ADA Webinars and Podcasts: Inpatient Care for Covid-19 Patients with Diabetes

Posted on April 28, 2020 by Laddie

In recent weeks Diabetes Connections and The Juicebox Podcast have featured interviews with individuals with Type 1 diabetes who contracted and recovered from Covid-19. These podcasts have also shared conversations with medical professionals discussing the coronavirus and diabetes. While these episodes were interesting, they did not address my biggest Covid-19 concerns as a person with diabetes. How will my diabetes be handled if I am hospitalized with Covid-19? Not if I have a mild-to-moderate case and can mostly self-manage my diabetes. How will it be handled if I am incredibly ill on a regular hospital floor or even in the ICU? Nothing I have listened to or read has answered these questions.

Until now.

For several years I have listened to the podcast Diabetes Core Update sponsored by the American Diabetes Association. The podcast has historically been a monthly review of “clinically relevant” studies from ADA professional publications. Most of the articles address Type 2 medications so the podcast is not usually relevant to me. But I listen anyway hoping to learn something and hear an occasional Type 1 discussion.

In April Diabetes Core Update released about 10 podcasts directly related to diabetes and the coronavirus. Although these podcasts are directed towards medical professionals, they contain the information that I as an engaged patient am starved for.

Last weekend I finally hit the goldmine with two episodes directly addressing the inpatient care of patients with diabetes, particularly those patients on insulin therapy. This population includes all of us with Type 1 diabetes and medical professionals in the trenches are finding that many/most patients with Type 2 diabetes and even pre-diabetes and undiagnosed diabetes are ending up requiring insulin when battling coronavirus.

The first podcast is titled American Diabetes Association Town Hall: COVID-19 & Inpatient Care for People with Diabetes. The 6 panelists are: Shivani Agarwal, MD, MPH, Albert Einstein College of Medicine; Jennifer Clements, PharmD, FCCP, BCPS, CDE, BCACP, American Pharmacists Association; Robert Eckel, MD, ADA President, Medicine & Science; Irl Hirsch, MD, University of Washington; Melanie Mabrey, DNP, Co-Chair – American Association of Nurse Practitioners – Endocrine Specialty Practice Group; Jane Jeffrie-Seley, DNP, BC-ADM, CDCES, Association of Diabetes Care and Education Specialists.

The topics discussed include insulin regimens in the hospital, blood sugar targets, use of patient devices such as meters, CGMs, and pumps, how coronavirus seems to affect BG levels, lots of dangerous hypoglycemia, and so on.

The town hall can be seen as a webinar at this link: American Diabetes Association Town Hall: COVID-19 & Inpatient Care for People with Diabetes

To access the podcast, go to Diabetes Core Update Podcasts and find this episode which is titled Covid-19 Inpatient Town Hall and was released on April 23. This page will give you the ability to open the podcast in Google Play, Apple Podcasts, or listen on your device.

The second podcast/webinar is titled Inpatient Care Questions April 15 Update and includes questions and discussion related to the topics from the Town Hall. The panelists are: Robert Eckel, MD, ADA President, Medicine & Science; Irl Hirsch, MD, University of Washington; Mary Korytkowski, MD, University of Pittsburgh.

You can access the webinar at this link: Answering Your Questions: Inpatient Care Questions April 15 Update.

To access the podcast, go to Diabetes Core Update Podcasts and find the episode titled Covid-19: Inpatient Management #2 which was also released on April 23. This page will give you the ability to open the podcast in Google Play, Apple Podcasts, or listen on your device.

My thoughts: Although I strongly suggest that you listen to both podcasts, here are some things that I heard. Coronavirus seems to raise blood glucose numbers drastically and many patients require multiple times their normal insulin. Many people who didn’t previously require insulin do need it while hospitalized. IV insulin is frequently used in the ICU but injected insulin is more common on regular floors. Patients are encouraged to bring their own supplies including meters, pumps, and CGMs. As long as you are able to safely operate your pump, you will most like be able to keep it. That might differ in smaller community hospitals.

Severe hypoglycemia has been seen in some patients, especially elderly patients. For that reason BG levels are often targeted to be in the range of 140-180 rather than 110-180. Nursing staffs are trying to minimize the number of direct patient contacts and will try to bundle BG checks, vital checks, and medication administration into each visit.

Although there is currently no hard data to support the hypothesis, the medical professionals thought that those with well-controlled diabetes prior to Covid-19 have a better prognosis than those with complications and co-morbidities. But they all considered blood glucose control in the inpatient setting to be hugely important.

