November is National Diabetes Awareness Month. Perhaps you, a family member, or a friend has diabetes. By reading this article, you can share this information and/or use it yourself to help manage diabetes. The first step to effective management is a good understanding of the diabetes disease process. From there, you can build upon that foundation to know signs or symptoms, how to monitor, knowing when to call your provider before symptoms worsen, importance of provider follow up, and most importantly adhering to the non-pharmacological (diet and exercise) and pharmacological prescribed regimens. This article will focus on four key questions surrounding diabetes and diabetes management.

1) How does diabetes affect Americans?
In 2019, 37.3 million Americans, or 11.3% of the population, had diabetes. Nearly 1.9 million Americans have type 1 diabetes, including about 244,000 children and adolescents.1 1.4 million Americans are diagnosed with diabetes every year, making the U.S. #3 in countries with the highest rate of Diabetes.2

2) What are the different types of diabetes?

Type 1 Diabetes:
Type 1 diabetes is a disease that starts when the pancreas stops making enough of a hormone called insulin. Insulin helps the body use sugar from food as energy or store it for later use. If there isn’t any insulin, too much sugar stays in the blood. Over time, high blood sugar can harm many parts of the body. These include the eyes, heart, blood vessels, nerves, and kidneys.
Type 1 diabetes can occur at any age, but it usually starts in children or young adults. It’s a lifelong disease. But with treatment and a healthy lifestyle, people can live a long and healthy life.3

Gestational Diabetes:
Gestational diabetes is high blood sugar that first occurs during pregnancy. High blood sugar can cause problems for you and your baby. But with treatment, most women can control their blood sugar and have healthy babies. Blood sugar levels usually go back to normal after the baby is born.4

Prediabetes:
Prediabetes is a warning sign that you are at risk for getting type 2 diabetes. It means that your blood sugar is higher than it should be, but not high enough to be diabetes. Prediabetes is also called impaired glucose tolerance or impaired fasting glucose. Most people who get type 2 diabetes have prediabetes first.5

Type 2 Diabetes:
Type 2 diabetes is a condition in which you have too much sugar (glucose) in your blood. Glucose is a type of sugar produced in your body when carbohydrates and other foods are digested. It provides energy to cells throughout the body. Normally, blood sugar levels increase after you eat a meal. When blood sugar rises, cells in the pancreas release insulin, which causes the body to absorb sugar from the blood and lowers the blood sugar level to normal.When you have type 2 diabetes, sugar stays in the blood rather than entering the body’s cells to be used for energy. This results in high blood sugar. It happens when your body can’t use insulin the right way. Over time, high blood sugar can harm many parts of the body, such as your eyes, heart, blood vessels, nerves, and kidneys. It can also increase your risk for other health problems (complications).6

3) What are some potential complications associated with diabetes?
There is no cure for diabetes. Management of diabetes is important to prevent and/or delay long term complications (risk for getting other health problems). This is especially true if your blood sugar levels stay high. Over time, high blood sugar can damage many parts of your body. It can lead to a variety of problems, including problems with your:

Eyes: High blood sugar levels may cause temporary blurred vision. Blurry vision, floaters, or flashes of light may be a sign of diabetic retinopathy, which can lead to severe vision loss. Having diabetes also puts you at risk for cataracts and glaucoma.
Heart and blood vessels: High blood sugar damages the lining of blood vessels. This is called hardening of the arteries, or atherosclerosis. It can lead to stroke, heart attack, peripheral arterial disease, or heart failure. Erection problems can be an early warning sign of blood vessel disease and may mean a higher risk of heart disease.

Nerves: High blood sugar levels can damage nerves throughout your body. This damage is called diabetic neuropathy. There are different types of neuropathy. They may be caused by damage to nerves that sense things like pain or touch or that control things like your heartbeat, digestion, or blood pressure. Nerve damage can be painful, especially in the feet.
Feet and skin: You may have less feeling in your feet. This means that you can injure your feet and not know it. Common infections from blisters, ingrown toenails, small cuts, or other problems can quickly become more serious when you have diabetes.

Kidneys: High blood sugar can damage tiny blood vessels in your kidneys that help filter waste from your blood. This kidney damage is called diabetic kidney disease (sometimes called diabetic nephropathy). You may not have any symptoms until the damage is severe. Then you may notice swelling in your feet or legs or all over your body.

Infections related to diabetes: High blood sugar from diabetes can affect the body’s immune system. The immune system is the body’s natural defense system that helps fight infections.
People with high blood sugar from diabetes can be more severely affected by common infections, such as influenza and pneumonia. They also are more likely to be infected with unusual organisms, such as Gram-negative bacteria or fungi.7

4) What can you or someone you know do to help prevent and/or manage diabetes?

