ATTD 2024 Round Up - Key Learnings from the Advanced Technologies and Treatments for Diabetes Conference.

From March 5-8, I attended the Advanced Technologies and Treatments for Diabetes conference in Florence Italy as a member of the press to cover the conference. My three days in Florence was spent jumping through multiple symposiums and presentations, as well as talking with various staff members from the companies represented at the conference. Here are the list of symposia I attended at the conference: 

1. #deDoc symposium - What we wish you knew and why 

2. Opening session - A new era in the management of T2DM and Obesity 

3. Medtronic Symposium: Unlocking the full potential of the MiniMed 780G System

4. Dexcom Symposium: Leveraging CGM Early and Across the Spectrum of Type 2 Diabetes Care

5. Accessibility and Disparities of diabetes therapy 

6. Medtronic Symposium: Real-world use of the MiniMed™ 780G system in the U.S. 

I was also fortunate enough to get dedicated time from Medtronic Diabetes, Omnipod, Dexcom and Mannkind to discuss 1 on 1 with members of their leadership to talk about the future of diabetes care from their respective companies, you can find the interviews here: 

• Medtronic Diabetes - Interview with Dr. Ohad Cohen 

• Omnipod - Interview with Dr. Trang Ly 

• Dexcom - Interview with Teri Lawver 

• Mannkind - Interview with Michael Castagna 

While this was my first time attending ATTD, it was not my first international diabetes conference. I’ve attended ADA scientific sessions 3 times (2018, 2019, 2023) and EASD in 2022. Compared to those conferences, the venue for ATTD 2024 was very different - taking place at the Fortezza da Basso in Florence, quite literally a fortress converted into a sprawling event center campus. This made the conference a bit more spread out with a much smaller than average exhibition hall, with about an 8-9 foot ceiling compared to the extremely tall exhibit halls of the other conferences I’ve attended. 

My Takeaways from ATTD: The Three A’s of ATTD:
I have decided to summarize my time at ATTD under my “Three A’s of ATTD”: 

1. Access 

2. Adherence 

3. Automation 

Access

My first A of ATTD is Access. In the Accessibility and Disparities of diabetes therapy symposium, featuring Partha Kar and Diabetics Doing Things Podcast alumni Dr. Ananta Adalla, there was much research shared supporting what we in the diabetes community know all too well: there are major disparities in both youth and adult populations based on race, even when you split the data by income. These disparities include: 

• Relationship with Providers 

• Perception of technology within different cultures 

• Inclusion and understanding of culture specifically around food

• Lower adoption of tech regardless of income 

Two quotes from the conference stuck out to me as thoughts that we deeply need to consider when we’re talking about diabetes access: First, Dr. Martin de Bock from New Zealand said in the Dexcom symposium: “In all countries, T2D is overrepresented in native populations and underserved populations.” Second, Dr. Partha Kar from the NHS said, that his approach to addressing disparities is very straightforward:  “If you give everything to everyone, then you don’t have a disparity.” 

I think too often we skim over the elephant in the room regarding diabetes care and skip straight to treatments, but if patients can’t afford the coverage for the treatments or their providers don’t make them available to them, we will not be able to achieve greater outcomes across the board.

Adherence 

The second A of ATTD is Adherence. This was particularly relevant for me because while Access is the number one issue, if the technology, medication or methodology doesn’t stick or isn’t sustainable, the patient will not be able to get to the benefit of improved outcomes. 

In fact, the research presented by Dr. Ananta Adalla showed that CGM wear time is associated with efficacy of CGM, and with Dexcom sharing that CGM access improves outcomes across the board with Type 2 diabetes, the key to achieving these outcomes is ensuring that patience have the tools, information and support to adhere to the protocols of the therapy. 

Here are some things to consider with adherence, specifically around high-risk and underserved patient populations: 

• You’re less likely to get a pump within a year of diagnosis if you are black/hispanic

• You’re 50% less likely to have a significant diabetes complication event if you have a patient navigator/care ambassador

• We have robust evidence that diabetes technology works quite well, so if there are disparities it means there are structural issues 

• CGM wear time is associated with efficacy of CGM 

• Insurance bias and racial bias are closely linked 

• There still exist major disparities in the use of pump & CGM in racial/ethnic minority youth

• Even when income is sliced, the disparities still exist 

• Hesitancy to embrace technology, perceptions of device burden, embarrassment/shame, gatekeeping (felt they weren’t offered or encouraged to use tech by providers) 

• Relationships with providers 

• Differences in parent perspectives

• Black Parents 

• Don’t want child to appear different

• Feelings of defensiveness, judgement

• View providers as gatekeepers 

• White Parents 

• Little concern about “otherness” 

• Pride in advocacy about diabetes

• Providers as facilitators 

Ultimately, if patient identities are not supported and empowered, adherence to technology and treatments are unlikely to be high enough to achieve improved outcomes. 

Automation 

My final A in the 3 A’s of ATTD is automation. There was a dramatic amount of research presented at ATTD 2024 about the impact of Automated Insulin Delivery via Hybrid Closed Loop insulin pump systems. The main systems who showed research were: 

• Medtronic Diabetes MiniMed 780G system 

• Tandem Control IQ system 

• Insulet Omnipod 5 system 

There are also newer AID systems like Beta Bionic’s iLet ACE pump which are also coming to market, as well as DIY Loop systems like iAPS. 

Ultimately, the research shows Time in Range on Automated Insulin Delivery Hybrid Closed Loop systems exceeds international consensus targets, and on the Medtronic Minimed 780G System, when the 100mg/dl glucose target and 2-hour active insulin time setting is used, 85% of users reported average Time in Range numbers greater than 70%. 

While I believe devices are an extremely personal choice with many factors that vary dramatically from patient to patient, the data from ATTD 2024 unequivocally shows that AID systems significantly improve glycemic outcomes, and when referencing the DIAMOND study, Advanced Hybrid Closed Loop systems reported greater time in range and greater time in target range than CGM alone. It will be very interesting to see how this data continues to unfold as more aHCL and AID systems come to market and are able to be studied in real-world populations.

Conclusion

Overall, my time at ATTD 2024 was well-spent and while I am excited about the future of diabetes technology. It is clear that there is a dramatic need for innovation within type 1 and type 2 diabetes globally. Prevalence of T1D is increasing globally, and more adults are being diagnosed with T1D than all other age groups (LADA is the most common form of adult-onset autoimmune diabetes). The uncomfortable reality is that T1D is associated with 3-fold higher mortality, and drastically decreases life expectancy. We need to ensure that all people with diabetes, no matter the type, have access to the technology and pharmacology they need to achieve greater outcomes across the board, and the information, support and care to ensure adherence to these protocols. We are rapidly approaching a world where the standards of care for diabetes will allow people who are diagnosed T1D to receive a CGM and Automated Insulin Delivery system on the day of diagnosis, but there are real barriers to making this a reality for all. 

There is also a CRITICAL need for more patient representation at these industry conferences. To have only one symposium (prior to the conference opening session) where patient stories are prominently featured (#dedoc voices symposium) is an oversight which needs to be rectified. Patient voices on issues such as Time in Target Range, Automated Insulin Delivery and Alert Fatigue can help connect providers and industry to the human stories behind these metrics.

The future of diabetes care is happening at these conferences, with or without patients, and I believe in order for us to really drive change through innovation, patients must be present.

Check out the ATTD Interview Playlist on our YouTube Channel 

Subscribe to Diabetics Doing Things Email Newsletter 

Interview with Brec Bassinger, T1D, Star of DC's Stargirl

Diabetics Doing Things had the pleasure of sitting down with the talented actor and Type 1 diabetic Brec Bassinger at the end of 2022 to talk about her life with diabetes and her journey as an actor on the CW’s Stargirl and other projects.

Brec shared that she was diagnosed with diabetes at the age of 8 and says she feels lucky that her diagnosis came early on in her life, as it has allowed her to adjust and learn how to manage her diabetes over the years.

Brec's diagnosis came as a result of her experiencing common symptoms of diabetes, including extreme thirst, bedwetting, and weight loss. Her mother took her to a care center, where she was diagnosed with diabetes and immediately referred to Cook's Children's hospital for treatment. She spent several days at the hospital, where she received top-notch care and support from the staff.

Despite the challenges of living with diabetes, Brec has never let it slow her down. In fact, she has become an inspiration to many by sharing her journey with diabetes on social media. Through her TikTok and Instagram accounts, she shows others how to stay positive, manage their diabetes, and live their lives to the fullest. We join her on zoom from Vancouver, BC for the interview, which can be heard in its entirety on episode 235 of the Diabetics Doing Things podcast.

DDT: So Brec, you're known for your role as a superhero on the hit show "Stargirl." And not only are you kicking butt on screen, but you're also managing your type one diabetes behind the scenes. Can you tell us a bit about how you navigate the demands of a busy shooting schedule while managing your diabetes?

Brec: Yeah, it can definitely be a challenge. Diabetes on its own has its daily burdens, and working 16, 17 hour days on top of that can be tough. But I always make sure to let the director and first assistant director know about my diabetes so that we can work together to make accommodations if needed. For example, if my blood sugar drops, we need to have juice on standby and I may need to step off for a few minutes to get back on track.

I had a particularly challenging moment recently while filming an emotional scene. We had been working on it for hours and when it came time for my coverage, my blood sugar started to drop and I couldn't remember my lines. I had to speak up and let everyone know that we needed to take a break so that I could get my blood sugar back up. It's all about open communication and being kind to yourself.

DDT: That's so important. And it's great that you're practicing empathy towards yourself. How do you balance taking care of your diabetes while also giving your best performance on set?

Brec: It's definitely a juggling act, but I make sure to always have my devices and supplies on hand and check my blood sugar regularly. I also try to be mindful of my diet and make sure I'm staying hydrated. And if I need to take a break to manage my diabetes, I do so without hesitation. At the end of the day, my health comes first.

DDT: You’ve mentioned that you're open to the idea of playing a character with diabetes on screen. Do you have any ideas of how you would bring diabetes to life in a character?

Yeah, I think it would be really important to have more representation of diabetes in media. And not just for the sake of representation, but also to educate people who may not be familiar with the disease. I know growing up, I didn't really know anyone with diabetes and I didn't really understand what it was. And I think if there were more characters with diabetes in TV shows and movies, it would help people understand it better. There have been a few more recent examples of characters with diabetes in movies and TV shows, but it's definitely just the start. And when we do see it, it's often not portrayed accurately or it's just kind of a token nod to representation, rather than really diving into the reality of living with diabetes.

But at the same time, I also think it's important to not make diabetes the defining characteristic of a character. Like, if a character has diabetes, it doesn't mean that's all they are. They can still be a complex, interesting character with a lot of different facets.

I think part of the issue is just a lack of awareness and understanding about diabetes. A lot of people don't realize that it's not just about not being able to eat sugar or needing to take insulin. There are so many different factors that can affect blood sugar levels, and it can be really hard to manage.

I also think there's still a lot of stigma and misconceptions surrounding diabetes. People might assume that it's something that only affects overweight or unhealthy people, which is obviously not true. And there can be a lot of shame and embarrassment associated with things like checking your blood sugar or injecting insulin in public.

Recently, I've been working on a project that centers around diabetes. It's written, directed, and stars Kelsey Bascom, a type one diabetic. When they approached me to be a producer on the project, I was immediately on board. The movie tells the real little things of diabetes, and I think it's very honest. What's even cooler is that Kelsey has involved many diabetics in the project. In one of the scenes, we were all diabetics, even though only Kelsey played a diabetic character in the movie. We would sit and chat about our experiences with diabetes in between takes, and it was such a lovely set experience. I'm excited for people to see this movie because it covers the unspoken, gross and weird parts of diabetes that people often don't talk about. It's the kind of movie that I wish I had when I was first diagnosed.

