Injecting Insulin Into Muscle: Good or Bad? was reported by Ginger Vieira for InsulinNation.com, 18 July 2019.  Insulin was designed to be injected into body fat (“subcutaneous tissue”) but when injected into muscle, insulin acts much more quickly.  Injecting insulin into muscle instead of fat is just another option for those who need their insulin to work much faster than usual and absorb more predictably,” according to Gary Scheiner, CDE and Director of Integrated Diabetes Solutions.

Is injecting insulin into your muscle safe?  The short answer is yes. The longer answer is that it should be done very thoughtfully and only when absolutely necessary.

Do not inject long-acting insulin into muscle.  This will severely interfere with ensuring it stays active in your body for as long as it’s supposed to in order to cover your background insulin needs.

It’s also important to remember that the insulin you inject will affect your blood sugar far sooner than a normal injection, putting you at risk for low blood sugars if you’re not prepared for that drop.  Certain situations or issues can make injecting insulin into muscle a useful option — as long as you’re not doing all or even most of your injections like this.

When is it useful to inject insulin into muscle instead of body fat?

• • When your blood sugar is high and you’re dehydrated (due to ketones etc.) “When high blood sugar is accompanied by dehydration — like when your pump-site fails and you’re producing ketones quickly. Insulin administered into the subcutaneous fat layer may not absorb properly due to reduced blood flow to the skin. But an intramuscular injection will work,” explained Scheiner.
  • When your blood sugar is high prior to an important activity (athletic event, exam, medical procedure, etc.).  “Using an intramuscular injection to correct a high blood sugar prior to an athletic event, an exam, a medical procedure can help lessen the impact the high will have on your performance. Especially when there isn’t enough time for a traditional subcutaneous injection to work,” explained Scheiner.
  • When you forget to take insulin for a meal… “If you flat out forget to take insulin with your meal, and you remember later on when your blood sugar is already unusually high, injecting into muscle can be very helpful,” explained Scheiner. In this scenario, you’re not only helping to correct the high sooner but using an intramuscular injection to prevent your blood sugar from climbing even higher while your meal continues to digest.

Read more:  Injecting Insulin Into Muscle: Good or Bad?

List of tests for diabetes was published by Deborah Weatherspoon, PhD, RN, CRNA for MedicalNewsToday.com, 11 July 2019. 

Type 1 diabetes develops when the body does not produce enough insulin.  We all know this.  But I thought this was an interesting list of lab tests for the T1 diabetic. 

• FPG: This blood test indicates how well the body is processing glucose.
• C-peptide: The pancreas produces this protein alongside insulin. Low levels of C-peptide in the blood can suggest low levels of insulin.
• Insulin autoantibodies: This test checks for the presence of proteins that target and destroy insulin.
• Glutamic acid decarboxylase autoantibodies: Doctors use this test to check for the presence of antibodies that can destroy enzymes in insulin-producing cells.
• Insulinoma-associated 2 autoantibodies: The presence of these antibodies can also indicate that the body is attacking the cells that produce insulin.
• Islet cell cytoplasmic autoantibodies: The Juvenile Diabetes Research Foundation estimate that 80% of people with type 1 diabetes have this type of antibody.
• Zinc transport 8: This test identifies antibodies that kill insulin-producing beta cells.

Read more:  List of tests for diabetes

Performance-Enhancing Bacteria Found in the Microbiomes of Elite Athletes was reported by Joslin Diabetes Center, 24 June 2019. 

New research has identified a type of bacteria found in the microbiomes of elite athletes that contributes to improved capacity for exercise. These bacteria, members of the genus Veillonella, are not found in the guts of sedentary people.

By taking a closer look at the bacteria, the researchers from Joslin Diabetes Center determined Veillonella metabolizes lactic acid produced by exercise and converts it into propionate, a short chain fatty acid. The human body then utilizes that propionate to improve exercise capacity.  The results were reported today in Nature Medicine.

Read more: Performance-Enhancing Bacteria Found in the Microbiomes of Elite Athletes

Why orthopedic shoes may not really be good for our feet was written by Maria Cohut for MedicalNewsToday.com, 18 July 2019. 

