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.

Here’s to a turkey-less, people-less Thanksgiving

It’s not surprising that a lot of families this year will be separated, or that you might be having Thanksgiving just with your immediate household. Here it’s just me and the husband. And, since I’ve never used my 12 year old oven for more than storing pots and pans (typical Seinfeld), it’s also a turkey-less Thanksgiving. But we’re still thankful.

Especially because I’m making one of the husband’s favorites, my low carb almond flour crust pizza (pictured above) Last time I discussed this dish, with my cousin, she emphatically told me I wasn’t making pizza at all! “Where’s the cheese?” she yelled. “Where’s the sauce?” she laughed. You call that pizza!

I will give her the point, maybe it’s not pizza, but it is round and I do cut it in 8 triangular slices – and that’s enough for me. Use the recipe linked above and add whatever topping you like. I dice whatever vegetables I have in the house like broccoli, Brussel sprouts, cauliflower, kale, mix with olive oil, red pepper and a little salt and pile on top for the second cooking. Sometimes I’ll also make a pesto to throw on top and avocado slices.

For those, however, who are going traditional today, this seemed carb chart is a great service from Beyond Type 1. Enjoy, count your blessings and be thankful for whatever you do have, no matter what your poison.

Travel during COVID, what to know

David Kindness, a fellow type 1, reached out to me wanting to share his joy of travel and tips about traveling during COVID with you. Here is his guest post for which I am greatly appreciative. I, a once veteran world traveler, have not left town since COVID began in my building way back in March.

Note: Since we are currently experiencing an off the charts rise in COVID infections, please take all the requisite steps to be safe, and pick your travel window wisely. As much as we want to see friends and family for the holidays, you are advised by the experts that holiday travel may increase your risk of contracting COVID.

David Kindness above

From David:

“Do what you’ll wish you’d done.” Whether you’re a person with diabetes (PWD) or not, you only have one life, and living it in fear is never a good answer. I’m a 27 year old medical lifestyle, product and adventure photographer with 18 countries and more than 30 US states under my travel belt.

I’ve cultivated hobbies like photography, rock climbing, trail running, hiking/backpacking, graphic design, travelling, and longboarding, among others. I’ve also had type 1 diabetes and celiac disease for more than 12 years now.

When I think about living a life free from fear, I imagine sitting down with my future self and asking him what he wishes he’d done. Then I do my best to figure out how to make that happen. While the prevalence of COVID-19 has heavily impacted both people’s ability and desire to travel, I’ve found that it’s still possible to see the world safely – albeit with a few more hurdles than in the past.

From day one, getting diagnosed with diabetes felt like a ball and chain had been attached to my ankle. How could I have time for hobbies when I constantly needed to focus on managing blood sugars? How can one leave the stability of one’s home and experience the uncertainty of travel and adventure with diabetes? How can you integrate blood sugar management into the activities you love?

With 2020 being racked with COVID and socio-political uncertainties, answering those questions has become even more difficult. But travel is not only possible with diabetes in the year of COVID, it can also be filled with joy and fun.

While pursuing the life you dream of may involve leaving the comfort of the life you already know, I can say first hand that it’s worth it and that it’s possible to manage blood sugars and stay healthy on the move… even with COVID. For me, travelling at any time with diabetes means checking blood sugars a little more often and finding creative ways to keep carbs on hand and insulin at the right temperature. It means micromanaging my blood sugars more than usual and being thoughtful about what I’m eating and when. It means planning for time zone changes, different languages, and different food types. It takes a little research and some critical thinking. But that’s about it, and in return, it’s possible to travel and experience the world freely with diabetes.

In the year of COVID, one of the most important aspects of travelling is taking a PCR test (the one where they tickle your brain with a giant Q-Tip) to make sure you’re negative for COVID before flying. Testing sites are popping up all over the country to provide rapid PCR tests to those looking to get on planes destined for locations either domestic or abroad – just google “PCR COVID testing sites near me” to find the locations closest to you. The results will be delivered through either an online portal or through the mail, and they should arrive anywhere from one to three days after you are tested. Once you get a negative result – meaning you don’t have COVID – bring a digital or printed copy (or both) to the airport to prove you’re safe to travel.

In addition to testing negative, travelling with COVID also means wearing masks in airports, on planes, and in taxis – improving safety and reducing the chances of airborne transmission of the virus. I recently traveled to Aruba, a tiny island country located nine miles off the coast of Venezuela. While people were required to social distance in the airport, all the seats on the both Delta and American Airlines flights were full, but everyone was required to wear a mask during the entire duration of the flight. Both airlines attested to having very low or no infections caused by close proximity on planes, and knowing that everyone on the flights tested negative and were required to wear masks was comforting.

