Google signs deal to put sensors directly on your eye

Link to original article:

Swiss pharmaceutical giant Novartis signs up to commercialize Google’s smart contact lens

By Vlad Savov on July 15, 2014 05:22 am

Google and Novartis have this morning announced an agreement to collaborate on the development of the smart contact lens that was unveiled by Google X in January. Using non-invasive sensors, the lens promises to analyze tear fluid in the eye to provide constant measurements of a person’s blood glucose levels. Those can then be sent wirelessly to a mobile device and help diabetics manage their disease more easily.

Novartis has now licensed the technology and, through its eye-care subsidiary Alcon, will look to develop it into a commercial product. Google co-founder Sergey Brin has said that his company is “very excited to work with Novartis [on using] the latest technology in the miniaturization of electronics to help improve the quality of life for millions of people.”

MAKING DIABETES EASIER TO MANAGE

Beyond the prospective benefits for diabetes sufferers, Novartis sees potential for this technology to also help “restore the eye’s natural autofocus” through more advanced applications such as implanting the lens directly into the eye. Today’s agreement doesn’t change the fact that this is a long-term development project that will take a long time to produce results, but Google’s glucose-tracking smart lens is now on a definite path to commercialization.

Significant increase seen in diabetes rates (Type 1 and Type 2) among youths

Link to original article:

Liz Szabo, USA TODAY

4:03 p.m. EDT May 3, 2014

The prevalence of diabetes in children shot up dramatically between 2000 and 2009, a new study shows.

The amount of type 1 diabetes, an autoimmune disease, climbed 21% from 2000 to 2009, to 1.93 per 1,000 children. The prevalence of type 2 diabetes — which is associated with obesity — jumped more than 30% in the same period, to a rate of 0.46 per 1,000 kids, according to a study presented Saturday at the Pediatric Academic Societies’ meeting in Vancouver, Canada.

Nationwide, nearly 167,000 children and teens younger than 20 have type 1 diabetes, while more than 20,000 have type 2, says study author Dana Dabelea, of the Colorado School of Public Health in Aurora, Colo.

“These increases are serious,” Dabelea says. “Every new case means a lifetime burden of difficult and costly treatment and higher risk of early, serious complications.”

The new study, published in the Journal of the American Medical Association, is the most comprehensive available, said David Ludwig, director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital, who was not involved in the study. The research, called the SEARCH for Diabetes in Youth Study, included 3 million children and adolescents in different regions of the USA.

Researchers acknowledge that the study doesn’t include information from the last five years.

“We don’t know what happened in the last five years,” Ludwig says. “Most likely, things have gotten worse.”

Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, occurs when the pancreas makes little or no insulin, a hormone that the body needs to let sugar to enter cells and produce energy.

In type 2 diabetes, once known as “adult-onset” diabetes, the body becomes resistant to the effects of insulin or doesn’t make enough insulin, according to the Mayo Clinic.

Doctors have made major progress in treating type 1 diabetes and preventing complications, Ludwig says. But children who develop type 2 diabetes face serious risks, which are compounded by the fact that most are already obese. Together, obesity and diabetes increase their lifetime risk of heart attacks, strokes, kidney failure, blindness and amputations.

Diabetes affects 25.8 million people of all ages in the USA, or about 8.3% of the population, according to the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health.

In the past, type 2 diabetes was considered a disease of middle or old age, developing in overweight or obese adults, Ludwig says. The fact that kids are developing this disease so young shows the seriousness of the country’s obesity crisis, he says.

The increase in type 2 diabetes appears to be driven by increasing rates of obesity, lack of exercise and low-quality diets, Ludwig says. Scientists are less sure about the reasons for increasing rates of type 1 diabetes. But some evidence suggests that it may be related to changes in the microbiome — the collection of bacteria and other microbes that live in and on the body, especially in the digestive tract, Ludwig says.

In a new book, Missing Microbes, Martin Blaser of the NYU Langone Medical Center notes that the human microbiome is changing, due to lifestyle changes and medical practices, such as the increasing use of antibiotics.

Eating diets rich in vegetables and plant fiber encourages the growth of gut bacteria that help to break down these foods, Ludwig says. As people eat a more processed diet, with little plant fiber, these bacteria may decrease. Although doctors aren’t totally sure how these bacterial changes affect the body, scientists are examining whether the trend could be related to rising rates of certain chronic diseases, from asthma and allergies to autism.

“Gut bacteria influence inflammation and the immune system,” Ludwig says. “As our diet changes and is increasingly sterile, we’re getting rid of a lot of beneficial bacteria.”

Delivery

On Tue, Jun 17, 2014 at 21:36 PST, F129 wrote:

Just wanted to send you an update and good news– baby F129 was born Sunday 6/8 at 2:31 am, weighing 8lbs 13oz and 21.26 inches. I was induced Saturday 6/7 at 2:30 at 37w 0d due to developing pregnancy hypertension.  After 24 hrs of labor, including 3 hrs of pushing baby he flipped sunny side up and I had to have a c-section. I was a bit disappointed to have the c considering how much work I did but at that point also wanted to just do what was best for my baby.

I had the epidural during labor and remained on my pump until active labor kicked in. Then I switched to insulin drip and maintained my sugars at 90-120 the whole time.  The c section was a bit rough for me as I had a complication (cervical laceration) during surgery. The first few days of recovery were challenging but doing much better now that we are home and comfy.

