Savvy Updates, 6/15/20: Inhalable Insulin Fewer Lows, Medtronic’s $337 Million Product Investment, T1D Wisdom in Pandemic

Hypoglycemia Is Reduced With Use of Inhaled Insulin Relative to Insulin Aspart in T1D

A study found that participants treated with Afrezza experienced significantly fewer hypoglycemic events than participants treated with insulin aspart. Additionally, this reduction occurs without an increase in A1c. Afrezza starts working faster and remains working for a shorter duration.

Participants using Technosphere Insulin experienced clinically non-inferior glycemic control and lower hypoglycemia rates across a range of HbA_1c levels compared with participants receiving insulin aspart. ClinicalTrials.gov: NCT01445951.

Medtronic Announces a $337 Million Product Investment from Blackstone Life Sciences to Expand Development of Future Diabetes Technologies, as announced 12 June 2020.

Medtronic plc and Blackstone today announced that Medtronic intends to significantly increase research and development (R&D) funding in its Diabetes Group through an agreement to receive $337 million of funding from funds managed by Blackstone Life Sciences including co-investors, aimed at advancing new, innovative products especially designed to reduce the burden of diabetes management. Medtronic’s diabetes device portfolio is designed to improve patient outcomes and provide greater lifestyle flexibility to Type 1 diabetes patients, which includes approximately 22 million individuals worldwide and 1.5 million individuals in the United States.

“This investment is important for people living with diabetes, as we expect it will expand our offering of future insulin delivery and sensor innovations that have the potential to improve patients’ management of their diabetes,” said Sean Salmon, Medtronic executive vice president and president, Diabetes Group.

Under the terms of the agreement, Medtronic will receive up to $337 million in funding over the next several years to fund four identified Diabetes R&D programs. For competitive reasons, Medtronic is not disclosing the specific development programs. Medtronic’s engineering, clinical, and regulatory teams will perform the development work to activate these programs. If successfully commercialized, Medtronic will pay royalties which are expected to be in the low- to mid-single digit range as a percentage of sales.

We are living in most unusual and stressful times, with coronavirus and economic challenges … just high anxiety. We are now seeing another potential rise in Covid cases as states open up … and there is rebellion about wearing face masks. For those of us living with T1D, the reality is this: while we may not be an any increased risk of contracting the virus, we can be at 3.5x the risk of negative outcomes. So … many of us continue to shelter in, others move out but with caution … and the risk does continue.

Here’s a great and pertinent Guest Blog Post by Jessica Ching, T1D and Disruptive Health Innovator & Speaker, on Combatting Covid – 5-10# (pounds!)

Yup, it’s all that home baked bread. Brownies. Comfort food. Sitting on the couch instead of going to the gym (ok, so maybe you didn’t go that often before the pandemic).

If you’re like many people being homebound has had unintended consequences: 2 or 3, 5 or more pounds. For T1s this is especially difficult because weight gain often affects blood sugars. And “affects blood sugars” is not any good effects.

But work at home has some advantages too. Whether you are really working from home or “working from home” (wink wink) you probably have some daytime schedule flexibility. Here are my COVID-x tips to stay physically healthy and manage diabetes during a pandemic.

- Speaking of exercise

You might need to get moving but “exercise” doesn’t have to mean marathon training or a home gym. Partly because I wouldn’t use the home gym anyway! The easy solution for getting exercise is to just walk it off.

Walks are great for clearing your head, just getting out of the house, and managing BG (“BG” or blood glucose levels. Or I guess we could just call it what it is: blood sugars or “BS?”). My suggestion is if you’re going out for a walk, go longer. It’s not that hard to walk a full 60 to 90 minutes or more. While walking you can enjoy the scenery, bring your phone and chat with family, walk the dog, and distance walk with friends.

- Ban eat-backs!!!

The awful thing a

s we T1Ds know is that exercise can cause lows, and then you have to eat back the calories you burned off !@*#@#$!!

Tips to avoid this: (a) walk after meals (and reduce your meal dose), or, (b) for pumpers, cut your basal rate by half or more, two hours before exercise. I’ve been doing method (b) for 20+ years and have run a couple thousand miles with little to no food, and minimal lows and highs.

- CGM trends

I found that insulin activates about twice as fast if combined with exercise. So if see you’re going up, you can take a correction dose and go out for a short walk around the block a couple times. With even this small amount of exercise, insulin starts to kick in and bring you back down much faster. You don’t need to walk until you see a downward trend— I just look for an improvement in the trend.

You can do this any time you see an upward trend, and can take a quick break from what you’re doing. If I see an upward trend but I know my bolus is correct for the food I ate, I know food is winning the race in my bloodstream. So with some insulin on board, I just take a quick 10 or 15 minute walk break; easier since working at home schedules are flexible. A short while later I usually see I’m headed for normal range. Much better than waiting an hour or two for the insulin snail to do the work on its own.

- F&V

Fruits and veggies are your friend. These fresh babies of nature are a great “calorie value,” they slow down the absorption of carbs, and fill you up. Since you have more time on your hands and walking to do but nowhere to go, why not go to the grocery store? I’ll go just to get a banana for my smoothie. Garlic. Persian cukes. Summer peaches! You get the picture. Bring your backpack, mask and credit card.

- When in Rome…

When in shelter, do stuff you’ve been putting off at home. The bonus in addition to getting home stuff done is the free exercise! It’s a totally legit form of burn off.

Clean out your spare room or garage, work on or improve your yard, move out old furniture, or do any of those things that are months (or years) overdue. Same no eat-back rule: do it after a meal or over several days after a meal, or turn down your basal rate. I worked 5 hours in the yard last weekend with no lows, no highs, and no eat-backs. 5 hours of great fat burning time. Yea!!

- Intermittent fasting

I have to admit I did try this newest fad, for a couple of weeks. It worked for COVID – 5-10# (pounds) purposes. But the downside is you can only eat during your eating hours! Long summertime days make it hard for me to stick to this schedule, so I’ve switched back to the long walks + pop-up walks.

- Carbs and goodies

Personally, I’m just not willing to stop eating what I love. Life is too short. In the last 2 weeks of March when things were really weird, I went overboard on comfort foods and desserts and carbs— who wouldn’t want to make sure their favorite bakery also survives COVID? However, I found I could eat mostly anything by taking long walks. It does help to reduce (not remove!) carbs, but the key seems to be total daily dose of insulin. Once this goes down, flab goes down with it.

All of these things have helped me get over COVID – 5-10# (“pounds”) and has been good for BG-BS. Mo’ veggies, mo’ exercise, and mo’ walks around the block for faster response. These small changes helped with COVID – 5-10# and also improved my time above range by around 30%. Hope you stay healthy, and free of both COVID-19 and COVID – 5-10#.