Insulin’s indirect path. Diasome is working to change that. Plus, my post for them – on innovation.

It’s a funny thing that we’ve known for a long time injecting insulin is a poor way to get it into our system. It doesn’t go directly where it’s needed and its path isn’t the same path as when insulin is released in a body that makes it. Yet, even though we’ve known this for –  ever, few have done much to improve this faulty system.

I don’t normally put stock in research companies working on tangly problems like this, but I’m intrigued and attracted to the idea that a company named Diasome is working to change this. They regard where insulin goes as important as dosage and timing. And so do I.

On another note, I wrote a guest blog post for them as they want to bring thought-provoking thinking from the diabetes space onto their site. I wrote about innovation, what we’ve seen over the years — and what we haven’t. Clue – it has nothing to do with technology.

Diasome’s explanation of where injected insulin goes and where it should

diaTribe, one of the best resources for diabetes news and information

If you don’t get diaTribe delivered to your inbox weekly, you should. Obviously if you’re reading this either you or someone you know has diabetes and you like to learn.

diaTribe is the online newsletter put out by the amazing Kelly Close and her team. It captures what’s happening regarding new medicines, guidelines, devices, policies, conferences, people, thinking and the wonderful Adam Brown’s weekly musings about staying on-road with type 1 diabetes.

Just today as I’m reading through the five or six articles, each a page to a few pages, the topics are as ever about things I want to know.

Sign up for your free newsletter here. This is a look at how it comes into your inbox and this week’s issue:

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We should be shocked by how much and why diabetes is in the news

I am happy that diabetes is in the news almost every day. We are getting more exposure and understanding from the general public. And I am sad it’s in the news every day because the reasons that is so are unforgivable.

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In the past few days I’ve read three articles that make me ill. Literally, they turn my stomach. The first was in the New York Post about a young man who died because he could no longer afford his insulin. When a doctor recommended a cheap, over-the-counter brand, he took it thinking the cost savings would also help his pay for his upcoming wedding, “Diabetic groom-to-be dies after taking cheaper insulin to pay for wedding.”  

When the never-to-be-groom’s body was found he had suffered multiple strokes, was in a diabetic coma and his blood sugar was 17 times what’s considered normal.

Then I read in the Washington Post, “A Detroit diabetic was deported to Iraq, where he’d never lived. He died from lack of insulin, family says.” Jimmy Aldaoud, who was born in Greece and lived in America his whole life was, under Trump’s ramp up to get rid of immigrants, rounded up by Detroit’s ICE, Immigration and Customs Enforcement, and deported to Iraq – a country of his heritage that he’d never been in.  He died for lack of insulin in Iraq.

I want to puke.

Then today I read on facebook an article a fellow T1D posted that CVS Pharmacy has decided they will not fulfill scripts for blood sugar testing strips beyond three a day. While this is a Medicare guideline, Medicare allows people with a written note from their doctor to get as many strips as their doctor prescribes. CVS has decided they will not. They say if you want more, go somewhere else.

I want to know what world I am living in. I want to know how safe I am, an average, educated, fairly healthy, fairly financially secure 65 year old woman  with type 1 diabetes? In my 47 years of living with diabetes I have never feared my condition would threaten my life – not in this way. To not be able to get the medication I need. And will my Dutch-Indonesian husband be rounded up one day walking to the grocery store and deported somewhere?

I can no longer say I am safe. I don’t recognize this country anymore. I don’t understand how people can do this to other human beings. And I feel a deep sense of dread.When articles like this come out every day I can only say do the best to keep yourself safe, we are all at risk.

Remedying blood sugar always trumps intermittent fasting and keto

 

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I was recently talking with a friend who was bemoaning the fact that she hates it when she has to break her nighttime or morning fast to treat a low blood sugar. So do I. And just these past two nights I’ve had to do it. I was around 78 mg/dl at 11 PM both Tuesday and Wednesday nights. I waited and watched my CGM til midnight, but no movement. Drat! I have to get up now and eat something, double drat!

Of course I hate it when I have to eat and I don’t want to. I’m not hungry and all I can see is the extra calories I wouldn’t eat if I didn’t have to raise my blood sugar.

Now that many of us are doing very low carb diets, keto or intermittent fasting, there’s even more chance your blood sugar may go low and you’ll have to remedy it with sugar.

I have to accept that’s diabetes and that’s just how it is. Getting blood sugar in a safe place, ESPECIALLY BEFORE GOING TO BED, ALWAYS TRUMPS maintaining your particular style of eating. We just have to not worry about those calories. They’re not much and if they’re worrisome you can eat a tiny bit less the next day.

Of course if this is a daily or nightly event for you, then it’s time to readjust what could be off. Did you take too much insulin? Did you exercise? Are you sick? Did your neighbors paint their house pink? You get it, there are so many variables at times you’ll have no idea.

But I think the reason I’ve been going too low at night this week is, even after 47 years with type 1 diabetes, I periodically, habitually forget that I am extremely sensitive to the action of insulin in the evening. So while it might take me 1 unit to cover a prune in the morning, it will take 1/2 unit at night or even less.

Then there’s also the, geez, how’d that happen? Tuesday night I treated my low with a prune which should have raised me 20 points. I ended up going up 60! Wednesday night I warmed 1/4 cup of almond milk and stirred in a teaspoon of honey. The results the next morning were a satisfying 95.  Suffice to say, you won’t always win this game either.

