Thursday’s Daily Piece: Finding Sunlight During COVID-19 Pandemic

We are living in unprecedented times globally. It is challenging to face fear head on each day. I have found rays of sunshine in this darkness through the following practices (and yes some days I do better than other days).

  1. Journalling specifically writing 3 things for which I am grateful each day.
  2. Calling or connecting virtually with a friend or family member at least 4 times weekly.
  3. Taking a walk outside to see the flowers and listen to the birds.
  4. Stay connected to my faith community virtually and prayer

Do these practices take away the reality of the challenges? No, they simply give a different perspective. I highly recommend a book on anxiety, Anxious for Nothing, by Max Lucado. Remember, the problem is how we think about our problem. Ponder on this one as I have been for the last few days. Don’t forget to make your daily gratitude list. Sending a virtual hug to each of you.

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#sunlight #COVID-19

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Wednesday’s Daily Piece: Novo Nordisk Offering Insulin Assistance Program in Light of COVID-19

Good news to share! Novo Nordisk has joined Lilly in offering program assisting with cost of insulin in light of COVID-19. Novo Nordisk’s program offers 90 day supply of insulin at no charge to those who lost health coverage due to change in job status due to COVID-19. While I know that this is not a long term solution, it is a short term help for those who have lost health insurance. This program is much needed in these challenging times. To get all of the details, please go to NovoCare.com or call 1-844-668-6463. found on NovoCare.com or by calling 1.844.NOVO4ME (668.6463). Please share this information with all persons with diabetes on insulin therapy.

Novo Nordisk (@novonordisk) | Twitter
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#insulin #program #COVID-19

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April Blog: Kidney Diabetes Connection

While we navigate the challenging and unprecedented times of life with COVID-19, it is vital that we not allow this pandemic to distract people with diabetes from managing critical health concerns.

Did you know that high blood glucose and blood pressure can create the perfect storm for developing chronic kidney disease? Chronic kidney disease is commonly caused by high blood glucose and high blood pressure over a long period of time. The pressure from the high blood glucose and blood pressure damages the blood vessels within the kidney leading to waste builds up in the body.  Remember, the blood vessels within the kidney clean our blood.  

NT, a 72-year-old male, has been living with diabetes for 25 years.  Recently, he was surprised when he found out he had chronic kidney disease due to his diabetes (diabetic nephropathy) and hypertension.   He realized early on he had been in denial he had diabetes. However, he had been so proactive over the last several years with self-managing his diabetes; He simply could not believe he had chronic kidney disease. 

Type 2 Diabetes | NIDDK

So what markers will the primary care provider access to screen for chronic kidney disease?

1- urinary albumin (measured by urine albumin (mg/dL) to urine creatinine ratio (g/dL) = UACR).

a. Albuminuria is present when UACR is greater than 30 mg/g

2- estimated glomerular filtration rate (eGFR) (goal > 60 mL/min/1.73 m2)

For persons with chronic kidney disease, referral to nephrologist (physician specializing in kidneys) is made when eGFR < 30 mL/mini/1.73 m2)

These markers are assessed at least once a year for all persons with type 2 diabetes and persons with type 1 diabetes for a duration of five years or longer. A person may have chronic kidney disease if UACR is > 30 mg/g and/or eGFR < 60 mL/min/1.73 m2).

Kidney Disease | NIDDK

Who are the health care team members that can help you prevent kidney disease?  Primary care provider, endocrinologist, and diabetes care and education specialist (CDCES) (formerly known as diabetes educators: nurse, registered dietitian nutritionist (RDN), pharmacist, behavioral health specialist).

What prevention steps can be taken? Remember, the major contributors to diabetes related chronic kidney disease is high blood glucose and high blood pressure.   The following are recommended goals and medications for each contributor.  It is worth noting referring to an RDN CDCES is critical for comprehensive nutritional guidance.

