Managing Diabetes When You’re Sick

How old is this device?

For folks taking insulin, Diabetes Daily has a good article by endocrinologist Dr Francine Kaufman. An excerpt:

Everyone with diabetes who takes insulin needs to have a sick day plan. This is something you develop with your healthcare professional to help you manage the high and low sugar levels that can be associated with an illness. The following advice applies to people with type 1 diabetes and people with type 2 diabetes who take insulin – the advice may be different if you have type 2 diabetes and do not take insulin.

Click to jump down to a section:

What happens when you are sick?

Track of your important numbers in a sick log

Glucose levels

Ketone levels

Temperature

Fluid intake

Urination

Vomiting, diarrhea, and dehydration

Insulin, amount and time

Medications

Key messages from Dr. Kaufman

When you get sick, you are at risk of becoming dehydrated from poor intake or from excessive loss of fluids due to nausea, vomiting, diarrhea, and fever (your body may lose more water when you have a high temperature). In addition, dehydration is common in diabetes because high glucose levels (above 180-200 mg/dL) cause sugar to enter your urine, dragging an excess amount of fluid with it. Illness also puts you at risk of developing ketones, which when coupled with high glucose levels can lead to diabetic ketoacidosis (DKA), a very serious condition. How do you know if you have ketones? Good question, click here!

The purpose of your sick day plan is to try to keep your glucose levels in a safe range – to avoid dehydration and to prevent ketones from rising to a dangerous level.

Source: Zoning in on Sick Day Management: Practical Tips, Strategies, and Advice – Diabetes Daily

 

Leave a comment

Filed under Uncategorized

Cut Your Diabetes Drug Costs

Caprese salad: mozzarella cheese, tomatoes, basil, extra virgin olive oil≠≠≠≠

Christine Fallabel has and article at Diabetes Daily that may save you beaucoup bucks on your diabetes care, whether or not you have insurance coverage.

If you live in a country like the United States, where the majority of health insurance is privatized and there is no strong social safety net, it can feel as though managing a chronic disease like diabetes requires nothing but lots of money. And it does. As of 2017, diabetes cost the United States a staggering $327 billion dollars per year on direct health care costs, and people with diabetes average 2.3x higher health care costs per year than people living without the disease.

Diabetes is also devastatingly expensive personally: the cost of insulin has risen over 1200% in the past few decades, with no change to the chemical formula. In 1996, when Eli Lilly’s Humalog was first released, the price for a vial of insulin was $21. In 2019, that same vial costs around $275. Studies show that 1 in 4 people ration insulin simply due to cost. Diabetes Daily recently conducted a survey study, with almost 2,000 participants, of which an overwhelming 44% reported  struggling to afford their insulin.

So where does this leave patients who don’t have tons of money to spend on insulin and supplies, or who don’t have adequate health insurance coverage for the technology to help prevent complications? Can you manage diabetes well without lots of money? The short answer is yes. The long answer is a bit more complicated.

Source: Can You Manage Diabetes Well Without Lots of Money? – Diabetes Daily

Steve Parker, M.D.

PS: What else can cut your diabetes drug bill? Low-carb eating!

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

Leave a comment

Filed under Drugs for Diabetes

Four in Ten U.S. #COVID19 #Coronavirus Deaths Had Diabetes

elderly, face mask, surgical mask, corona, epidemic, pandemic, couple

Still unclear whether masks prevent infection. I wear an N95 when admitting COVID-19 patients. 

In July, the CDC published data on the characteristics of 50,000 U.S. residents who died of COVID-19 between mid-Feb and mid-May, 2020.

Some points:

  • 55% were male
  • 80% were aged ≥65 years
  • 14% were Hispanic/Latino (Hispanic)
  • 21% were black
  • 40% were white
  • 4% were Asian
  • 0.3% were American Indian/Alaska Native (AI/AN),
  • 3% were multiracial or other race
  • race/ethnicity was unknown for 18.0%
  • median decedent age was 78 years (median means half who died were over 78, half were under 78)

CDC didn’t have much clinical data on all 50,000 decedents. But they were able to collect supplementary data on close to 11,000 of them;

  • 61% were male
  • 75% were aged ≥65 years
  • 24% were Hispanic
  • 25% were black
  • 35% were white
  • 6% were Asian
  • 3% were multiracial or other race
  • race/ethnicity was unknown for 6%
  • decedent age varied by race and ethnicity; median age was 71 years among Hispanic decedents, 72 years among all nonwhite, non-Hispanic decedents, and 81 years among white decedents. The percentages of Hispanic (35%) and nonwhite (30%) decedents who were aged <65 years were more than twice those of white decedents (13%)

What about underlying conditions among these 11,000 decedents for whom supplementary data was available?