Baby F129’s initial BG was 43 but it quickly came up and he passed all his BG  checks which was such a relief. He is my darling little angel and I am so in love with my man.

On Fri, Jun 20, 2014 at 11:57 PST, F26 wrote:

I just had a perinatal appointment, and since I’m almost 28 weeks we are starting to talk a bit about labor. I should maybe preface this by saying that the doctor I saw today isn’t the one in my group practice whom I see most often, and he a little bit rubs me the wrong way– I have felt previously like he tried to scare me, and treated me as more high risk than I in fact am given how this pregnancy is going so far.

Anyway, I asked him if he automatically started IVs for diabetics during labor. He said they do it for ALL their patients, which seems weird to me. He said I could ask for a saline lock, but that there was a “90% chance” I’d end up with an IV, so I might as well just get one right away. When I asked why, if I was staying on my pump, I’d need an IV, he said it was because they wouldn’t want me to treat lows with juice, since I was at higher risk for an emergency c-section, and you don’t want anything in your stomach for that. On the one hand, I don’t want to put myself or he baby at risk in any way, but on the other, I really don’t want an IV if I don’t need one, and don’t want to be scared into doing things I don’t actually need to do. I can’t actually remember what other people’s experiences have been with this, but I’m curious. Thoughts?

On Fri, Jun 20, 2014 at 17:45 PST, F40 wrote:

First off, good for you for fighting back against fear-based decisions when it comes to your labor.  Yes, we are all “high risk” because of our diabetes, BUT so long as things are going well and you and the baby are healthy, you shouldn’t be bullied into choices that don’t feel right for you. My experience: they did in fact set the IV, but we put a saline lock on it and covered it up with a “bracelet” fashioned out of a hospital sock with the toe part cut off (highly recommend this so that you don’t have to stare at the gnarly IV set during your labor!).  My goal was to labor without pain medication as long as I could stand it, and then if I needed it/wanted it, I was okay with an epidural. Personally, whether to have the IV wasn’t a big deal-breaker for me…I was okay getting it and having the saline lock.

As for sugar lows, the plan was to treat them with a glucose drip if I needed it (My nurse had really specific instructions for how that would work) – so the issue of drinking juice or taking glucose tablets never came up.  I didn’t go on a sugar low during labor, but I was 88 before it was time to push and I asked for a little bit of sugar to give me some energy. The hospital’s “standard” guidelines were that a sugar low was anything under 70, meaning that if it had just been up to the nurse, they wouldn’t have given me anything…but the perinatologist’s orders was that anything under 90 could be treated with glucose (again, with very specific instructions on how to do that), so I ended up with a little bump and it was great.

On Fri, Jun 20, 2014 at 22:05 PST, F26 wrote:

Thanks, F40!

I actually asked for a saline lock. That was what seemed so weird to me! When this doctor said he started IV’s for everyone, he meant he actually started fluids. I’m totally fine with the saline lock, but it seems unnecessary to me to start fluids. Women can usually drink water, at least, during labor these days. And the risk of having an emergency c-section during which I was under general anesthesia (which you almost never are with a c-section now), and then aspirating my stomach contents, which is what he was telling me I was at risk for if I consumed any fluids orally, is just really, insanely low. The whole thing felt sort of fear-mongering and strange to me.

On Sat, Jun 21, 2014 at 7:15 PST, F4 wrote:

Agreed, sounds like unnecessary scare tactics.  I also got the saline lock immediately but didn’t use saline until was necessary (or at all? Can’t quite remember).  I also didn’t use any D5 (sugar) the second time around and maybe just a bit the first time.  At my hospital they were ok if I wanted to pop a few tabs but I never had to.  Honestly a bit of juice or tabs should be fine.  Think of all the 2nd or 3rd time moms who eat a burrito and go into labor (quickly).

Yeah the whole thing sounds strange.  Your are right – go with your gut!

On Sun, Jun 22, 2014 at 9:31 PST, F130 wrote:

I am totally in agreement with all the replies. It is pretty standard to get the saline lock, but not necessarily to use it… And as far as eating, that sounds bunk. I think this just depends on the MD, but I think you should be able to eat if you feel like it! This guy sounds like a fear- monger. Sorry you had to fight to stand up for yourself…

On Sun, Jun 22, 2014 at 22:09 PST, F129 wrote:

Agree with the other ladies, you shouldn’t be bullied into doing something cause it is standard practice. Yes we are higher risk but if you are in good control you are just like any other patient.

I did have an IV which I didn’t mind. I had the saline lock on it while I was on my insulin pump for the first 10 hrs or so of labor. I was allowed to have water, juice they even let me have a light breakfast and lunch the day Baby F129 was born  (was induced sat at 2:30 am sat and was allowed to even eat until noonsun). They said I would need the energy, so it sounds no guys saying you can’t eat. If I hadn’t of had those meals I don’t know how I would have made it through all the labor/pushing/surgery. Once I got my epideral around 5cm and was more in active labor I went on fluids/insulin/glucose drip. Personally I loved it. I still wore my CGM the whole time and they also checked my BG every hour. I basically stayed 80-110 whole time and best part is I didn’t have to worry about my diabetes. I found it refreshing to have a break and just focus on labor, pushing etc without being solely focused on tweaking my levels and managing my pump. Since I did end up in an emergency c section it was also super helpful the next day since I was on liquid diet and pretty out of it to manage things myself. It is important though to feel like you have all options at your disposal and you can make the best decision for you. I had that with my docs and it really put me at ease, and really helped me adjust to being more flexible when things did not go according to plan. It is daunting but you can do it!!!