But that extra prune or peach or spoonful of honey or two glucose tabs is not going to turn you into a glutton or gorilla or put on 20 pounds. And you can always eat a wee bit less the next day. But not waking up in the morning, now that’s something I’m never, and you should never, be willing to risk, as best you can.

 

New nasal glucagon spray approved by FDA

 

 

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Baqsimi, (yes, where do they get these names from?) has just gotten FDA approval and that’s great news. Great news. Now, for the first time ever, there will be a fairly easy solution for a severe low.

 

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Baqsimi is glucagon in nasal powder form, delivered in a puff through a nasal spray bottle. No difficulty mixing up dry and wet ingredients like today’s glucagon, much reduced nervousness from the person who is going to spray this in your nose as opposed to stick a needle in your body.

It’s supposed to be on the market in retail pharmacies in a month. Eligible commercially insured people with diabetes can pay as little as $25 for up to two BAQSIMI devices (1 two-pack or 2 one-packs) if you use the savings card. That’s all I know about the pricing. I don’t know if Medicare will cover it but I do intend to find out. And I don’t know if it only has a one year shelf life. If anyone does know, please do tell.

Baqsimi is being brought to market by Eli Lilly after acquiring Locemia, the small start up that began work on the product four years ago. At the time I was helping with the copy and branding. So I am personally delighted to see this product green lighted.

For more information.

 

Congress takes action on soaring price of insulin

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Two emails popped into my inbox pretty much within minutes. This was the first from the American Diabetes Association. This gives me a bit of hope we will see insulin prices come down. The second email was from JDRF making the same announcement. It’s very rewarding when you see the advocacy organizations that represent you really in there for the fight. Of course, if you were part of the fight, maybe writing your congress person, pat yourself on the back too. (Since below is a screen shot, the links aren’t live but you can google the appropriate web sites.)

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Be careful of extreme temps. They ruin your insulin.

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Just a gentle reminder that in these dog days of summer, it’s in the high 90’s in New York and tomorrow will be 100 F, insulin can go bad. The same is true if insulin freezes.

You can see above that I keep my two insulins, Fiasp on the left and Tresiba on the right, in separate vessels. Given how much the pens resemble each other, separating them helps. I also store them upside down so I can see the color difference that also helps distinguish them.

However, I don’t normally keep these containers where you see them. Normally they’re on my kitchen counter. But since I spent the better part of today baking – keto rolls and biscotti – I realized my insulin pens would stay cooler in the living room where they’d also be nearer the air conditioner. So, that’s where they are, and where they’ll stay until this heat wave breaks.

If you’re curious, the little blue and white houses behind them are ceramic gifts you get flying business class on KLM. They contain Geneva, a Dutch gin. Given the husband has flown back and forth to Holland on business the past 17 years, although he normally flies coach, we still have managed to erect a small town ;-). I can’t tell you about the gin however as we’ve never opened one.

 

The first 24 hours of the Dexcom G6 are different than the G5

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Dexcom G6 CGM. From left to right: inserter, receiver, transmitter in sensor pod, iPhone app, apple watch.

The G6 is not new, it’s just the latest iteration of Dexcom’s continuous glucose monitor. There are lots of reviews online about how people like it. Basically, it’s an upgrade and the big advantage cited is it doesn’t require calibration. However, I still find I can’t let go of checking it against my meter now and then, and sometimes it needs to be calibrated. I was told by a Dexcom rep to do so if there’s more than a 30% discrepancy.

Other than that, for me, the G6 pluses are not terribly significant – yes the sensor and transmitter make a slimmer and sleeker package, the sensor is easier to insert, but that humongous insertion device pains me to discard. It’s got a predictive alert which I like – it warns you at 70 mg/dl that in 20 minutes you’ll be 55 mg/dl, but I don’t care for the pastel colored screen (I only use my iPhone to see my readings).I wonder if that is to keep us calm looking at our numbers?

Three times last week I had to call customer service and get Dexcom to send me a replacement sensor, which they do without argument. First, I bled under the sensor pod, likely due to a too heavy-handed insertion, and the sensor stopped working. I’ve forgotten why I needed to replace the second sensor, but why I had to replace the third sensor came as a complete surprise. With the G5 you can put the sensor on and wait a day before you activate it. If your first day numbers are not accurate, as mine never were, letting the sensor sit on your body for a day before you start a new session helps. When you activate it, its had some time to read its new environment, you, and it’s more accurate. This way you don’t waste the first day of use.

So, I did the same thing with my G6 sensor. I put it on and didn’t “start new session” until the next morning, when it told me I could not reuse my sensor and needed to put on a new one. Of course I’d not activated it, it had only been on my body a day. But when I called Dexcom to ask about this, I was told as soon as you put the G6 sensor on your body it starts starting up, even though you haven’t clicked “start new session.”

So, a tip to the wise – if you’ve done this with your G5 you cannot do it with a G6. If you use the G5 and never heard of this tip, it’s a smart move if for you your first 24 hour readings are not trustworthy.

American Diabetes Association conference 2019 highlights

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The ADA conference, the largest scientific U.S. diabetes conference, took place last week in San Francisco. I wasn’t there but diaTribe and DiabetesMine, run by Kelly Close and Amy Tenderich respectively, were. They posted highlights from the event that I followed and now share with you. The recaps cover new technology, trials and medicines.

DiaTribe – “The Biggest News in Diabetes Technology, Drugs, and Nutrition: Highlights from ADA 2019”

DiabetesMine Healthline – “What’s new in Diabetes Research”