Once again noted as a favorite T1D blog

I never take it for granted that those in the field appreciate what I do. Thank you Diabetes Self-Management for naming this blog among your 21 favorites. And thank you for supporting me by coming here time and again.

I was diagnosed at 18 in 1972, (photo above) pre-glucometer, pre-much of anything. Luckily I can say nearly fifty years later, ‘I’m still kicking.’

Should you like to take a look at the other 20 blogs they singled out this year you can do so here.

Poor glycemic management – first 48 hours in hospital – leads to worse COVID outcomes (Even if you have good blood sugar management at home?)

I have to admit this hadn’t crossed my mind until it crossed my inbox this morning.

“Hi Riva, 

Glytec has just released brand new research published in Diabetes Care, which is the first study of its kind to study the ‘opportunity window’ for treating hospitalized patients with hyperglycemia or diabetes. Findings included:

  • A higher risk of mortality for patients that did not achieve target blood glucose levels soon after being admitted to the hospital.
  • 7x mortality risk for non-ICU patients with severe hyperglycemia after 48 to 72 hours, indicating the need to start treatment of hyperglycemia on admission.

Glytec is offering a webinar Tuesday, February 2nd at 1 PM EDT with those who co-authored the research if you want to learn more. You can register here.

Yes, I did know that people with diabetes who have poor blood sugar management are 2-4x more likely to have worse outcomes if they get COVID-19.

Yet, I had thought I would fall into the other camp, the studies that show people with diabetes, who have good blood sugar management, are no more at risk of getting COVID than those who don’t have diabetes.

Like the Jewish holiday, Passover, COVID would just pass over me and chose someone else. It never crossed my mind that should I get COVID, and end up in the hospital, the poor care I might receive there (few hospitalists know how to manage blood sugar) would be my undoing; my good blood sugar management unraveling quickly under another’s uneducated care.

I often remind the husband should I be in the hospital (this was pre-COVID) you must be my advocate. You must make sure they let me manage my blood sugar provided my brain cells are working. Now I realize how important heeding that directive is.

Addendum: I checked in with my diabetologist expert in Israel, Professor Itamar Raz, about this who said this information is not yet evidence-based and is controversial. And I checked in with my diabetes expert in the UK, Professor Philip Home, who says roughly that if you have had good management of your blood sugar for some time, and no major complications, before contracting COVID you would tend to deteriorate less quickly and you will be less at risk for worse outcomes. So let’s all take a breath.

That said, experts advise you have a letter from your doctor with you at all times that states your health condition(s), medications and that if you are able and prefer, you should continue to manage your blood sugar if in the hospital. For a look at my letter click here.

Tip: Hacking a limitation of MDI (multiple daily injections)

…Or I might name this “the kiss.” Above withdrawing insulin from an insulin pen with a syringe.

God bless you if you use an insulin pump and you love it and it works for you. I don’t use a pump, never have. It’s basically because I don’t want to be tethered to something more than my CGM. And while I know the pump would give me what I call more ‘elegant management,’ my natural discipline, CGM and feeling pretty cozy with routine make managing my blood sugar pretty solid.

The pump, however, has the benefit of what I wish I could get from MDI – smaller doses. You can program the pump to stream very small amounts of insulin. Insulin pens, on the other hand, are designed to deliver mostly whole units, with a few in the field that do deliver half units. Still, being fairly insulin sensitive, there are times I want 1/4 unit or 2/3rds of a unit.

My low carb eating and daily exercise, and who knows, maybe just my metabolism mean there are times even 1/2 of a unit is too much. Before bed, if I want to bring down my blood sugar 20 points, I need 1/4 of a unit. A half unit is too much. Or I may need 2/3rds of a unit during the day, a half won’t be enough and a whole will be too much. Now you’re probably thinking I’m obsessive compulsive, which I’m not, or crazy, which no one who knows me would say I am. I merely want the ‘tighter accuracy’ that I would get if I could adjust my insulin doses more finely than in half units. I have long said insulin pens should use a different mechanism so that dosing is on a sliding scale. But it’s not in manufacturers’ interest, and I know that.

