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19th Annual Shooting Stars JDRF Walk to Cure Diabetes Sunday, October 26, 2014 in Newport Beach, CA

For a contribution of $45 (or MORE!), walkers will receive a VERY COOL Shooting Stars Team T-Shirt along with FREE pastries, bagels, and coffee or juice. Questions or to Register email joanne@TheSavvyDiabetic.com. If you are unable to attend but would LOVE to donate on-line go to: http://www2.jdrf.org/goto/ShootingStars.

Savvy Updates 7/21/2016: CGM Benefits Shot Takers, Sleep & Diabetes Risk, Human Gut Microbiome, Intensive BG Control and Kidneys

CGM Benefits Injection Users, according to the results from Dexcom’s DIaMonD Study, presented at the ADA Scientific Sessions in June, 2016 and reported by www.diaTribe.org, 6/28/2016.  According to Dr. Howard Wolpert of the Joslin Diabetes Center, healthcare providers should consider recommending CGM to ALL patients with Type 1 diabetes who have not attained their glucose goals, not just those on insulin pumps.  Currently only about 7% of MDI users with Type 1 use CGM.

DIaMonD adds to the evidence that CGM improves time-in-range, reduces highs and lows, and improves A1c. This does not come as a surprise since glucose value and trend can be observed every five minutes and alarms sound for lows and highs, allowing people to recognize patterns, tighten the feedback loop, and take action to improve.
I’ve always said that if I were forced to choose between using a pump or using CGM, hands down, I’d choose my CGM.  Even though it is not perfect and you have to make sure not to overreact and overcorrect with such instantaneous data, it gives me trends and patters as well as annoying but necessary alerts.
By the way, DIaMonD stands for Daily Injections and continuous glucose Monitoring in Diabetes.
Read more: Does CGM Benefit Injection Users? Yes!
 

Men Who Sleep Too Much OR Too Little May Have Impaired Insulin Sensitivity … BUT NOT WOMEN, according to a study published on June 29, 2016 in the Journal of Clinical Endocrinology & Metabolism, and reported in EndocrinologyAdvisor.com.
Really?!?!?  Wow, that’s wild!
Compared with men who slept about 7 hours a night, the men who slept the most or the least were more likely to have impaired insulin sensitivity and beta-cell function, putting them at increased risk for diabetes.
However, the researchers found that compared with […]

FDA Advisory Meeting on CGM: Votes in Favor of Expanding CGM Use!

FDA’s Advisory Committee meeting just voted to recommend approval of the expansion of the Dexcom G5 CGM label. Thank you DPAC (Diabetes Patient Advocacy Coalition)!

 

The results are in and the FDA panel has voted the following for the labeling change of the Dexcom G5 Continuous Glucose Monitoring System:

Is there reasonable assurance that the Dexcom G5 Continuous Glucose Monitoring System is safe for the proposed indications of use?  YES: 8 NO: 2
Is there reasonable assurance that the Dexcom G5 Continuous Glucose Monitoring System is effective for the proposed indications for use? YES: 9 NO: 1
Do the benefits of the Dexcom G5 Continuous Glucose Monitoring System for the proposed indications of use outweigh the risks of the Dexcom G5 Continuous Glucose Monitoring System for the proposed indications for use. YES: 8 NO: 2

Thanks to everyone who shared support with FDA through the DPAC petition or other means. Patients’ voices are an important consideration in decision-making and we have shown with this success that we are being heard. This is just a quick thanks for being part of the good news.

Please remember that this is just an FDA Advisory Panel which sends recommendations to the FDA for a final ruling. But it is a great step in the right direction! Next, maybe Medicare will remove the caution of CGM being simply “precautionary”, and thereby affording Medicare coverage for CGM.

ADA 2016 Scientific Sessions ~ Artificial Pancreas, Finding a Cure, Better Cannulas

From the American Diabetes Association 2016 Scientific Sessions, held in New Orleans, June 2016.

Artificial Pancreas: Several new products in development show tremendous improvements in glycemic control and reductions in hypoglycemia … and they are not far off now.

Medtronic’s insulin-only hybrid closed-loop 670G system is the  furthest along … premarket approval submission to the FDA is expected this summer.

Close behind is the “bionic pancreas”, developed by Dr. Ed Damiano from Boston University.  A fully integrated dual-chamber device, called the iLet will come out by Beta Bionics, a public benefit corporation, working with Denmark-based Zealand Pharma.  One chamber will hold insulin, and the other chamber, with a separate infusion set, will hold a new stable glucagon analog.  The iLet single change device will reach the market first, due to the torturous regulatory path.