So I think it's really important to have more representation in media to help break down those stereotypes and show that diabetes is a complex, nuanced condition that affects people from all walks of life. And I'm really excited to be part of a project that's doing just that.

DDT: I think that's where having someone like you, who has diabetes but is also a superhero, is really powerful.

Once I was asked if having diabetes and being in the spotlight made me feel a responsibility to be an advocate. Honestly, I see it as an opportunity rather than a responsibility. When I was diagnosed at eight years old, my mom brought me a People magazine article with Nick Jonas holding a diet coke and talking about his diabetes. Seeing him do that made me feel like if he can do it, I can do it too. It really impacted me and made me realize the impact of representation. So now, with my own career, I see it as an opportunity to be that representation for someone else. I want to be that Nick Jonas for even one individual.

DDT: Recently I saw a TikTok you made where you talked about using Afrezza (insulin human) Inhalation Powder to manage your diabetes.

This episode is sponsored by Mannkind as part of our ongoing collaboration with Diabetics Doing Things. Please see full Prescribing Information and Medication Guide, including BOXED WARNING on Afrezza.com/safety. AFREZZA (insulin human) Inhalation Powder is a man-made insulin that is breathed in through your lungs (inhaled) and is used to control high blood sugar in adults with diabetes mellitus. AFREZZA must be used with basal insulin in people who have type 1 diabetes mellitus. Please read additional Important Safety Information below.

During my training for Stargirl, I was speaking with a friend who has diabetes and he recommended that I talk to my doctor about Afrezza as a mealtime insulin option. Initially, I only planned to use it for the months leading up to filming, but I found that adding Afrezza as my go-to mealtime insulin, along with maintaining a healthy diet and exercise routine, allowed me to focus on other things. It has been over three years since I started using Afrezza, and I believe that finding the right mix that works for you is key to being your best self.

Important Safety Information 

AFREZZA can cause serious side effects, including:  

· Sudden lung problems {bronchospasms). In a study, some AFREZZA treated patients with asthma, whose asthma medication was temporarily withheld, experienced sudden lung problems. Do not use AFREZZA if you  have long-term (chronic) lung problems such as asthma or chronic  obstructive pulmonary disease (COPDJ. Before starting AFREZZA, your healthcare provider will give you a breathing test to check how your lungs  are working.  

Please see continued Important Safety Information at the end of this  article. 

DDT: Lightning Round! Let’s ask Brec for her quick responses to these questions:

Current TV Binge:

Love is Blind

Celebrity You Would Challenge in Pickleball:

Dwayne the Rock Johnson

Favorite thing about Alfie (Brec’s dog):

The way he prances instead of walks (laughs)

DDT: What would you tell a young person living with diabetes today that you wish you had been told when you were diagnosed?

That it will get easier. I meet so many diabetics who are still in like their first year of diagnosis and I just tell them that eventually you will know what a low blood sugar feels like. You'll know how to communicate to people when your blood sugars are out of range. Yes, it'll still be a daily burden. It will still be difficult, but you will learn and it will get easier to manage.

DDT: Thanks for your time today, Brec and for all you do for people with diabetes.

Thank you! XO to everyone reading this

Brec's positive attitude and unwavering determination are a true testament to her strength and resilience. She continues to inspire and empower others with diabetes to not let the disease define them and to chase their dreams no matter what challenges they may face.

Brec Bassinger and Rob Howe are paid spokespeople for MannKind Corp. but the thoughts and opinions contained in this interview are their own.

Continued Important Safety Information:

What is the most important information I should know about AFREZZA?

What is AFREZZA?

• AFREZZA is a man-made insulin that is breathed-in through your lungs (inhaled) and is used to control high blood sugar in adults with diabetes mellitus.

• AFREZZA is not for use to treat diabetic ketoacidosis. AFREZZA must be used with basal insulin in people who have type 1 diabetes mellitus.

• It is not known if AFREZZA is safe and effective for use in people who smoke. AFREZZA is not for use in people who smoke or have recently stopped smoking (less than 6 months).

  It is not known if AFREZZA is safe and effective in children under 18 years of age.

  Who should not use AFREZZA?

  Do not use AFREZZA if you:

• Have chronic lung problems such as asthma or COPD.

• Are allergic to regular human insulin or any of the ingredients in AFREZZA.

• Are having an episode of low blood sugar (hypoglycemia).

What should I tell my healthcare provider before using AFREZZA?

Before using AFREZZA, tell your healthcare provider about all your medical conditions, including if you:

• Have lung problems such as asthma or COPD

• Have or have had lung cancer

• Are using any inhaled medications

• Smoke or have recently stopped smoking

• Have kidney or liver problems

• Are pregnant, planning to become pregnant, or are breastfeeding. AFREZZA may harm your unborn or breastfeeding baby.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins or herbal supplements.

Before you start using AFREZZA, talk to your healthcare provider about low blood sugar and how to manage it.

What should I avoid while using AFREZZA?

While using AFREZZA do not:

• Drive or operate heavy machinery, until you know how AFREZZA affects you

• Drink alcohol or use over-the-counter medicines that contain alcohol

• Smoke

What are the possible side effects of AFREZZA?

AFREZZA may cause serious side effects that can lead to death, including:

See “What is the most important information I should know about AFREZZA?”

Low blood sugar (hypoglycemia). Signs and symptoms that may indicate low blood sugar include:

• Dizziness or light-headedness, sweating, confusion, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability or mood change, hunger.

Decreased lung function. Your healthcare provider should check how your lungs are working before you start using AFREZZA, 6 months after you start using it, and yearly after that.

Lung cancer. In studies of AFREZZA in people with diabetes, lung cancer occurred in a few more people who were taking AFREZZA than in people who were taking other diabetes medications. There were too few cases to know if lung cancer was related to AFREZZA. If you have lung cancer, you and your healthcare provider should decide if you should use AFREZZA.

Diabetic ketoacidosis. Talk to your healthcare provider if you have an illness. Your AFREZZA dose or how often you check your blood sugar may need to be changed.

Severe allergic reaction (whole body reaction). Get medical help right away if you have any of these signs or symptoms of a severe allergic reaction:

• A rash over your whole body, trouble breathing, a fast heartbeat, or sweating.

Low potassium in your blood (hypokalemia).

Heart failure. Taking certain diabetes pills called thiazolidinediones or “TZDs” with AFREZZA may cause heart failure in some people. This can happen even if you have never had heart failure or heart problems before. If you already have heart failure it may get worse while you take TZDs with AFREZZA. Your healthcare provider should monitor you closely while you are taking TZDs with AFREZZA. Tell your healthcare provider if you have any new or worse symptoms of heart failure including:

• Shortness of breath, swelling of your ankles or feet, sudden weight gain.

Treatment with TZDs and AFREZZA may need to be changed or stopped by your healthcare provider if you have new or worse heart failure.

Get emergency medical help if you have:

• Trouble breathing, shortness of breath, fast heartbeat, swelling of your face, tongue, or throat, sweating, extreme drowsiness, dizziness, confusion.

The most common side effects of AFREZZA include:

• Low blood sugar (hypoglycemia), cough, sore throat.

These are not all the possible side effects of AFREZZA. Call your doctor for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088 (1-800-332-1088).

Please See Full Prescribing Information, including BOXED WARNING, Medication Guide and Instructions for Use at Afrezza.com/safety.

Q&A with Eric Tozer

The below article is a transcript and summary of episode 205 of the Diabetics Doing Things podcast sponsored by Afrezza® (insulin human) Inhalation Powder and MannKind Corp. The podcast features host Rob Howe and guest Eric Tozer, Type-1 Diabetic and a co-founder of Diabetes Sports Project. You can listen to the entire interview here.

Please see full Prescribing Information and Medication Guide, including BOXED WARNING on Afrezza.com.

Rob Howe: Hello, Eric, it's great to have you on the show today. Can you start by telling us about your experience with diabetes?

Eric Tozer:  Hi Rob, thank you for having me. My journey with diabetes started when I was suddenly 20 pounds lighter after a trip to Europe and my mother noticed it when I returned to America. She recognized the symptoms and took me for a checkup, and my A1C was in the twelves and fasting blood sugar was 500. It was a difficult time, but I learned so much from my experiences. Early on, I had a seizure caused by low blood sugar, but that didn't stop me from pursuing my passions. Diabetes was a shock for my family and me however, I learned to manage my diabetes through a combination of physical and mental preparation. I've been running marathons for the past 15 years and co-founded Diabetes Sports Project to help others with diabetes by sharing my experiences and knowledge. 

Rob: That's amazing. Tell us more about Diabetes Sports Project and your experience as a marathoner.

Eric: DSP is comprised of the world’s elite diabetic athlete ambassadors who inspire and educate the diabetes community to achieve their goals and aspirations. Living with diabetes is like a marathon, not a sprint. It requires physical and mental preparation, and having a plan in place is crucial. The support of the diabetes community has been instrumental in helping me manage my diabetes, and I believe it's important to be involved and make friends with others who have diabetes. Social media has made it easier for us to connect with others and support each other. I love helping others and sharing my experiences with diabetes, and it's truly rewarding to see the positive impact it has on people's lives. It has certainly part of what has powered me through my marathons.

Rob: I completely agree. Can you talk about the role of technology in managing your diabetes in your life, in and out of sport?

Eric: Absolutely. Continuous glucose monitoring (CGM) devices and insulin delivery systems have made a huge impact in managing diabetes on a day-to-day basis. I personally have been using Afrezza for 7 years and have found it very helpful, especially for mealtime insulin and corrections. I work with MannKind to support the diabetes community, and I believe in the benefits of Afrezza.

Rob: Thank you for sharing. Mental health is an important aspect of a life with Diabetes, and even leaders like yourself can struggle with difficult situations. Can you share how you work through difficult situations in your life? 

Eric: One of the biggest challenges I've faced is the loss of a friend to suicide. It was a difficult time for me, and I struggled with grief and even had a panic attack. However, with the support of my wife and therapist, I was able to get through it. I believe it's important to be vulnerable and share difficult experiences to help others who may be going through similar struggles. Grief is tough, but having support from friends and family, celebrating small wins, and talking about our feelings can make a big difference. Whether the difficulties are related to Diabetes or not. 

Rob: I'm so sorry for your loss. That's a tough situation to go through. I'm glad you were able to get the support you needed during that difficult time. You manage to try to make the best out of bad situations and strive for greatness. Can you talk about what it means to be the best version of oneself?

Eric: Being the best version of oneself is a cliché, but it's also true and important. There are many areas where people can be great, such as video games, creativity, and sports. It's about having a conversation with oneself and finding one's own path in life, making decisions that can lead to unexpected opportunities. I believe that being the best version of oneself is achievable, but it is a lifelong journey.

Rob: That's a great message, Eric. I couldn’t agree more. Before we close, can you tell us how you find a mindset to help others?

Eric: I believe in a service mindset. I feel that serving others and helping leads to personal growth that doesn’t happen until you get outside yourself. I've had a successful career, and I'm grateful for the recognition I receive for my work helping people with diabetes, but what keeps me going is helping others with Diabetes. I hope to inspire others so they don’t have to regret not taking a chance to do what they love, and the people I work with inspire me daily. I can say I am truly excited to see what the future holds for people with Diabetes. 

Rob Howe and Eric Tozer are paid spokespeople for MannKind Corp. but the thoughts and opinions contained in this interview are their own.

Important Safety Information

What is the most important information I should know about AFREZZA?

AFREZZA can cause serious side effects, including:

• Sudden lung problems (bronchospasms). Do not use AFREZZA if you have long-term (chronic) lung problems such as asthma or chronic obstructive pulmonary disease (COPD). Before starting AFREZZA, your healthcare provider will give you a breathing test to check how your lungs are working.