I am terrified of contracting Covid-19 and being so sick that I must be hospitalized. Along with most people I know with diabetes, I will continue to stay home most of the time and social distance when I am at the grocery store or walking in my neighborhood. My next project is to organize a Diabetes Go-Bag to use if I do end up going to the hospital. I am currently woefully unprepared for that scenario.

** Please note that these episodes have somewhat different titles on different webpages, but I think you’ll be able to find them.

Healthy Lunch Day

Posted on November 15, 2016 by Laddie

I have been a quiet blogger this November and done little to advertise or celebrate diabetes month. I was an active participant in the Big Blue Test but that was all behind the scenes. I have read the wonderful blogposts by other diabetes advocates and chosen not to feel guilty for my lack of participation.

This morning I received an email from Chelsea at the American Diabetes Association asking me to participate in the second annual Healthy Lunch Day which is celebrated today. Easy enough because I eat lunch almost every day and it is usually a “healthy” meal!

A salad is my most common lunch and today was no exception. The base was a Mann’s Power Blend containing Brussels sprouts, Napa cabbage, kohlrabi, broccoli, carrots, and kale. I topped it with raspberries, leftover cooked broccoli, a hard-boiled egg, and a yogurt-based dressing. I guessed the carb count to be 18 grams and bolused accordingly.

fullsizeoutput_1a22 I tend to spend two or three hours each afternoon at my kitchen table “desk” and like to avoid BG spikes with a lowish carb lunch. I go heavy on vegetables and berries to make up for my oatmeal breakfast that has nothing green or colorful.

So here’s to #HealthyLunchDay and the ADA’s November theme of #ThisIsDiabetes. My lunch was healthy and I have diabetes, so it’s a perfect fit!

Friday Notes

Posted on July 22, 2016 by Laddie

Yesterday was a busy diabetes day. In addition to just having diabetes (and believe me, that’s enough!), I attended an advocacy training program sponsored by the American Diabetes Association (ADA) and there was a vote by an FDA Advisory Committee regarding the Dexcom G5.

Number #1: My Diabetes: Nothing momentous to say about my diabetes except that yep, I’ve still got it. I had a big unexpected BG spike after a restaurant salad lunch. Maybe there was hidden sugar in the salad dressing. Maybe my glass of wine decided to be a problem. Maybe it was the mid-morning peanut snack dosed with an extended bolus. Maybe it was because it was 90+ degrees outside with off-the-chart humidity even though I was comfortable inside with air conditioning. Maybe it was because it was Thursday. This is the sort of stuff that makes it a miracle that those of us dealing with Type 1 even have a modicum of sanity left in our lives.

Number #2: ADA Advocacy Training: I attended a late afternoon Advocacy Training seminar sponsored by the American Diabetes Association. I found it to be very empowering and in a moment of bravado, I signed up to be available for in-person office visits to my congressional representatives. I am a confident advocate when writing, but speaking and putting myself “out there” border on terrifying.

The ADA has a good app for advocacy and I suggest that you check it out. It provides information on national and state advocacy priorities and links to easily become involved in ADA advocacy. Search for “Diabetes Advocacy” in the app store.

Because Scott Johnson was the reason that I knew about this seminar, I can’t say that it was a surprise to run into him by the Diet Coke cooler. But it’s always a pleasure to see Scott.

Number #3: FDA and Dexcom G5: I was pleased to receive an email from Bennet Dunlap of DPAC sharing news from yesterday’s FDA Advisory Committee meeting on Dexcom G5 labeling. The panel voted 8-2 to recommend approval of a G5 labeling change to allow insulin dosing without a confirmatory BG meter test. The FDA will have to make the final approval, but it is likely that the advisory committee’s recommendation will be accepted. This change should help justify Medicare coverage for CGM’s as well as expand the use of CGM to more patient populations.

That’s it for today. Have a good weekend!

Diabetes Cookbooks: A First Time for Everything

Posted on March 13, 2014 by Laddie

IN JANUARY I SAW A REQUEST FROM THE BOOK DEPARTMENT OF THE AMERICAN DIABETES ASSOCIATION FOR BLOGGERS WHO MIGHT BE INTERESTED IN READING AND REVIEWING BOOKS. AS SOMEONE WHO ENJOYS READING AND IS ALWAYS LOOKING FOR BLOG TOPICS, I JUMPED AT THE OPPORTUNITY. RATHER THAN BEING ASSIGNED A BOOK, I WAS ABLE TO SELECT THE BOOK(S) I WANTED TO REVIEW. I DECIDED THAT I WOULD OPT FOR BOOKS THAT WERE A BIT OUTSIDE MY COMFORT ZONE: BOOKS THAT RIGHTLY OR WRONGLY I MIGHT NOT NORMALLY READ. THE BOOKS THAT I CHOSE WERE PROVIDED TO ME FREE-OF-CHARGE, BUT MY REVIEWS, AS ALWAYS, ARE MY OWN OPINIONS.

