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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Daily Piece: New Diabetes Combo Med Approved

Qternmet XR (AstraZeneca) has been FDA approved as oral adjunct treatment to diet and exercise in type 2 diabetes as adjunct in U.S. It contains dapagliflozin (SGLT2-inhibitor), saxagliptin (DPP-IV inhibitor) and metformin hydrochloride. This is an ideal combination in terms of the variety of drug mechanisms of action involved. To learn more, please click below.

https://www.mdedge.com/endocrinology/article/200430/diabetes/fda-approves-qternmet-xr-adjunct-therapy-glycemic-improvement

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#Qternmet XR #FDA #diabetes #treatment

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Daily Piece: ADA Standards of Care Incorporate CREDENCE Trial Findings

As you may already know, ADA Standards of Care are now the living standards which basically means updates are made in real time rather than once year. CREDENCE trial results revealed that the SGLT-2 inhibitor, canagliflozin, was associated with both reduced renal failure and cardiovascular events in persons with type 2 diabetes and chronic kidney disease. These are game changing results. Updates to sections 10 and 11 of the ADA Standards of Care have been made as a result of CREDENCE trial findings. A few highlights of the updates include…

  1. At least annual assessment of urinary albumin and estimated glomerular filtration (eGFR) rate in all persons with type 2 diabetes.
  2. GLP-1 agonist medication may lower risk for albuminuria risk progression and/or CV risk in persons with CKD at elevated risk of CV events.
  3. SGLT-2 inhibitor should be considered when eGFR is at or above 30 in persons with type 2 diabetes and chronic kidney disease especially with albuminuria above 300 mg/g to lower CV and renal risk.

To learn more, please click on links below.

https://www.nejm.org/doi/10.1056/NEJMoa1811744?query=pfw&jwd=000020040769&jspc=

http://care.diabetesjournals.org/living-standards#June/%203

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#CREDENCE #ADA #updated #standards

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Daily Piece: Renal Protective Enzymes Identified

Dr. Gordin and fellow researchers with Joslin Diabetes Center have published their findings on enzymes, pyruvaste kinase M2 (PKM2) and amyloid precursor protein (APP), which potentially protect against kidney disease in those living with Type 1 diabetes. To learn more about these very interesting findings, please click below.

http://care.diabetesjournals.org/content/early/2019/05/03/dc18-2585

https://www.medscape.com/viewarticle/913692

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#enzymes #protect #kidney

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Daily Piece: Rates of New Diabetes Cases Declining

Much work has been put forth by Centers for Disease Control, American Association of Diabetes Educators and American Diabetes Association in diabetes awareness and prevention. It looks as though this hard work has paid off. Recent analysis of data (1980 – 2017) from National Health Interview Survey reveals a decline in new diabetes cases. To learn more about these interesting findings, please click below.

https://www.medscape.com/viewarticle/913686

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#declining #new #diabetes #cases

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