So, I do what works for me and may help you. Maybe you’d call it a hack. I withdraw my insulin from an insulin cartridge (it may be in a pen or standing free) using a 30 unit syringe with whole or half unit markings. I eyeball whatever dose I want regardless of the markings. (The photo above shows roughly 2/3rds of a unit in a whole unit 30 unit pen. Sorry it’s a bit blurry). I use the markings as a guide to judge a quarter unit or third of a unit. Trust me, I know eyeballing is not precise, but then what in diabetes is? But it’s a way to get your dose closer to what you may need and I think a lot of people don’t realize they can take any amount of insulin they want and not be restricted by the markings on a syringe.

It does mean that you can’t use the insulin pen as designed. You can’t dial up the dose to 1/4 or 2/3rds and inject. But you can use this method and then for the shots where you do want a whole or half unit unit, you can use the pen as designed. Just remember, you will have to prime a bit more until you see the insulin come out of the pen needle, as you’ve been sucking doses out in between that may leave space in the pen before it releases insulin. Not dangerous, you just need to prime the air out.

Also, note that when you withdraw insulin from a cartridge or vial, you have to look for air bubbles in the syringe and get them out by tapping the side of the syringe and slightly emptying the syringe. Don’t do this in a darkened bathroom, trust me you’ll never find them.

I’ve been using this method for years and it’s one of the prime (yes, pun intended) things that has helped me manage my blood sugar. Give it a shot (yes, pun intended) if like me you find customizing your dose might work for you.

My Christmas Eve letter to Santa

I posted this letter for the first time many years ago, and then a few more times in subsequent years. In truth, given what we endured this year, 2020, there are many more things I’d ask Santa for, but I’m going to keep my request as simple as it always was.

Dear Santa,

All I’d like this Christmas is for you to take this diabetes away. I’m so tired of it already. All these finger sticks and guessing when my blood sugar’s high or low. Now that I’m in menopause I can barely tell if I’m sweating because I’m losing estrogen or my blood sugar’s crashing at 50! And, can we talk…I mean the constant figuring out how many carbs are in a ravioli or bread stick or that fried calamari that will be at the company Christmas party. Some days I just want to lay down and shoot myself. Please, please Santa, would you take this diabetes away?



Dear Riva,

I’m very sorry you’re having a tough time during my favorite season. I only want people to be singing carols and drinking eggnog and feeling good cheer. Unfortunately, it says in my contract, that I’m not allowed to interfere with life’s natural occurrences. So here’s my suggestion, after you open your holiday gifts, look under your Hanukah bush for the gift in having diabetes. You may have to spend a few days looking so why don’t you schedule it for the week between Christmas and New Years while you have some down time? Then you can start the new year fresh.

Best wishes,

Santa and the gang

Dear Santa,

A gift in my diabetes? What are you crazy? Meshuggah? Thanks, but no thanks!


Dear Rabbi,

I seek your wise counsel. I wrote to Santa to take away my diabetes but he wasn’t helpful at all. Surely you who have studied so much and represent our people who have suffered throughout history can help me with this awful diabetes. It’s such a strain, Rabbi. I have to test my blood sugar when I really want to be lighting the sabbath candles. I forgot all about the High Holy days this year because I was so busy counting carbs in the Challah, bagels and honey cake. Rabbi, please, what solace can you offer me? What words of wisdom? Surely you would tell me to just forget about this diabetes thing and study the Torah, right?

Please write soon,


Dear riva,

Santa and I just returned from the Caribbean and he told me about your difficulty. He said he told you you should look for the gift in your diabetes. I concur with Santa, there are many gifts to be found in diabetes if you look. For one, my child, you won’t have to drink the traditional Manishewitz holiday wine anymore. The Counsel all agree it is much too sweet. Bring out the Chardonnay!

When Santa asks you to look for a gift in your diabetes, he is not saying this because you are not Catholic and he is not bringing you anything, although this is true. He is speaking like our brothers the Buddhists, who profess there is a gift in everything if you look for something positive it can bring into your life.