Two weeks ago I was having a glass of wine with some girlfriends and one of them asked: “When was the last time that you did something for the first time?” I did not have to think for very long to come up with an answer.

The one thing that I have done in recent weeks that was a first time experience for me was to use a diabetes cookbook. Actually not just one cookbook, but two. I have had diabetes for 37 years and until recently, I have never owned nor used a cookbook that was intended for people with diabetes. I may have cut out a few recipes from magazines like Diabetes Forecast or Diabetes Health, but I don’t think I ever fixed any of them.

You might wonder whether I have anything against diabetes cookbooks. I don’t think so. In general I’m not very interested in cookbooks and most of the cookbooks I own were gifts or purchased to support a fund-raising project. I don’t like to cook and I keep waiting for my husband to have a mid-life crisis and decide that he would like to be a chef. Unfortunately that doesn’t seem to be on his agenda. My guess is that newly-diagnosed diabetics are a big market for cookbooks, but when I was diagnosed in the 1970’s, I wasn’t carb counting and didn’t need the nutritional analysis that is now contained in diabetes cookbooks.

When I decided to go outside my comfort zone and review two ADA cookbooks, I actually got excited about doing it the “right way”. For me that meant choosing 4 or 5 recipes from each cookbook and following them exactly. (I have a bad habit of altering recipes and then wondering why they are not as good as advertised.) It also meant using the carb counts as provided and evaluating whether the nutrition info was a helpful tool in my diabetes life.

The first cookbook I delved into was the ADA standard bearer titled The Family Classics Diabetes Cookbook. This is a collection of 140 “favorite” recipes from Diabetes Forecast Magazine. My overall impression was that this is a well-organized cookbook with beautiful photographs and clear detailed instructions. There is a good mixture of standard favorites such as Old-Fashioned Beef Stew, Classic Potatoes Au Gratin, and Classic Baked Artichoke Dip along with newer-style recipes such as Chickpea Tabbouleh, Tilapia Tacos, and Zesty Broccolini and Garlic.

I tried five recipes from this cookbook. My two favorites and recipes that I will make again were Fresh Greens Soup with White Beans, Basil, and Tomatoes and Provencal Zucchini and Yellow Squash Medley. Two other recipes were just fine and maybe worth repeating. I only disliked one recipe and it was because of ingredient substitutions designed to make the recipe lower in fat than the original dish.

That leads me to a discussion of the “dietary philosophy” of this book. The recipes are consistent with traditional ADA clinical guidelines prescribing a “heart healthy” diet with an emphasis on eating low-fat with a significant number of calories coming from healthy carbohydrates. This cookbook was published in 2012 and precedes the ADA’s 2013 acknowledgement that low-carb diets might be a successful tool for weight loss and diabetes management. Although the ADA has modified its stance on dietary recommendations, most physicians still advise their patients to follow a traditional low-fat diet. Therefore this cookbook is a good resource for good food with a low-fat emphasis. There are also some good recipes that are not high in carbohydrates if that is your preference.

The second cookbook that I tried out was The Smart Shopper Diabetes Cookbook. This cookbook by Robyn Webb, MS was filled with quick and easy recipes designed to be “stress-free” by using ingredients “from the Deli Counter, Freezer, Salad Bar, and Grocery Shelves”. This book was published in 2013 and Webb’s introduction addresses the idea that there is no “one-size-fits-all nutritional approach for people with diabetes.” She attempts to provide a variety of recipes that emphasize healthy fats, high fiber, varying amounts of carbohydrates, and lots of flavor. Detailed nutritional information for each recipe is provided so that you can make up your own mind about which recipes are appropriate for your meal plan.

Because I am generally a lazy cook, I liked some of the short-cuts she used to make a healthy meal without too much time in the kitchen. My favorite recipe was Chicken, Artichoke, and Spinach Soup with a close second-place finish for Mexican Chicken. The other 2 recipes that I tried were fine, but I would probably try another new recipe before repeating them. And there are definitely a few other recipes that are on my list to try: Rosemary Turkey Salad and Salmon with Blueberry Salsa.

