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ADVOCATE: n. [ad-vuh-kit, -keyt]: a person who speaks or writes in support or defense of a person, cause, etc.

It’s really not very hard … and it’s really important. After all, who’s more important to your own life than you? It is survival.

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21th Annual Shooting Stars JDRF Walk to Cure Diabetes Sunday, October 23, 2016 in Newport Beach, CA at The Waffle House

For a contribution of $50 (or MORE!), walkers will receive a VERY COOL Shooting Stars Team T-Shirt while supplies last. Contact Joanne if you are interested in attending the event. joanne@TheSavvyDiabetic.com. To donate on-line, please go to: http://tinyurl.com/z5c2x8e.

Savvy Updates, 8/13/2017: Immunotherapy, Drugs and Glucose Levels, Marijuana, Coffee, Apple Watch

What’s in the news?!
Immunotherapy succeeds in thwarting Type-1 diabetes in study, as reported in the Los Angeles Times Science, 9 August 2017 about a study published in the journal, Science Translational Medicine. 
 
In a small but rigorous clinical trial at Cardiff University and King’s College London, British investigators gave patients recently diagnosed with the metabolic disorder a truncated version of the chemical that gives rise to insulin.
42 Sec LA Times Video on Immunotherapy and Type 1 Diabetes
The experimental treatment appears to quell the immune system’s assaults on the body’s insulin-production machinery. The authors of the new study call their experimental treatment “an appealing strategy for prevention,” both in the earliest stages of Type-1 diabetes and in children who are at high genetic risk of developing the disease.
Read more: Immunotherapy succeeds in thwarting Type-1 diabetes in study
 

Non-Diabetes Drugs and Supplements That Affect Glucose Levels, a list provided by a certified diabetes educator including information on what to do to prevent blood sugar swings, as presented on InsulinNation by Jennifer Smith, 2 August 2017.

The main medicine people with Type 1 diabetes take on a daily basis is insulin, but did you know that other non-diabetes-related medications can affect your blood sugar, too? This side effect can create havoc on your glucose management if you don’t adjust your insulin levels to accommodate it.

 
Some common medications that can increase glucose levels:

Valium and Ativan (benzodiazepines)
Thiazide diuretics, which are taken as blood pressure medicine
The steroids cortisone, prednisone, and hydrocortisone
Birth control pills
Progesterone
Catecholamines, which include the EpiPen and asthma inhalers
Decongestants that contain pseudoephedrine
Niacin
Zyprexa and many other antipsychotic medications

Some common medications or supplements that can cause low glucose levels include:

Aspirin
Asian ginseng
Aloe
Magnesium salicylate
[…]

Savvy Updates 7/26/2017: Roche is Not Gone, Dexcom Clarity

Every day, I find interesting or surprising items in my inbox!
Roche partners with Senseonics, TypeZero on ‘artificial pancreas’ as reported on FierceBiotech today!  Roche is NOT GONE!  Who knew?!?!?
Senseonics and TypeZero Technologies first tied up on “artificial pancreas” R&D in May, and now, Roche is getting in on the action. The trio will develop a long-term, closed-loop system for blood glucose control to be tested in the NIH-funded International Diabetes Closed Loop Trial (IDCL).

Senseonics’ Eversense continuous glucose monitoring system includes a sensor which is implanted under the skin of the upper arm. It lasts 90 days and measures glucose levels in the interstitial fluid and sends this data via a transmitter to a mobile app.

Under their original agreement, Senseonics and TypeZero would integrate glucose readings from Eversense with TypeZero’s inControlsoftware to automatically adjust insulin delivery from a patient’s insulin pump. Now, Roche will bring its AccuChek Insight insulin pump to the system, Senseonics said in a statement. The system will be tested at three sites in Europe.
In November, TypeZero joined forces with Dexcom and Tandem Diabetes care to develop a closed-loop system for the IDCL trial. The system comprises Dexcom’s G5 glucose sensor and Tandem’s touchscreen insulin pump. While the current version of the system runs TypeZero’s inControl algorithm on a smartphone, the partners hope to integrate it directly in the Tandem pump’s touchscreen. The ICDL trial is running at seven U.S. sites in addition to the three in Europe.
As an aside, remember when Roche bought Solo from Medingo … it was an FDA approved patch pump with great promise until Roche shelved it.  Wouldn’t that be fabulous if they would revive the Solo into a closed loop system?!?!?
Read more: Roche partners with Senseonics, TypeZero […]

ANNOUNCEMENT: Dexcom G5 CGM and Medicare!

I received a call on Friday, 7/21/17 from an inside sales rep for Dexcom, to let me know that they will be selling G5 CGM directly to those covered by Medicare!  WOOOOOOHOOOOOO!!! 

