At ADW Diabetes, we like to offer you cutting edge information to keep you on track with new diabetes technology, studies and medications. FDA approvals can happen overnight. Multiple major diabetes meetings and conferences take place at this time of the year. New technology and protocols in the world of diabetes can ultimately help you.
Let’s see what is currently being discussed and recognized in the diabetes world.
Diet plans and products
Even though diet plans and products continue to thrive in a multimillion-dollar business, Americans are still eating way too much sugar, starch and saturated fats which leads to obesity, type 2 diabetes and heart disease. A study quoted at a recent prestigious diabetes conference stated, “Americans continue to eat 42% of daily calories from refined grains, added sugars and low-quality carbohydrates.” No nutritional value comes from these convenience foods.
Foods like fried and sugar-coated donuts, fruit flavored drinks, hot dogs and various deli meats, fake, breaded poultry nuggets, instant soups and noodle dishes laden with salt and fat, and bagged snacks are plentiful in every store. Only 9% of our daily calories come from whole grains, vegetables and fruits, and the high-quality, fiber rich carbohydrates.The concept that, “a carb is a carb and should not be eaten by people with diabetes” is still floating out in the public. This remains a confusing statement for many of you. High quality carbohydrates are needed for body fuel, muscle uptake and central nervous system energy.
In reality, vegetables, whole grains, fruits, beans and legumes are perfect sources of fiber, fuel and nutrients when eaten in portion size, even with diabetes. Total saturated fat intake also rose even though evidence shows, “saturated fat causes systemic inflammation and heart disease,” the leading cause of death in diabetes. A new report confirms we are still eating 10% over the recommended limit of 12% saturated fat in our daily intake. Saturated fat comes from red meat and full-fat dairy products. These findings were reported on September 24,2019, in The Journal of The American Medical Association based on 44,000 participants. The study ran from 1999-2016.
Un-Healthy Advertising Focus
Advertising dollars target snacks, sodas and other sugary drinks, pizza chains and grab and go meals. No one is focusing on advertising for fruits, vegetables or beans. Low income households continue to consume poorer diets compared to more educated/higher income Americans. Some is related to nutrition knowledge, but most is dependent on affordability and availability of fresh foods. “Food deserts” still exist in America which means they lack the best sources of whole nutrition. Many rural areas do not have the resources and markets offering fresh produce.
Healthy eating goes way beyond just the need for weight control. Better food choices could lower the risk of heart disease, diabetes, hypertension, high cholesterol and chronic kidney disease. Nutritional education could and should begin during pregnancy when women can learn to choose wisely. Then it can follow into early childhood as good habits are easily learned when started early. Smart eating choices once learned, can continue throughout the life cycle. Although not “cutting edge” information, it was talked about frequently at all the diabetes conferences to improve our nation’s health. We, as a country need to reverse the obesity trend now or continue to suffer the consequences of chronic disease.
Key points to improve your diet plan:
- Cook at least a few meals at home.
- If cost is an issue, buy frozen fruit and veggies in no syrup or sauce.
- Do not add salt. Cook with spices and herbs.
- If you replace one sugary beverage a day with a glass of water, you can lose 15 pounds in a year.
- Avoid powder or instant meal replacements. Do not eat bars for meal replacements. Eat fresh foods.
- Include meatless meals a couple of times a week. Add soy, legumes, beans, nuts and seeds.
- Avoid over thinking about food and mealtimes. Keep it simple, fresh and be flexible.
- Artificial sweeteners may lead to a “need to eat sweeter things” and eventual weight gain.
Medical and Health Apps
In 2017, over 300,000 mobile health and diabetes apps accounted for 16% of the market. They assist with tracking blood sugars, counting carbohydrates, contain a nutritional database and monitor fitness and weight. There is social support, messaging and diabetes reminders. The thing to remember is when using mobile apps, make sure you are using secure ones. Read the fine print and make certain your information is not being stored on a remote server.
Although these apps do offer a lot of good information and assistance, you need to be aware of privacy and security risks. Hospitals and doctors must protect your medical information by law, apps and tech companies do not have these same rules in place. When you provide consent on the app, your information may be shared. Read the terms and conditions before signing off, just as you would on any contract. See if the apps have built-in security measures. Free apps usually are selling personal data. Be selective with your decisions. Do your research, there are many solid and helpful apps.