At least one underlying medical condition was reported for 8,134 (76%) of decedents for whom sup­plementary data were collected, including 83% of decedents aged <65 years. Overall, the most common underlying medical conditions were:

  • cardiovascular disease (61%)
  • diabetes mellitus (40%)
  • chronic kidney disease (21%)
  • chronic lung disease (19%)
  • among decedents aged <65 years, 83% had one or more underlying medical conditions
  • among decedents aged ≥85 years, 70% had one or more underlying medical conditions
  • diabetes was more common among decedents aged <65 years (50%) than among those aged ≥85 years (26%).

From the CDC report

Regional and state level efforts to examine the roles of these factors in SARS-CoV-2 transmission and COVID-19-associated deaths could lead to targeted, community-level, mortality prevention initiatives. Examples include health communication campaigns targeted towards Hispanics and nonwhite persons aged <65 years. These campaigns could encourage social distancing and the need for wearing cloth face coverings in public settings. In addition, health care providers should be encouraged to consider the possibility of disease progression, particularly in Hispanic and nonwhite persons aged <65 years and persons of any race/ethnicity, regardless of age, with underlying medical conditions, especially diabetes.

Steve Parker, M.D.

PS: Are poorly controlled diabetics more likely to die from COVID-19? We don’t have any hard data on that yet. Almost 40 years of clinical practice tell me the answer is quiet likely “yes.” Let me help you control your diabetes.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

 

2 Comments

Filed under Coronavirus

Your Proton Pump Inhibitor Might Kill You By Doubling Your Risk of #COVID19

Click for details.

Prilosec and similar proton pump inhibitor drugs (PPIs) drastically reduce stomach acid. You should assume there’s a good reason or two why we have acidic stomach juice in the first place. One reason is to prevent infection.

I see two many patients who are put on these drugs for a good reason, but they keep taking them after the drug has finished its job.

An “as needed” H2 blocker like Pepcid may be a reasonable substitute for PPIs. Check with your personal physician.

I have nothing against Prilosec in particular. It can be very helpful. It’s one of several PPIs on the market.

Steve Parker, M.D.

PS: If you take a PPI for frequent heartburn, note that low-carb diets help prevent heartburn.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

1 Comment

Filed under Diabetes Complications

Weight-Loss Maintenance Requires More Calories If Eating Low-Carb Versus High-Carb

Low-Carb: Spaghetti squash “spaghetti” with meaty sauce

From The Journal of Nutrition:

In this analysis of a large feeding study, we observed higher estimated energy requirement on a low- compared with high-carbohydrate diet during weight-loss maintenance. The magnitude of this effect (about 200 to 300 kcal/d, or ∼50 kcal/d for every 10% decrease in carbohydrate as a proportion of total energy) and the numerical order across groups (Low-Carb > Moderate-Carb > High-Carb) are commensurate with previously reported changes in TEE [total energy expenditure], supporting the carbohydrate-insulin model.

Source: Energy Requirement Is Higher During Weight-Loss Maintenance in Adults Consuming a Low- Compared with High-Carbohydrate Diet | The Journal of Nutrition | Oxford Academic

In other words, in order to maintain weight loss, you have to (or can) eat more calories if you’re eating low-carb versus high-carb. If your chosen calories are expensive, this could be a drawback. On the other hand, many folks who lose weight complain that they just can’t eat very much or they’ll gain the weight right back. So, if they eat low-carb style, they CAN eat more……calories. Just not more Doritos and Ding-Dongs.

Steve Parker, M.D.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

1 Comment

Filed under Weight Regain

Ketogenic Diet: Evidence for Optimism 

Ketogenic compatible

From The Journal of Nutrition:

For >50 [years], dietary guidelines in the United States have focused on reducing intakes of saturated and total fat. However, rates of obesity and diabetes rose markedly throughout this period, with potentially catastrophic implications for public health and the economy. Recently, ketogenic diets have received substantial attention from the general public and nutrition research community. These very-low-carbohydrate diets, with fat comprising >70% of calories, have been dismissed as fads. However, they have a long history in clinical medicine and human evolution. Ketogenic diets appear to be more effective than low-fat diets for treatment of obesity and diabetes. In addition to the reductions in blood glucose and insulin achievable through carbohydrate restriction, chronic ketosis might confer unique metabolic benefits of relevance to cancer, neurodegenerative conditions, and other diseases associated with insulin resistance. Based on available evidence, a well-formulated ketogenic diet does not appear to have major safety concerns for the general public and can be considered a first-line approach for obesity and diabetes. High-quality clinical trials of ketogenic diets will be needed to assess important questions about their long-term effects and full potential in clinical medicine.

Source: Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed | The Journal of Nutrition | Oxford Academic

PS: If have Conquer Diabetes and Prediabetes, you already have the Ketogenic Mediterranean Diet.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

3 Comments

Filed under ketogenic diet

Obesity Is a Risk Factor for Greater #COVID19 Severity #Coronavirus

BMI over 30

From Diabetes Care:

Health care professionals caring for COVID-19 patients should be cognizant of the increased likelihood of severe COVID-19 in obese patients. In particular, the presence of obesity increases the risk of severe illness approximately threefold with a consequent longer hospital stay.