Let me tell you a story my child. My own Aunt Sheila had diabetes and after she stopped kvetching, she went to a spa and learned how to eat healthy. She shopped along Rodeo Drive and bought a cute little jogging outfit and started running. On her jog along the ocean she met her fourth husband, Marvin, and they’re very happy. They just moved into a $6,000,000 mansion in Jupiter, Florida — right next to Burt Reynolds! Everyone’s plotzing! Darling girl, find a gift in your diabetes, because to be honest, since you’re not orthodox, and all I have are these great wigs I got on sale from my cousin Schlomo, I’m not bringing you anything either. And really, it’s not very pleasant to whine.

Shabbat Shalom

Rabbi, Local Union 107

Dear Rabbi,

I thought about what you and Santa said and have decided to become a Buddhist. I picked up the Dalai Lama’s book, The Art of Happiness. He says, “Happiness is a butterfly, which when pursued, is always just beyond your grasp, but which, if you will sit down quietly, may alight upon you.” I told my friend, Joe, I like butterflies and I like the robe, so these aren’t bad gifts. Joe said the quotation meant that we are the source of our happiness, that happiness can only come from inside us regardless of what happens in our lives. Hmmm, I said, maybe I need to learn more. So I booked a flight to Tibet. Now if only I didn’t have to drag all this damn diabetes stuff with me….ohm…ohm…oy. riva

Can’t get a straight answer about alcohol and diabetes? Now you can.

You’ll get it straight from the bottle as Drs Steve Edelman and Jeremy Pettus, both endocrinologists who have type 1 diabetes themselves, conduct an uproarious experiment imbibing three drinks each within 45 minutes, and we’re with them all the way. I loved it, Getting Drunk with Dr. E and Dr. P: How Alcohol Affects Blood Sugars.

The alcohol experiment was part of TCOYD’s one day educational conference for people with diabetes that went virtual last week, including an Exhibition Hall. Solid information and fun. Dynamite experts and respect for the condition we all live with, and its host, us.

There’s tons of information on the TCOYD site and it looks like the next virtual conference is February 27th. Better get your shot glass ready.

Auvon Glucose Meter, simple and within 10% accuracy

A relatively new glucose meter was sent to me to try out and let you know what I think, and I’m being paid a small fee to do so. I tell you that in full disclosure: I did not seek out the meter nor pay for it or the 50 strips it came with. The company is Auvon, a Chinese manufacturer of various medical devices like TENS muscle stimulators and tech-household goods, in addition to this glucometer.

Since I use the Dexcom G6 CGM, I don’t use a meter very much anymore. That said, I do use it whenever I think my CGM might be off, or when I take a few days off from my CGM in between sensor sessions.

Although the wording on the box, “Blood Glucose Monitoring System” is a bit of a hype, as it’s just a glucose meter with the usual paraphernalia, Auvon does have reason to hype something – the highest accuracy among meters – 10%; most meters come in at within 15% of laboratory tests.

This released from the company – Auvon exceeds International standards functioning within ±10%, or ±10 mg/dl of laboratory values over 95% of the time. This is beyond the ISO passing standard  of within ±15% or ±15 mg/dl. The manufacturer is certified with CE mark, GMP, ISO 13485:2016, and ISO 15197:2013 without having any recall on the market in the past 14 years.

Of course there’s no way for me to test its accuracy. I can only say it always did seem accurate for what I’d expect, and when I checked it against the meter I own, it was always within 10 points. I’m not setting up my own meter as the better point of accuracy, only as another data system. Right off the bat I like the assurance that greater accuracy gives me.

Then there’s the advantage of simple for those of us who, tired of messing around with our devices, crave simple. Like (almost) all meters today, this meter needs no coding, it turns on when you insert the strip and off when you take it out, it takes a small drop of blood (0.7 ul) and 6 seconds to give you your result. It comes with an inexpensive ordinary lancing device and lancets, (I don’t remember if meters include lancing devices anymore) a little paper diary to record your blood sugar numbers, and of course an instruction booklet for the meter. How nice it’s only 35 2”x4” pages instead of the encyclopedia most manufacturers enclose. 

