Daily Piece: Adding GLP-1 Agonist to Insulin

As an educator and clinician, I hear the frustration over weight gain resulting from insulin therapy. For those requiring insulin therapy, this reality can be disheartening to say the least. So I when I read summary of study that showed liraglutide (Victozia) can improve glycemic control and reduce body weight in persons with type 2 diabetes on insulin therapy, I thought it was worth sharing. The link is below. I do encourage persons with type 2 diabetes on insulin to have discussion with their primary care provider, endocrinologist or diabetes educator about adding GLP-1 agonist to their current diabetes medication regimen as it will lower glucose and weight (now that sounds good!).

http://univadis.com/player/ysgckxcim?m=unv_eml_essentials_enl_v5-q12019_20190715&partner=unl&rgid=5xzzntsmvumvuucxuzefqyb&ts=2019071500&o=tile_1_id&utm_source=Retention&utm_medium=newsletter&utm_campaign=unv_eml_essentials_enl_v5-q12019_20190715_01

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#liraglutide #insulin #therapy #diabetes

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Daily Piece: Antidepressant Decreases Death

For people living with diabetes and major depression, antidepressant (medication used to treat symptoms depression) medication classes except reversible inhibitor of monoamine oxidase A (RIMA) were shown to reduce death by approximately 35% in a small study.

https://www.medscape.com/viewarticle/915376

Bottom line: treating major depression is very important. If you are a person with diabetes who suspects you are suffering from depression, talk with your primary care provider, diabetes educator or other health care professional so can you get treatment. If you are health care professional and diabetes educators, screen persons with diabetes for depression that you see in your practice.

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#antidepressants #diabetes #major depression

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Daily Piece: Prediabetes Turning It Around

Being a person having had prediabetes (and having had a life long struggle with emotional eating), I was greatly encouraged by a recent study that show lifestyle interventions work for a group of older adults with prediabetes to prevent develop of Type 2 diabetes. In the study of 2,575 women and men 60 years of age and older, 36% (918 people) had prediabetes. Only 13% (119 people) who began study with elevated glucose went on to develop diabetes. 22% (204 people) had glucose levels return to normal range. I just love the quote by Ying Shang, lead study author, “progressing to diabetes is not the only destination.” Below is link to study.

https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12920

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#prediabetes #older #adults

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Daily Piece: Sticky Adhesives to Battle Summer Heat

I am back from vacation. I had a great problem solving conversation with a person living with Type 2 who wears insulin pump and CGM this week. She was frustrated that her infusion set and sensor would not fall off due to working out in the heat and sweating. What to do? Clean the area with alcohol or IV prep wipe (let it dry) then apply either antiperspirant (solid or spray) then wait 10 minutes before inserting infusion set. Additional options include Skin Tac and Mastisol which create a sticky feel on skin.

http://www.diabetesforecast.org/2013/jan/infusion-sets-2013.html

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#sticky #adhesive #summer #heat

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Daily Piece: Potential Cybersecurity Risk

FDA has issued a warning regarding potential cybersecurity risk with Medtronic’s MiniMed 508 insulin pump and MiniMed Paradigm insulin pumps. These insulin pumps wirelessly connect with blood glucose meter and continuous glucose monitor. Additionally, the remote controller and CareLink USB are also used with these pumps. FDA’s concern lies in the cybersecurity vulnerabilities identified in these pumps as potential for someone besides the person wearing the pump could wireless adjust the insulin pump settings leading to either high or low blood glucose. Medtronic is providing alternative insulin pumps with enhanced cybersecurity features. To learn more, please click below.

https://www.fda.gov/news-events/press-announcements/fda-warns-patients-and-health-care-providers-about-potential-cybersecurity-concerns-certain?utm_campaign=062719_PR_FDA%20warns%20of%20potential%20cybersecurity%20risks%20with%20certain%20insulin%20pumps&utm_medium=email&utm_source=Eloqua

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#FDA #cybersecurity #insulin #pump

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Daily Piece: Can I lose weight while taking insulin?

Recently, a person with diabetes asked a great question, “can I lose weight while taking insulin four times per day?” Great question! I must be honest — while it is doable it can be challenging. So here are some practical tips.

Increase or begin to incorporate physical activity (150 minutes of aerobic moderate intensity activity (walking, running, cycling, swimming) and 2 days of resistance training at least 2 days per week) — warning, if you have been physically inactive for a number of years or have multiple chronic conditions, I recommend checking with your primary care provider or endocrinologist before starting physical activity. Once you have started, gradually increase your physical activity.

Moderating the amount that you eat (aka portion size) is key. I typically recommend keeping carbs at max of 3 servings per meal unless you are doing physically demanding work or training. Keep a food journal and incorporate principles of mindful eating. Request an appointment with a dietician to develop a customized eating plan that is just right for you.