What is AFREZZA?

• AFREZZA is a man-made insulin that is breathed- in through your lungs (inhaled) and is used to control high blood sugar in adults with diabetes mellitus.

• AFREZZA is not for use in place of long-acting insulin. AFREZZA must be used with long-acting insulin in people who have type 1 diabetes mellitus.

• AFREZZA is not for use to treat diabetic ketoacidosis.

• It is not known if AFREZZA is safe and effective for use in people who smoke. AFREZZA is not for use in people who smoke or have recently stopped smoking (less than 6 months).

• It is not known if AFREZZA is safe and effective in children under 18 years of age.

What should I tell my healthcare provider before using AFREZZA?

Before using AFREZZA, tell your healthcare provider about all your medical conditions, including if you:

• Have lung problems such as asthma or COPD

• Have or have had lung cancer

• Are using any inhaled medications

• Smoke or have recently stopped smoking

• Have kidney or liver problems

• Are pregnant, planning to become pregnant, or are breastfeeding. AFREZZA may harm your unborn or breastfeeding baby.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins or herbal supplements.

Before you start using AFREZZA, talk to your healthcare provider about low blood sugar and how to manage it.

What should I avoid while using AFREZZA?

While using AFREZZA do not:

• Drive or operate heavy machinery, until you know how AFREZZA affects you

• Drink alcohol or use over-the-counter medicines that contain alcohol

• Smoke

Do not use AFREZZA if you:

• Have chronic lung problems such as asthma or COPD

• Are allergic to regular human insulin or any of the ingredients in AFREZZA.

What are the possible side effects of AFREZZA?

AFREZZA may cause serious side effects that can lead to death, including:

See “What is the most important information I should know about AFREZZA?”

Low blood sugar (hypoglycemia). Signs and symptoms that may indicate low blood sugar include:

• Dizziness or light-headedness, sweating, confusion, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability or mood change, hunger.

Decreased lung function. Your healthcare provider should check how your lungs are working before you start using AFREZZA, 6 months after you start using it, and yearly after that.

Lung cancer. In studies of AFREZZA in people with diabetes, lung cancer occurred in a few more people who were taking AFREZZA than in people who were taking other diabetes medications. There were too few cases to know if lung cancer was related to AFREZZA. If you have lung cancer, you and your healthcare provider should decide if you should use AFREZZA.

Diabetic ketoacidosis. Talk to your healthcare provider if you have an illness. Your AFREZZA dose or how often you check your blood sugar may need to be changed.

Severe allergic reaction (whole body reaction). Get medical help right away if you have any of these signs or symptoms of a severe allergic reaction:

• A rash over your whole body, trouble breathing, a fast heartbeat, or sweating.

Low potassium in your blood (hypokalemia).

Heart failure. Taking certain diabetes pills called thiazolidinediones or “TZDs” with AFREZZA may cause heart failure in some people. This can happen even if you have never had heart failure or heart problems before. If you already have heart failure it may get worse while you take TZDs with AFREZZA. Your healthcare provider should monitor you closely while you are taking TZDs with AFREZZA. Tell your healthcare provider if you have any new or worse symptoms of heart failure including:

• Shortness of breath, swelling of your ankles or feet, sudden weight gain.

Get emergency medical help if you have:

• Trouble breathing, shortness of breath, fast heartbeat, swelling of your face, tongue, or throat, sweating, extreme drowsiness, dizziness, confusion.

The most common side effects of AFREZZA include:

• Low blood sugar (hypoglycemia), cough, sore throat

These are not all the possible side effects of AFREZZA. Call your doctor for medical advice about side effects.

Please see full Prescribing Information and Medication Guide, including BOXED WARNING on Afrezza.com.

My 2022 in Review - by Rob Howe

"'Tis the season!"

Although it isn't said as authentically as it once was, in the west we know that no season takes on as much of its own persona as the winter holidays. At time of writing, we are currently nestled in the last week between the Thanksgiving and Christmas/Hanukkah/New Year's Eve/etc holidays, a sort of last bit of permission to labor amidst the three major holidays in the US.

I've been working to curate more seasonality in my life, in my work, physical fitness and mindset. Like many others I benefitted from the pronounced and specific structure of adolescent life: School, Sports, Semesters, Finals, etc.

The season gave cues to the behaviors we should take to make best use of the time.

For basketball, at any level, it was very simple:

• Winter - Season (performance)

• Spring - Postseason Workouts (optimization)

• Summer - AAU & Offseason (rest & work on skills)

• Fall - Preseason Workouts (preparation)

For school, just as straightforward:

• Fall - School starts

• Winter - finish the semester, finals and holidays

• Spring - spring break, midterms

• Summer - school's out, rest, relax, vacation

Yet once we enter the "real world" most of that seasonality that was dictated to us over the years is left for us to create in our own lives, or not. From my own experience, my first 10 years of my professional career were spent in an "always on" seasonality. In the 3 years following the outbreak of COVID-19, I've been curious as to what seasonality would look like in my professional and personal life, but have met a lot of resistance and it seems as though the status quo on seasonality is: "We'll get to it when we get to it."

As part of my efforts to bring seasonality into my life, I decided to go back to my habit of making an end of the year list. What gets measured gets managed, after all.

So I've attempted to do that below, from TV and Entertainment to Health, Diabetes & otherwise, here are my Top 5 lists of 2022. Videos and social media posts to follow!

enjoy

Rob

Top 5 lists of 2022

Top 5 Favorite New TV Show Episodes of 2022

• Andor S1 E10 - "One Way Out"

• Rings of Power S1 E6 - "Udün"

• The Bear S1 E7 - "Review"

• Tokyo Vice S1 E1 - "The Test"

• We Own the City S1 E6 - "Part 6"

Note: I have yet to watch Severance, Abbott Elementary and Industry, but they are next up.

Top 5 Movies of 2022

• Top Gun: Maverick

• Everything, Everywhere, All At Once.

• Nope

• Avatar: The Way of Water

• The Batman

Top 5 Reads of 2022

• 4,000 Weeks: Time Management for Mortals by Oliver Burkeman

• Heat 2 by Michael Mann & Meg Gardiner

• A Heart That Works by Rob Delaney

• Atomic Habits by James Clear

• The Network State by Balaji Srinivasan

Top 5 Purchases Under $100 in 2022

• Athletic Greens AG1 monthly subscription

• Nedrelow Laptop Mat

• Momentous Supplements Magnesium Threonate

• Slant Boards

• Move Insoles All Day Shoe Inserts

Top 5 Meaningful Personal Changes I Made in 2022

• Adding 20 push-ups to my morning routine

• Renu Therapy Cold Immersion Tank

• No caffeine for the first 90 mins of the day

• Journaling before I get on my computer

• All-Time low levels of Alcohol Consumption

Top 5 Diabetes Decisions

• Taking a pump break to let my body heal

• Going back on my pump after the break

• Listening to my body and switching back to Humalog from Lyumjev

• Focusing on sleep, hydration and movement as part of my essential Diabetes therapy

• Recognizing and accepting that my needs as a person with Diabetes are different than the general Diabetes population

Top 5 Questions for 2023

• How can I do more with less?

• What is enough?

• Am I operating in gratitude?

• What does consistency look like?

• Do I need rest or adventure?

Diabetics Doing Things & North Texas Food Bank Launch Collaboration

8/30/2022, For Immediate Release 

(Dallas, TX) Diabetics Doing Things, a Dallas-based Diabetes Media Company, introduces first collaboration with North Texas Food Bank (NTFB), North Texas’ Feeding America Chapter, in an effort to bring resources and information about Diabetes to food-insecure people in North Texas. The printing costs were paid for by a $5,000 grant from BeyondType1, a leading Diabetes non-profit that provides programs and resources to enhance the lives of people living with Diabetes.

“We are extremely excited to announce our partnership with North Texas Food Bank,” said Rob Howe, Founder of Diabetics Doing Things. “The research shows 1 in 3 people living in North Texas live with some kind of Diabetes, and underserved communities are often hit the hardest. We felt like it was our duty to help.” Since NTFB serves 136 million meals to kids, seniors and families across North Texas, we felt like that was a good place to start.” 

Starting in September, Family and Senior Kits from NTFB will include a printed postcard with links to Diabetes Resources in English and Spanish. Howe says this is a “simple technological solution to a very complex problem,” but he is hopeful that by creating an opportunity for someone to get critical information about Diabetes in a user-friendly, bi-lingual interface, they could make a difference. “1 in 4 people are rationing insulin in the United States. If this program helps one person get information on clinics, savings cards or mutual aid, it could be the difference between life and death.” 

The 90,000 postcards will serve as a test to determine the volume of need to be met. The partnership between NTFB and Diabetics Doing Things has already opened up other opportunities at the Food Bank, such as updating Diabetes programming and content to include more up-to-date information with actionable resources and guides to make life with Diabetes a little easier. 

Howe closed with, “This is just the beginning. I’m incredibly encouraged by the opportunity to serve the people of North Texas. I hope we can show that with the right solutions, small amounts of money can have a big impact on people’s lives.” 

About North Texas Food Bank

The North Texas Food Bank (NTFB) is a top-ranked nonprofit hunger-relief organization that sources, packages and distributes food through a diverse network of more than 400 feeding partners including food pantries and community organizations across 13 North Texas counties. The organization also provides food to children, seniors and families through various direct-delivery programs, including mobile pantries. 

In its last fiscal year, the NTFB provided access to nearly 137 million nutritious meals, a 9% percent increase over the prior year. In response to the ongoing elevated hunger crisis, the organization has launched a $500 million campaign, Nourish North Texas, to provide more food for today and hope for tomorrow by addressing the barriers to food security that our neighbors face.  

The North Texas Food Bank is designated a 4-Star Exceptional organization by Charity Navigator based on its governance, integrity, and financial stability. NTFB is a member of Feeding America, the nation’s largest hunger-relief organization. www.ntfb.org

About Diabetics Doing Things 

Diabetics Doing Things was founded in 2015 by Rob Howe and began as a podcast and social media platform before transforming into a new kind of Diabetes Media Company providing practical solutions for people with Diabetes using technology and media.

Live TV News and Diabetes by Kelly Reardon

“How do you do it?” That’s probably the number one most-asked question I get when I tell other diabetics I work in live television news. The biggest hurdle, as you may be able to guess: low blood sugar. But first...let’s go back to the beginning. I was diagnosed with type 1 diabetes within my first few months of college. I was in Florida, my family... in New England. It was obviously a lot to process, especially since I was already going through something so new and challenging. Fast-forward a few years….and my a1c dropped to 7% and I was happy on a pump and cgm. I accepted my job in TV news knowing damn well the huge hurdles I’d have to jump through to make my product seem the same as all the other meteorologists with working pancreases. But I was determined. If there’s something you want, you’ll find a way to get it done. Without a pump and cgm, live tv news would be much more challenging. That’s because avoiding low blood sugar is number one on my priority list while doing weather during a live newscast. I have a few tricks up my sleeve -- first, I set my low blood sugar alert relatively high -- near 80 mg/dL. On top of that, I have the alert before low feature enabled on my pump. I’m also on auto mode with the medtronic 770g, so if I’m dropping it’ll stop my insulin delivery much quicker than if I was doing it all myself. With a higher low alert, and alert before low, I have plenty of wiggle room until I really start feeling and getting low. I keep a drawer full (literally) of fruit gummies within reach...ready to go at a moment’s notice. But as you very well know, even with a higher low alert and alert before low… low blood sugar still happens. I won’t lie, I’ve gone on the air with a blood sugar of 50. It didn’t feel great, and I probably didn’t even need to do it. It’s not too difficult to get my weather segments pushed off a few minutes if needed. But even 3 years in, I have yet to go low enough for that to be necessary. That’s without a doubt all due to auto mode on my pump. It really has significantly reduced not only the frequency of lows, but also the severity. So I just put on a smile and work through my low of 50, and usually the fruit gummies have kicked in before my next weather segment. 