Cutting Edge Diabetes Technology Options
Stick-Free Continuous Glucose Monitoring: Free Style Libre
Finger stick home monitoring began in the 1970s, and it became a major breakthrough in diabetes management. Today, one of the most frequent patient complaints is “daily, multiple finger sticks are painful and annoying” to know my blood sugar results. Unfortunately, diabetes treatment is not complete without knowing your blood sugars. It helps with decisions on diabetes medication, eating, food choices/amounts along with your exercise plan. Blood sugar testing can also help you decide when insulin adjustments may be needed.
Continuous glucose monitoring (CGM) has been an option for a while, but the Freestyle Libre is the first CGM to not require a fingerstick for calibration. It is best used as an educational tool, for those who are type 2, well controlled on insulin or not on any insulin. It does not have an alarm to warn you of excessive highs or lows. After placing the sensor on the upper/outer arm with a spring-loaded device, you simply wave a reader over the sensor to learn your blood sugar results. The original Free Style Libre was approved in 2017 for 10 days of wear with one sensor. The new updated version allows wearing a sensor for 14 days without a finger stick.
Dexcom G6 CGM: Home Use
A traditional CGM measures your blood sugar every 5 minutes and can send the information wirelessly to a pump or smart phone. It detects blood sugar trends and patterns. The Dexcom G6 was approved last year and has an alarm that sounds for high and low blood sugars when they fall outside the set parameters. It is a better alternative when blood sugars are out of control, and for type 1 diabetes with more intensive insulin regimens. Unfortunately, less than 40% of type 1 use a CGM. It is a wonderful tool if you have hypoglycemic unawareness or frequent bouts of hypoglycemia. The G6 does not require finger sticks. It can be used alone or with an automated insulin dosing system.
Eversense Implantable Sensor
Eversense is the first long term implantable sensor which can be used for 3 months after it is placed just under the skin. It monitors the blood sugar every 5 minutes for 90 days. A qualified health care provider implants the device and closes the incision with steri-strips. The sensor “works by generating a light signal in response to the amount of glucose in the interstitial fluid which is just under the skin. The light signal is converted into a blood sugar reading.” The Eversense has a transmitter that is removable, rechargeable and water resistant. It sends data to a mobile device every 5 minutes and does not require a separate receiver. Some patients love the ease while others oppose an implantable device as it becomes a personal decision. The Eversense has proven to help people better manage their diabetes.
Type 2 medication now available in pill form
The FDA recently approved a new tablet called Rybelsus, manufactured by Novo-Nordisk, for adults with type 2 diabetes. Before Rybelsus, GLP-1 treatments were only available in an injection form. These injections include Byetta, Bydureon, Trulicity, Victoza, and Ozempic. Many type 2 patients have a real fear of injections and miss out on this effective diabetes medication option. Along with an injection comes the added hassle and expense of extra supplies such as needles, pens, a needle disposal container and using proper injection technique. Rybelsus is an exciting and wonderful addition to diabetes pills.
What does a GLP-1 do?
- Stops the liver from producing too much sugar.
- Slows gastric emptying- leads to less hunger.
- Helps the pancreas make more insulin.
- May aid in weight loss.
There is a box warning about “the potential increased risk of thyroid C-cell tumors”, which is also seen in the injectable form. Although never given as a first line medication for type 2 diabetes, it is a solid choice for treating the condition. Talk to your doctor to see if you are a possible candidate. Take the pill, wait 30 minutes and then eat. Insulin, which is the other injectable medication for diabetes, must still be injected since stomach acids break down the drug. Rybelsus has a way of protecting the protein from the stomach acid which is why it can be taken in pill form. This will be a convenient option for type 2 diabetes.
T:slim Insulin Pump with Basal-IQ Technology
Low blood sugar is a common diabetes problem, especially when injecting insulin. Low blood sugar symptoms include sweating, shakiness, headaches, dizziness, hunger ,and anxiety. If not treated, hypoglycemia may result in coma or death. T:slim insulin pump with basal-IQ technology helps predict whether your blood sugars are going to drop. It senses the fall and stops insulin delivery. Without these major swings and symptoms of low blood sugar, quality of life improves. In February 2019, the FDA approved the T:slim pump for children too. “Their technology in diabetes is dynamic and constantly evolving.”
Insulin pens have been around for a while and make the delivery of insulin much easier. Pens combine the vial and syringe into one device. Instead of requiring a vial and syringe, the pen has a cartridge (usually disposable) filled with insulin and only requires a new pen needle with each injection. Now you can have a smart pen, “which offers all the memory capabilities of a pump” without needing the pump.