I had the opportunity to hear Dr. Damiano speak this month, to see the data charts of the amazing effectiveness of the dual chamber system … and to actually see the iLet prototype.  I wish I had this device NOW! (More on this in an upcoming post.)

Read more:        Coming Soon: ‘Artificial Pancreas’ Options for Diabetes
Artificial Pancreas is Coming, Other Highlights from ADA 2016
 

A Cure for Type1: A press conference called Beta-Cell Replacement pointed to 2 possible cures, still a ways off.

Dr. David Cooper at the University of Pittsburgh is working to genetically engineer pigs to produce beta cells that wouldn’t trigger their recipients’ immune systems (instead of forcing recipients to take large doses of immunosuppressant drugs).  That’s right, fix the pig, not the human!

Dr. Chad Cowan from the Harvard Stem Cell Institute, a co-founder of CRISPR Therapeutics, is trying to create genetically modified human stem cells that would be invisible to the immune […]

An Interesting Exchange about Diabetes Alert Dogs

I subscribe to www.insulinpumpers.org … a wide-ranging but well-managed forum about living with mostly T1 diabetes.  I can post a question or a comment … responses come back pretty fast.

Today, I read a series of interesting posts about Diabetes Alert Dogs (D.A.D.) … just had to share it with you. (Full names and email addresses have been deleted)

 

 

 

 

 

 

 

 

 

Subject: (Now) Diabetic Alert Dogs

From: Melody

This subject is a little painful for me because I just lost my Diabetic Alert Dog yesterday to a mass on his colon, two weeks shy of his 11th birthday.

I trained dogs for 30 years before training Boone for this job, — training any type of service dog is a large undertaking, usually about 2 years for a reliable medical alert dog with public access training.

And the “washout” rate is high, even among the major guide dog schools, because it’s often toward the end of formal training when the dog reveals that (s)he would rather be a treasured pet, or working in another career.

Not everyone would want to embrace the service dog lifestyle, either.  It’s a big responsibility, it’s time consuming, and it certainly draws attention to the person on the end of the leash.

But . . . a good alert dog can detect a low or a rapidly dropping BG long before the meter or the CGM.   They can dig you out from under the covers during a nocturnal hypo, and knock on the shower door when you’re low.  With more training, they can retrieve a meter kit, find the glucose tabs, get juice from the fridge, fetch a telephone, push a call button, alert a family member.   Mine rode in the back seat while I drove and would put […]

Video: T1 Diabetes in 2016 ~ hilarious skit!

Starring Dr. Steve Edelman, Jeremy Pettus, Dr. Bill Polonsky and Kelly Close … ENJOY!

Smart Insulin Update: Is It Really Smart Yet?

Here’s a great review article from the JDRF-Helmsley Charitable Trust Glucose Responsive Insulin (GRI) workshop last month, as reported by Emily Regier, Alexander Wolf and Kelly Close in diaTribe.org, 5/20/2016.

The theory behind “Smart Insulin”: a next-generation insulin that works automatically in response to blood glucose: the higher the blood sugar, the more insulin is released or activated, and the lower the blood sugar, the less insulin is released or activated.

As noted in this article, the long-term, “best case scenario” idea of the “perfect” smart insulin is very compelling for people with diabetes on insulin: one injection per day, blood sugar levels that stay in zone without hypoglycemia, no more carb counting, no more guessing what dose is correct, no more feeling frightened, and a much safer and less stressful life. That would be my “Dream Insulin.”

The reality, as the leaders emphasized at this meeting, is that glucose responsive insulin (GRI) is still in its infancy, and development will likely proceed in steps: the first generation of these drugs may offer some, but not all, of the anticipated benefits.

Definitely something to watch but don’t hold your breath! Maybe there’ll be a cure before there is smart insulin?!

Read the entire review: Getting to Glucose Responsive Insulin – How “Smart” Will It Be?

 

 

NEWS FLASH: Medicare Told to Cover CGMs

Medicare doesn’t typically provide coverage for continuous glucose monitors (CGMs), as insurors who oversee Medicare coverage have long argued that CGMs are a “precautionary” device rather than a “medically necessary” one. Now, that argument’s premise is facing serious questions in federal court and in the Medicare appeals process.

The first case that successfully pushed back against the policy involved Wisconsin resident Jill Whitcomb, who has had Type 1 diabetes for 40 years. Ms. Whitcomb was first prescribed a CGM by a nurse practitioner, and she used it successfully during a six-month trial. In 2011, she sought to have the device covered under her UnitedHealthcare Securehorizons Medicare plan. The Medicare-insuring contractor denied the claim.