When I and my travelling companion arrived in Aruba and deplaned, we happily presented our negative test results to Aruba’s airport authorities. They checked our temperatures and we were on our way. All in all, the process was quick and smooth. Including going through customs, we were out of the airport 30 minutes after deplaning. We were also happy to see that people in Aruba typically wore masks during any kind of gathering –restaurants, shopping, and tours included. In terms of COVID the island felt safe and low-risk.

With all the fear about COVID, I actually found a unique comfort in travel. When you walk into an airport or get on a plane, everyone around you has had to test negative for COVID to be there, including you. When travelling to Aruba during COVID, the planes felt safer than my local grocery store because I knew everyone around me had tested negative and was wearing a face mask for the entire flight. The result was a strange sort of comfort in a very weird pandemic-riddled year 2020.

So what’s the point of all this? Well, the point is that for all the cautionary tales newly-diagnosed PWDs hear from loved ones, all the fears and worries we subconsciously cultivate for ourselves, and the wrench that COVID has thrown into the gears of our lives, our most incredible lives are still out there waiting for us.

If you plan on travelling soon, plan a little more, take an extra COVID PCR test or two, and stay smart and safe. The lives and adventures we dream of are still out there. So do your dreaming, do your research, prepare well, enjoy – and don’t forget your facemask. Do what you’ll wish you’d done.”

David’s website:

David’s Instagram:

From David’s medical photography portfolio, taken in Aruba September 2020

Omnipod tubeless insulin pump offers free 30 day trial

I want to share this information I read on diaTribe. Click here for fuller article.

Basically, Omnipod is available for a free 30 day trial if you want to give this tubeless, disposable insulin pump a try. You’ll get a script which you can take to the pharmacy for your free pump.

Note: You are not eligible for the free 30-day trial if you have Medicare, Medicaid, or other federal health insurance, if you are a member of Kaiser Permanente or United Health Care, or if you are already an Omnipod customer.

Click here to get to the Omnipod website to request your free 30-day trial.

Happy World Diabetes Day!

COVID levels are rising so me and the husband decided this may be the time to make our last outing. Not that we’ve had many at all for the last eight months, ever since we went into lockdown in March, when someone in our building was diagnosed with COVID.

We took the ferry for the first time from Manhattan to New Jersey where we met a friend and did some shopping in the Japanese stores there (large Asian community) and had our last dinner out for I’m sure months to come. Of course we were masked all along the way.

The Empire State building is lit up blue today and we are appropriately pinned with the universal symbol for diabetes. Happy Diabetes Day – and stay safe.

Hypoglycemia from the lived experience

I am currently consulting with Forefront Collaborative, a medical education and accrediting company, helping to educate health professionals about hypoglycemia. Below shares one of my experiences of a severe hypo and further thoughts regarding this serious side effect of using insulin and any blood glucose lowering medication.

Q: Riva, can you please describe a time you had severe hypoglycemia? What happened and what did it feel like?

A: It was 10:00PM, and I was weaving on the boardwalk of the beach community where I was staying with a friend. “Are you okay? Are you okay?” Susan, an acquaintance who was walking with me, kept asking. I couldn’t respond. My brain wasn’t working. Like a firefly, it was flitting on, off, on, off, refusing to hold its light. 

I’d been leading us back from a fireworks display to our mutual friend Carol’s house. We’d been walking for 25 minutes, and I knew we were practically there. Yet, even after having done this walk three times earlier that day, nothing looked familiar. I was staring at Google Maps on my phone—and all I saw were zig zags. I had enough mindshare to register that Susan was frightened but not enough to explain anything. Then I heard Carol’s voice; we’d been only 100 feet from her house! 

Susan said, “She’s drunk.” Carol said, “No, it’s her blood sugar.” I bounced my way into the house and weaved down the hall to get my glucose meter. “32,” I whispered, pushing Carol’s cookie away, while I began chewing glucose tablets. With all the energy I could muster, I breathed, “the cookie…take too long.” 

As you’ve surmised, I came through this episode and all it took was my glucose meter, four test strips, my meter’s coaching service call, three glucose tablets, a slice of rhubarb pie with ice cream, half a banana, and the warmth and safety of the five people in the house keeping an eye on me for the next 90 minutes. I went to bed at 136 mg/dL and woke up at 129 mg/dL. I know mostly why this happened—the walk was unexpected, dessert was supposed to be served right after dinner but it wasn’t, and I was eating things I don’t normally eat so I couldn’t guess my carb load as accurately. 