3rd Trimester insulin adjustments

On Fri, Apr 25, 2014 at 9:42  PST, F129 wrote:

As for my pregnancy I am 31 weeks today!  It is going by so fast. I have been spending all my free time nesting and getting his room ready and prepping to leave for maternity leave.  My last day of work is 5/22 and I am beyond excited and ready.  In regards to the diabetes it has been a bit challenging starting around week 29.  My insulin needs have gone way up, and I started to get weird hormonal spikes around 3-4am which I never had before and overall insulin resistance.  I have had to add extra bigger basals overnight to account for these spikes and the last two weeks have just been battling overall highs.  Sometimes even with no meals i will just hover at like 140-150 with no rhyme or reason so working with my endo’s to adjust basals again today.  It is a never ending thing and seems to change on a daily basis, I just try to take it one day at a time.  I have also noticed a lot of insulin resistance with certain foods.  Carbs are getting harder to work with, and I always have to do my basals at least 15 min before and walk after meals or I get crazy spikes– even with a carb ratio of 1:3 in day and 1:2 at night (I use to be 1:8).  It is just crazy to me how much it changes as you go along, I have to pretty much change my pump site every 1-1.5 days cause I go through insulin like crazy.  Besides that though the pregnancy is going really well, he is in the 67% percentile for growth and everything looks healthy.  I start my NSTs next week and weekly appts with my OB.  My doctor said everything has been going so well, and my diabetes is so well controlled he considers me a “normal” patient and plan as of now is for vaginal delivery. This makes me happy as a lot of doctors I consulted with prior to finding him automatically push c section just because I am type one.  I appreciate that he is treating me individually and not just making assumptions.  Anyway sorry for long email, that is the latest and greatest. 🙂

On Fri, May 2, 2014 at 13:34 PST, F4 wrote:

Congrats on being a “normal” patient!  Haha!  Sounds like you are in the thick of it.  I defintely had a steep ramp around week 27-29 and slowed around week 35 and starting decreasing 36+.  I would literally make changes every day if needed, as I knew I just needed more and more insulin.  My advice would be to just keep on it and be aggressive with insulin.  Sounds like you are already taking a lot with those ratios!

On Mon, Jul 14, 2014 at 18:59 PST, F26 wrote:

One other question for the pregnant/those who have been pregnant: I am now 31 weeks, and although I am definitely taking more insulin than I took before, I’d say I’m only taking maybe 1.5 x’s what I used to take. Doesn’t that seem a little low for 7 months pregnant? Or not? How much more were you taking by the end? The baby is growing and moving, and my numbers haven’t suddenly dropped, so I think my placenta is OK. I attribute some of this to the fact that I just eat less sugar and white flour than I did, so maybe I am eating foods for which I need less insulin, but it seems weird. I guess if it’s working, no big deal, but I’m sort of curious/wondering if I should be concerned at all.

On Mon, Jul 14, 2014 at 20:17 PST, F4 wrote:

F26 – I think that sounds reasonable.  From what I remember, at 31 weeks my resistance was climbing daily (probably started aggressively around 27 weeks) and leveled off around 35-36 weeks and then plummeted.  I only got to about 2-2.5x with Baby F4.2, and probably 2.5-3x with BabyF4.1.  So a few more weeks should get you into the 2x range.  Plus, everyone is different!  Do you feel like your control is still good?  You could always get an A1C and see if you are still where you want to be.

Overall though, how are things going F26?  I can’t believe you are 31 weeks already!!!

On Tue, Jul 15, 2014 at 8:41 PST, F26 wrote:

Overall, everything is actually going really well. The baby measured a little ahead last week, but I was a giant when I was born so that’s not surprising, and the doctor didn’t seem concerned. I on the other hand am weirdly gaining like no weight, so now I am just a smaller body carting around a giant uterus. Good for the back.

A month ago I felt like my BG was really hard to predict, and like my insulin needs were changing too quickly for me to keep up with them. Now things feel a little more even. I feel like the resistance seems to climb, and then plateau for a week, and then climb again. Maybe I’ve just hit a plateau right now. My A1c’s have been 5.8 or 5.7 the last three or four months, so in general, yes: on target. It’s good to hear you only got to 2 or 2.5 x’s with Cara– that seems like where I might be by the end, and makes 1.5 x’s right now seem reasonable. Thanks!

On Tue, Jul 15, 2014 at 11:00 PST, F129 wrote:

F26, I can’t believe you are so far along– so exciting!  Agree with F4, everyone is different but it sounds about right.  I started to get resistance 28-30 wks and by 36 weeks it decreased.  Sounds like you are doing everything right and rocking this pregnancy– kudos to you mama.

 

Breastfeeding

On Fri, Apr 25, 2014 at 3:16 PST, F4 wrote:
As for me, things with baby are going well, she’s just hitting peak fussy stage at 6 weeks now. Hope this tapers soon! 3am is getting old. ;)- oh, and diabetes has taken a backseat these days… It’s good to hear you talk about tight control to jog my memory!

On Fri, Apr 25, 2014 at 9:42 PST, F129 wrote:
F4, sounds like you have been busy with your new little one. How have your BS been postpartum? Are you breastfeeding? I am really concerned about managing my BS and breastfeeding so any insight would be much appreciated.

