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.