What a lot of people don’t know about my broadcast meteorology job is that we ad lib. That means we are completely unscripted. Everything we say is off the top of our heads. And you can imagine how, with diabetes, that can be tricky. Ad libbing weather, while in the back of my mind I’m simultaneously thinking about why my pump is vibrating, or is the reason I feel ill because of my blood sugar or just lack of sleep. It’s a lot to take on. Some days are harder than others. I wake up at 1:30 a.m., to get ready for the 4:30 a.m. newscast. I’ve had my nights where I endured 15+ notifications that woke me up every 20-30 minutes, and then had to go on air looking like I slept 12 hours and sang with forest animals on my way to work like some sort of Disney princess. 

But it’s what I love. 

TV weather is my passion, and no matter what diabetes throws at me, that’ll never change. Me telling you how challenging diabetes and a demanding career isn’t meant to discourage you. In fact, I want it to do the exact opposite. If I can do sleepless nights, low blood sugar, high blood sugar, the doctor’s appointments, the blood work, the endless insurance phone calls and the general mental strain diabetes can cause….then you can too. No matter how impossible it may seem to you now. 

I am so thankful for the modern technology we have access to today, that allows us to live (a little bit more) normal lives. That technology allows me, and Nick Jonas, to do live television broadcasts. Which, 9 years ago, is something I thought I was never going to be able to accomplish with diabetes. But if you go after your dream, if you go after that career, you will eventually get a schedule down, and find what works for you. Truly, you can do anything. 

National Diabetes Awareness Month 2021 - A Focus on Humanizing Diabetes

It’s November 2021, or as people with Diabetes know, National Diabetes Awareness Month. For people who have been involved with the Diabetes Online Community, this is a time for sharing personal stories, advocating for important causes or participating in social media challenges to help raise awareness about life with Diabetes.

For Diabetics Doing Things, we decided to focus on the 9 out of 10 Americans who DON’T live with Diabetes, and created a series of graphics that we posted to our Instagram account.

The following are the topics we wanted to create awareness about for NDAM 2021.

Insulin Access and Affordability

You simply cannot discuss Diabetes without discussing the Insulin crisis, which affects 50% of people with Diabetes, and data from T1International says 1 in 4 Americans with Diabetes have rationed their insulin. For National Diabetes Awareness Month 2021, we wanted to ensure this was top of the list for people without Diabetes to know.

The Chronic Effects of Diabetes - Sleep Loss

Diabetes causes sleep loss, which can simultaneously lead to insulin resistance. A vicious cycle for people with Diabetes, but it is one of the invisible burdens of living with a chronic illness. If you’d like to calculate how much sleep you’ve lost to Diabetes, use this tool from JDRF.

The Cost of Diabetes

Outside of insulin costs, Diabetes places a significant strain on finances. The financial burden of Diabetes is significant. When the average cost of Diabetes per capita is compared with Median Household Income in the United States, the numbers are a shocking 14% of income would be needed to cover Diabetes costs.

Health Insurance and Macro Statistics

When I hear macro statistics about Insurance or Healthcare, I always think about the people with Diabetes that it affects. The COVID-19 pandemic has created conditions that are adversely affecting people with Diabetes, even if they are unaffected by the virus itself. The number of uninsured Americans increased in 2020. It's important to remember there are people with Diabetes within macro statistics. If 30M Americans do not have insurance, it's reasonable to think that at least 10% of those people have Diabetes, if 1 in 10 Americans live with the disease.

1 in 10 Americans live with Diabetes

The Many Types of Diabetes

It’s more than just Type-1 or Type-2 these days. We’re learning more and more about the different types of Diabetes and the most important thing we can do is de-stigmatize Diabetes and end the harmful language that is rooted in ignorance.

The Rising Cost of Insulin

The cost of insulin in the United States has risen 11% annually from 2001-2018 (source: American Action Forum)

Diabetes and COVID-19

"Although anyone can contract COVID-19, individuals with pre-existing medical conditions, such as diabetes, appear to be more vulnerable to becoming severely ill with the virus. Initial data from COVID-19 cases, recently reported by the American Diabetes Association, show that individuals with uncontrolled diabetes are more likely to have worse outcomes." T1DExchange

Diabetes and Socioeconomic Class

"The difference in average A1c between the lowest income group and the highest income group is 1.46%." T1DExchange We know that class affects nearly all aspects of healthcare, but to see HgA1C outcomes listed like this was particularly poignant.

Conclusion

So what do we do with all this information? Continue to spread awareness by sharing this blog with your friends and family who do not live with Diabetes. In order for people with Diabetes to change the status quo it is essential for us to garner the attention and favor of the greater population. It is difficult for people to care about things that do not directly affect them, so tell your friends why they should care about the issues that you and other people with Diabetes face.

Happy NDAM 2021,

Diabetics Doing Things Staff

Cup of Oj Takeover: Festive Low Carb Cocktail and Fall Inspired Charcuterie Boards

Hi there! Ariana here, back with some more festive recipes to enjoy this season! This is an exclusive sneak peek at my October Low Carb Cocktail that hasn’t even been announced on my website, Cupofoj.com, where I post all of my monthly low-carb recipes. 

This month, I thought it would make something fresh, easy, and ready to be enjoyed at any fall party. I use tequila for this recipe, but it would also taste great with vodka or gin as well.

Low Carb Poison Berry Smash

INGREDIENTS:

Makes 1 serving

• 2 oz. tequila

• 5-6 blackberries

• 2 oz. fresh-squeezed lemon juice

• 1 oz. stevia simple syrup*

• lemon sparkling water

• handful of ice

• fresh thyme

INSTRUCTIONS:

1. Add the blackberries to a cocktail shaker and muddle thoroughly. Spoon the blackberries into a rocks glass with ice.

2. Add the tequila, lemon juice, stevia simple syrup, to the cocktail shaker and shake over ice.

3. Pour into a rocks glass and top with lemon sparkling water.

4. Stir and garnish with a lemon peel and fresh thyme.

*HOW TO MAKE STEVIA SIMPLE SYRUP:

1. Bring one cup of water to a boil.

2. Add 2 tablespoons of stevia and let it simmer at low heat until stevia has completely dissolved.

3. Remove from heat.

4. Let it cool at room temperature before using, refrigerate the rest.

In the chance that you are headed to a potluck, fall festivity, or simply want a tasty autumnal treat to enjoy with your cocktail this season, I’ve put together a fall-inspired charcuterie board recipe to try. 

AUTUMNAL HARVEST GRAZING BOARD

HERE’S WHAT I USED:

Cheese: cheddar cheese with caramelized onion, creamy Toscano cheese dusted with cinnamon

Crackers: pumpkin cranberry crisps, fall leaves tortilla chips, multigrain wheat crackers, Italian breadsticks

Dips: pumpkin four-cheese greek style yogurt dip

Seeds: in-shell roasted pumpkin seeds

Fruit + veggies: black figs and Persian cucumbers

Sweets: pumpkin-spiced teeny tiny pretzels, crunch dried honey crisp apples

Garnish:  sprigs of rosemary and mini pumpkins 

Everything was purchased from Traders Joe’s!

I hope you enjoy the festive fall flavors! Follow along at Cupofoj.com for more autumnal low-carb cocktails and fall-inspired charcuterie ideas. If you’re looking for some fun and cute items for T1Ds check out my shop at shopcupofoj.com.



We need to talk about Complications by Daniel Newman

I’ve been living with type 1 diabetes for over 25 years, which is many more years living with it than without it. My diagnosis story isn’t as traumatic as some others in the community, my levels were from what I’ve been told around 29-30mmol/L (yes I’m from the UK and we use mmol/L so that’s roughly 522 mg/dL), I never lost consciousness and was never in a coma. I am very fortunate. Like most people living with diabetes, my biggest challenges were yet to come. 

I was diagnosed at 10 years old (you can work out how old I am right?) and my biggest challenge were my teenage years and early 20’s. It was a struggle, a really hard struggle. Looking back during that period I was experiencing what I now know as diabetes distress and diabetes burnout. (You can learn more about these conditions here). In that period, I was hearing from various healthcare professionals scare tactics as to why I needed to look after myself and what would happen to me if I don’t. Whilst these words were supposed to motivate me, they didn’t. Far from it. I was a teenager who thought I was invincible and these potential consequences were so far away and of course they would happen to someone else just not me. I lived my ‘best life’ or at least what I thought it was. That’s the thing with diabetes is that it can, if you allow it to, lull you into a false sense of security. 

Diabetes and its associated complications almost come hand in hand. Living with diabetes you are always aware of the impact this condition brings in the short, medium and long term. Hypos, hypers, DKA, eye, kidney and foot problems, eating disorders, disordered eating, diabetes distress and diabetes burnout, nerve damage and sexual problems are all complications of diabetes. The conversation around the first three is quite comfortable but the others not so much. This needs to change.

You may be thinking what makes me qualified to say that the conversation needs to change? What does he know about life with complications? I’m currently living with diabetic retinopathy (I can’t remember when this was first diagnosed) I’ve had multiple laser surgeries in both eyes and I’ve had vitrectomy surgery in my right eye. In 2013 I was diagnosed with Chronic Kidney Disease and in 2018 I was very fortunate to receive a kidney transplant. I have some lived experience of living with complications. Ok so I live with complications so why do we need to talk about them?

This is where it gets interesting. You may be reading this and be living with complications or you may not. That’s fine. My experience of being diagnosed with complications meant that I felt like I had failed some sort of diabetes test. I felt alone and also like a failure. All of those warnings I received years ago, the scare tactics were all coming true. I initially thought to myself if only I had listened at the time. These same thoughts came about when I was diagnosed with Chronic Kidney Disease. That feeling of being alone hit like no other if I’m honest. Imagine feeling out millions of people worldwide living with diabetes, you are the only one who has complications. It makes no sense but at the time it did. I’ve spoken to others and they’ve said something similar. This is why we need to speak about complications because there are others out there like me and possibly like you. 

We are always told it is good to talk and it is, it really is. So why not talk about a subject that many of us living with diabetes, regardless of the type, face on a daily basis? There’s a deep-rooted stigma attached to someone have complications. They didn’t look after themselves, they don’t care about their life and so on. This can be found in the diabetes community. 

I believe that even though many aspects of the community is great, we as a community, where all members face these challenges should be proactive in having these conversations in a safe environment because none of us are excluded from developing complications. Diabetes is relentless and doesn’t discriminate. To create this safe space means us as a community taking back the power from negative narratives and stigmas and having open and honest conversations. I’m in no way saying that anyone living with diabetes shouldn’t be doing their best every single day although some days our best is better than others. I’m saying that normalizing the conversation means that if you are either living with or diagnosed with complications that you don’t feel alone or feel like you failed a test. You instead know that others have faced what you have. 

The results? A community that openly embraces all aspects of life with this relentless condition that none of us asked for and an understanding that you are never alone on this journey with diabetes. 

Tackling the COVID vaccine by Basma Adams

I – like many of us worldwide – have a newfound respect for public health nursing as I’ve found myself obtaining my own Master’s degree in Nursing during a worldwide pandemic. I’ve learned a great deal about evidence-based practice, the importance of advocacy, and what it means to be an individual living with diabetes amid global uncertainty and fear. 

What do I need to know about the vaccines that are available? What kind of side effects can I expect? Should I receive the booster shot? Hours of researching, speaking to my own doctor and nurses, consulting with peers and professors and ultimately, trusting my own experience to lead me through these questions, I’m honored to be able to share that all with you guys in my own guest post on here! I hope you find this informational and if there’s one thing you take away from my personal experience today, I hope it’s that at the end of the day all we can truly do is our part in protecting ourselves and each other in order to combat this pandemic! We’re in this together! 

