“Dear diabetes,” what I, and others, would say to our diabetes now


Screen Shot 2020-03-28 at 8.13.40 AM.pngHedia, a Danish diabetes app company, is featuring what people (including me) living with diabetes would write to their diabetes in a short letter, now having some wisdom looking back over the years. Interesting reading, A Collecton of Letters to Diabetes.

Not only will you gain some hard-won wisdom reading them, but if you should do the same, write a letter to your diabetes, and what better time than during this pandemic to look back at a situation that’s likely improved, it can be a very healing experience.

Today’s headlines on diabetes and the coronavirus

I received this information from the Diabetes Education & Camping Association. Here are the headlines. You can google the details:

Insulet, maker of Omnipod, does not anticipate any product supply issues and will continue to deliver Pods to those who use them without delays.

Eli Lilly, maker of Humalog and other diabetes medications, does not anticipate shortages for any of its medicines, including all its insulins.

Lilly and AbCellera to co-develop antibody therapies for Covid-19 treatment

Lilly will participate in making insulins more affordable for Medicare members under Medicare Part D

Tandem Diabetes Care, maker of T-slim insulin pumps, does not anticipate any shortage of infusion sets, cartridges or other supplies

Xeris pharmaceuticals is offering a $0 copay card through the end of April for Gvoke PFStheir glucagon product

Preventive Measures During CoronaVirus 19

Unknown.png  Things to do to safeguard yourself

First I’m going to tell you I can’t authentic the information I’m going to give you here. A good friend sent me an audio based on research the Chinese have so far on the virus. They now have a better handle on how the virus behaves.

Below are 11 steps they advise we take to keep our airways open and to help prevent getting the virus. The virus obstructs respiratory airways, so to have medicine work one needs to keep their airways open.

Our fright is like a runaway train. Most people who get the virus will get a mild case and be fine. The problem is with so many people getting the virus, those who get a severe case and need hospital care will not be able to enter the hospital. There will be no beds or health care providers available. This is already the situation in New York City, my home. So do your best to avoid needing to be in the hospital.

Here are recommendations to safeguard yourself and loved ones:

  1. Wash hands for 20 seconds. Wash hands every time you come in from outside.
  1. Drink lots of hot liquids, ie, tea, coffee, soups, warm water. Reason below.
  1. Take a sip of warm water often throughout the day, even every half hour. Warm and hot liquids send any virus germs that may be in your mouth into your stomach where your gastric juices neutralize the germs before they can get to your lungs.
  1. Gargle with vinegar, lemon or salt in hot water every day
  1. The virus attaches itself to hair and clothing. Soap and detergent kills it. When you come in from the street, take a bath/shower. Don’t sit down when you come inside, go straight to the shower.
  1. If you’ve been in a crowded place (which you shouldn’t be!) wash your clothes when you get inside or hang them in direct sunlight which neutralizes the virus.
  1. Wash metalic surfaces. The virus stays active on metallic surfaces for 9 days
  2. Be vigilant about touching handrails, doorknobs etc. Wipe them down regularly in your own home.
  1. Eat fruits and vegetables. Consider taking vitamin C and zinc to strengthen your immune system.
  1. Avoid eating/drinking cold things. Again, warm liquids and foods will move the virus away from the lungs, cold will not.
  1. The virus typically enters through your throat. Be cautious if you feel a sore throat coming on. 

These times with the coronavirus


My neighborhood is a ghost town. Who could have imagined three weeks ago New York City is shutting down?

I imagine like me you’ve read a ton of articles about the coronavirus. Some say having diabetes puts you at greater risk, others say if your blood sugar is well managed and you don’t have comorbidities like heart disease and high blood pressure you’re at no more risk than anyone else. Who knows? But I thought I’d pass on an article from diaTribe for general diabetes coronavirus info.

Below is an email I received from Nurse Specialist/CDE Carolyn Robertson: 

What are the facts?
Diabetes is a chronic disease, If you have Type 1 diabetes, it was caused when the immune system mistook the beta cells as a foreign invader.  That response ramped up your the system and it destroyed what it perceived as a threat.   Having diabetes does not mean you are immunocompromised.   It means you are hormone deficient. 
Are you more at risk ? 
Per se, you are not inherently more vulnerable to the virus. However, that statement assumes that your glucose control is mostly good and you do not have other medical problems.  The diabetes makes you more vulnerable when your blood sugars are increased or if your blood sugars are fluctuating with wide swings.   Values over 180mg are associated with a change in the body’s ability to  identify infection and it’s ability to fight infection. The higher the blood sugars the more the system is affected.   It is vitally important that you aim to manage the diabetes so that you get 70% of your daily values below 180mg.  Achieving that level of success would be awesome and it will reduce your risks.   
What should you do?  
Try to maximize the effectiveness of your insulin. 
  •  Bolus for all carbs and bolus  before eating.  If you take rapid insulin ( humalog, novolog, aphidra), give it time to work before you start eating. 
  • Rapid acting insulin takes 15 min to start to work. So by delaying a meal or snack by 15min, it means that when you start the meal, the insulin will be also starting 
Consider verifying that carbohydrate counting skills are good.  
  • Use an app like Calorie King to look up the carb value of the items you eat. 
  • Weigh  and measure your carbohydrate portions for a few days. .  
Consider using activity to help the insulin be more effective.  The gyms might be closed but you can still walk. 
  •  Walking, while it doesn’t burn as many calories, has a profound effect in mobilizing glucose.  Some people have found that walking drops the blood sugar levels more than a workout.    
Use your support system.  Don’t isolate yourself.  Skype,  Face Time and  phone calls can keep you connected even while you social  distance. 
Consider using telemedicine to get help with your diabetes management.  Many centers are making this an option – including UCLA and Mt Sinai.  I have been doing Telemedicine with many of you for years and I plan to continue to offer this as an option to all my patients.  I am still available to you.   If you want to schedule a visit,  let me know.   We can do a phone/Skype call. I am in AZ so my time zone is the same as California  and 3  hrs earlier than NY. 
This is a unique and unprecedented challenge for our country, but with our resilience, innovation, resolve, and unity, we will prevail.  
With warm regards

