complications are preventable can create a sense of blame in the person with diabetes if they develop complications. Reframing the conversation so focus is on reducing complications which creates opportunity for person to share more freely and openly without feeling judged. Shift the focus from prevention of complications to daily care. As a diabetes educator, I have committed to transform my conversations with persons with diabetes. Will you join me this commitment?
Exciting news for Guardian Connect CGM users in the US who are paired with Sugar.IQ app as they now have a new hypoglycemia prediction feature, IQcast. This feature provides users notification if low event is predicted to occur within next 1 – 4 hours.
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Much news over the last couple of years with regards to SGLT2 inhibitors and cardiovascular outcomes from studies has been highlighted. A study of dapagliflozin and its impact on cardiovascular outcomes in 17,160 patients with Type 2 diabetes (who had or were at risk for atherosclerotic cardiovascular disease) who were followed for a median of 4.2 years. Specifically, patients were randomly assigned to receive receive either dapagliflozin or placebo. The primary efficacy outcomes were major adverse cardiovascular events (MACE) (cardiovascular death, myocardial infarction, or ischemic stroke) and a composite of cardiovascular death or hospitalization for heart failure. The primary safety outcome was a composite of MACE. Treatment with dapagliflozin resulted in a lower rate of cardiovascular death or hospitalization for heart failure which reflects a lower rate of hospitalization for heart failure. However, treatment with dapagliflozin did not result in a higher or lower rate of MACE as compared to placebo. To learn more, please click below.
A current first ever randomized trial of oral insulin use in persons with Type 2 diabetes shows feasibility. This trial which is sponsored by NovoNordisk has been discontinued yet it shows promise for the future studies of oral insulin. To learn more, please click below.