On Fri, May 2, 2014 at 13:34 PST, F4 wrote:
As for breastfeeding… first off, post partem, I’ve pretty much ignored my diabetes. I just don’t have time, and honestly my body is doing pretty good considering I barely test and eat crazy foods. I just had my first diabetes checkup, and they said I was doing a great job and my A1C is a 6.2! No idea how I’ve been doing this well, living on pizza and thai food takeout…

Sorry – back to breastfeeding (see, this is how your brain will work!) – at first I was getting low each time I nursed and would have to have a 15 g snack. But lately, I haven’t found this to be the case. Honestly, it just seems to fluctuate throughout the weeks as my body’s hormones change and adjust to the baby’s needs. I keep snack, tabs, juice, etc. handy and just use it as needed.

I do have some notes on how to adjust your rates after you deliver. Let me find those and send them along, as Jasmine and I were seeing some similar things in terms of still needing a decent amount of insulin immediately after delivery, but then dropping quickly (within 24-48 hours). Has your team talked to you about how to adjust down afterward? You’ll want everything written out ahead of time bc you won’t be able to think about it then!

On Wed, Jun 18, 2014 at 7:51 PST, F129 wrote:

F4/F40 I will def be reaching out about breast feeding advice. So far it’s going really well and as long as I have a 15g snack with no bolus I can maintain my BG or only drop by a few points. Without a snack I drop anywhere btw 40-60 pts. I am sure this will evolve and change as Baby F129 nurses longer so any advice on what is working well for you guys is much appreciated!

On Tue, Jul 15, 2014 at 11:00 PST, F129 wrote:

As for Baby F129 and I, we are doing great.  He is 5weeks 2 days and is growing like a weed!  He was born 8lbs 13oz and at our 1 month check up he was already 11lbs 12oz!  Everyone assumes he was so big cause of diabetes which annoys me since I had such good control and it is genetics.  His dad and uncles were all big babies so looks like he is following in their footsteps.  Breastfeeding is going really well– the lows and fluctuations have tapered off a bit.  The first few weeks were nice, I barely needed any insulin and could eat carbs/treats to my hearts content without going high– that has since worn off, lol.  I do tend to drop about 30-50 pts depending on the feeding session.  If I am 130 or under I eat a 15g snack before a nursing session and that seems to keep me stable or in the 100-130 range.  I have not been as on top of my BG as I would have liked partially because I needed a break and it is hard to find the time with a newborn.  I have an endo appt the end of this month though so excited to see how the A1C is doing, my meter avgs are around 140 so not to shabby for postpartum.

Comments on T1D pregnancy and lows

On Thu, Apr 24, 2014 at 20:58 PST, I wrote:

I just had an appointment today and saw the fetuses on the ultrasound moving.  Interestingly, at my 1st appointment with high risk OB a few weeks ago, they were more concerned about my lows (even 50’s and 60’s) and so had me raise my target from 90 to 100 and I adjusted my carb ratio at lunch and dinner to take a little less insulin.  My A1c was 5.5 last week but over the last 2 weeks I’ve seen a few more sustained 170-180’s than I would like. At the appointment today though, the high risk OB team was “happier” that I was having fewer lows (though I’m not with my higher frequency of highs!). Starting this week I’ve noticed a little more insulin resistance/a few higher blood sugars after meals though so I’m probably going to kick up my carb ratio at lunch to prevent those a little more. I’m Week 12 tomorrow 🙂

On  Thu, Apr 24, 2014 at 21:44 PST, F26 wrote:

Emily, a question: are your doctors more concerned about hypoglycemia being dangerous for you, or for the babies? I ask because I have struggled WAY more with lows than highs during pregnancy. I have at least one low every day, I’d say. My perinatalogist told me that there isn’t really research that shows that lows are risky for the baby, but this just seems weird to me, and I have found at least a couple of articles that would seem to suggest otherwise. I’m probably heading for more highs soon, and I can’t change the lows I’ve had, but this is something I’ve wondered about all along: how to balance avoiding highs with avoiding lows, and the relative risks of each. I still have trouble staying in between, and lows seem easier to fix and less dangerous for the kid. But maybe not? Just curious what your (or others’) two cents might be.

On Thu, Apr 24, 2014 at 23:18 PST, I wrote:

Hi F26,

If you can forward the articles you’ve read re: low blood sugar impact on fetuses, I’d be curious to read them.

When I asked, my high risk OB group said that they were worried about lows for the babies (basically the same risk as other unhealthy behaviors during pregnancy, can cause miscarriage etc and if Mom’s blood sugar is low, then baby is getting even less sugar) but I have this feeling they were saying that because it’s the best way to get patients to comply.  (They also asked me to not go to Yoga because my bloodsugar was low for 2 hrs [it took 40g of juice to bring it up] after the class I went to right before my 1st appt; I said no, any type of new activity for me will require some working out. I’ll figure out what I need to do to accommodate the class. It’s actually easier for me to do this since I know the class is at the same time and the same length every week.  The next week I had awesome blood sugars after eating 30g of carb before the class and only bolusing 0.5 when my Dexcom said my bloodsugars were starting to rise.)  Since my blood sugars have started rising again, this may not work this coming Saturday, but as always I’ll test and adjust.