We’ll start with the basics – there are currently 3 vaccines available in the U.S. – Moderna, Pfizer BioNTech, and Johnson & Johnson. As of August 2021, Pfizer BioNTech is the first COVID-19 vaccine to be approved by the U.S. Food and Drug Administration (FDA) for individuals aged 16 and older against the prevention of COVID-19 disease. Pfizer continues to be available under emergency use authorization for individuals ages 12-15 years of age as are Moderna (for individuals ages 18 years and older) and Johnson & Johnson (for ages 18 years and older). 

Side effects can vary for each of these vaccines, but the most common include pain at the site of injection, sore arm, swelling or redness on your arm, increased fatigue, headache, chills and/or fever, muscle pain, and nausea. From personal experience, I’ve learned that these side effects truly vary depending on the individual. After my first and second dose of the Moderna vaccine, I experienced an extremely sore arm (I’m talking like a semi-truck ran over it!) and some moderate fatigue. Nothing more, nothing less. This is all to say that you can’t go into getting your vaccine expecting certain side effects – you might get these, you might not! 

I know what you’re wondering… “Basma, how did it affect your diabetes?!” It didn’t… not that I could truly notice. I kept a hawk eye on my Dexcom blood glucose values and trends, and to be quite honest I expected my blood sugars to drastically be affected. But aside from the adrenaline and excitement of receiving my vaccine, I saw no aftermath effects of the vaccine on my blood sugar… with my first two doses, that is. 

Currently, there’s a lot of talk about the COVID-19 booster shot. The booster shot is exactly that – another shot of a vaccine you’ve received (like the MMR or tetanus vaccines!) which aims to prolong your immunologic immunity and protection against SARS-CoV-2 which ultimately causes COVID-19 disease. For now, the CDC recommends individuals who are “moderately to severely” compromised immune systems (those who are immunocompromised) who may end up being vulnerable to COVID-19 to receive a booster shot. As of now, there isn’t too much detail regarding which individuals specifically are eligible for the booster, so I recommend speaking to your health care provider if you think you might fall into this category (please consult with your provider regarding any decisions you take based on this post). 

Personally, with the help of my own provider, I decided I wanted to receive my 3rd Moderna booster shot. Along with living with diabetes, I am back on campus for graduate school as well as seeing patients and in the hospital setting for clinicals. I want to not only protect myself and my loved ones, but my patients and those I may encounter at any time. 

Booster side effects are expected to be the same, and although I had no symptoms after my first 2 doses, I had just about every symptom following the booster. I experienced a low-grade fever, chills, body aches and muscle pain, headache, swollen lymph nodes (which are considered normal), and extreme fatigue. I tried to combat this by staying hydrated and remembering to eat, keeping a cool cloth on my forehead to cool me down, and resting as much as I could (aka, lying in bed ALL day). I did experience high blood sugars about 10-12 hours after receiving the booster, but that didn’t last all day. I was vigilant with ensuring I treated my blood sugars as I normally would, especially since I was lacking physical movement that would normally help keep me in range. I found that being conscious with pre-bolusing helped the most as did drinking plenty of fluids. 

What we tend to forget as a society is that these adverse effects, which can occur as a result of ANY vaccine, is the doing of cells in our bodies that respond to the vaccine by secreting antibodies and memory immune cells in our bloodstream. Thanks to our memory cells, we amount protection if infected with the virus later. This is what leads to the inflammation that occurs throughout our body and consequently, the headache, fatigue, fever, etc. that some of us experience. Our immune system is doing exactly what it should be doing – building protection against the COVID-19 virus! 

There are countless questions that arise every day and it can be worrying that the pandemic is everchanging. We’re finding out information as we go and it’s our job to seek out reputable sources to conduct our own research and reading. As someone who has both received and provided vaccines and is embarking in a career and healthcare, I hope my own experiences and knowledge can serve someone else. The only way to beat this pandemic, is together!  

About the author: Basma was diagnosed at three years old and is a diabetes National Advocate & speech writer, a public speaker, & social media content creator. She got involved in the diabetes community on social media after realizing her story and journey could help thousands of other kids, teens, and adults. Ever since then, she has made it a point to advocate for those living with any form of diabetes. 

Basma has been volunteering with the ADA since age 10 and in 2014 was the National Youth Advocate for the ADA. She has given hundreds of speeches around the country at galas, fundraisers, events, interviews, and podcasts. She has been to Call to Congress on Capitol Hill twice for advocacy and has traveled to camps all around the U.S speaking to children living with type one diabetes. 

After her own personal experiences, Basma decided to share her story on social media and has built a following to help other kids, teens & adults who might struggle with their own diabetes journey. Since then, she has created a blog, podcast, and YouTube channel to further help her community and educate the masses. Basma is a 2nd year Masters in Nursing student and attributes her diagnosis for her love & passion for medicine and future career in the medical field! She spent her undergraduate years working at the UCSD School of Medicine Division of Endocrinology and Metabolism laboratory, shadowing physicians and nurses in low-income communities and clinics, and traveling the country as a National Youth Advocate. She is eager to contribute her experience as a diabetic and share her love of public health and advocacy within the healthcare field.

Hispanic Heritage Month Spotlight: Damaris Palacios

Por amor de comida/ For the love of food

Growing up first generation, my parents taught me the importance of valuing food and its security since they both had rough childhoods in Mexico. I was a relatively non-picky eater and when going places to see family or friends I knew damn well to finish everything on my plate as a sign of respect and gratitude. In the Hispanic culture, you also know to offer something or anything as small as a glass of water to guests out of hospitality, because even if you don’t have much, manners and kindness go a long way.

My maternal grandmother was our next-door neighbor and my favorite things growing up would be her gorditas and tamales that she’d make year-round. Her hot chocolate and champurrado during the holidays still fill my memories with warmth and love. As a person, she wasn’t the most affectionate, but her actions and cooking would make me feel loved and cherished long after she passed. Food is essential to everyone’s well-being yet something about those little gestures made the world’s difference to me as a kid and made me appreciate the eating experience as an adult even more.

I spent my summers in Monterrey with my dad’s side of the family before my diagnosis for months on end since I was the only natural born citizen of my siblings with that privilege. My mom would phone my grandmother to make sure enough money was sent over to buy me all the milk, cereals, and snacks that I would possibly need. I would house hop between my aunt’s and uncle’s homes during that time and knew that I would be well fed or being a visitor they’d also take requests to make me feel as much at home as possible, which a kid typically only dreams of. With such a large family, parties were normal and often during my stays, and they were centered around food, drinks, and music, so think fajitas and taquitos for days!

Houston luckily has a good amount of diversity with its people and cuisine, and my neighborhood specifically reflected that by being predominantly Hispanic. I grew up very much in that bubble of thinking that having roosters and hens or guard dogs in your backyard was the norm. At home, we were usually fed home-cooked meals and rarely we’d get fast-food because if there were rice and beans or tortillas at the house there was a meal waiting for us. My mom would never deny us anything sweets/ dessert wise because she loved to “treat” us when possible in any way she could, though constantly in a conscientious way. Being the chubby sibling I did have a strenuous relationship to food seeing that both my siblings were on the lean to normal side, and my “gorda de harina” (flour tortilla) nickname wasn’t always helpful.

My DKA story is pretty standard to most with no previous diabetes education in their lives. I had all the symptoms and didn’t get bloodwork or urine samples until my 3rd clinic visit. I lost weight at every doctor’s visit and rather than raising concern, I was being praised by staff that knew nothing about me for shrinking myself at 11 years old. Once diagnosed in the ER and fully recovered, the diabetes educators informed my mom of the different sugars in all foods and she did feel overwhelmed. The handbook was fortunately bilingual with staple pieces she was used to making, which later brought me back to a healthy weight.

There was a lot of trial and error that would occur from the lack of portioning my meals because my mom’s recipes rarely required any measuring cups or tools. My mom did supplement more veggies into our diet, but other than that not much changed and I recognized the importance good food had on my health. I ate all the things I wanted with my mom’s support, recognizing that her foods would always be dear to me and those traditions were worth keeping, from the Pozole and Albonidagas, to the handmade flour tortillas and huge tostadas de la Siberia - I would never trade them for anything in the world.

I knew not everyone would be willing to learn the complexity behind my illness and compare me to their elderly neighbor or grandparent so that’s why I avoided bringing attention to my diabetes for the most part. The major nuisances for me occured when people would comment on my plate at gatherings, seeing that type 2 diabetes is common in the Latino population they thought they knew best regarding my diet and steering clear from tortillas and rice was obviously the only alternative. Calling my diabetes “azúcar” irked me some, too because the narrative was always, “you shouldn’t have any sugar or carbs since your body makes too much already”. To them I merely did my best to educate the importance of insulin as my treatment and as long as I took my medicine and watched my glucose it would be fine, food was never something I feared and they shouldn’t be concerned about it for my sake either. 

 I do nevertheless experience my burn out periods because life gets hard and sometimes your mentality makes a bigger impact than you think. What helped me most was accepting that I was entitled to grieve the life I had prior to diagnosis and not seeing myself as a burden for whatever reason. As I lived life on my own and did the things my childhood heart would have never imagined - I finally gained my confidence in wearing my CGM proudly and acknowledged that my disease is a part of my identity just like my upbringing and love of food. It was being at home in my own body- no matter its size, in taking care of myself and allowing myself yummy pleasures with moderation and responsibility. It’s in eating the things I love like carb heavy tamales, and not feeling guilty about it because if they bring me joy and I’m watching my health simultaneously what harm can come from it? Overall, it’s really just a balancing act of knowing what works for you, what resonates with your life as a person foremost and how diabetes is a piece of that life you want to live. So here’s to living unapologetically and knowing we are strong, fierce and human. We deserve all of the health and happiness the world has to offer, and I wish everyone a “panza llena; corazón contento” (full tummy, happy heart).

Hispanic Heritage Month Spotlight: Laura Rosales

“Y tan joven?” (Why so young?) - this is something I often hear when family members or family friends find out I’m type 1. Growing up in El Salvador was never easy, but I loved it. I was never that child that got sick often (besides my unknown pancreatitis episodes that happened a few times a year) - if anything, people thought I was healthy because I was chubby. Chronic illnesses were never (and are still) talked about. As a child, I thought chronic illnesses only happened to “viejitos” (older people) - but never it occurred to me that it could happen to children, “normal” children, like me. Illnesses have always been talked about with such worry in my family, that having one, almost felt like you were sentenced to death. 

I remember going back to El Salvador five years after I had moved to San Antonio, Texas and having a physical done - you know, because it’s mas barato (cheaper). I recall my parents talking amongst each other about my blood results. I heard “que tiene el azucar alta” (she has high blood sugar) and didn’t really think anything of it. No one did. I came back to San Antonio and things were fine - until I turned 14. I remember that day so well; before I went to bed I ate 3 starbursts - just 3. Next thing I knew, I was in a diabetic coma. 

A few social workers, doctors, nurses, diabetic educators, and days later I still didn’t know what it meant to be diabetic. I was confused. Maybe in denial? And I don’t think my parents knew what was going on either - everything was taught to me in English. Coming home was interesting - I remember my mom clearing out the fridge and filling it up with vegetables. At that moment, I remember thinking “okay - so from now on I only eat vegetables?”. And that’s how it was for a few months, until it all fell apart. Being salavadoreña means pupusas, tortillas, tamales, pan dulce, atol de elote, riguas, pasteles, atol shuco - CARBS. A salvadoreño cannot have a proper meal without having two or three tortillas accompanied with rice, or beans - tell me, how can I make that low carb? Impossible. I started to fall off the “healthy” train and went back to my carb heavy diet. The weight started to pile on until people started to notice. “Estas gordita” (you’re chubby). Is all I would hear - but the thing is, not a lot of people knew I was diabetic. As I had mentioned, in my culture, my family, my roots - being diagnosed with a chronic illness is like being sentenced to death. No one talks about it. 