She appealed through the complex Medicare appeal process. Two years later, when she’d reached the administrative law judge (ALJ) level of appeal, a judge determined that even though a CGM didn’t fit into Medicare’s definition of “glucose monitor,” the benefit was indeed available under her plan. UnitedHealthcare appealed to the Medicare Appeals Council, which reversed the decision by arguing that a CGM is a “precautionary” rather than “medically necessary” device. Ms. Whitcomb took her appeal a step further to the federal district court for eastern Wisconsin. In May 2015, a federal judge ruled that the Medicare Appeals Council decision was in error and sent the case back to the council. That’s where the case now stands.

Debra Parrish, a former DHHS staff attorney who now represents Ms. Whitcomb, successfully pushed back against UnitedHealthcare’s outdated understanding of what a CGM does. She also was able to show that a CGM represents a more efficient and less error-prone method of keeping tabs on one’s glucose count, and that the device was more capable of warning the […]

Savvy Updates: 5/30/2016: T1 and Bacteria, 90-day CGM, Lab Beta Cells, & MORE

Type 1 Diabetes May Be Triggered by Bacteria

Reported by Honor Whiteman, MedicalNewsToday.com, 5/17/2016
A study by researchers from Cardiff University in the UK suggests that a part of a bacterium that activates killer T cells may cause them to bind to beta cells and kill them.
“Killer T cells sense their environment using cell surface receptors that act like highly sensitive fingertips, scanning for germs,” explains Dr. David Cole of the School of Medicine at Cardiff.
“However, sometimes these sensors recognize the wrong target, and the killer T cells attack our own tissue. We, and others, have shown this is what happens during type 1 diabetes when killer T cells target and destroy beta cells.”
Once these beta cells are destroyed, insulin is no longer produced, meaning patients will require lifelong insulin therapy in order to control blood glucose levels.
In other words, Killer T cells go “a little crazy” and kill the wrong guys!
Read more: Type 1 Diabetes May Be Triggered by Bacteria7
 

Eversense 90-day Implantable CGM Receives CE Mark Approval

diaTribe 5/20/2016
Senseonics recently announced CE Mark approval in Europe for its Eversense 90-day implantable CGM sensor, body-worn transmitter (worn over the sensor), and mobile app for viewing real-time glucose data.
Eversense is being positioned as the “world’s first long-term wear sensor,” as current glucose sensors from Abbott (FreeStyle Libre), Dexcom (G4, G5), and Medtronic (Enlite, Enlite 2) require a new insertion every 7-14 days. Eversense uses a 90-day implanted sensor (a bit larger than a pill) that is placed in the upper arm in a 5-10 minute in-office procedure. A rechargeable transmitter device is worn on top of the skin, directly over the sensor, which powers the implant and sends the current glucose value and trend arrow to a smartphone. […]

Just Sayin’

This was posted from Camp NYDA (a camp for kids with diabetes way back when I was a teenager in NY, run by the American Diabetes Association of NY.

What do you think? I like it!

Diabetes Blog Week (My Tip): SMILE~ LAUGH~ GIGGLE

The topic is Tips and Tricks, everything from how I organize for travel to how I keep track of medications to what I do that is “unconventional.”
I SMILE.  A lot.  And often.  As often as possible, I LAUGH or GIGGLE.  This is NOT a cop-out.  I really SMILE or LAUGH or GIGGLE as a way to cope and get by and feel better. I don’t actually always feel like smiling or laughing or giggling.  But I do it to feel better, reduce my anxiety and help me put it all into perspective.  Plus I just think I look younger that way

“Sometimes your joy is the source of your smile,but
sometimes your smile can be the source of your joy.”  
~ Thich Nhat Hanh

 
Benefits of Smiling and Laughing (that includes Giggling)

Neurotransmitters called endorphins are released when you smile. These are triggered by the movements of the muscles in your face, which is interpreted by your brain, which in turn releases these chemicals. Endorphins are responsible for making us feel happy, and they also help lower stress levels. Faking a smile or laugh works as well as the real thing—the brain doesn’t differentiate between real or fake as it interprets the positioning of the facial muscles in the same way. This is known as the facial feedback hypothesis. The more we stimulate our brain to release this chemical the more often we feel happier and relaxed.

Endorphins make us feel happier and less stressed. They also act as the body’s natural pain killers. For sufferers of chronic pain, laughing and smiling can be very effective in pain management, as can laughing off the pain when you bump an elbow or fall over.

While the release of endorphins is increased, […]