What I’ve understood from reading is that lows are more a danger for the mom and not as much for the baby.  A friend of mine who’s an Ob-Gyn doc helped me look up in one of her medical texts info on non-diabetic pregnant women’s blood sugars which stated numbers could run as low as 60 and that wasn’t considered dangerous.  In general, babies are really good at taking what they need during pregnancy from mom, that’s why mom often gets depleted of nutrients like Iron, Calcium etc. My sense is that sugar probably works the same way.  I also know from working in the lab department that Critical Values for newborn bloodsugar is actually much lower than adult critical values, i.e. even 30 for a newborn isn’t considered critical.

So… what I take from all this is, while low blood sugars in general aren’t a good thing (as any abnormal lab values for extended amounts of time aren’t), there seem to be more risks to the baby (weight gain, etc) for having blood sugars high for extended amounts of time than there are lows. A few considerations to Type 1 lows and blood testing though:

1. A 60 reading for us may not be an accurate 60, i.e. with calibration and potential machine reading errors, a 60 could be a 50 which is where High Risk OB starts to worry since that’s a slippery slope down to 40, etc

2. I suspect that it’s less about the high or low numbers and more about the blood sugars swings.  Cheryl Alkon’s book had people mentioning a few examples of moms with really high A1c’s who had healthy babies, makes me think that fetuses adapt to environment and create a state of homeostasis based on what’s around so having significant peaks and valleys maybe more challenging for the fetus to adapt to (this is just my theory though 😉 ).

Anyways, at my 1st visit to high risk OB, I was probably running low about 20-30% of the time with a few significant lows (i.e. 38, 27… no passing out though 🙂 ).  At my current visit, I’m running low about 15-20% of the time and they liked that better.  If you’re getting a low about once-a-day and it’s like a 50, my sense is as long as you’re not low for extended periods of time it probably isn’t super dangerous for you or the baby.

On Fri, Apr 25, 2014 at 3:16 PST, F4 wrote:

Emily, 27?! Be careful! I don’t know the technical answer to the lows but both of my teams were always very concerned about lows.  I thought they said it was an issue for the baby but also that lows create swings and thus more highs.

I was also told that having a low A1C is not better if you are too low.  It’s better to have slightly higher A1C and be more stable.

Both teams taught me to fix the lows first because that would lead to more stable sugars.

On Fri, Apr 25, 2014 at 8:46 PST, I wrote:

🙂 believe me, I know, 27 is rare but I have had it happen and yes, definitely can’t be good for anyone!

Lows leading to highs are a super bad thing but I actually am pretty good at treating lows without causing a bounce back. I know that if I get below 40, if I take a honeybee gel (this is organic Gu 🙂 ) that has 24g of carb, it’s the right amount to bring me back up without bouncing. Blood sugars in the 40’s require glucose tabs for me and 50’s I can do juice or apple sauce.

Most of the time im trying to prevent lows when I see 60-70 blood sugars

Fri, Apr 25, 2014 at 9:42 PST, F129 wrote:

Emily, sounds like you are also kicking diabetes ass, way to go!  I was always curious how much harder or challenging it would be with twins, excited to hear how your journey continues.  In regards to lows, I know my doctor told me his concern was going to low and ability to treat, and then the swings– which is where the danger for the baby comes in.  Seems more dangerous for me and the scary things they mention- birth defects, etc seem to be a bigger concern with highs and constant low/high swings.  I also know from experience one of my best girlfriends who is a type one had two dangerous lows with her first pregnancy, where she actually went unconscious when both went under 30.  Luckily her husband was there to give her glucagon kit but she had to stay in hospital both times to monitor the baby.  They were specifically concerned about the babies heart during both episodes.  I think that is what doctors try to avoid when they talk the dangers of lows and why they are so concerned about us having them as it can be dangerous for mama and baby.  My doctors at Stanford have felt most comfortable with my A1C around 6.0-6.5, when I got down to 5.7 they were concerned about too many lows and didn’t want my A1C to get any lower.

On Tue, Apr 29, 2014 at 8:29 PST, F26 wrote:

Re: hypoglycemia, it actually seems to me that this just hasn’t been studied all that much, in large part because type 1 women didn’t have as many children in the past, and maybe more importantly because it really wasn’t possible for type 1 women to control their BG tightly enough for chronic hypoglycemia to be a big problem until the past… 20 years? Not sure. Seems like everyone was busier studying hyperglycemia, maybe since it’s a much more common problem, maybe because it is indeed more dangerous for fetal development. I found this: http://www.ncbi.nlm.nih.gov/pubmed/8379913, which to me mostly indicates “we aren’t really sure what effects hypoglycemia has on the fetus.” I may also be bad at finding scientific articles. (If you want literary scholarship, I’m your man!)

Obviously, hypos are dangerous for the mom, but wearing s CGM makes me feel a bit better about that. My endo gave me a goal of 5.7, and my doctors seem generally happy– though my perenat says my control is “a little bit tight”– so I’m feeling basically OK. It’s just hard not to worry when you’re pregnant, as I’m sure you know. Now that I’m almost 21 weeks (actually out of the first tri– mid-way through the second!) I’m just waiting around for the insulin resistance to kick in a bit more. Not looking forward to it, but fewer lows would be excellent, too.

New pump site absorption issues

Em’s notes: As of July 2014 I have not had any pump site absorption issues that I’ve noticed but thought this message string maybe helpful in case it does come up. At this time I’ve been using an insulin pump for about 11 years.