One thing that I liked, but haven’t used yet was the daily menus provided at the end of the book. I find that when I want to experiment with a new style of eating, it is helpful to start with a structured program with daily menus. Just follow the rules and don’t think too much. These menus very much remind me of the balanced diet that was the basis of the Exchange System that I used in the first half of my diabetes life. Although I carb count now, I still think in blocks of 15 grams and really feel that the Exchange System was not a bad way to eat.

Summary: I enjoyed trying new recipes and expanding my normal dinner options beyond meat and vegetables cooked with little creativity. The carbohydrate counts provided were helpful and saved me a little time. At the same time, none of the measurements in either book were provided in grams, so I was stuck with guessing at what is the ubiquitous “medium banana” or “large onion.” Because I selected relatively low carb recipes to try, I was comfortable with guessing at some of the quantities.

I am very impressed with Robyn Webb, MS and would love to see the ADA publish a Low Carb cookbook with her input. Although I am not perfect in living a low carb lifestyle, I am convinced that it makes my diabetes life easier and I would love to infuse some creativity into my menus. I’ve definitely found some “keeper” recipes in the two ADA cookbooks that I explored. But a whole low-carb cookbook would be fabulous and I would buy it in a minute.

If you would like to purchase the cookbooks that I reviewed or any other books in the American Diabetes Association Store, please go to this link: http://www.shopdiabetes.org/ Also, Amy Tenderich at Diabetes Mine recently reviewed and raved about another ADA cookbook titled The Mediterranean Diabetes Cookbook. To read her review, click here.

Feet

Posted on January 27, 2014 by Laddie

A few weeks ago on Twitter, I saw a request from the Book Department of the American Diabetes Association for bloggers who might be interested in reading and reviewing books. As someone who enjoys reading and is always looking for blog topics, I jumped at the opportunity. Rather than being assigned a book, I was able to select the book(s) I wanted to review. I decided that I would opt for books that were a bit outside my comfort zone: books that rightly or wrongly I might not normally read. The books that I chose were provided to me free-of-charge, but my reviews, as always, are my own opinions.

My first selection was a short book by Neil M. Scheffler, DPM, FACFAS titled 21 Things You Need to Know About Diabetes and Your Feet.

Why did I pick this book? I chose it because I currently have no issues with my feet related to diabetes and I usually skip the chapter on foot care when reading diabetes books. By selecting this book, I wanted to force myself to read and learn everything that the podiatrist author deemed important. I also wanted to compare his recommendations to what is happening with my care team, my feet, and my diabetes.

The Book

Dr. Scheffler has written a concise guide to just about everything you need to know about having healthy feet and about the specific risks that those of us with diabetes face. Like every other discussion about diabetes and feet, he spells out the grim statistics on the first page and doesn’t take long to start talking about amputations. Fortunately he very quickly moves on to the good news as stated by the Center for Disease Control (CDC) that “comprehensive foot care programs, i.e., those that include risk assessment, foot-care education, and preventive therapy, treatment of foot problems, and referral to specialists, can reduce amputation rates by 45% to 85%.”

The “21 Things” referred to in the title are the 21 chapters of the book. Topics include the Diabetes Foot Care Team, Diabetic Neuropathy, Foot Ulcers, Shoes and Socks, and Emergencies. One thing that I particularly appreciated was the discussion that foot care requirements are not the same for everyone. Kind of a YDFMV (Your Diabetic Foot May Vary) attitude. (Thanks, Bennet of YDMV.) Although the author states that everyone should check their feet daily, he is quick to concede that a recently diagnosed Type 1 in her twenties probably does not have the same needs as someone who is a senior citizen with 20 years of diabetes and numbness in his feet.

My Feet

So how do I measure up with the care of my feet which have carried me through 37 years of Type 1 Diabetes?

I’ll tell you the bad stuff first. By the third paragraph of Chapter 2, I’m already looking at a failing grade. Rather than an annual exam with a foot specialist, I have never seen a podiatrist in my life except for a free 5-minute exam at the ADA Expo in October. I wear sandals and thonged flip-flops frequently. Last year I didn’t go to the doctor for a bloody toe from an extended downhill climb in wet hiking boots. My endocrinologist does not check my feet.

Before you take me into custody for a foot intervention, let me explain myself. My feet have always been in good shape and the last time my endo saw them, she stated that she wished all of her patients had feet as well-cared for as mine. Although many endocrinologists check feet at every visit, the ADA Standards of Care only require an annual comprehensive foot exam that includes checking for pulses and sensation as well as a visual screening. For me that exam is performed at my annual physical by my internist and my endo questions me to ensure that it has been done.