Prevention – You can help prevent or delay complications by keeping your blood sugar in a target range. You also need regular medical checkups to look for early signs of complications. If complications are treated early, the damage may be stopped, slowed, or reversed. 7

Management of diabetes –
• Follow up with your physician. Your physician will monitor lab values (hemoglobin A1C) (defined below), kidney function tests, and others as needed/warranted] on a routine basis. Eye and foot exams are also recommended to be performed every year.
• Stay up to date with recommended vaccinations.
• Keep up on latest education, treatments for diabetes. Diabetic educators are available to assist and educate with diabetes. The ADA (American Diabetic Association) is a great resource.
• Monitor your blood sugar based on your physician’s treatment plan.
• Understand the signs and/or symptoms of low and/or high blood sugar.
• Diet, nutrition, exercise – follow your physician’s suggestions. Coaches, Dieticians, Care managers, and/or Diabetic educators are available to assist, check with your health plan for benefit coverage.
• Take your medications/insulin as prescribed by your physician.
• Utilize your smart phone application(s) that help with managing Diabetes.
• Joining a support Group (online and/or in person sessions) may be beneficial in connecting with others that are affected by Diabetes.

• List of Sources:
  1) American Diabetes Association. Website url: https://diabetes.org/about-us/statistics/about-diabetes. Accessed 10/19/22
  2) Medical News Today. Website url: https://www.medicalnewstoday.com/articles/diabetes-rates-by-country#type-2. Accessed 10/23/22
  3) Healthwise: Website url link: Type 1 Diabetes (healthwise.net). Accessed 10/19/22
  4) Healthwise: Website url link: Gestational Diabetes (healthwise.net). Accessed 10/19/22
  5) Healthwise: Website url link: Prediabetes (healthwise.net). Accessed 10/19/22
  6) Healthwise: Website url link: Type 2 Diabetes (healthwise.net). Accessed 10/19/22
  7) Healthwise: Website url link: Diabetes Complications (healthwise.net). Accessed 10/19/22
  List of additional Resources:
  1) https://www.heart.org/en/health-topics/diabetes/diabetes-tools–resources
  2) https://professional.diabetes.org/search/site?f%5B0%5D=im_field_dbp_ct%3A32&retain-filters=1

We all need to be cautious as COVID-19 continues to spread across the United States. However, people with type 1 or type 2 diabetes need to be extra careful. According to the CDC, the risk of catching the virus isn’t greater for those with diabetes, but the symptoms could be worse. That’s especially true if diabetes is not well managed or controlled. Here are some ways to reduce your chance of contracting COVID-19 if you have diabetes.

• Keep your distance
  The best way to avoid getting sick is to stay home. However, we know that is not always possible. If you do go out, stay 6 feet away from other people and wear a face mask.
• Use good hygiene
  It’s important to wash your hands often to prevent the spread of infection. Be vigilant about washing your hands before you give yourself a finger stick or insulin shot. Also, remember to clean each area first with soap and water or rubbing alcohol.
• Keep your blood sugar under control
  When you have diabetes, your blood sugar levels may be consistently high. Many parts of your body can be affected or damaged by too much sugar including your immune system, which puts you at greater risk of infection.
• Keep moving
  Your lifestyle may have changed since the COVID-19 pandemic. You may be working remote, going out less, or avoiding the gym. However, moderate activity is still very important to your overall health and management of diabetes. Yard work, brisk walking, cycling, or in-home workouts are all safe ways to get exercise.
• Supportive family and friends
  To protect you, your friends and family should take extra precautions. Some of these may include washing their hands more often, not sharing personal items, and wearing a face mask if you’re in the same room.
• Stay positive
  Staying positive and focusing on those circumstances you can control is always a good foundation for health. Mindfulness activities and gratitude will go a long way to maintaining wellness.

If you do start feeling sick and have COVID-19 symptoms such as a dry cough, fever, or shortness of breath, call your doctor.

Source: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

While there may be some debate as to who deserves credit for originally developing insulin in the 1920s, there is no doubt that its serendipitous discovery had a life-saving impact. In an attempt to provide affordable treatment to the public, the researchers opted to sell the patent for insulin to the University of Toronto for $1. The researchers later collaborated with a pharmaceutical company to develop insulin due to limited ability of the university to develop it on its own. Once made primarily from animal sources in limited selection, several insulin options are now available, and each product differs slightly in manufacturing and design to better mimic the lacking endogenous insulin in patients with diabetes. Today, insulin is marketed primarily by three manufacturers, and counterintuitive to its length of time on the market as a primary treatment, insulin costs continue to increase. One assessment reported that annual spending per person with type 1 diabetes nearly doubled between 2012 and 2016, and the reported cost of one specific brand of insulin increased by 668% from 2001 to 2015. There are several purported reasons for the high costs of insulin, even resulting in lawsuits and a push for legislative involvement.