In my reading, this article covers a topic few have: how to maintain a low carb diet if vegetables become scarce. While others are loading up on pasta and rice following low carb these aren’t very desirable options. But, if we will need to eat more of these foods, here’s are two tips: 1) basmati rice has the lowest carb count of any rice. 2) If you cook any rice in twice as much water, for instance eight cups of water rather than four for one cup of rice, more starch will exit the rice and go into the water, therefore there’ll be less carbs in your rice.  Worth a try.

As to life going on, it’s a most bizarre time. I take a walk in my neighborhood every day just to move, do my qigong every morning, am baking a lot of low carb goodies like Keto rolls and chia seed almond scones – you can find a ton of recipes online – and googling how to freeze fish and chicken now that I have supplies for two weeks.

I have a number of books on my kindle, many about North Korea, a personal fascination, and I’ve just started watching The Valhalla Murders on Netflix. Not great, but anything that takes me to another country right now is welcome. A few Netflix and Amazon Prime programs that I do recommend:


The Crown, Shtisel, Bordertown, Trapped, Breaking Bad, Fauda, The Cakemaker

Amazon Prime:

Scott & Bailey, Silent Witness, Fleabag, Criminal, The Baker and the Beauty

Stay safe, wash your hands and keep breathing. Or as the Brits probably are already making a new T-shirt, “Keep calm and carry hand sanitizer.”

Dexcom and I, it’s a love/hate relationship

I see this warning below and I already feel a loss, my special friend is leaving me. I know that until I put on a new sensor (I use the G6) I’ll miss you terribly, wonder what my blood sugar is several times an hour and be frustrated beyond description that I don’t know. Yes, I love you Dexcom.

Then again, often, when your little arrow is inclined or declined I make a premature decision not to my benefit. I take more insulin or eat something to stop the rise or cushion the fall. Yet five minutes later you laugh at me, hurling a straight line at me saying, “only kidding.” How many times will it take me to learn to check the last three black dots and judge the momentum, fast or slow, as Stephen Ponder of Sugar Surfing told me to do. It’s good advice.

So, until we get on the dance floor again, yes, I need a day or two just to chill – so nothing gets in my way while putting on my shirt or heaving my knapsack over my shoulder – I’ll brave the uncertain. Hating it and loving the freedom.


What does the coronavirus mean if you have diabetes?

Screen Shot 2020-03-09 at 12.51.03 PM.png

Good article from Joslin Diabetes Center including what to do if you’re feeling sick, organizational resources and what to put together as a diabetes kit, including things like make, model and serial number of your insulin pump or CGM, doctor’s name, phone number and address and more. Worth reading.

This article was just put out by the International Diabetes Federation and it’s a good summation. In truth, there really isn’t a lot you can do other than :

  1. Do your best to have your blood sugar in range
  2. Have extra medicine on hand should there be a shortage

As for the general recommendations:

1 Wash your hands for at least 20 seconds frequently and especially after you’ve been outside and before cooking

2. Stay away from crowded places

3. Know the basic symptoms of the virus – typical flu-like symptoms: a fever, cough, breathing difficulties, tiredness and muscle aches.

4. Don’t panic



Awards summit for people with type 1 diabetes


Okay, I tricked you – just a little. You’re not getting an award. Actually no one is getting an award. Yet, those who’ve already received a Joslin medal for living 50 plus years with type 1 diabetes (T1D) will have the secrets of their success revealed.

For the first time on the West Coast, the research findings from Joslin’s 50-year Medalist Study will be reported on by Dr. George King, Dr. Sanjoy Dutta, VP of Research at JDRF and others. King is the Principal Investigator of the Study,

The conference logistics: April 19, 9 AM-4 PM at the LAX Marriott Hotel. The conference is free, includes lunch, and is funded by JDRF under an Impact Grant and NIH.

Chris Stiehl who put this together with Dr. King has had T1D himself since he was 10 years old, diagnosed in 1960. He was moved to do this because he said and I agree, “The research on the Joslin 50-year Medalists is rarely reported and even less well understood.”

The conference is open to anyone interested in the long term effects of type 1 diabetes – people with diabetes, loved ones, health practitioners…

If my math is correct, Stiehl has lived with T1D nearly 60 years. I just passed my 48 year mark. Only two years away from my medal!

Thank you Chris. For more information and to register please click here.