For a while I thought my parents were embarrassed to tell people I was a type 1 - which at some point made sense. Why would anyone want to tell all their family and friends that their child is diabetic and that people may think they fed their child too much sugar? And be judged? Yeah - I get it. Then, it didn’t make sense. Being newly diagnosed, going through puberty, and living in a salvadorian household, where feelings sometimes don’t exist, was hard. I had never felt so alone. I then started to not talk about it - to the point I pretended I didn't have it. I was never officially diagnosed, because again, feelings don’t exist sometimes - but I’m sure I was depressed and had developed an eating disorder. It got really bad that I stopped using insulin. I was so obsessed with the thought that “the more insulin, the fatter I will be.” 

That, of course didn’t end well. My parents never really found out - if anything, using less insulin was great! It meant I was getting healthier - and everyone else thought so too. Now, at 25 years old, I sit here and realize this was all due to the lack of education and resources. I don’t blame my parents, because truly, I don’t think any parent is prepared (especially immigrant parents who don’t speak english) to come to this country to have a child diagnosed with a chronic illness. Not only that, but I didn’t expect my 14 year old self to teach them everything there was to know about diabetes (in addition to translating important documents that you have no idea what they’re saying). As years have gone by, I have noticed how resources are very limited in the hispanic/latine community. People are mainly told “Hey diabetes is bad - don’t eat tortillas and bread” and that’s it - at least that’s how it’s been with my dad who was diagnosed with type 2. Health insurance is expensive and almost non-existent for those working in blue collar jobs. Prime example - my mom has been working with Chick-Fil-A since we got here and has never had health insurance. My dad does have insurance, but it's mainly a “just for show” type of insurance - super limited. So, with that - how can anyone expect them to raise a child with diabetes or any kind of chronic illness? 

I will be cliche and say that if I hadn’t gone through all these things, I wouldn’t be who I am today. If I could see my 14 year old self after diagnosis, I would tell her that I’m proud of who she is and who she will be. That I’m proud of her not giving up. Proud of her not letting a disease define her. Proud of how strong she is. 

- Laura Rosales 

Note from the Author: This was taken in Tenancingo, Cuscatlan a few years ago. It’s where my parents grew up. What’s funny, is that the soda I was holding wasn’t mine - because you know, “too much sugar”. My mom gave it to me to pose with it.

f you or your caregivers are looking for Spanish diabetes education materials, please visit:

https://es.beyondtype1.org/

https://es.beyondtype2.org/

Football and Diabetes by Elliot Fry

Its late October in 2013. Its 40 degrees and we are playing at the University of Missouri. We find ourselves in Double Overtime and need a 40-yard field goal to take our first lead of the game. I go in to attempt the field goal, to potentially win the game, but what if my blood sugar is low? What if my blood sugar is spiking like crazy and it causes me to miss the kick? Even if I grab a Gatorade on the sideline, it’s too late. I can’t just ask to call a timeout and the play clock is running down.

 I ended up making the kick and we won the game. But this thought terrified me through my freshman year of college while playing for the University of South Carolina. I was a true freshman and a diabetic trying to figure out how to do both at a high level. The thought always crossed my mind, “What if I go low and have to go out and kick a field goal and miss because of it”. Under the right circumstances, that could end my career. It’s not like I could just walk up to the head coach and ask for a 15 minutes break until my blood sugar rises back to normal. I knew that if I ever showed my diabetes as a weakness, they would never trust me again.

 I realized that season that I had to get really serious about my diabetes if I wanted to continue to play and continue my career as a kicker. I was diagnosed with diabetes when I was 7 and had a lot of knowledge around what to do and how to manage it, but like most of us, life always gets in the way. Going through high school and some of college, the ability to keep diabetes at the front of your mind becomes harder and harder. Other things become more important and its easy for diabetes management to get pushed to the side. Friends, family, sports, college, grades, and having fun all start to become more important and it’s easy to just say, “I’ll just test my blood sugar later, I feel fine”. I think it’s very normal for us to do this because there are no off days with diabetes. You don’t just get to wake up one day and take a day off, it is an everyday struggle, so I think it can be easy to try and take breaks away from it in any way we can.

 I do remember making the decision to take really good care of my diabetes when it came to football. I realized that if I ever wanted to take my career further, make it to the NFL and have a successful college career, I was going to have to put diabetes at the forefront of my life. I started testing my blood sugar as much as I could before and during practices and games. I tried to be perfect and make sure that I knew what was going on with my body so that I could be the best I could be. I took my routine very seriously, I ate the same things on gamedays at the same time. I would test my blood sugar about 10 times in the 2-hour window before the game. I found that the trick for me was keeping a good routine. As long as I could control my routine and eat the same foods, I could be in good control. I also found that I needed to treat my diabetes proactively instead of reactively. I stopped waiting to treat a low when it happened and started preventing myself from having lows during the game.

 I have always told younger kids that diabetes won’t stop you from doing whatever it is you want to do in life, but there’s a caveat. YOU HAVE TO TAKE CARE OF IT! If you don’t control your diabetes, it can absolutely control you and control your life. I know that I wouldn’t be where I am today unless I made that decision back in college to take diabetes seriously.

Life is a marathon, not a race - by Casey Terrell

“It matters not how strait the gate,   

How charged with punishments the scroll,   

I am the master of my fate:

I am the captain of my soul.”

-Invictus, William Ernest Henley

These words, which conclude the famous poem “Invictus,” by William Ernest Henley describe how I feel about my relationship with Type 1 Diabetes, but this wasn’t always the case. 

I was diagnosed with Type 1 in the fall of 2010. I had left my small hometown in Western Wyoming to go to Community College in a town 100 miles away. Shortly after arriving at school I began noticing rapid weight loss, constant thirst, and other symptoms which I now know to be classic indicators of Diabetic Ketoacidosis (“DKA”). As someone who grew up heavy, I was excited about the weight loss rather than concerned for my health, so I ignored these symptoms for several months. Eventually my foolishness earned me a trip to the emergency room and a week-long stay in the hospital where I was diagnosed with Type 1 at the age of 18.

Although I put up a strong front, I struggled with my diagnosis. At that point in my life I had a pretty pessimistic outlook anyway, and when the new set of challenges that comes with Type 1 was layered on top of it, I struggled under its weight. I look back now and can see the evidence of these pressures on different parts of my life. My weight steadily increased, well beyond where I had been before I began experiencing DKA, because turning to food was one of the things that helped me feel better. I couldn’t always control my blood sugar, but I could choose to eat if I wanted to. I also took an active role in many different organizations at my college, which appeared to be a good thing, but I was partially motivated to do so as a means of not addressing how I was feeling, making it unhealthy. 

I continued on with these coping mechanisms for the next 8 years while earning my bachelor’s degree, master’s degree, and juris doctorate. The whole time I felt like I was on a roller coaster with my diabetes management, weight, and self-confidence, which were all very interconnected. I would have a good summer or semester working out and taking care of myself and my blood sugars, weight, and attitude would reflect it. Then, inevitably, I would fall into disarray again and find myself in a dark place where I didn’t really care about my health or future. 

I wish I could point to the moment when I began to turn things around, but much like most of the significant changes in our lives, it happened a little bit at a time and not all at once. While I was finishing law school, the endocrinologist I was working with left the state and there wasn’t another one within roughly 300 miles. Although I love living in Wyoming, having an illness that requires specialized care like Type 1 Diabetes can be challenging in our sparsely populated state because there simply aren’t local resources to provide care and support. I wanted to take this opportunity to find a care provider who could help me make a change and, with my mother-in-law’s help, I started seeing the folks at UC Health-Anschutz in Denver, Colorado.

I can’t say enough good things regarding the quality of care I have received with my new team at UC Health. For the first time since I was diagnosed, the question changed from, “why can’t you understand?” to, “how can we help you succeed?” Once I had a supportive diabetes care team in place, my wife went above and beyond to help me transition to a healthier lifestyle. At this time, our wedding was roughly a year away and I knew that I wanted to be my best self when I started that journey. So, her and I started focusing heavily on balanced nutrition and being active in whatever ways we could. 

Please do not think, even for a second, that this journey was without challenges, learning curves, and frustration. I remember when I first started working out, I would focus on eating well all day and work out in the evening, only to wake up at 1:30 am to a low glucose alarm. I would find myself sitting on the kitchen floor in the dark feeling like a failure, eating the calories I had done my best to forego the previous day in order to treat my low blood sugar. I didn’t understand how to properly dose and eat while undertaking physical activity, so I was constantly experiencing peaks and valleys with my blood sugar. I also initially made the mistake of associating carbohydrates with weight gain when I was trying to work on my nutrition. This left me feeling lethargic all day and unmotivated when it came time to work out. 

Although I felt defeated, I wasn’t going to let that be the end of my story. I kept at it. Day by day. Week by week. I worked with my care team and relentlessly researched how my body was responding when I exercised and what I could do to work with it, instead of against it. I eventually embraced the mantra that although it wasn’t my fault that I had Type 1, it was my responsibility to understand and manage it if I was going to become the person I wanted to be. I started attending therapy regularly and worked through a lot of the underlying psychological challenges that were leading me to make unhealthy choices. I also found folks in my community that did the cool stuff I wanted to do and asked for their help in understanding and improving at it. 

Specifically, I found friends who were into trail running. I want to be very clear; I have never been a runner and I still wouldn’t call myself a runner. In fact, when I was finishing law school, I couldn’t walk up a single flight of stairs without getting winded. However, I always admired runners and when I began my health journey, I felt like if I could run a race one day, I would know that I was where I wanted to be. So, I put on my shoes and hit the road. Running has a completely unique impact on my blood sugar and there were many scary times that I had to stop mid run to treat a low blood sugar. 

Putting one foot in front of the other, I got better and better and eventually completed a 5K race. I felt on top of the world, but I didn’t want to stop there. I worked my way to completing a 10K race, then a half-marathon, and eventually an 18-mile trail run. At that point I began to feel like I was running not only for myself, but for all the other folks out there with Type 1 who have been put in a box, and who have had their abilities questioned by folks who don’t even know them. So, I resolved to complete a 32-mile trail run in 2021, my first ultramarathon. It took over 12 hours and a whole lot of grit, but I finished that ultramarathon in June of this year. I am very proud to have ran that race wearing a shirt that read, “access to insulin is a human right,” to bring awareness to the insulin affordability crisis our community faces. 

My parting thoughts to you are these. Whatever your ultramarathon is, get out there and do it. For far too long in my life, I let other folks and my own fears tell me what I was capable of, especially when it came to what I could accomplish as a diabetic. My life truly changed when I realized that who I am is up to me, and no one else. For those of you on a journey like mine, I see you struggling and striving, and I am proud of you and you should be, too. Remember, diabetes doesn’t define your limits; you are the master of your fate, you are the captain of your soul. 

The Complexity of Diabetes & Identity by Grace Choi

I am not my diabetes. 

There’s so much more to me than just an illness. I’m Korean American, born in New York, raised in Delaware, and now living in New York City. I struggle with depression, anxiety, and body image. I’m a daughter, a sister, a roommate, a girlfriend. I’m an ex-athlete figuring out what that means as an adult. I’m a professional in finance as a woman. I have so many facets and complexities of my identity and Type 1 Diabetes is just one of them.