On Wed, 18 Jun 2014 16:55:41 PST, F51 wrote:

Each time I start a new infusion set I have absorption issues for the first 5 hours or so. Anyone know the cause of this and any tips to avoid this?

I already eat pretty low carb, but after eating an egg breakfast my blood sugar spikes and even if I inject several units it doesn’t seem to budge until hours later when my blood sugar crashes.

After that the infusion site works great so I don’t think it’s scar tissue or anything like that.

Just wondering how others deal with this.

On Wed, 18 Jun 2014 16:59:22 PST, F123 wrote:

F51,

Have you tried any other insulin? You may try this and get good results.  I
had issues with humalog, when I changed to Aprida…no more issues.

Good luck!

On Wed, 18 Jun 2014 17:02:11 PST, F58 wrote:

I found I have to prime 5 units instead of the .5 or .7 they normally recommend. This was the case with either U500 or U100.

On Wed, 18 Jun 2014 17:06:51 PST, F124 wrote:

I have the problem from time to time and I use Apidra.

On Wed, 18 Jun 2014 17:16:28 PST, F51 wrote:

I just switched from novolog to humalog because of insurance, but I had the same problem before but maybe not as pronounced.  But it has always been a problem with either insulin.

On Wed, 18 Jun 2014 17:21:02 PST, F75 wrote:

This is a common phenomenon that occurs quite often with many pumpers. I believe the tissue beneath the cannula needs to be saturated with insulin before
it is release. And it often seems like the insulin kicks in all at once several hours later. I always give some extra insulin to start a new site.

On Wed, 18 Jun 2014 18:16:49 PST, F84 wrote:

If you’re pulling the old set out immediately, you’re likely losing insulin. Many of us leave the old site in for 2 or 3 hours after doing a change-out. That leaves the insulin in the pipeline (so to speak) to absorb instead of losing it.

On Wed, 18 Jun 2014 18:20:09 PST, F51 wrote:

Have tried both. Sometimes leave the other one in for a extra few hours just to be able to bolus for a meal and not have to worry about it.

On Wed, June 18, 2014 18:25:23 PST, F125 wrote:

I sometimes do a 10% temporary basal rate for a few hours to speed up the release of insulin with a new site.

On Wed, June 18, 2014 18:35:55 PST, F115 wrote:

If you’ve been pumping for a long time, it may be time for a longer cannula?

On Thu, 19 Jun 2014 05:00:08 PST, F53 wrote:

Now that’s a notion.  When I started pumping, because I am somewhat overweight, I was told I needed the 9 mm cannula.  A friend gave me some 6 mm.  I was afraid it would pull out.  Amazing to me, I had great results. So I can use either one.  I also get some highs after an infusion change; but they are random.  I had not thought much because I wait until the reservoir is empty to change.  I reasoned that the pump could not possibly push the last drop out.  My prime is at .7

On Thu, 19 Jun 2014 06:32:33 PST, F51 wrote:

I also leave my old site in place for a good while. I usually do my site changes in the morning, and I’ll usually leave the old one in there until the following morning and remove it in the shower. That way if it starts gushing blood I don’t have to worry about blood getting everywhere.

If the old site is irritating me I’ll remove it as soon as it starts to irritate me though.

I also try to change my reservoir when there are about 50 units left. I too seem to notice poorer absorption and higher BGs if I wait until the last minute to change the reservoir.

On  Thu, 19 Jun 2014 08:24:05 PST, F115 wrote:

I often change the infusion site when it is time (I do notice less absorption after day 3) without changing the reservoir – hate to waste the insulin.

On Thu, 19 Jun 2014 08:27:06 PST, F126 wrote:

Very interesting observation, F51.  But it doesn’t make sense.  Does it also happen if you just inject the bolus with a syringe?  If not, then how does your body know that that first bolus is coming from a needle or a catheter?  If it also happens with an injection, then it has something to do with the insulin.
–F126

<<<<<<<Each time I start a new infusion set I have absorption issues for the first 5 hours or so. Anyone know the cause of this and any tips to avoid this?>>>>>>>>>

On Thu, 19 Jun 2014 08:42:13 PST, F51 wrote:

It has been so long since I bolued with a syringe I might be scared to try 🙂  But that is a good suggestion to try.  Back when I was on MDI many years ago I never remember having a problem.  It may be the needle is going further or that needles are less prone to getting tissue inside of them vs. a cannula?  Don’t know.

On Thu, 19 Jun 2014 10:21:18 PST, F124 wrote:

I do leave the old site in for a few hours.

On Thu, 19 Jun 2014 10:37:47, F127 wrote:

This has happened to me frequently. I may be nuts, but I massage the area on my stomach thinking I am helping that insulin get going. Seems to work. I like the
idea of shooting extra insulin in at change. I will try that one. Thanks.

On Thu, 19 Jun 2014 10:47:02, F115 wrote:

Now I recall, when first Dx’d (30+ years ago) it was recommended that I massage the area right after injecting. I also up the fill cannula amount depending
on whether or not it is in “virgin territory”. If it is, then I don’t up the recommended amount by much, it is is somewhat older territory (i.e. previously used before) I increase the cannula prime amount by more.

On Thu, 19 Jun 2014 11:13:46, F60 wrote:

I was having the same new site absorption issues and I considered going back to shots, it was so frustrating. Then one day I thought about injections with a
steel needle working so well, perhaps the plastic might be the problem. So I took a Sure T which has a steel needle and inserted it the same way that I did with shots. It turned out that the steel needle was the answer because it delivers the insulin with no hang ups what so ever. Since then, my Hbac went from 7.2 in January to 6.1 in my latest test.