What can a smart pen do?
- Help you remember your insulin doses.
- Protect against giving duplicate insulin doses.
- Allow you to bolus insulin according to meals.
- Prevent wrong insulin calculations and improper regimens.
Smart pens connect by Bluetooth to an app on your smartphone that keeps track of your insulin and timing. InPen and GoCap are 2 smart pens with this innovative technology. InPen even helps you calculate the correct dose which can be shared with your physician. At the end of 2019/early 2020, a new reusable insulin pen will be approved. Called NovoPen Echo Plus, it will be able to “store and download your last 800 injections to another device and display the most current dose on the cap.” It will connect with other diabetes monitoring systems to help you manage your diabetes at the next level.
Hypoglycemia is a real complication of type 1 diabetes or type 2 diabetes when you take insulin or sulfonylureas. Glucagon injections have been around for a while. They bring up the blood sugar by counter-balancing the actions of insulin, when you are unable to chew or swallow. Previously, it has only been available in injection form which needed to be mixed prior to the injection. In July 2019, the FDA approved Baqsimi from Eli Lilly. Baqsimi, “delivers Glucagon as a dry powder spray in a portable, single use, ready to use device.” It can be used by patients 4 years of age or older. After taking Glucagon, a fiber rich carbohydrate and protein snack should be eaten to keep blood sugars from dropping again unless it is time for a regular meal.
New Injectable Glucagon
The new Glucagon injection, called Gvoke, does not need to be mixed prior to injecting, which allows it to be used much faster. It is ready to use and should be kept at room temperature. Gvoke can be used in patients 2 years old and above. The caregiver needs to know how to use Gvoke before injecting.
- Do not open foil pouch until needed.
- Read all instructions before use.
- Inspect Gvoke. It should be clear with no visible particles.
- Inject into lower abdomen, outer thigh or upper/outer arm.
- Gvoke can’t be reused. It is a single dose product.
Possible diabetes remission?
Just outlined in Diabetes Care, a new treatment encourages cell growth, “which may have potential to put diabetes into remission in certain patients.” Still in a research phase, it is a process that involves growing cells on the small intestine’s surface. These new cells are supposed to encourage the pancreas to make insulin again. The lining of the small intestines is responsible for insulin production. This process may benefit people with type 2 diabetes. It is known as “duodenal mucosal resurfacing.”
The results have been on-going for more than 1 year and the study participants saw blood sugar improvements in a few days to weeks after the procedure. The improvements did not depend on weight loss or diet plan. Already being used with great results are gastric sleeve and gastric bypass surgery, since it changes the contact with the small intestine. Diabetes remission has been seen in some of the patients. In the end, long term results must be looked at before health insurance companies will ok this procedure.
Onduo: A virtual diabetes clinic
This is a Verily/Sanofi joint-venture known as Onduo. Launched a few years ago, it is a “virtual diabetes clinic and coaching service” originally set up with pilot programs in the Southeast. it is now ready for a national launch. It is said to show data suggesting significant A1C improvements among the users.
Pops: One system
Pops is considered glucose testing on the go. It is a complete glucose monitoring system. It is a device stuck to the back of a smartphone. Plus, all you need with results in less than 30 seconds. There are built in needles and a sensor. After the testing is complete, you can check the values on the smart phone app. Pops also offers a coaching app.
Insulin pumps have been around for some time. The first pump patch was the Omnipod. Patch pumps bypass the bulky hardware and are in the form of a disposable patch. They are small, lightweight, free of tubing, applied directly to the skin and are easy to operate. Pump patches are now kept on for 24 hours and then discarded. The newer pump patches have fewer insulin delivery options and are considered best for type 2 diabetes.
- BD’s T2 patch pump – it is fully disposable, worn for 3 days, and offers both basal (long acting) and bolus (short acting) dosing. It is very simple to use and may be easier than a traditional pump for those with type 2 diabetes. The T2 patch pump holds 300 units of insulin and has a handheld reusable controller with Bluetooth connection to a smartphone app.
- Roche Accu-Chec Solo – this patch pump is available in Europe since 2018, but has yet to be approved for use in the US. They are working closely with the FDA for approval.
There are so many new things happening in the field of diabetes. New devices, products, medications, technology and virtual diabetes educational programs. Work with your health care provider to find out which would be best for your own needs.