I am fortunate to have no numbness in my feet. I can feel the tiniest grain of sand and quickly respond to shoes or socks causing irritation. I use moisturizing foot creams daily to prevent painful heel cracks. My flip-flops are thick-soled with good arch support and I only wear them at home (okay, also at the beach). I wear high-quality socks such as Thorlo and Smart Wool. When hiking I often put on dry socks at lunchtime and always wear gel protectors (they’re like toe socks) on my second toes to prevent the kind of injury I had last year. I am still agile enough to inspect my feet and clip my nails.

Believe me, I take foot care very seriously even though I don’t follow every rule. I accompanied my father-in-law to many podiatrist appointments for wound care of foot ulcers resulting from Type 2 diabetes and congestive heart failure. One of my friend’s husband with diabetes had a leg amputated a few years ago. I have heard Kelly’s story of her continuing battle to save her foot as she fights various tissue and bone infections. There are others in the DOC who struggle with balance and numbness in their feet.

I’m not stupid. This is serious stuff. Although Dr. Scheffler would wish that I saw a podiatrist, I think that he would approve of how I care for my feet, work on achieving good blood sugars, and very importantly, don’t smoke.

I am getting older and have had diabetes for a long time. Just because I have never had a podiatrist appointment in the past doesn’t mean that I never will in the future. In fact I probably will. And like everything with diabetes, what I do is not necessarily what you should do. Follow your good sense, the advice of your medical team, and take care of your feet.

If you would like to purchase this book or any other books in the American Diabetes Association Store, please go to this link: http://www.shopdiabetes.org/

2013 ADA Expo in Minneapolis

Posted on October 14, 2013 by Laddie

Saturday was the American Diabetes Association Expo in Minneapolis. It was the first time that I have ever attended this event because I had always thought that there would be little for me there. Although I enjoyed my 3-1/2 hours there, I think that was the case.

I was warned that the event was heavily oriented towards Type 2’s and that was partially true. There were many booths like Medifast, SlimGenics, and Extend Nutrition whose target audience is definitely Type 2. Similarly it was easy to stereotype the Active Living and the Healthy Eating areas as having a Type 2 emphasis, but really the intent was to get everyone, diabetic or not, exercising and eating healthy foods. Type 1’s were definitely not ignored because the major pump and CGM manufacturers had a strong presence. I particularly enjoyed the opportunity to see Medtronic’s new Enlite sensor and the smaller Omnipod. Because I continue to second-guess my decision to go with the Animas Ping a year ago, I could hardly bear to look at Tandem pumps….

I think that a lot of my disconnect was that in recent years I have learned a huge amount about Type 1 from personal experience, reading, and involvement in the DOC. Therefore almost everything at the Expo was too basic and generic to appeal to me. Of course it would be unrealistic to expect anything different because those of us in the DOC who are highly involved in our care are a small percentage of people with diabetes. I had hoped that the talk by a well-known local endocrinologist about getting off the high and low rollercoaster might be interesting. He was an engaging speaker, but unfortunately 30-45 minutes is not enough time to move beyond superficial ideas especially when you are addressing an audience of Type 1’s and Type 2’s.

There was a large screening area where free cholesterol and A1c tests were available. You could get risk assessments and screening for strokes, PAD, high BP, dental problems, and sleep apnea. I had a brief eye exam that included photographs of my retinas. Because I had never seen a podiatrist in my 37 years of diabetes, I had a foot exam that confirmed that everything was okay. I didn’t participate in many of the screenings because my annual physical was just a few weeks ago. If it had been several months since my last A1c, I definitely would have taken advantage of that test.

As is common at events like this, I came home with a bunch of free stuff. Two tote bags were appropriately royal blue and ready for #BlueFriday. Several toothbrushes, dental floss, glucose Quick Sticks, and a pedometer were part of the loot. I’ll definitely use the sizable tube of foot cream and the USB hub that I picked up. Other than that, I was very good at refusing things that I had no use for. Somehow I ended up with too many handouts and magazines that ended up in the recycling bin.

Chances are that I will never go to this event again. But if you’ve never gone to an ADA Expo, I’d say that you should go and see what you think. If you’re considering a pump or CGM, it’s a great place to see different devices and make contact with the local reps. If nothing else, it’s an opportunity to see that there are a lot of people in the world with diabetes along with many healthcare providers trying to help us and a ton of companies trying to sell us stuff.