My parents moved to the states over 30 years ago, seeking a better life than the one they left behind. They stayed to give my sister and me opportunities they never had. I grew up in a primarily white neighborhood in the suburbs of Delaware always feeling slightly out of place. Subtle racism was a staple and I just got used to it. Over the past few months, we’ve seen a rise in Asian Hate and it breaks my heart. I go back to visit relatives in Korea and I’m not quite Korean. I’m a New York native but it would seem to some that I’m still not quite American. When I was first diagnosed, I was misdiagnosed as Type 2 Diabetic and my severe DKA was overlooked because of my heritage. The GP took one look at me and told me to rethink my lifestyle and I probably got diabetes because “well, you know, Asians eat a lot of rice.”

Over time, I’m seeing the diabetes community slowly becoming more inclusive but I also still see Asian Americans often overlooked. Politicians and companies actively choose to overlook the Asian demographic because we’re “statistically insignificant.” From a marketing or campaign standpoint, I get it. But from a human standpoint, can you imagine how it feels to be told you’re insignificant?

Then I think about why inclusion is so important – it’s not just so that I can placate my feelings of being “other than,” it truly is about life or death when it comes to things like my diagnosis. If we shoot for inclusion and education, I can’t imagine that GP would have sent me home when he should have sent me to the hospital. No one in my family knew how to handle Type 1 Diabetes and when I looked for literature, not a lot existed beyond the very White male dominated space. I tried to give my mom a book on Type 1, but with English being her second language, she got stuck on a lot of the jargon. The lack of inclusivity has very real consequences.

I’m open about my story because I want to challenge the norm; tell people, maybe I’m not significant, but I’m here. I want other Type 1 Asian Americans to know they’re not alone either. It’s tough, it really is, to be so “other than” but it’s also forced me to face who I am and really know who that girl is. It’s complex and it’s messy but that’s me.

Name the best diabestie duo… I’ll wait :)

Hi! It’s Paloma and Gretchen! We were both diagnosed with diabetes around the same time,  in different ways and places but somehow we still found each other. Had our pancreas kept producing insulin, we probably wouldn’t have had the chance to meet but here we are! Something we have in common is we LOVE to celebrate. Let’s all celebrate International Friendship Day together! 

 About Gretchen

As a young 23 year old, Gretchen was diagnosed with type 1 diabetes while on a cruise traveling through Europe in the summer of 2014. She felt so frustrated, confused, and alone with no one to truly understand what she was going through. There was so much change happening, and she felt that there was no one to talk nor relate to. After searching the internet for answers, she found nothing. So she then turned to creating my own Instagram (@typeonetypehappy) and blog (Type One Type Happy) to share about her journey with diabetes to hopefully help someone else going through the same scary things and loneliness that she felt when first diagnosed. Gretchen wanted to create something that would inspire and empower people living with diabetes to continue to live their life to the fullest, accomplishing anything they want! As social media and the diabetes community naturally started to grow, she’s been able to make so many new connections and friends from all over the world, all experiencing all the same things together. It has truly changed her life, outlook, and even relationship with diabetes management. It is strange to say, but in some ways she feels thankful for the struggle because she would have never met her best friend/diabestie- Paloma!

 About Paloma

Paloma wears many titles including *unofficial* Miss Arizona, The Bachelorette, Cat Mom but her favorite is Glitter Glucose. Paloma was diagnosed in 2013 and created GG as an alter ego to connect with people living with diabetes like herself. When she was first diagnosed she felt so lost and alone. It wasn’t until she connected with people like Gretchen on social media that she FINALLY felt like she belonged somewhere. Now on her social channels you can find her sharing her everyday life which includes fashion, beauty, dating, and fitness. Paloma brings you along for the ride with the overall goal to make life with diabetes a little brighter! 

 It Takes 2

 1. What is your favorite thing about having a friend with diabetes?

Gretchen: I love being able to complain to Paloma and she just gets it. For me, my absolute favorite thing is teaching each other tips and tricks! Honestly, if it wasn’t for diabetes friends, I would have never tried a CGM because I was too scared. But once I saw a friend put one on and show me everything about it, I felt eager to use one and haven’t looked back since!

 Paloma: I always feel safe. I feel like there's always someone who has my back no matter what. I’m low- here's a snack. I’m high- let's slow down. I had a great endo visit- high 5. It’s just nice knowing someone actually understands first hand. 

 2. Diabetes brought us together but the friendship is so much more than that. What else do you have in common?

Gretchen: That’s honestly the best part! We obviously connect with diabetes, but there’s so many things! Our love for country music, cute clothes, fun adventures, creating… just to name a few!

Paloma: I probably would have NEVER met Gretchen if it wasn’t for the commonality of diabetes! So for that, THANKS DIABETES! Now I have a partner to gossip with about our fav shows, a singalong partner, a work colleague, and overall just an awesome +1!

 3. What are some tips on how to meet new friends with diabetes? 

Gretchen: Try attending diabetes events, meet-ups, diabetes camps, etc! It’s a great way to meet new people because everyone is there for the same reason so it makes for an instant ice breaker. Secondly, make friends virtually. The diabetes online social media community is bigger than you think! People are always open to new friendships and diabetes connections, so don’t be afraid to slide into the DMs (that’s how me and Paloma initially met)!

 Paloma: Be open about diabetes! You never know who might see or hear you.

 4. What is your favorite low snack?

Gretchen: Gummy bears! But for lows in the middle of the night, I always want apple juice.

 Paloma: Same! :) When I forget mine, I know Gretchen will have hers. 

 5. What's your most embarrassing or funny diabetes moment?

Gretchen: One embarrassing/funny moment was when I was newly dating a guy who didn’t know I had diabetes yet. So one evening, we were kissing and my CGM alarms were blowing up my phone. It was consistently alerting my phone that I had high blood sugar every minute! So it kept interrupting our romantic moment- Every. Single. Time. It got to the point where he said to me “Man, you’re really popular with all your text messages going off!” and I just said “Ya, I guess I am. You should feel lucky to be hangin’ with me!” *wink face* haha

 Paloma: OMG, I’m laughing at Gretchens story! Mine also has to do with dating! I was on a first date and I wear my insulin pump clipped to the center of my bra. I didnt realize my tubing was hanging out of my vneck when the guy showed up. He saw my tubing and said “Are you wearing a wire?!” He thought I was with the FBI or something. Spoiler alert: we were not a match.

 Even though living with diabetes sucks, one of the positive things to come out of it is the friendships we make. Having a friend that understands the struggles we all go through inside and out, is life changing. The fact that a friendship can come from a terrible diagnosis and blossom into a friendship where we can connect on so many other levels and similarities beyond just diabetes, really is special. It’s simple to say that if we didn't have diabetes, we would have never met- and that’s when I say that in this instance, I am thankful for our diabetes!

You can be our friend too by finding us here:

Paloma

Instagram: @glitterglucose

Blog: www.glitterglucose.com

Gretchen 

Instagram: www.instagram.com/typeonetypehappy  

Blog: www.typeonetypehappy.com 

Facebook: www.facebook.com/typeonetypehappy 

Twitter: www.twitter.com/type1typehappy

Tiktok: @typeonetypehappy https://vm.tiktok.com/ZMd77LJF2/

Grief and diabetes: here’s what surprised me

When you’ve lived with Type 1 diabetes for over a decade, you think there aren’t that many things that will surprise you. Many things that will frustrate / annoy / remind you, but not that many that will flat out surprise you. Or, at least, that’s what I thought. And then grief hit me - sideways, like a bus - and I realised how little I knew. 

My name is Bridget McNulty, and I live in Cape Town, South Africa. Here’s what I wish I’d known in the Before Time.

The adrenalin days

My mom died very suddenly - 13 days from diagnosis till death. It was honestly like something out of a badly made movie, where the volume was turned up too high and there was too much drama, not enough breathing space. She was totally fine, and then she was in hospital with four kinds of cancer, and then she was in a morphine coma, and then she was gone.

During these intensely stressful, disbelieving days, my diabetes didn’t go on holiday. I wish it had! I urged it to take a break and leave me alone. But no, it stayed by my side, ever present, demanding attention and care when I had none to give.

At the time I was finger pricking (not yet using the FreeStyle Libre) and injecting (MDI, as I still am), so there weren’t many patterns I could find - especially amidst the chaos. During the day, I was so preoccupied with all the details we had to figure out to help my mom (and the rest of my family) that food was functional. I love eating, so food is usually a real pleasure and something I look forward to, but I went into survival mode and just ate whatever was there and wouldn’t spike my blood sugar, and didn’t take that long to prepare.

At night, though, the adrenalin that had been coursing through my body all day suddenly left - able to relax for a few hours. And you can probably guess what happened then: sudden, violent lows. Every night, in the wee small hours, I would wake up with my heart racing, desperate to eat something, anything. I started injecting half my dose at dinner time, and eating carb-loaded meals that I usually didn’t indulge in: lasagna followed by fruit followed by chocolate. Still went low. It was as if the strength and volume of the stress during the day needed an outlet in the middle of the night, and that outlet sent my blood sugar crashing.

The side effect of this, of course, is that I was awake at 2 or 3 or 4am - the worst time of the night to be awake, especially when all you want to do is forget what life is throwing at you. I could fall asleep fine (thanks to Sarah Blondin meditations on Insight Timer), but staying asleep became a battle - as soon as I was awake, I was awake, running through the horror story of my mom’s rapid decline on repeat. The night lows persisted until my mom died, and then my grief took on a new shape.

Chronic stress response

For months, my blood sugar stayed high. Literally, months. Things that had worked before - meals and insulin doses - suddenly didn’t work any more. It was like there was a barrier to normal blood sugar, and that barrier, it turns out, was cortisol.

I didn’t know this at the time, of course. It was only when researching my book, The Grief Handbook: A guide through the worst days of your life, that I realised that grief is a chronic stress response. We all know what happens to our blood sugar when we’re stressed - it goes up, and it stays up. That’s because stress used to be a response to a sudden, urgent danger. A lion is chasing you! Flood the body with cortisol and other stress hormones! Escape! And then relax. But there’s no escaping grief - it is a constant, daily reminder of what you have lost and what you can’t ever get back.

Coupled with this, for me, was extreme fatigue. It’s a common physical side effect of grief, and one that left me listless and uninterested in doing exercise of any kind. Exercise is a superpower when it comes to blood sugar control, particularly during times of stress, but all my usual methods no longer worked for me. Yoga had too much silence, too many still moments to reflect on how much I missed my mom. Hiking required too much energy, and the chance of seeing other people when I didn’t feel up to socialising. Walking was okay, but it was more of a trudge than a walk, if I’m honest, and that wasn’t enough to really rid my body of the stress it was carrying. What worked, for me, was gardening - even if it wasn’t much exercise, it got me outside in the fresh air, planting seeds of hope in the future.

But that came later. At first, there were just days and days of high blood sugar - with all the tiredness, irritability and high emotions that come with that.

Lingering malaise

Before my mom died, I didn’t realise how much motivation and care I was putting into my diabetes. I knew it required self discipline to eat the same thing for breakfast and lunch most days, and that figuring out carb counts and injecting at least 20 minutes before I ate was a bit of a hack, but I didn’t realise the sheer energy it took to keep doing this - consistently, day after day. Until I had no energy to do it, and saw the results.

The trouble is that when you’re in deep grief, you don’t care. Your appetite goes, your interest in life goes, your motivation to look after yourself goes. I was forced out of bed by my two young kids (almost-5 and not-yet-3 at the time), and I knew I had to keep injecting and testing my blood sugar and eating somewhat healthy food, but I just didn’t care any more. This lingering malaise is a common aspect of grief, and can be crippling when it comes to diabetes… We all know what happens when you don’t give diabetes the attention it demands - it shouts louder. Highs and lows, blood sugar rollercoasters and mood swings, exhaustion piled on exhaustion. It’s the pits (literally). Especially because life doesn’t stop just because you’ve lost someone. It doesn’t even necessarily slow down. I still had to wake up every day and do my work for Sweet Life Diabetes Community, South Africa’s largest online diabetes community. I still had to parent. I still had to survive.