  • Managing blood pressure to reduce risk or slow progression of chronic kidney disease
    • Overall target range for blood pressure in person with diabetes: <140/90
    • Lifestyle: what practical steps can be taken from a nutrition standpoint to assist in keeping blood pressure healthy
      • Dietary Approach to Stop Hypertension (DASH) diet
        • Eating plan rich in fruits and vegetables, low fat and nonfat diary, whole grains, along with nuts, beans and seeds
        • Cut back on foods high in saturated fat, such as fatty meats, full fat dairy foods and tropical oils as well as sugar-sweetened beverages and sweets
        • Limiting sodium to less than 2,300 mg per day or 1,500 mg per day
  • Medications for lowering blood pressure with focus on classes shown to be of benefit with chronic kidney disease.  For a person with diabetes who has a blood pressure < 140/90, and UACR and estimated glomerular filtration rate within normal range, it is not recommended to initiate an ACE-inhibitor or ARB for primary prevention of chronic kidney disease. Also, ACE inhibitor and ARB medications continue to be safe in light of the current pandemic with COVID-19.  Your healthcare professional will periodically monitor your serum potassium and creatinine while taking ACE-inhibitor or ARB.
    • Angiotensin Converting Enzyme Inhibitor (ACE-inhibitor):
      • Lisinopril (Zestril) or enalapril (Vasotec)
    • Angiotensin Receptor Blocker (ARB):
      • Valsartan (Diovan) or losartan (Cozaar)
  • Managing blood glucose to reduce risk or slow progression of chronic kidney disease
    • Overall glucose targets: hemoglobin A1c <7%, fasting and prior to meals 80 – 130 mg/dL, 2 hours after eating < 180 mg/dL (these target values/ranges should be individualized for each person with diabetes)
    • Lifestyle: what practical steps can be taken from a nutrition standpoint
      • Carbohydrate counting
        • Working with a CDCES to learn how to count carbohydrates
        • Typically recommend 30 – 45 grams of carbohydrates per meal, and 15 grams of carbohydrates per snack
      • Healthy Eating Behaviors
        • Learning portion management
        • Plate Method: ½ plate nonstarchy veggies, ¼ plate protein, ¼ plate of starch (carbohydrate), diary product (i.e. milk or yogurt) and fruit
      • Mediterranean diet
        • High in vegetables, fruits, whole grains, beans, nuts, seeds, and olive oil
        • Plant based, not meat based
        • Main components:
          • Daily intake of vegetables, fruits, whole grains and healthy fats
          • Weekly intake of fish, poultry, beans and eggs
          • Moderate portions of dairy products
          • Limited intake of red met
  • Medications
    • Glucagon -like peptide receptor agonist (GLP-1 agonist) drug class
      • In persons with diabetes and chronic kidney disease who have increased risk of cardiovascular (heart) event, GLP-1 agonist may reduce risk of progression of albuminuria, cardiovascular events or both
        • Liraglutide (Victoza)
        • Semaglutide (Ozempic)
    • Sodium-glucose cotransporter 2 inhibitor (SGLT-2 inhibitor) drug class can decrease progression of chronic kidney disease
      • Useful if estimated glomerular filtration rate is >/= 30 mL/min/1.73 m2 and urinary albumin > 30 mg/g creatinine particularly if urinary albumin > 300 mg/g creatinine
      • Specific medications include empagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin (Invokana)

Along with healthy eating and medications, moving your body each day is key for staying healthy.  The 2020 ADA Standards of Care Guidelines recommends at least 150 minutes a week, that’s less than 22 minutes each day, of moderate-intensity physical activity such as brisk walking. This will not only help you manage your weight and lower your stress, but also help lower your blood glucose and blood pressure, which will essentially help reduce your risk for chronic kidney disease and many other potential complications.

Racial and ethnic minority communities hit hard by type 2 diabetes ...

Back to NT, after sharing with his physician, and CDCES his concerns and fears, he felt less guilt and hopelessness.  His diabetes treatment plan was adjusted to add Jardiance 10 mg once daily. He felt empowered and motivated to continue proactively self-managing his diabetes, hypertension and chronic kidney disease.

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#diabetes #kidney #connection

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Tuesday’s Daily Piece: New! $35 Monthly Insulin Copay through Lilly Value Insulin Program

Exciting news to share!!! Lilly is now offering $35 monthly copay for insulin through the Lilly Value Insulin Program. This is available for those with commercial insurance and those who do not insurance. Call Lilly Diabetes Solution Center today at 833-808-1234 to obtain this big savings.

https://investor.lilly.com/news-releases/news-release-details/new-35-co-pay-now-available-through-lilly-insulin-value-program

Eli Lilly and Company - Wikipedia
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#savings #insulin #diabetes #Lilly

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Saturday’s Daily Piece: Removal of OTC Ranitidine (OTC Zantac) from Market: Why and Alternatives

Well, I have am going away from diabetes on this daily piece. Over the counter (OTC) medications are medications available for purchase without a prescription. OTC ranitidine ( OTC Zantac) has now been discontinued due to impurity of N-Nitrosodimethylamine (NMDA; increases person’s risk of developing cancer) found in some of the products. NMDA within some of the OTC ranitidine increases over time and at temperatures above room temperature. We do not know who long or how these products are stored so discontinuation of OTC ranitidine (OTC Zantac) is best. OTC alternatives for ranitidine within the same drug class (histamine 2 receptor antagonists) are famotidine (Pepcid) and cimetidine (Tagamet). I do advise caution with cimetidine (Tagament) as it interacts with many medications.