In 48 years of living with type 1 diabetes, I have only experienced severe hypoglycemia four times. I’m extremely disciplined in my management, and I’m lucky. This was the first time someone thought I appeared drunk, not recognizing this was a severe hypoglycemic event. The symptoms associated with both inebriation and severe hypoglycemia include both physical and cognitive impairments. Due to this, people with type 1 diabetes have been falsely arrested and shamed as the true underlying cause, severe hypoglycemia, may be unrecognized. 

Q: How does the potential of future hypoglycemic events make you feel? How does this impact your life? 

A: I’m not frightened of hypoglycemia as an everyday feeling, but there is a general sense of potential danger in the back of my head. To ameliorate the potential danger, I do a few preventive things. First, I wear a continuous glucose monitor; it’s a game changer to be able to see your blood glucose in real time. Second, I carry small plastic containers that hold four glucose tablets. I have one in every purse and backpack and one on a table by my front door so I can slip it in a pocket. Also, for 46 years of my life living with diabetes, I never had glucagon because it was so difficult to administer. But now I have two nasal glucagon puffers in my drawer should I need them, and my husband can easily administer them if I can’t. 

Before newer insulins, I would wake at 3:00AM almost nightly, sweating through my nightgown from a moderate low, because that’s when my basal insulin peaked. Luckily, the basal insulin I take now doesn’t have a peak, and my blood sugar stays pretty steady through the night. And each night before I go to sleep, I do my best to have my blood sugar around 100 mg/dL. 

I know many people with type 2 diabetes who live in terror having experienced a low, and everyone with type 1 fears a severe hypoglycemic event during the night from which they will not wake up. Unfortunately, that makes many people keep their blood sugar higher than it should be, and this can have adverse consequences over time. But I feel confident by being prepared, and I would tell people to get familiar with their blood sugar patterns and then plan a preventive treatment approach with their healthcare professional. 

Q: What would you like healthcare professionals to know?

A: When your blood sugar goes low, it is both a physical sensation and a mental fog. When my blood sugar is moderately low, like in the 50s and 60s, I feel my heart beat more rapidly, I’m a bit lightheaded, I may start sweating, and I’m ravenous. And the emotional upset for me is I have to eat when I don’t want to! As my blood sugar drops lower, my body movements become uncoordinated and my brain becomes muddled; I can’t hold on to a thought. The lowest my blood sugar has been is 29 mg/dL, when I found myself in the middle of the night, gripping the bathroom sink and staring into the mirror wondering why I was there. 

I find it shocking that such a dangerous side effect of insulin and other blood sugar lowering medications is barely discussed. Given the potential severity of hypoglycemia, I believe everyone on these drugs should be prescribed glucagon and shown how to use it in their healthcare professional’s office.

Get 75% off the ‘fake’ list price of insulin 

I got this information from Scott Strumello, a noted diabetes advocate and diabetes sleuth: investigator, statistician and as he describes himself, ‘general badass.’ As long as I’ve known him, actually at least a decade now, he’s been searching through the weeds and uncovering the truth about Pharma.

Scott asked me to share this information about apps and coupons that drastically reduce the cost of insulin. Scott wrote on his blog specifically about coupons here. So, while you’re weighing your decision of perhaps what health insurance plan to choose during this open enrollment season, have a look into these options as well. 

The bottom line is a number of coupon-generating websites/apps, provide major assistance regarding the cost of insulin, even for people who would otherwise not qualify for manufacturer patient assistance programs.

Look into:

1. I know GoodRx as an app you download on your phone. GoodRx can also be found on Twitter @GoodRx and on Facebook @GoodRx. It offers patients lacking insurance (or those still trying to satisfy a deductible) access to PBM-negotiated discounts on insulin and many other prescription drugs. Scott says their discount on generic U100 Lilly Insulin is $68.38/vial sold at Walgreens and some local pharmacies. Novo Nordisk Aspart costs about $72.

2. RxSaver (on Twitter @RxSaverOfficial and on Facebook @RxSaverOfficial) offers Novo’s Aspart a few dollars cheaper for $67/vial at Walgreens and some local pharmacies. It also offers Lilly’s generic Lispro but in reverse, for about $71. Pens are a bit more costly. 

Both these apps/websites offer savings which amount to 75% off the list price for Humalog and Novolog respectively. Unfortunately Scott says he hasn’t yet found such discounts for basal insulin. But, there are coupons available from the manufacturers of Basaglar and Semglee (generics for Lantus) which can be used at most pharmacies. 

As for what’s to come, perhaps we can be cautiously optimistic. Another two biosimilar (generic) insulins are pending FDA review and Scotts says Wall Street notes historically when there are three or more competitors manufacturing the same product, costs start to fall. 

If you’d like to read about the nuts-and-bolts of why insulin is so costly in the U.S. check out Scott’s blogpost here