While I know personally (as I have battled with my weight all of my life), it is hard at times but is doable. Do not go at alone — create accountability and seek our professional guidance (personal trainer or exercise physiologist, and dietician).

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#combating #insulin #weight #gain

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Blog: Advocacy: Relationship Building

III Part Series: Advocacy

Part I: Relationship Building

Hi, I am Mandy from Gainesville!  Advocacy starts for me with a simple introduction. How many of us, when we think of meeting with a legislator, gets a bit anxious or nervous? If we are honest, most of us do.  Legislators, whether at the state or federal levels, are no different than you and I at the end of the day.  They represent the people – which are us!  So how do you build a meaningful and lasting relationship with your state and federal legislators before you need them?  Please do not wait until you need them.  Simply make a friendly introduction of yourself and advocacy begins.

Attend as many of your legislator’s town hall meetings as possible.  Most legislator’s hold public town hall meetings a couple of times a year on the average.  Many are now holding virtual town hall meeting as well as traditional public meetings.  Before going, notify their office (whether in person, phone call or email) in advance that you will be attending and that you are representing a professional association (i.e. American Association of Diabetes Educator), and you would appreciate the opportunity to briefly introduce yourself to them.  For in person town hall meetings, identify one to two questions to ask during meeting. Also, submit a question ahead of time for virtual town hall meetings.  There’s nothing wrong with asking challenging questions but since you are trying to build a relationship, I highly suggest that you stay away from emotionally charged questions or “gotcha” type questions.

Attending a fundraising event is another great way to build your relationship with a legislator. Participating in a fundraiser is not as challenging or expensive as one might imagine. Don’t worry – you do not have to be a larger contributor to participate.  Learn about upcoming fundraising events is easy as signing up for campaign emails and their newsletters.  Settings for fundraising events can include private homes or event venues.  Last summer and fall, I had a great time attending several fundraising events for both my US Congressional Representative and my state legislators.  I realized after attending one fundraising event held in the backyard of a local home you were able to have a lot of one on one time with several state and federal legislators.  I had no idea that I would be able to meet that many legislators in one place.  Another event held in a local restaurant was a great opportunity to have discussion with two federal and several local and state legislators.  The key is building upon these conversations to strengthen your relationship with the legislators.

One and done is not the case! As in any relationship, ongoing communication is essential.   Maintaining communication is not daunting as it may seem.   As I previously shared, signing up for newsletters and emails allows you to stay informed about your legislators efforts, what is on their priority list and how to individualize your “ask” around each specific legislator.  Additionally, scheduling monthly or quarterly meetings with legislators or their staff is vital to keep particular legislation and issues at the front of their mind. When there is specific legislation that has been introduced, I recommend every four to six weeks for meetings.  When legislation is forth coming but not yet introduced, a quarterly meeting would be more appropriate.  When it comes to communication, “how” we share our perspective, passion and case is just as important as “what” we say.  While I know first-hand that it can be difficult at times to show respect, it is ABSOLUTELY vital to show respect in word and deed regardless of which political party they represent and especially if they differ from your political preference.

No magical wand exists for advocacy. As like most things in life, we learn and sharpen our skills as we practice advocacy.  Please join me in advocacy and simply start by you introducing yourself as I did.

Hi, I am Mandy from Gainesville! And I would appreciate a moment of your time to share with you…

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Daily Piece: International Consensus for CGM (ADA 2019)

At ADA 2019, new recommendations for international consensus on CGM were presented (endorsed by ADA and EASD). Use of a standardized CGM report (such as ambulatory glucose profile); 14 day composite glucose profile; table with specific target range and time in range for type 1 and 2 diabetes (70 – 180 mg/dL) and special populations (pregnancy (63-140 mg/d), medically fragile (less stringent target)). Below is a link to consensus document.

https://care.diabetesjournals.org/content/early/2019/06/07/dci19-0028

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#CGM #international #consensus

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Daily Piece: Metformin

Recently, I was asked when is the best time of day to take metformin immediate release and extended release. Taking metformin immediate release with first and last meal of the day – 10 – 12 hours between doses is ideal. Taking metformin immediate release with food can decrease the stomach upset. Metformin extended release is best taken in the evening as it works overnight to prevent the excess release of glucose from the liver.

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#metformin #timing #doses #diabetes

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Daily Piece: Age Expansion for Victoza

Great news! FDA has approved liraglutide (Victoza) (GLP-1 agonist) is now approved for person age 10 and older with type 2 diabetes. This is exciting because there are limited medications (metformin and insulin (usually basal)) indicated for type 2 diabetes in adolescents. Please share with others.

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#Victoza #FDA #adolescents #type2diabetes

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