I spoke with the rep today.  He was wildly polite and knowledgeable.  He took me through the process they need to set up the account.  He asked me about 8 questions … best to answer YES for all (including that you use your receiver at all times to get your data.  Trust me, that’s the answer!).  Then he will follow up with my endo’s office.  The system for ordering sounds very organized, with the ability to place a monthly order for whatever you need.  They will also offer the Ascensia Contour Next meter and strips. 

If you have not heard from Dexcom directly yet, give them a call and ask for the Medicare Order Group. 

I’m almost smiling!

Savvy Medicare? CMG and maybe even Hearing Aids?

Kind of fascinating … the history of Medicare’s decision to cover CGM.   

 
Could Medicare Cover Hearing Services? reported by Shohet Ear Associates, 8 July 2017.
Since the inception of the program 50 years ago, Medicare has excluded coverage for dental, vision and hearing services. The program has directly contributed to sharp declines in mortality and longer life expectancy for those aged 65 and older. Today, however, given the linkage between increased costs and poorer overall health and disorders related to these three conditions, policy experts are rethinking how Medicare, a single-payer, national social insurance program administered by the US federal government, could begin covering dental, vision and hearing services for adults aged 65 and older.
According to Amber Willink of the Bloomberg School of Public Health at Johns Hopkins University and her two co-authors, the low uptake of hearing services by older Americans on Medicare is supported by a 2012 Medicare Current Beneficiary Survey that indicated 75% of Medicare beneficiaries reported having a lot of trouble with their hearing, and 84% of that group reported that they did not have a hearing aid. Further, the authors cited a 2017 report that found Medicare beneficiaries spent 4% of their incomes on dental, vision and hearing services; with the average spend on hearing services being $1338. Since these services are mainly an out-of-pocket expense, many Medicare recipients are likely to forgo these services and cope with the negative consequences associated with them.
Why is this important for T1s?  Health experts medical researchers have debated the possible link between diabetes and hearing loss since the 1960s and early attempts to establish such as association were not very convincing. But in recent years there has been growing evidence to suggest diabetes contributes to hearing […]

Savvy Updates 7/22/2017: ADA News, Insulet, Bigfoot Biomedical, Novo and Glooko

 

Lots of news from ADA Scientific Sessions last month in San Diego plus more.

 

 

Jessica Ching gave us her update of the important takeaways:
Medtronic’s Hybrid Closed Loop 670G

Not quite the godsend we hoped for.  Why?
It’s complicated and frustrating to use
The sensor takes 2 days to stabilize but only lasts 7 days, so you lose some of the benefit off the top
When the sensor is confused it will also “kick you out” of closed loop mode.  Those are additional days of lost closed loop time
Thus, your Medtronic closed loop might not work when you really need or want it
Medtronic needs to ‘work out the kinks’ and make it usable.  Probably a couple years down the road
There’s a wait list for the system if you’re not on the priority list.  Note there is also a shortage of Medtronic sensors…

Omnipod lovers, rejoice

Strong data (good results) on Omnipod’s Horizon artificial pancreas system is coming in. One report shows better results than 670G
Available ~2019
The analysts says that Omnipod not being first to market is a benefit; Insulet can learn from other manufacturer’s mistakes
Slimmer ‘Dash’ PDM + ability to send the PDM’s info to smartphone expected end of 2017

Abbott Libre “FGM”

This is Flash Glucose Monitoring (vs Continuous Glucose Monitoring)
Similar, but you ask it for data (instead of it pinging you), and no alarms.  But a breeze to use and wear
Probably must still do blood tests
Timing:  they are saying available end of 2017, but it could be in 2018

Animas

The Vibe Plus (using G5) was approved by the FDA last year, but Animas is not going to be selling it.  Yet.  Maybe ever— they haven’t decided
For […]

Savvy Debate: Is the Diabetes Industry TOO BIG to Allow a Cure?

Here’s the debate: “They’re never going to cure diabetes, because there’s too much money in it.”
Diabetes is big business, and as the drugs and medical devices have become more sophisticated and expensive each year – and as more people are diagnosed each day – diabetes itself becomes an even bigger business. In the United States, about $200 billion a year is spent in direct costs for diabetes, including hospital and emergency care.
Hence the conclusion: In the view of frustrated patients, family members, and loved ones, there’s just too much money to be made in this disease for a cure to ever be found. Powerful corporate interests will see to that. Even worse: Conspiracy theorists believe that the companies that profit from diabetes are actively thwarting a cure. Or as one person told me, “Eli Lilly has the cure in its vault, but it won’t let it out.”
On one side of the debate, James S. Hirsch, author of Cheating Destiny: Living with Diabetes, America’s Biggest Epidemic (see link below to purchase book), discussed the myth that the diabetes industry does NOT want a cure on diaTribe.org, 31 May 2017.  It’s a very interesting read.  His takeaway:
Here’s the truth about type 1 diabetes. It occurs when the immune system mistakenly destroys a body’s insulin-producing beta cells. A cure, at minimum, requires “re-educating” or “re-wiring” that immune system – an inscrutable ocean of white blood cells – so it doesn’t turn its deadly fire on its own body. Even if that hurdle is cleared, the body would still have to restore or replenish the beta cells that have been destroyed. We don’t have a cure because the immune system is too powerful, too complex, too resistant to […]