“As habitually barefoot individuals are thought to develop thick calluses, and individuals with minimal calluses often find barefoot walking on rough surfaces to be uncomfortable, it is commonly assumed that thick calluses, similar to thick shoe soles, trade off foot protection with the ability to perceive tactile stimuli,” the researchers, led by Dr. Daniel Lieberman, note in their study paper, which appears in Nature.

“However,” they continue, “if callused skin is stiff, it should transmit mechanical stimuli to the [specialized sensory receptors] in the deeper [skin layers] with little dampening [of sensation].”  This, they go on to explain, would make sense because processing sensations from our feet helps us make automatic judgments about the terrains we navigate, allowing us to maintain our balance and move safely.

The researchers argue that wearing footwear with uncushioned soles might come closer to the experience of having natural calluses, when it comes to offering protection without affecting tactile sensitivity and, possibly, our posture and balance. In their paper, the authors conclude:“There is a need for prospective studies on the potential costs and benefits of minimal footwear, such as moccasins or sandals, with relatively thin, stiff, and uncushioned soles that function more similarly to calluses, relative to highly cushioned shoes that have become common only since […] the industrial era.”

Read more: Why orthopedic shoes may not really be good for our feet

T1D and Heart Failure Risk: Not Equal Between Sexes was written by Kristen Monaco for MedPageToday.com, 18 July 2019. 

Women and men with diabetes have different degrees of heart risks, researchers reported from a meta-analysis.

Among more than 12 million people analyzed in published studies, women with type 1 diabetes had more than five times the risk for heart failure than in women free of diabetes (risk ratio 5.15, 95% CI 3.43-7.74), reported Toshiaki Ohkuma, PhD, of the University of New South Wales in Australia, and colleagues.

Although men with type 1 diabetes also had a significantly higher risk of heart failure compared with men free of diabetes, its magnitude wasn’t quite as high as for the women (RR 3.47, 95% CI 2.57-4.69), the team wrote in Diabetologia.

Read more:  T1D and Heart Failure Risk: Not Equal Between Sexes

The Dexcom Interview was shared by Ross Wollen for ASweetLife.org, July 2019. 

ASweetLife was lucky enough to score an interview with Kevin Sayer, the President & CEO of Dexcom.

ASweetLife published their interview in two parts. In part one, Sayer sketches out Dexcom’s business strategy going forward, following the runaway success of the G6 Continuous Glucose Monitor (CGM). The G6 was released last year, delighting patients and sending Dexcom’s stock price soaring. The company has big plans, and we consider the upshot for people with Type 1 diabetes. In a forthcoming part two, Sayer teases us with the next generation model, the G7.

Part 1:  While Hemoglobin A1C has long been the single critical measure by which diabetes control has been judged, the rise of the CGM has given users new metrics to pay attention to: standard deviation and time-in-range. Forward-thinking endocrinologists have encouraged their patients to pay close attention to these new markers. The more that experts accept that time-in-range (or other, related measures) is the best measure of glucose control, the more doctors and patients will request it, and ultimately, the more insurance companies will feel obligated to pay for it.

Read more:  The Dexcom Interview, Part 1: “Standard of Care”

Part 2:  Dexcom continues to announce new collaborations with other firms that will enhance the G6’s functionality. In the past year, Dexcom acquired diabetes management system TypeZero and announced partnerships with several other firms to increase the system’s interoperability. And continually improving accuracy is a constant goal with the company.

“All these features we’re putting into the G6 are going into the G7, because the G7 is not a change of the algorithms or app experience, it’s a completely physical change.

“The insertion will be actually easier than G6. The transmitter will be disposable. The sensor is significantly smaller than the G6. We have committed internally to an extended life of up to 14 or 15 days. It is designed to be manufactured at mass volumes. Our hope is that, over time, it will be a cost-saving endeavor, that it’ll actually save money.

Read more:  The Dexcom Interview, Part 2: Introducing the Dexcom G7

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