Source: Obesity Is a Risk Factor for Greater COVID-19 Severity | Diabetes Care

Not sure if you’re obese? Check your BMI.

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

3 Comments

Filed under Coronavirus, Overweight and Obesity

If You’re Gonna Eat Grains, Minimally-Processed May Be Better for You

Brown color may be food coloring rather than minimal processing

From Diabetes Care:

Consuming less-processed whole-grain foods over 2 weeks improved measures of glycemia in free-living adults with type 2 diabetes compared with an equivalent amount of whole-grain foods that were finely milled. Dietary advice should promote the consumption of minimally processed whole grains.

Source: Whole-Grain Processing and Glycemic Control in Type 2 Diabetes: A Randomized Crossover Trial | Diabetes Care

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

3 Comments

Filed under Carbohydrate

Characteristics and Risk Factors for Death in #COVID19 Patients With Diabetes in Wuhan, China

elderly, face mask, surgical mask, corona, epidemic, pandemic, couple

Still unclear whether masks prevent infection

From Diabetes Care:

In summary, the findings of our study suggested that COVID-19 patients with diabetes had worse outcomes compared with the sex- and age-matched patients without diabetes. Diabetes was not independently associated with in-hospital death, while hypertension, cardiovascular disease, and chronic pulmonary disease played more important roles in contributing to the mortality of COVID-19 patients. In-hospital death among COVID-19 patients with diabetes was associated with hypertension and advanced age, whereas only older age was independently associated with death among matched patients without diabetes. The need for early monitoring and supportive care should be addressed in these patients at high risks.

Source: Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study | Diabetes Care

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

2 Comments

Filed under Coronavirus

One More Reason to Avoid Proton Pump Inhibitors: Dementia

I have nothing against Prilosec in particular. It can be very helpful.

There are reasons our stomachs produce acid. One is that the acid helps kill pathogens in our food before they make us sick. Another is to start the digestion of proteins we eat. You can imagine that drastically reducing stomach acid production has some potential adverse effects.

We have two major classes of drugs that reduce acid production by the stomach. The first was H2 blockers, the granddaddy being Tagamet (cimetidine). Tagamet was the first H2 blocker on the market in the U.S., probably 25–30 years ago. Several H2 blockers are are available without a prescription. The second and later class of acid-reducing drugs are the PPIs: proton pump inhibitors. These are more potent than H2 blockers. Because of H2 blockers and PPIs, and the discovery that H. pylori causes many ulcers, we have many fewer patients requiring surgery for upper GI ulcers. Surgery like Billroth’s and vagotomy & pyloroplasty. Once the ulcer heals, most folks don’t need to take a PPI for the rest of their lives.

Bix at Fanatic Cook turned me on to the possibility that chronic use of  PPIs might cause cognitive decline, up to and including dementia. In the U.S., PPIs are available over-the-counter and many physicians prescribe and recommend them to patients in order to reduce stomach acid. The most common reason for chronic usage must be gastroesophageal reflux disease (aka GERD), which is severe or frequently recurrent heartburn. Common PPI names are Protonix, Nexium, Prilosec, omeprazole, and pantoprazole.

A German population study a few years ago linked PPI usage with higher risk of dementia.

A total of 73,679 participants 75 years of age or older and free of dementia at baseline were analyzed. The patients receiving regular PPI medication (n = 2950; mean [SD] age, 83.8 [5.4] years; 77.9% female) had a significantly increased risk of incident dementia compared with the patients not receiving PPI medication (n = 70,729; mean [SD] age, 83.0 [5.6] years; 73.6% female) (hazard ratio, 1.44 [95% CI, 1.36-1.52]; P < .001).

The avoidance of PPI medication may prevent the development of dementia. This finding is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models in which the use of PPIs increased the levels of β-amyloid in the brains of mice. Randomized, prospective clinical trials are needed to examine this connection in more detail.

Source: Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis – PubMed

I don’t know about Germany, but there’s evidence that the incidence of dementia has been decreasing lately in the U.S. I’m guessing that the use of PPIs has been increasing over the last couple decades. So this doesn’t fit with the PPI-dementia theory.

Check out Bix’s article to read that:

  • PPIs interfere with production of acetylcholine, a major chemical than nerve cells use to communicate with each other
  • Healthy young folks who took a PPI for 10 days performed worse on tests of memory

If you have GERD, a low-carb diet may well control it, allowing you to avoid the side effects of PPIs, not to mention the cost.

Oh, darn. I may not be getting my check from Big Pharma this month.

Steve Parker, M.D.

PS: Buy one of my books so I don’t have to depend on Big Pharma.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

 

 

 

1 Comment

Filed under Dementia