FDA Requests Removal of All Ranitidine Products (Zantac) from the ...
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#ranitidine #discontinued #FDA

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Tuesday’s Daily Piece: COVID-19 Resources for Persons with Diabetes, and Keeping Connected

We are living in unprecedented days with a real need for resources and vital information. American Diabetes Association and diaTribe have compiled COVID-19 resources for persons with diabetes. Links are provided below.

https://diatribe.org/covid-19

https://www.diabetes.org/coronavirus-covid-19

On a different note, while physically distancing ourselves from friends and family (who do not live in same household) is necessary, we do not have to technically socially distance ourselves because we have lots of virtual resources such as FaceTime, Skype, Google Hangout and Zoom to stay connected. So reach out to a friend or family member by calling or virtually connecting with them today.

Stay Connected to Friends and Family by Hosting a Virtual Happy Hour
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#COVID-19 #resources #diabetes #stay #connected

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Thursday’s Daily Piece: New Regulatory Pathway for Insulin

While cost of insulin continues to be a challenge, a light of hope is on the horizon. Back in 2009, Congress passed the Biologics Price Competition and Innovation Act which creates a new regulatory pathway of approval for biologics such as insulin. Now it took 10 years of preparation to make sure all stakeholders were prepared. The new pathway is NOW open which will allow for safe and effective biosimilar and interchangable versions of biologics such as insulin. Ultimate this creates opportunity to reduce costs. This is certainly a step in the right direction. To learn more, please click below.

https://www.healio.com/endocrinology/diabetes/news/online/%7B808d5c1e-0e1c-432f-8836-48b2e10250a3%7D/fda-transitions-insulin-to-new-regulatory-pathway-opening-door-for-more-biosimilars?M_BT=4557970002905

Insulin Gains New Pathway to Increased Competition | FDA
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#FDA #insulin #pathway

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Friday’s Daily Piece: Stopping SGLT-2 Inhibitors Prior to Surgery

FDA released a new labelling update this week to SGLT-2 inhibitor drug class. Due to the risk of potential ketoacidosis, SGLT-2 inhibitors should be discontinued prior to surgery and reinitiated after surgery once person is able to eat. Specifically, canagliflozin, dapagliflozin and empagliflozin should be discontinued 3 days prior to surgery, and ertugliflozin at least 4 days prior to surgery. For more information, please click below.

https://www.medscape.com/viewarticle/927047?nlid=134562_3901&src=wnl_newsalrt_200319_MSCPEDIT&uac=293412PG&impID=2316419&faf=1

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#SGLT-2 inhibitors #discontinuation #surgery

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Wednesday’s Daily Piece: Expert, Dr. Anne Peters, Provides Insight for Persons with Diabetes Regarding COVID-19

I can only imagine how frustrating it must be for a person with diabetes to keep hearing that you are high risk group when it comes to protecting again COVID-19. The reality is that COVID-19 is more real now than ever. I do courage you to stay connected with friends and family via phone calls, social media and FaceTime. Below is guidance from Dr. Anne Peters (a rockstar physician who has a passion for caring for persons with diabetes). Praying for our nation and each person as we face this crisis.

https://www.medscape.com/viewarticle/926418?utm_source=diaTribe&utm_campaign=3b4eed3c6d-EMAIL_CAMPAIGN_2020_03_12_09_51&utm_medium=email&utm_term=0_22467a8528-3b4eed3c6d-152660205

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#prepare #COVID-19 #diabetes

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Tuesday’s Daily: Coronavirus Preparation for Persons with Diabetes

If you are like me, you feel bombarded by news regarding coronavirus. So as a person with diabetes, what are some practical prevention tips? Wash your hands frequently for at least 20 seconds with soap and water or alcohol-based hand sanitizer, and avoid contact with people who sick. Kelly Close with diaTribe has created a wonderful tool kit of information on coronavirus. Please click below to check out this timely, helpful information.

https://diatribe.org/coronavirus-preparation-strategies-people-diabetes?utm_source=diaTribe&utm_campaign=ae505baf02-EMAIL_CAMPAIGN_2020_03_09_07_12&utm_medium=email&utm_term=0_22467a8528-ae505baf02-152660205

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#coronavirus #preparation #diabetes

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