The high cost of insulin is a hurdle for many patients and the entire healthcare system, especially considering a reported 1.2 million Americans have type 1 diabetes and a portion of the nearly 30 million Americans with type 2 diabetes are insulin-dependent. So, what happens when a medication necessary for life continues to increase in price? Patients may resort to acquiring insulin from less expensive resources outside of the United States (US). In addition, some patients will continue to use insulin vials beyond their stable use (i.e., beyond 28 days once opened) or share insulin pens. Patients may ration their insulin for their own use or sell the remaining insulin to others, as the temptation for potential income may be too enticing for those with limited financial means. One study reported that the rise in costs has resulted in nearly 25% of patients not taking insulin as directed. Lack of blood glucose control resulting from these measures could be life-threatening.

Taking insulin access to another level, one project aims to develop a protocol for insulin production that would circumvent intellectual property concerns, enabling manufacturers to produce more affordable insulin. Theoretically, an open protocol for manufacturing of insulin could result in community biolab production or somewhat “home-brewed” insulin, but there would still be several costly regulatory hurdles for each product. Even if crowdfunding could support these “biohacked” insulin barriers, would the resulting product be the best treatment for all patients? Would it still result in a high-cost product?

Historically, the US Food and Drug Administration (FDA) has regulated insulins as small molecule drugs; thus, the few generics available are actually branded competitors and considered “follow-on” insulins. The FDA has announced insulins will be transitioned from the small molecule pathway to the biologics pathway effective in March 2020 as part of their Biosimilars Action Plan. According to acting FDA Commissioner, Dr. Ned Sharpless, after this transition, the FDA will be able to license biosimilar and interchangeable insulin products that may be substituted at the pharmacy, potentially leading to increased access and lower costs for patients.

While the idea for “generic” (cheaper) insulin is becoming more of a reality, what will patients do in the meantime for a disease state in which the treatment is not optional? Will interchangeable biosimilar insulin finally be the solution for reversing the constant upward trajectory of insulin prices?

The holidays are an opportunity to gather with family and friends and are filled with endless quantities of sweets at school, work and home. But the celebration over food and eating during this season can be very tough, especially for those living with diabetes.

Before you decide to hide from family and friends, you should know that being diabetic doesn’t mean you have to give up your favorite holiday traditions. With a little planning and preparation you can make better choices this holiday season and still enjoy your favorite treats. Stay in control of your weight and glucose levels this holiday season by following these 10 easy tips.

Focus on the fun – The holidays are our opportunity to spend time with family and friends. Focus on some of the fun holiday rituals and traditions like tossing a football, trimming the tree or gathering with loved ones. Making a conscious effort to redirect your thoughts can make a big difference in the decisions you make.

Eat before the feast – Skipping a meal or snack earlier in the day to save calories for the big feast later on will make it much harder to control your blood glucose. People are more like to overeat when they are hungry.

Find treats that work – Look for treats to help you satisfy that craving to indulge over the holidays. Substituting sparkling water and tea in place of sugary soft drinks are ways to enjoy the holiday experience without adding a lot of calories. Consider seeds and nuts as they are a great source of protein and healthy fat.

Save calories for very special treats – Training yourself about what to indulge in and what to skip is a lot like effectively managing your money. Instead of eating the store-bought cookies, maybe hold out for the homemade treats that are special to you and your family.

Get back on track – Redirect your focus on the people around you, not the food. Try and incorporate some extra exercise that day, monitor your glucose levels and get right back on track the next day with your usual eating routine.

Reduce the fat – Reduce the fat and calories in the traditional recipes by using fat-free or low-fat milk and cheese. Trim meats before cooking and remove skin before eating. Cook meats on a rack so that the fat can slowly drip away. Many baking recipes can be adjusted by using applesauce in place of half the butter.

Go light on the gravy and sauces – You may not be able to control what’s being served during the holidays, but you can control what you put on it. Try limiting (or cutting out altogether) the less healthy sauces or gravies that are typically offered.

Stock your freezer with healthy meal options – Take a proactive approach several weeks ahead of time by cooking meals intended specifically for your freezer. And if you don’t have time to cook, purchase and store healthy frozen meals for your freezer. You’ll thank yourself later when you can pop one of those healthy meals in the oven and turn your attention to your holiday chores.

Drink in moderation – If you choose to drink alcohol, it is important to remember to eat something beforehand to prevent low blood glucose levels. Drinking alcoholic beverages can add a significant amount of calories to your holiday intake. Try limiting servings to one drink for ladies and two drinks for gentlemen, per occasion.

Stay active – Lack of physical activity is a major reason we have problems with weight and diabetes management over the holidays. Understanding that this is a busier time of year than normal, it is extra important to plan time each day for exercise. Consider a nice long walk about an hour after a holiday meal.

This holiday season is about celebrating and enjoying the people in your life. With some careful planning and smart choices, you can make sure that your holidays are both happy and healthy. Try to focus your energy on the people you love and not the food. Invest in yourself and your diabetes health this holiday season by being prepared and planning ahead. Happy Holidays!