Savvy about Insurance and Medical Political Correctness

Insurance and Political Medical Correctness … lots to debate, hard to unravel.  Here’s some reading …
New California Law Protects Patients From Surprise Billing, reported on ASweetLife.org, July 2017 by Karin Klein, is all about “surprise billing.”
A 2015 survey by Consumers Union found that almost one in four Californians covered by private health plans had been hit by these surprise billings from out-of-network doctors.
But a new California law protects most patients from ruinous surprises. Under Assembly Bill 72, which took effect July 1, when a hospital is within a patient’s insurance network, the doctors and other healthcare providers cannot charge more than if they were in the network as well, whether they are or not.
Read more: New California Law Protects Patients From Surprise Billing 
 
When Insurance Gets Turned Down: Appeals Explained, from diatribe.org, 31 May 2017. 
It can be extremely distressing if an insurance provider decides to deny coverage of treatment. Fortunately, there are options available for asking the insurance provider to reconsider their decision and for letting them know why they should – this process is called “appealing.”
In fact, it’s often very worthwhile to appeal. A 2011 report sampling data from states across the US found that patients were successful 39-59% of the time when they appealed directly to the insurance provider (called an internal review), and 23-54% of the time when appealing through a third party (an external review) – the step taken when the internal review still doesn’t resolve the situation.
Despite this promising success rate, submitting an appeal can be a daunting task. The sections below aim to demystify the appeals process and provide an overview of why claims are denied and how they can be appealed.
Read more: When Insurance Gets Turned Down: Appeals […]

Savvy Gut, Gluten and Microbiome

I truly believe that in the next 5-10 years, scientists, biologists and medical professionals will know a lot more truth about the gut biome, gut bacteria in diabetics and gluten and other intolerances.  For now, there are lots of articles and most traditional medical professionals roll their eyes (yes, they really do … I saw them!!!) if you mention gluten, gut biome, leaky gut. lyme’s disease and more.  I often remind them that doctors, for the very longest time, believed ulcers were caused by spicy food! While “they” believe there isn’t just a single cause for ulcers, “they” do know ulcers come from an imbalance between digestive fluids in the stomach and duodenum. Most ulcers develop because of an infection in the lining of the small intestine with a type of bacteria called Helicobacter pylori (H. pylori). The treatment is a course of antibiotics … but that would have been pooh-poohed before 1982!

 

Gut Bacteria Linked to Diabetes was a headline in the Dr. Gabe Mirkin Reports, 11 June 2017, based on a report in Cellular and Molecular Gastroenterology and Hepatology, June 2017.

 
The study shows the Type 2 diabetes is linked to gut bacteria that invade the inner lining of the colon, while the dominant bacteria of most non-diabetics do not try to invade the inner lining of their colon.  The types of bacteria that invade your colon lining are the ones that turn on your immunity to cause inflammation that prevents your cells from responding to insulin. 
Accumulating evidence shows that avoiding the foods that foster the growth of colon-invading bacteria helps to both prevent and treat diabetes. These studies help to explain why you may be able to both help to prevent (Type 2) […]

Savvy Fun Quiz: The Carb Quiz

DLife.com published a great quiz about carbs to test how much you know about carbohydrates and blood sugar.  Takes just a minute, is very informative!

The 12-Question Carb Quiz

Diabetes Patient Voices Push the Industry SURVEY

From DiabetesMine:
As you may know, a core of the DiabetesMine Innovation Project is conducting annual surveys where we ask patients to speak up on what’s working, what’s not and why.

And then – the important part! – we package those patient sentiments and feed them directly back to the Powers-That-Be: all the top pharma and device companies working in diabetes, FDA regulators, mHealth designers, leading clinicians and other influential experts.
PLEASE HELP DiabetesMine & Beyond Type 1 gather patient input this year by spreading the word and encouraging PWDs to take this survey.

You can read more about this effort on the Beyond Type 1 website here.

A few sample tweets that might help:

Speak up in the 2017 @DiabetesMine Patient Voices Survey: http://tinyurl.com/DBMinePatientVoices-2017
Let #Diabetes Patient Voices lead the industry! Add your input here:
http://tinyurl.com/DBMinePatientVoices-2017 #DOC
Care about new tools that help improve life w/ #diabetes ? Add your patient input here: http://tinyurl.com/DBMinePatientVoices-2017 #DOC

PWDs: Help rate #diabetes tools & services! Take a few min to fill out the @DiabetesMine 2017 survey here http://tinyurl.com/DBMinePatientVoices-2017  #DOC
Thank you!!
Amy Tenderich 
Founder & Editor-in-Chief, DiabetesMin​e​