The Avon glucometer does what I basically want my meter to do: tells me my blood sugar, stores my recent blood sugar values, and gives me a 7, 14 and 30 day average. Mind you, there’s only one function button on the meter. You have to cycle through to reach whatever you’re looking for. Still, pretty easy. I feel Auvon may have kept the cost down on functionality and materials in order to invest in the strip technology that provides the greater accuracy. That may also be why this meter does not come with a hard case, but satiny-like little carry bag.

The last thing I really like about this meter is the really quick, almost magnetic feeling of how speedily the strip pulls up the drop of blood. I don’t know if there’s special technology that causes that, I imagine there is. Also the channel for the blood to enter the strip is wider than it is long so I’m thinking this may also enhance the quick blood suck. Forgive my draconian language 😉

If you want a meter with bells and whistles, and one you can charge, Auvon is definitely not it. You cannot charge this meter. Instead, you get a pre-packed disc shaped (3-volt lithium) battery that we all remember meters once used. But it you want a small, quite light, easy to fit in your hand, more accurate and simple meter, I think you’ll be pleased.

The Auvon includes 50 test strips and costs about $20 on Amazon. Additional strips cost about $.15/strip.

3 weeks to take advantage of learning, fun and expert advice

Christel Oerum, who wrote a guest post here recently, and hosts Diabetes Strong is offering a free 3-week ‘Fit With Diabetes Challenge’ in January 2021 with lots of experts in the field – and everyone is welcome to join.

Fitness guru, Christel, along with her team of experts (featured above) will share the most important things you need to know to live a healthy life with any type of diabetes. And it will be fun.

Not only is it free to participate, but there will be weekly prizes! You’ll get daily challenge emails, a lot of interaction in the closed Diabetes Strong Facebook groups, free workouts from Glucosezone, and live webinars like, “Ask a Diabetes Educator Anything” with Gary Scheiner, “How to Work Through Diabetes Burnout” with Bill Polonsky and “Healthy Eating for The New Year” with Toby Smithson.

What’s not to like or take advantage of here? Register and learn more here.

Big news: A new test to see if you’re at risk for type 1 diabetes

Just got this news from the JDRF. It’s an enormous benefit in families that already have a member with type 1 diabetes (T1D). And maybe even more so in families that have no member with T1D, like I was. 85% of T1D diagnoses happen to people with no family connection to the disease.

You can order a test here. It’s a simple blood test that screens for whether you have type 1 diabetes autoantibodies. If you have them, it means you are at a very early stage of T1D and likely to develop the full-blown condition and become insulin dependent over several years.

JDRF says having this early information can help families/adults plan and prepare before symptoms occur. This can help avoid life-threatening conditions like ketoacidosis and possible hospitalization. Also, it’s a run in the ladder of JDRF-funded research pursuing therapies that can intervene and disrupt the disease’s progression before insulin dependency begins.

The test is available to anyone of any age. Check the steps to get the test to your home. There is a fee and you will need to provide payment.

One thing to note: tests are not currently available to those who live in New York, Pennsylvania and Maryland. JDRF is working to make these available as quickly as possible. You can check the website for availability or email info@jdrf.org

How to make your visit with your HCP more successful

Well, I’d say I’m a triple threat, but there’s only two videos…

As we end Diabetes Month, I’m proud to share my impending splash onto a small screen somewhere near you. These videos will be playing in doctor’s waiting rooms to offer people with diabetes inspiration and education.

Mid way through the pandemic I had a friend drive me to New Jersey where these were shot. Temperature taken, everyone in masks and face shields, I was make-upped and entered the studio. My five person crew were amazing and it was a lot of fun. Most of all, I believe they are five minutes of worthy service. The company that produced them, PatientPoint, offers other patient videos on varying conditions here.

The video above shares a bit of “my story.” The one below offers you four tips to make your doctor’s visit even more useful. As we with diabetes know, diabetes month or not, diabetes is an everyday affair. Wishing you well today and every day.