And so, one day, I realised I had to snap out of it - at least the diabetes part of it. I had to get back on track and start doing the things I know I need to do to get the diabetes control that lets me forget about diabetes a little more. Ironically, it’s when I take the time to tend carefully to my diabetes that it disappears into the background for me - it becomes just another aspect of life, rather than a wailing infant demanding attention.

One day at a time

If you are in grief at the moment, I see you. It is so hard. So unbelievably hard. While it doesn’t ever get better (as in, completely better and totally fine), it does get easier to live with - as all things do, diabetes included. One day at a time or, if that feels too hard, half a day at a time. You can do this, I promise.

- Bridget McNulty (@msbridgetmcnulty), co-founder of Sweet Life Diabetes Community (@sweetlife.org.za)

Diabetes is a Journey, This is mine by Lina Kazi

I was 10 years old when my life changed forever! Something I never saw coming happened to me. I remember becoming violently ill, slowly but surely. It began with multiple trips to the restroom in elementary school and a constant urge to drink water or just be in water. My teacher Ms. Rodriguez, constantly questioned why I always had to disrupt the class by leaving to urinate. I promised her I genuinely had to pee! (I did not blame her because I was a social butterfly at that time (lol). The trips to the restroom turned into constant vomiting, excruciating stomach pains that felt like someone was stabbing me in my side, and extreme weight loss within a month. After a trip to my primary physician, my dad asked for a blood test to be given to me but was refused. I remember my dad arguing with that doctor. 

The doctor insisted that I just had a stomach flu and prescribed me medication. I was okay for a few days thereafter but then all of the symptoms came back. My dad refused to believe the diagnosis and took me to the emergency room where they frantically hooked me on IVs and transferred me to the Intensive Care Unit (ICU) at a Children’s Hospital in South Florida where we lived at the time. My parents were told that I could have slipped into a coma within 24 hours had I not come at that exact moment. Within a few days, I was officially diagnosed with Type 1 Diabetes. 

After the diagnosis, my father and this physician exchanged a few words as he refused to give me a blood test when asked for one. ***The complications black women face in health care in this country is a topic for another day and one that needs to be discussed on global platforms in order for changes to be made. We are not super humans and feel pain just as much as the next person.***

My name is Lina Kazi, I am a Type 1 Diabetic living in Washington, DC. Advocate, Entrepreneur, Influencer, Fake IG Model (haha), and young Professional, this is how I define myself. 

Full disclosure, it was not until I hit my teens that I realized the impact Diabetes will have on me – financially, physically, mentally and emotionally for the rest of my life. When I was diagnosed, I genuinely thought there would be a cure within my lifetime! I wholeheartedly believed I would be cured at some point and held unto that glimmer of hope for as long as I could! As I approached my teen years… the faith I had in that dream slowly began to fade and eventually, I accepted that I most likely will not see a cure. When I was 14, I unexpectedly lost my father. My dad or as I would call him “papa” was in the medical field, thus whenever it came to ANYTHING diabetes related, he was there for me – he assisted me in carb counting, defended me if I would forget low blood sugar snacks at home, constantly advocated on my behalf as a child to doctors, read me scientific articles on the latest medical updates for diabetes, checked on me in the middle of the night for low blood sugars, and all of the great things dads do for their kids. Adjusting to life without my dad was the second life changing event that occurred within my life. Although my dad was not a diabetic, he still had medical knowledge and was overall empathetic to the battle I fought every day. 

For many years, I didn’t talk too much about diabetes. My culture teaches us that speaking on whatever we suffer from is “taboo” – but as the years go by, the internet has grown and its connected us in ways I am sure we all never thought would be possible. Because of social media by way of the internet, I have met other diabetics that truly “get it”. As the internet grows, we have been able to change laws and speak on the insulin crisis in America, we share stories, we educate individuals all over the world who for so long believed in the Diabetes stereotypes, and we have a genuine community. At the age of 14 when I lost my father, I never thought I would find anyone who “got it” again. 

On the bright side of my story, my close friend who had moved away a year prior to my diagnosis, ended up in the same Children’s Hospital as me and we spent a month together as roomies adjusting to our new lives. My entire 5th grade class and Ms. Rodriguez came to visit me while I was in the hospital and most of my classmates were so excited to see my friend that they had not seen because she moved away from our elementary school!

Type 1 Diabetes has been a journey. I have ups and downs several times a day but this is the hand I have been dealt with. With this hand I will continue to fight this battle, grow closer to the people that “get it/me”, educate, and advocate for T1D. T1D has taught me patience, kindness, empathy, sympathy, resilience, and I have to add that I am now a mathematician when counting carbs. Although there has not been a cure, technology has come so far to make life easier for us with the help of Continuous Glucose Monitors (CGMs) and pumps. We still have a long way to go with the insulin crisis at an all time high, but with all of us interconnected and advocating, I know things will change for the better within my lifetime. 

May my first love, my dad “papa” Rest in Peace. I love you and I will never forget you.

Lina Kazi

Living with Type One Diabetes as a Family by Saira Gallo

When I was diagnosed with type 1 diabetes, my father told me that hard things only happen to strong people. That Allah only gives us as much as we can handle. I didn’t tell him this, but 8-year-old me wanted Allah to take my strength away. I didn’t want to be strong. 

I was raised knowing that I could just as easily have been born a beggar on the street. That I was no better than the child tapping on the car window asking for two rupees. I didn’t deserve the comfortable life I had any more than anyone else. This may sound harsh, but it’s true. I don’t deserve the vials of insulin in my fridge more than any other person on this planet. 

I didn’t realize I was allowed to be angry at diabetes. I wasn’t shielding my children in a bomb shelter. I wasn’t afraid of getting shot while walking home from school through my uncle’s gated community. I wasn’t walking miles to the closest health clinic once a week only to get turned away because they had run out of test strips, again. I wasn’t dying because I lived in a part of the world that didn’t have equitable access to vaccines. 

Sure, paying more for healthcare than my mortgage is a pain. Sure, dealing with all the orders, the prescriptions, the doctors’ visits, the blood draws (all of it x4), is exhausting. Sure, the highs that won’t budge and the lows that won’t come up until you’ve eaten the whole house really suck. Sure, the failed infusions, the wonky insulin, the sites that get ripped out—they’re all awful. Sure, the guilt when one of my kids has a really shitty diabetes day is heart-wrenching. I can go on, but if you guys are reading this, you know this life. You know the hard days that make you angry at the cards you’ve been dealt. 

But hopefully you also know the days that diabetes is just in the background. The days where I am overwhelmingly grateful for the tools we have access to. The days where I am baffled by the fact that I can choose between the best tools on the market based on my mental health (Loop vs. the InPen vs. Control IQ?) whereas other people have to ration their insulin, or worse. Yes, T1Dx4 can be really, really hard some days. But more often than not, it’s just something I am privileged enough to have the tools to manage. 

Unfairness and shitty cards are relative terms. I can choose to see the world as though I got the short end of the stick. And don’t get me wrong, on those hard days, I sure do. But I try really hard to view the life I have been lucky to live the way my parents raised me to. My life, even with T1Dx4, is a glass way more than half full. Even on the days I don’t want to be strong, I have the means to be all the same. 

Father's Day with Diabetes - with Dr. Jerry Brzozowski

For Father's Day 2021, we're highlighting stories of Fathers with Diabetes who also have children with Diabetes, and how they navigate a complex life of managing their own Diabetes, managing their children's Diabetes as well as just being a family.

Dr. Jerry Brzozowski was Diagnosed with Diabetes at Age 18, but it wasn't until his daughters Vivian and Evelyn were diagnosed with T1D that he became more outspoken about his Diabetes. He and his wife Sam and the rest of the Brzozowski family live near Houston Texas, but you're very likely to find them all throughout the United States as Jerry is a big part of the Diabetes pilot community! You can follow their family on Instagram at @TypeWildTogether

Q: Diabetes diagnoses are always difficult. What do you remember about the day Vivian was diagnosed?

Whew...the flood of emotions still get to me today! I remember thinking that the glucometer had to be wrong, though I had a gut feeling that we were right.

Q: How did that change your relationship to your own Diabetes?

I had to step up my game for sure! I had worn a CGM off and on, but now I had to be the example to be followed. Although my A1C wasn't too bad since I was keeping T1D tightly controlled to maintain my FAA medical to fly, but I dialed it in keeping in mind we have to #livebeyond.

Q: Thinking like a pancreas for yourself is difficult enough, but how challenging is it to balance your own Diabetes as well as working with Sam to manage Vivian and Evelyn’s T1D?

Sam will be the first to tell you I tried to manage her as I managed myself, but that did not work as her little body responded quicker to insulin and even today, you can tell when Daddy is on duty as it looks like a fighter jet doing loop de loops while mom has a pretty stable line. Luckily Loop has saved both of us some frustration and allowed all of us to sleep better as we know rest is sooooo important.

Q: In what ways did you find knowing about Diabetes management for yourself help you and your family with treatment for Vivian and Evelyn?

We had a jump start on the knowledge curve to a certain degree, that I wish I could upload into all parents with T1D kiddos as well as other T1Ds. My mantra of "knowledge is power" allowed us to get her on a CGM and pump without hesitation, but the reservation and trepidation came with how diet would affect her and overcoming fear of insulin and hypoglycemic events. Although we have overcome these fears, we are always prepared wherever we go!

Q: How did you and Sam make the decision to test the rest of the family for antibodies?

Working in the medical field and understanding the pathophysiology of how we come to be T1D, we researched a ton of information and although hindsight may be 20/20, ended up wanting to be better prepared. The hindsight is in reference to the constant worry factor from the time of results to time of diagnosis...which was pretty spot on for Evelyn. We couldn't test her until a year of age and holding her down just brought flashbacks of Vivian's hospital stay with the blood draw. She tested positive for 3 of the 4 antibodies and with these results, it was estimated that she would develop T1D by the time she was 5 years. All the worrying and hyperawareness allowed us to catch her T1D before ending up in DKA or a hospital stay working with our awesome Pediatric Endocrinology team led by Dr. Stephen Ponder. She was initially on a CGM with MDI during her honeymoon phase and transitioned to the same system Big Sister was on and haven't looked back!

Q: How has being a Diabetes Dad changed the way you manage your own Diabetes?
I try my best to lead by example in eating as healthily as I can, seeing my doctors regularly, being compliant with testing and therapies, and living life to it's fullest!

Q: What is one piece of advice you would give to Dads who are caregivers to a person with Diabetes?
My best advice would be to have sympathy without enabling...being firm, but kind. T1Ds go thru ALOT of s#!^ that is lifelong and can be draining, but persevering thru the s#!^ with confidence (firm without enabling) with open ears and arms when necessary (kindness and sympathy) knowing it’s going to be okay

Q: If you could go back in time to 18 year old Jerry, what would you tell him about the road (or sky) ahead?

I think everyone that is as Type A as I am would tell themselves to not sweat the small stuff and as Dr. Ponder’s analogy of this is a marathon, not a sprint. I would also tell myself that if it wasn’t for the path that would be taken, I would not have found my beautiful wife, Samantha, or be where I am today with a possible flying career on the horizon. Let the river of life be my guide & don’t try to swim or paddle upstream…everything happens for a reason.

Q: In one sentence, describe how silly Rob looks getting into the back of a small airplane 😂

Air Rob! Fly on until next time! (The planes I fly now all have AC & command doors or air stairs, sorry!)

Happy Father's Day to all the Dads with Diabetes, Dads of someone with Diabetes, and Moms who play the Dad role for someone with Diabetes.