On  Thu, 19 Jun 2014 13:47:54, F128 wrote:

Some people forget to prime the new cannula when changing.  The amount of space varies from .2 to .7 depending on the infusion set used.  The prime rate would be found on the information sheet within each box or check with a CDE.  I have found Novalog has a delayed starting absorption.  Humalog works more quickly.

F128, type 1 for 61 yrs, tslim

On Thu, 19 Jun 2014 15:15:05, F62 wrote:

> Each time I start a new infusion set I have absorption issues for the first 5 hours or so. Anyone know the cause of this and any tips to avoid this?

Besides leaving the old site (unhooked from pump) in for a few hours to assure complete absorption, the new one can be tested by rehooking the old site. If your BG returns to normal, then the new site is at fault and a new one needs to be placed.

Do you also fill the canula with the recommended amount the instructions for your infusion sets give? Do you do a prime until there is a *healthy drip* emerging from the tip of the canula before inserting it? Do you stay away at least 1″ in a month before returning near that place and avoid 2″ from the navel?

I was having problems until I rotated from my right thigh (lap area) to my left, then lower right stomach, to the left; then right abdomen to left. Then I return to my thigh. *I* changer every 4-5 days so it is a good many days before returning near to an area. It has made a huge improvement for me.   Also, a few years ago Humalog failed me and I switched to Novolog with success.

Vheck well for bubbles.

Try one thing at a time so you know which one works for you.  Best to you.

F62- T-1, 11/5/50, pumping 8/23/83, Dialyzing 7/8/02

On Fri, 20 Jun 2014 06:23:48, F53 wrote:

When my BG is very high, I bolus with a syringe/needle.  It seems to work better than bolusing with the pump.  I speculate that it has to do with the fact that I take the shot in my legs, not by abdomen that old territory (used a lot for infusions).

 

Diarrhea

On Wed, 7 May 2014 19:20:49 PST, F118 wrote:
I have had bouts of diarrhea lasting a week over the past 6 yrs. and as suddenly as it begins it stops. I had a colonoscopy 5yrs ago and everything was fine. Call back in 10yrs. Now since March 28, I have had non stop diarrhea, going as much as 10x a day. My sugars are always low due to lack of absorption. Called my GI doctor and he gave me Fiber, Probiotics and Lomotil until my colonoscopy on May 14th. Saw my endo on Monday and he was thinking that neuropathy which I’ve had for the past 14yrs, has infiltrated my bowels. Has anyone been diagnosed with this due to neuropathy? Ha1c 6.1 last normal 6.4.
Thank you for any feedback.
F118
DXd 01/64
Pumping 04/04

On Thu, 8 May 2014 01:18:40 PST, F119 wrote:

Have they tested for celiac?

On Fri, 9 May 2014 01:49:27 PST, F109 wrote:

My diarrhea issue was resolved with omeprazole prescription strength, but over the counter works, just not as strong.. One a day

On Tue, 13 May 2014 06:18:33 PST, F120 wrote:

If you’ve taken antibiotics recently for anything, be sure they check for c-diff. My daughter recently had this after being prescribed antibiotics, and no one thought to test for it.

On Tue, 13 May 2014 08:47:17 PST, F54 wrote:

They used to think they colon was the ‘thing’ to watch.  They are learning more about the small intestine affecting absorption.  And the impact of diabetes on the small intestine.  The small intestine is not supposed to have bacteria but in diabetics if  it does, it can cause the diarrhea.  They want to do a biopsy on my small intestine and scope it at the same time they do a colonoscopy.  The last colonoscopy sent me to the emergency room… well the prep did cause my sodium got dangerously low.

So…probiotics dont help if the small intestine has an issue. Not really sure I want both tests.

F54

T1 46 yrs

On Wed, 14 May 2014 11:59:43 PST, F121 wrote:

You might also look into the types of food you are eating that are genetically modified. They’ve found that the BT toxin, when ingested, makes tiny holes in the stomach and the food goes directly into the blood stream instead of the way it’s supposed to be digested. This causes all sorts of food allergies.

On Wed, 14 May 2014 13:10:12 PST, F118 wrote:

Thank you everyone for your feedback.  I had my colonoscopy today got a clean bill of health and don’t need another one for 10yrs.  My GI doc, although, is testing me for Celiac  Disease.

On Fri, 16 May 2014 08:18:49 PST, F122 wrote:

I was having terrible bouts with diarrhea until I added a lot of fiber to my diet. You can also buy chewable fiber, much like chewable Calcium.  I have
gastroparesis, so that’s definitely a contributor.. Neuropathy in the digestive system?  Oh, yeah.

On  Fri, 23 May 2014 13:40:21 PST, F118 wrote:

Was Diarrhea now Colitis

MD called today, I have colitis, prescription called in.  Celiac blood test was negative. Thank you to everyone for ur feedback re diarrhea.

Aspirin inhibits chronic wound healing, providers should dispense it with caution, researchers warn

Link to original article:

Tim Mullaney, Staff Writer

May 13, 2014

Long-term care professionals might want to opt for non-aspirin pain relievers for residents with chronic wounds, as researchers have discovered that aspirin appears to suppress healing.

Investigators affiliated with various universities in Japan conducted experiments on diabetic mice with wounds. In one, they discovered that high-dose aspirin reduces the production of a molecule called 12-HHT, which promotes skin healing by spurring the movement of keratinocytes. The migration of keratinocyte skin cells across the wound is an important part of restoring the outermost layer of skin.

“This study describes a novel mechanism for aspirin’s effect in delaying wound healing and suggests that aspirin should be used with caution in patients with chronic wounds,” said lead author Takehiko Yokomizo, M.D., Ph.D., of Kyushu University.

In another experiment, the researchers discovered that introducing a “synthetic mimic” of BLT2 — the receptor for 12-HHT — accelerated healing in the mice. This suggests a potential proactive therapy to treat stubborn wounds, they noted.

Findings appear in the Journal of Experimental Medicine.

Liraglutide plus insulin improved HbA1c, body weight, QOL in patients with type 1 diabetes

Link to original article:

May 18, 2014

LAS VEGAS — Adding 1.2 mg and 1.8 mg of liraglutide to insulin significantly reduced HbA1c, mean blood glucose, insulin dose, body weight, carbohydrate intake and c-reactive protein while improving quality of life for patients with type 1 diabetes, according to a presenter at the AACE 23rd Annual Scientific & Clinical Congress.

“Since the discovery of insulin by Banting and Best in 1921, no significant advances have been made in the field of type 1 diabetes,” Nitesh D. Kuhadiya, MD, MPH, assisant professor of medicine at the University of Buffalo, said during his presentation. “Living with type 1 diabetes continues to remain a major challenge. It is akin to a wild horse that is very hard to train and it kicks you 10 times a day.”

The researchers studied 72 patients who had with type 1 diabetes for at least 1 year, were on insulin therapy and had no detectable c-peptide in plasma (mean BMI: 30±1; mean body weight: 184±5 lbs; mean HbA1c: 7.57±0.09%; mean age: 44±2 years; mean age of diagnosis: 20±1 years). Fifty-four patients received 0.6 mg, 1.2 mg and 1.8 mg of liraglutide daily for 12 weeks; 18 patients were randomized to placebo. In the 1.2 mg and 1.8 mg groups, mean change in average blood glucose was –10±2 and –10.0±1mg/dl, respectively, (P<0.0001 vs. placebo). In the 1.2 mg group, HbA1c fell by 0.78% from 7.84±0.17% to 7.06±0.15% (P<0.0001, P<0.01 vs. placebo) and in the 1.8 mg group, HbA1c fell by 0.42% from 7.41±0.15 to 6.99±0.15 (P=0.001,P=0.39 vs. placebo).

During the 12-week period, the average total daily dose of insulin in the 1.2 mg group fell by 12.4±3.9 units and by 10.0±2.3 units in the 1.8 mg group (P<0.05 vs. baseline and placebo). There was a reduction in body weight by 11 lbs from 210±9 lbs to 199±9 lbs in the 1.2 mg group (P<0.001); from 182±10 lbs to 171±10 lbs in the 1.8 mg group (P<0.0001); and from 176±8 lbs to 170±9 lbs in the 0.6 mg group (P<0.01). The diabetes-specific quality of life significantly improved in both 1.2 mg and 1.8 mg groups.  Patients in the 1.8 mg group also reported improvement in systolic blood pressure. Patients in the placebo group and those who were given the 0.6 mg liraglutide dosage did not report improvements in any of these areas except weight loss of 6 lbs.

“This is the first randomized clinical trial demonstrating that the addition of 1.2 mg and 1.8 mg of liraglutide to insulin significantly reduces HbA1c, mean blood glucose, body weight, carbohydrate intake and CRP; improves quality of life and reduces systolic blood pressure in the 1.8 mg group in type 1 diabetes,”Kuhadiya said. “Our findings have significant implications for the future treatment of patients with type 1 diabetes.”

For more information: Kuhadiya N. Abstract 1317. Presented at: AACE 23rd Annual Scientific & Clinical Congress; May 13-18, 2014; Las Vegas, Nevada.

Disclosures: Novo Nordisk funded this study. Kuhadiya received a grant award from the Endocrine Fellows Foundation.

PERSPECTIVE

George Grunberger

• This was a well-done, single center, albeit a relatively small study.  Since it was done by the same staff, however, it has the flavor of a controlled study.One of my own patients participated in the study and told me after the fact. Patients love the results, but then you have to think about the logistics — adding another injection, the cost of additional medication, potential for its side effects, and then, because it’s not indicated or on-label, who is going to pay for that?

  The fact that there is less hypoglycemia, 25% less insulin use, drop in blood pressure, drop in weight, reducing those glycemic variations, this is an attractive way to do it. Now there are additional trials going on with GLP-1 receptor agonists in patients with type 1 diabetes and the FDA is also looking at potential use of liraglutide in obesity.

  Like it or not, obesity is a bigger market than diabetes. If you have a treatment that works, why not? And, additional question pops up: now that we have weight loss drugs approved — should they be approved for diabetes prevention and/or treatment?

  • George Grunberger, MD, FACP, FACE
  • AACE President-elect
    Clinical professor, internal medicine and molecular medicine and genetics
    Wayne State University School of Medicine
• Disclosures: Grunberger reports financial relationships with Amarin Corp., Bristol-Myers Squibb Company, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S, sanofi-aventis US LLC, Santarus, Inc., Takeda Pharmaceutical Company Limited, and Valeritas, Inc.